Forms of tobacco chewing include pan (piper betel leaf filled with sliced areca nut, lime, catechu and other spices chewed with or without tobacco), pan-masala or gutkha (a chewable tobacco containing areca nut) and mishri (a powdered tobacco rubbed on the gums as toothpaste).[4]In India tobacco use is estimated to cause 800,000 deaths annually.[5] The World Health Organization predicts that tobac