Relationship between Chewing Betel Quid and HPV-related Malignancy: The prevalence of HPV-related malignancy in betel-chewing population is high. Betel quid, gutka and paan contain areca nut, tobacco and slaked lime. Areca nut increases collagen synthesis, ROS production, and DNA and fibroblast damage. Tobacco also increases DNA and fibroblast damage. It also increases gingival blood flow. Slaked lime increases cellular turn-over , ROS production and DNA and chromosomal damage. All the ingredients increase incidence of HPV-related malignancy.