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Presented by : dr shabeel pn

Smokeless Tobacco & Oral Cancer New

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Text of Smokeless Tobacco & Oral Cancer New

  • 1.Presented by : dr shabeelpn

2.

  • INTRODUCTION
    • Tobacco is responsible for a significant amount of morbidity & mortality among middle aged adults.
    • India has one of the highest rates of oral cancer in the world.
    • Tobacco-related cancers- 1/2 of all cancers - men & 1/4 th among women.
    • Oral cancer-1/3 rd total cancer ; 90%-tobacco chewers.
    • Men are affected 2-3 times than women due to higher use of alcohol & tobacco and higher exposure to sunlight .
    • Tongue&intra-oral cancer - equal in both as chewing tobacco among women is common.
    • Effects of tobacco use, heavy alcohol consumption , and poor diet together explain over 90% of head & neck cancers.

3. 4.

  • What Is Smokeless Tobacco?
  • Smokeless tobacco / spit tobacco / chewing tobacco.
  • Mainlytwo forms:snuff andchewing tobacco .
  • Snuff -users "pinch" or "dip" between their lower lip and gum.
  • Chewing tobacco - users put between their cheek and gum.
  • The tobacco juice is sucked and chewed- nicotine -absorbedinto the bloodstream through the oral tissues.
  • No need to swallow.

5.

  • Consumption
  • Chewed:gutkha, pan, mawa, mainpuri tobacco, khaini, zarda
  • Applied on gums and teeth : mishri, gudhaku, bajjar, tooth paste
  • Inhaled : snuff

6.

  • TYPES
  • Gutkha
  • Khaini
  • Mainpuri tobacco
  • Mawa
  • Mishri
  • Paan
  • Snuff
  • Zarda

7.

  • gutkhA
    • Leads to Oral sub-mucous fibrosis (SMF).
    • Main component - arecanut along with tobacco .
  • KHAINI
  • Paste of tobacco + slaked lime & is used with arecanut.
  • Mixed with the thumb to make the mixture alkaline-premolar region of mandibular groove.

8.

  • MAINPURI TOBACCO
  • Tobacco+ slaked lime + finely cut arecanut + camphor + cloves.
  • Mainly-Uttar Pradesh.
  • High incidence of oral cancer & leukoplakia.
  • MAWA
  • Gujarathi preparation made from shavings of arecanut, tobacco and slaked lime.
  • Sold by tobacco vendors in cellophane papers tied like a small ball.

9.

  • Mixed & chewed excessively and kept in mandibular groove- causes oral cancer.
  • MISHRI
  • Prepared by roasting tobacco on a hot metal plate-black-powdered-used with catechu.
  • Used to clean teeth.
  • Common in women leads to low birth wt. babies .

10.

  • PAN (BETEL QUID) WITH TOBACCO
  • Most common-ancient habit.
  • Betel leaf + arecanut + slaked lime + catechu.
  • Arecanut-vital component-drastically affects oral health.
  • Contains nitrosamines-carcinogenic.
  • Pan masala - mainly contains tobacco - causes oral cancer.

11.

  • SNUFF
  • Finely powdered air-cured & fire-cured tobacco leaves.
  • Used orally/nasally.
  • Carried in a metal container-a twig is dipped into it-placed in oral vestibule.
  • Causes oral squamous cell carcinoma.

12.

  • ZARDA
  • Tobacco leaves + lime+spices boiled in water.
  • Residual tobacco dried & coloured.

13.

  • CONSTITUENTS OF TOBACCO
  • Polycyclic aromatic hydrocarbons
  • Nicotinecarcinogenesis
  • Nitrosamine
  • Phenoltumour promotion& irritation
  • Benzopyrene
  • Carbon monoxide-impaired oxygen transport
  • Formaldehyde & oxides ofN-toxicity

14.

  • EFFECTS OF TOBACCO
  • Oral cancer
  • Cracking & bleeding lips & gums.
  • Receding gums tooth falls out.
  • Increasedheartrate, high B.P, irregular heartbeats - greater risk of heart attacks .
  • When pregnant women smoke, carbon monoxide and nicotine passes into their lungs and bloodstream, reducing the oxygen supply to their unborn baby leading to:- asthma attacks, chest infections and colds in later life - premature birth - underweight birth.

15. 16. 17.

  • Oral cancer refers to cancer of the mouth , lips, tongue, floor & roof of the mouth, cheek & the gums.
  • Cancer from chewing tobacco does not remain in the mouth itself & it spreads to the stomach,esophagus & bladder.

18.

  • ETIOLOGY & RISK FACTORS
      • Genetic factors
      • Dental factors
      • Occupational risks
      • Tobacco use
      • Alcohol
      • Mouthwash
      • Viral & fungal infections
      • Diet & nutrition

19.

