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The nut is then chewed for few seconds followed by addition of betel vine leaf, stalk or pod and a quantity of lime.[8] In Java and Bali in Indonesia, betel chewing was associated with concurrent custom of cleaning the teeth by using shredded tobacco, a large wad of which was then placed in the buccal sulcus and commissure region and left dangling outside the mouth

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Additionally, what roles do socioeconomic and policy factors play in facilitating or hindering this transition