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To the Editor.—
With regard to the recent QUESTIONS AND ANSWERS article on betel nut chewing among Indochinese refugees in the United States (1982;247:2715), I would like to add four further pertinent items. First, long-term betel nut chewers tend to have a variety of oral pathologic conditions besides leukoplakia. These include the gradual absorption of the calcium by the lime, gingivitis, periodontitis, and chronic osteomyelitis. Second, I have had a few patients who have been able to obtain betel supplies in the United States through oriental grocery stores (Taiwan is the source). It costs about $2 to $5 per day. Third, most long-term betel nut chewers are women in their middle and older years. Fourth, whereas in Asia they would not hesitate to come to the physician with the betel nut cud in their buccal pouch, in the United States they are removing them before physician visits. Thus, the physician
Westermeyer J. Betel Nut Chewing. JAMA. 1982;248(15):1835. doi:10.1001/jama.1982.03330150029014
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