Areca nut (AN), the fourth most abused substance globally, presents significant public health challenges due to its widespread use, particularly in South and Southeast Asia. It is consumed in various forms in traditional preparations and commercial products. The chemicals in areca nut, particularly the alkaloids, adversely affect cardiovascular, metabolic, neurological and systemic health. It has oral health consequences, including the development of oral submucous fibrosis (OSF), a progressive, irreversible condition that can lead to oral cancer. The pathogenesis of OSF involves complex interactions among fibroblast stimulation, copper-mediated effects and inflammatory responses, often complicated by genetic susceptibility. Given its widespread use, addictive properties and harmful effects on both general and oral health, there is a need for coordinated public health interventions through education, regulation and continued research, calling for collaboration among healthcare providers, researchers, policymakers and community leaders.