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Certain bacteria, such as Actinomyces and Prevotella melaninogenica, produce compounds that show up as black pigmentation on tooth enamel

The growth of common Streptococcus species, in particular Streptococcus intermedius , Streptococcus anguinis , and Streptococcus mutans from saliva are shown to be suppressed by prolonged exposure to the aqueous extracts of betel nut such as tannic acid (De Miranda et al., 1996)

An independent study from 2018 is less encouraging, finding that 63 percent of heated tobacco users in Japan were still smoking cigarettes at least once a month