“…For example, calcium hydroxide (slaked lime) was present in all the chewed products, and calcium hydroxide is a strong alkali that can irritate the oral mucosa (Dunham, Muir, & Hamner, ; Javed, Chotai, Mehmood, & Almas, ). Another common element observed in the chewing products was the areca nut, which has been demonstrated to alter gingival keratinocytes and fibroblasts (Chang et al., ; Jeng et al., ) and modify the antimicrobial function of neutrophils (Lee et al., ). Furthermore, the effect of tobacco used locally (chewed tobacco) causes hyperaemia in the gingiva (Mavropoulos, Aars, & Brodin, ) and increases the levels of periodontitis and gingival bleeding (Amarasena et al., , ).…”