Purpose: To survey an adult population in a deprived district of Karachi, with reference to factors influencing perceived oral health. Materials and Methods: Of 1000 questionnaires distributed to households, 994 were returned. The respondents were aged between 30 and 50 years old. Women comprised 49% of the sample. Results: Pan and betel nut chewing had a strong influence on the perceived oral health of the respondents. Pan chewers, 32% of the respondents, had a greater risk of oral problems, odds ratio 3.63. In contrast to other oral problems, dental caries was significantly less frequent among pan chewers (odds ratio 0.63). Betel nut chewing (28%) was less deleterious to oral health: the only significant effects were a higher risk for dental caries, odds ratio 4.51, and more gingival bleeding. While most of the respondents used a toothbrush for oral hygiene, a substantial proportion (27%) used their fingers. The oral hygiene method had no influence on the perceived oral health, nor did consumption of sweets and tea with sugar. Over 80% of the participants seldom or never visited a dentist. Cleaning frequency was significantly associated with oral health: those who cleaned their teeth at least daily had fewer oral problems. Almost all participants considered that eating sweets, smoking, and chewing pan and betel nuts endangered oral health. Conclusions: In this population, typical of deprived urban areas of Pakistan, betel nut habits and frequency of oral hygiene have a strong influence on perceived oral health, while cleaning method and sugar intake do not. Keywords: betel nuts, dental care, oral health, oral hygiene