⚠️ The deadly danger of using Thul and the risk of oral cancer

"Doctor, I have a white spot on the inside of my right cheek that won't heal. I don't smoke cigarettes, doctor. I just hang out with my friends and have a little Thul in my mouth. This isn't as bad as smoking, is it, doctor?" 22-year-old Asela asked Dr. Priya, pointing to her cheek.

Dr. Priya explained sadly, "Asela, you are in great danger. Thule is a highly toxic, deadly addiction made by combining tobacco, betel nut, and lime. Since Thule comes into direct contact with the mucous membrane of the mouth, the risk of developing oral cancer is even higher if you don't smoke. This white spot in your mouth could be a precancerous condition known in medical science as Leukoplakia."

What is Thul, a smokeless tobacco use that is rapidly spreading among the youth in South Asia and Sri Lanka? In this article, we will discuss in detail the deadly carcinogenic chemicals it contains, the harm it causes to the body, and how to break free from this deadly addiction.

What is Thul?

Thule is a type of smokeless tobacco made from tobacco, areca nut, slaked lime, and various flavorings, and is held between the cheek and gums in the mouth. It is a very popular and dangerous addiction among the youth in South Asian countries such as Sri Lanka and India.

#### Ingredients in the Thule mixture:

• Tobacco: The chemical nicotine contained in this substance releases the hormone dopamine in the brain, providing a temporary boost and making the patient highly addicted to it.
• Areca Nut: Alkaloids such as Arecoline increase heart rate and blood pressure, and over time, cause a condition called Oral Submucous Fibrosis.
• Lime (Calcium Hydroxide): Alkalizes the pH of the mouth, allowing the nicotine in tobacco to be absorbed into the body much faster, which can lead to oral mucosal irritation and carcinogen entry.

🏥 Deadly health threat: Oral cancer

According to the World Health Organization (WHO), the main cause of oral cancer is chewing tobacco with chewing gum or betel leaves.

#### 1. Types of Oral Cancer:

• Squamous Cell Carcinoma (SCC): This type accounts for more than 90% of oral cancers. It arises from the epithelial cells that line the mouth and spreads to the lips, tongue, inside the cheeks, or the roof of the mouth.
• Verrucous Carcinoma: A type of cancer that grows slowly but can spread to the jawbone.

#### 2. The chemical process of cancer formation:

Tobacco-specific nitrosamines in tobacco and arecoline in betel nuts are potent carcinogens that mutate the DNA of cells. These carcinogens can directly penetrate the cells through the mouth ulcers caused by chewing gum and initiate the growth of cancer cells.

#### 3. Precancerous Lesions:

Leukoplakia is a thick, white patch that forms inside the mouth that cannot be scraped off, and erythroplakia is a dark red patch. These are not cancerous, but if left untreated, they can quickly turn into cancer.

🚨 Red Flags That Need Immediate Medical Attention

If you notice any of the following changes in your mouth, see a dentist or oral and maxillofacial surgeon immediately and have a biopsy done before two weeks have passed:

• Non-healing mouth ulcers that last more than two weeks.
• Painless white or red spots that form inside the mouth.
• Difficulty opening the mouth (Trismus) or difficulty moving the tongue.
• Difficulty swallowing, feeling like something is stuck in the throat, and changes in voice.

🛠️ Action Steps to Avoid and Protect Yourself from Alcohol Addiction

• Step One (Strong Determination): Decide to stop using drugs completely at once (Cold Turkey method).
• Step Two (Medical Support): If the addiction is severe, use Nicotine Replacement Therapy (NRT) such as Nicotine Gum or Nicotine Patches as directed by a doctor.
• Step Three (Substitute Use): Whenever you feel like putting a toothpick in your mouth, use cardamom, cloves, a piece of regular betel nut, or a sugar-free chewing gum instead.
• Step Four (Oral Examination): While brushing your teeth daily, use a mirror to examine the inside of your mouth, cheeks, and under your tongue for any spots or sores.
• Step Five (Counseling): If you are tempted to smoke due to stress, see a counselor and receive cognitive behavioral therapy.

📊 Comparison of the effects of using Thul (Effects of Thul)

📖 Sources and Scientific References

• WHO Fact Sheet on Tobacco: WHO Tobacco Fact Sheet (Accessed 2026)
• NCBI Literature Review: Health Effects of Smokeless Tobacco Products (PMC3188822)