Young maidens traditionally carry ornamental betel boxes on a stand called kundaung and gilded flowers pandaung in a shinbyu novitiation procession. Chewing betel leaf quid and smoking, the scientists claimed, shortened the life span by nearly six years. Oral submucous fibrosis and lichen planus, which are generally accepted to be precancerous conditions, appear to be related to the habit of chewing paan. It is exported to Pakistan for the consumers of Karachi. Areca nut chewing starts the talk between the groom's parents and the bride's parents about the young couple's marriage.

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In festivals and dinners, in pujas and punyas pan is an indispensable item. The paan business is famously handled and run by muhajir traders, who migrated from western India to Pakistan after the independence in also cite pg 60, of Pakistan, By Samuel Willard Crompton, Charles F. Spittoons, therefore, are still ubiquitous, and signs saying "No paan-spitting" are commonplace, as it makes a messy red splodge on floors and walls; many people display betel-stained teeth from the habit. Some parents allow their children to consume meetha in special occasion because it is tobacco-free. A recent study found that areca-nut paan with and without tobacco increased oral cancer risk by 9. They also offer a khili paan for diabetic patients called the "paan afsana". After screening for various causes, the scientists reported paan chewing to be the major risk factor, with or without tobacco. Total cultivated area under the crop in Bangladesh is about 14, ha and the total annual production is about 72, tons. Paan stalls and kiosks used to be run mainly by people of Indian origin in towns and cities. Throughout Terai, paan is as common as anywhere in northern India. Although 'paan' has been a staple Bengali custom for ages, a number of high-end stores with premium quality paan has become available in recent times. Old Dhakaites have a rich heritage of creating the best khili paan with many complex, colourful, aromatic and mouth-watering ingredients. Kun, hsay, lahpet paan, tobacco and pickled tea are deemed essential items to offer monks and elders particularly in the old days. Paan leaf is usually plucked in Kartik, Phalgun and Ashad. At present, this variety is becoming extinct, due to emergence of more profitable and lucrative fast-growing varieties of paan crops. The culture of chewing paan has also spread in Punjab where a paan shop can be found in almost every street and market. Betel leaves are arranged aesthetically on a decorated plate called pandani and it is offered to the elderly people, particularly women, when they engage in leisure time gossip with their friends and relatives. As it is chewed, the peppery taste is savoured, along with the warm feeling and alertness it gives similar to drinking a fresh cup of coffee. A Lancet Oncology publication claims that paan masala may cause tumours in different parts of the body and not just the oral cavity as previously thought. During the zamindari age, pan preparation and the style of garnishing it on a plate pandani was indeed a recognised folk art. In addition to oral cancer, significant increases were seen among chewers for cancer of the oesophagus, liver, pancreas, larynx, lung, and all cancer. Paan-shupari shupari being Bengali for areca nut is a veritable Bangladeshi archetypal imagery, employed in wide ranging contexts. It is exported to Pakistan for the consumers of Karachi. On formal occasions offering paan symbolized the time for departure. Since the s, betel chewing has been actively discouraged by successive governments, from the State Law and Order Restoration Council SLORC onward, on the grounds of health and tidiness. Almost every paan-producing district has its own special variety of betel leaf of which consumers are well acquainted. Paan is also used in Hindu puja and wedding festivals and to visit relatives.

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