The silent trajectory: unaddressed adolescent arecanut chewing and early onset of oral submucous fibrosis

Abstract Introduction Arecanut chewing is common in many parts of South and Southeast Asia, but its effects on young people are often ignored. Many adolescents start this habit early, which is concerning because it is linked to early development of Oral Submucous Fibrosis—a condition that can cause serious problems and may progress to cancer. Content A structured review was done using PubMed/MEDLINE, Scopus, and Google Scholar, including English studies from 2000 to 2025. Studies were included if they reported arecanut use in adolescents, focusing on age of initiation and oral fibrotic changes. Studies limited to adults or without age-specific data were excluded. Out of 25 studies, 12 focused on adolescents. Arecanut use was found to begin in early teenage years, influenced by peers, family habits, and low awareness of risks. Early signs of OSMF, such as reduced mouth opening, have been reported, with prevalence ranging from 3.4 % to 8.8 %. Processed arecanut products appear to increase early onset and severity. Summary Adolescence is a vulnerable period for both starting arecanut use and developing early features of OSMF, requiring greater clinical and public health attention. Outlook Arecanut use in adolescents should not be seen as a harmless cultural habit. Early detection, awareness, and prevention at school and community levels are essential. Better regulation of processed arecanut products is needed to reduce early exposure and prevent long-term oral health problems, including oral potentially malignant disorders.