  • CLASSIFICATION OF ORAL CANCEROUS LESIONS
  • Benign tumours-Epithelial origin
  • Papilloma
  • Squamous acanthoma
  • Pigmentedcellular nevus
  • Premalignant lesions-Epithelial origin
  • Leukoplakia
  • Leukodema
  • Erythroplakia
  • Intraepithelial carcinoma
  • Oral submucous fibrosis

20.

  • Malignant tumours-epithelial origin
  • Basal cell carcinoma
  • Epidermoid carcinoma
  • Carcinoma of lip, tongue, floor of mouth, gingiva, buccalmucosa, palate, maxillary sinus
  • Verrcous carcinoma
  • Adenoid squamous cell carcinoma
  • Malignant melanoma
  • Benign tumours- connective tissue origin
  • Fibroma
  • Giant cell fibroma

21.

  • Peripheral central ossifying granuloma
  • Lipoma
  • Hemangioma
  • Myxoma
  • Chondroma
  • Codmans tumour
  • Osteomas
  • Malignant tumours ofconnective tissue
  • Fibrosarcoma
  • Kaposissarcoma
  • Ewings sarcoma

22.

  • Chondro/Osteosarcoma
  • Non-Hodkins lymphoma
  • Burkitts lymphoma
  • Multiple myleoma

23.

  • RED & WHITE / PRECANCEROUSLESIONS
    • Leukoplakia
    • Erythroplakia
    • Oral lesions- tobacco/alcohol
    • Carcinoma-in-situ
    • Bowens disease
    • Oral submucousfibrosis
    • Actinic keratosis
    • Discoid lupus erythematosis
    • Dyskeratosis congenita
    • Lichen planus
    • Lichenoid reactions

24.

  • Leukokeratosis/white patch formed by keratinization/ thickening of the mucosa.
  • Most common malignant lesion of the oral mucosa.
  • Raised white part of the oral mucosa measuring 5cm / more which cannot be scraped off & which cannot be attributed to any other diagnosable diseases.
  • Definable white lesions:
    • Hyperplastic candidiasis
    • Hairy leukoplakia
    • Tobacco-induced /smokers palate
    • Tobacco-associated
    • Idiopathic leukoplakia
  • EPIDEMIOLOGY :
    • Highestprevalence in Ernakulam

LEUKOPLAKIA 25.

  • ETIOLOGY:
    • S moking
    • S pirits
    • S pices
    • S epsis
    • S harp tooth edge
    • S yphilis
  • CLINICAL FEATURES:
    • Age : after 30yrs.
    • Strong male predominance.
    • Site:buccal mucosa,commissures,tongue,alveolar mucosa,etc
    • Yellowish-whitechanges tobrownish-yellow.
    • Types:
      • Homogenous
      • Ulcerated
      • Nodular

26.

  • Resembles early leukoplakia
  • Opaque appearance of buccal mucosa grayish white
  • Common in occlusal line bicuspid&molar region.

27.

    • Erythroplasia of Queyrat
      • Red patch
      • Rare-most imp. precancerous lesion.
      • More dangerous than its white kin.
      • Bright red velvety plaques cannot becharacterized clinically/pathologically as dueto any other condition.
      • No sex predilection.
      • Occur in 6 th &7 thdecades.
        • ETIOLOGY & CLINICAL FEATURES:
          • Smoking & alcohol abuse-same.
      • Types:
        • Homogenous
        • Granular/Speckled

ERYTHROPLAKIA 28.

  • Malignant transformations:
    • Preleukoplakia
    • Leukodema
    • Smokers palate

29.

  • ORAL SUBMUCOSIS FIBROSIS (OSF)
    • Chronic,progressive,scarring disease.
    • A chronic mucosal condition affecting any part of the oral mucosa characterizedby mucosal rigidity of varying intensity due to fibro - elastic transformation of the juxta epithelial connective tissue layer.
    • Etiology: Pan chewing
    • Clinical features :
      • Onset is incidious - 25yrs.
      • Site buccal mucosa.
      • Presence of palpable fibrous bands.

30.

    • Cheek mucosa & tongue become fibrosed-loses its elasticity.
    • Opening of mouth restricted
    • Blanching of oral mucosa - impaired vascularity.
    • Difficult to tolerate both spicy & hot foods.
    • Pain on palpation at areas of submucosal fibrotic bands.
  • Epidemiology:
    • Prevalent in Ernakulam- Kerala.

31.

  • BASAL CELL CARCINOMA
      • Most common malignancy.
      • Common site exposed surface of skin, face,scalp.
      • Age middle-aged/elderly
      • People with fair complexion-high rate.
    • Etiology:
      • UV radiation-shorter wavelength-more
      • Chronic sun exposure
      • X-ray exposure / arsenic.

32.

  • Clinical features:
    • Age after 40yrs
    • Sex male:female=3:2
    • More in fair skin individuals , rare in dark.
    • Common in middle third of face.
    • Does not arise in the oral mucosa arrives by invasion & infiltration from a skin surface.
    • Begins as a small, elevated papule ulcerates-heals-crusts down-develops a rolled border.

33.

  • EPIDERMOID CARCINOMA/SQUAMOUS CELL CARCINOMA
    • Most common malignant neoplasm of oral cavity.
    • Etiology:
    • Tobacco
    • Alcohol
    • Syphilis
    • Nutritional deficiencies
    • Sunlight
    • Trauma , sepsis
    • Viruses-EBV,CMV, immunocompromised.

34.

  • Clinical features:
      • Mainly-ulcerated & indurated margin
      • Occurs as carcinoma of lip , tongue, floor of mouth, gingiva,etc.

35.

  • Carcinoma in situ
      • Intra-epithelial carcinoma.
      • Cancer which involves only the place in which it began & that has not spread.
      • Early - stage tumour. eg: Bowens disease.
      • Common site- floor of mouth , tongue , lips.
      • More common in males /elderly.

36.

  • DISCOID LUPUS ERYTHEMATOSIS( DLE)
      • A chronic , scarring , atrophy producing, photosensitive dermatosis.
      • Red-atrophic , white - keratotic , red - telangiectatic zones provide a characteristic appearance.
      • Sites - cheeks, gingiva, labial mucosa, lip.
      • Age 3 rd & 4 thdecades.

37.

  • LICHEN PLANUS /LICHEN RUBBER PLANUS
      • Common mucocutaneous disease.
      • Affects skin /mucosa /both.
      • Causes bilateral white striations, papules/plaques on the buccal mucosa, tongue & gingiva.
    • Epidemiology:
    • Prevalent in Ernakulam.
    • Clinical features:
    • Common site in oral cavity buccal mucosa.
    • Affects all racial groups/older people.
    • Flat papules covered by grayish white lines WICKHAMS STRIAE.
    • Association of lichen planus, diabetes & vascular hypertension -triad -GRINSPANS SYNDROME.

38.

  • FORMS OF LICHEN PLANUS
      • Reticular form
      • Plaque form
      • Erosive form
      • Annular & Linear form

39.

  • STAGING OF CANCER
  • TNMCLASSIFICATION - 3 mainparameters:
  • T- extentof theprimary tumour
  • N- condition of regionallymph nodes.
  • M- absence/presence of distantmetastasis.
  • New parameters:P- Pathology&
  • S- Site of the tumour

40.

  • T- primary tumour
  • Tx primary tumour cannot be assessed
  • To no evidence ofprimary tumour
  • Tis-carcinoma in situ
  • T1 tumour 2cm / less in greatestdimension
  • T2 tumour>2cm but not more than 4cm in greatest dimension
  • T3 tumour >4cm in greatest dimension
  • T4 tumour invades adjacentstructures
  • N regional lymph nodes
  • Nx regional lymph nodes cannot be assessed
  • N0 no lymph nodes
  • N1 metastasis in a single ipsilateral lymph node,3cm/less ingreatest dimension

41.

  • N2 metastasis in a single ipsilateral lymph node, >3cm but not>6cm in greatest dimension,or in multiple ipsilateral lymphnodes , none >6cm in greatest dimension
  • N2a metastasis in a single ipsilateral lymph node ,>3cm ,butnot >6cm in greatest dimension
  • N2c -metastasis in bilateral / contralaterallymph nodes, none>6cm in greatest dimension
  • N3 metastasis in a lymph node >6cm in greatest dimension
  • M distant metastasis
  • Mx presence of distant metastasis cannot be assessed
  • M0 -no distant metastasis
  • M1 -distantmetastasis

42.

  • PREVENTION & CONTROL OF ORAL CANCER
    • 3wellknown approaches to public health:
      • Regulatory / legal approach
      • Service approach
      • Educational approach
      • Regulatory approach :
      • Health warning displays.
      • Ban on tobacco advertisements.
      • Service approach :
      • Active search for the disease & its treatment.
      • Educational approach :
      • 4 stages
      • Awareness
      • Initiation /Experimentation
      • Habituation
      • Maintenance / Dependence

43. 44.

  • References:
    • Essentials of Preventive and CommunityDentistry-3 rdedition- Soben Peter.
    • Shafers textbook of Oral Pathology 6 thedition
    • Indian Dentist Research and Review.

45.