EPIDEMIOLOGY OF ORAL CANCER 

INTRODUCTION:

• One of the major threats to public health in the developed world-cancer
• 2nd most common cause of death
• According to world health report :9.6 million death in 2018 its estimated that new cases will rise by 50% in the next 20 years .
• Cancer is defined by 4 characteristic trait:

1. Clonality
2. Autonomy
3. Anaplasia
4. Metastasis 

• International classification of disease (ICD) WHO (9TH version)

Oral cancer is classified under rubrics 

• Lip-140
• Tongue-141
• Gingiva-143
• Floor of mouth-144
• Other parts of mouth-145 

CANCER REGISTRATION IN INDIA:

• National cancer registry program(NCRP)was commenced by Indian council of medical research 
• 3 (PBCRPS )  Population based cancer registries :

1. Bangalore 
2. Chennai 
3. Mumbai

• 3 Hospital based cancer registries :
• Chandigarh,
• Dibrugarh,
• Thiruvanthapuram 
• Commenced from January 1 in 1982 
• Currently there are 36 (PBCRS) and 236 (HBCR) under NCRP.

ETIOLOGY AND RISK FACTOR :

• Tobacco and alcohol -2020 WHO fact sheet :1.3 billion tobacco users in the world.
• 80% -low +middle income countries .

TOBACCO PREPARATION:

• Genus - Nicotiana 
• Family- potato
• Varieties :Nicotiana rustica , nicotiana tabacum
• Tobacco leaves- flue -curing - fire curing-sun curing - SOLD in India ,tobacco :smoked,smokeless 

SMOKED TOBACCO:

A)REVERSE SMOKING ;

• Temperature of palatal mucosa - 58 degree celsius 

Smoking habits :

• Bidi
• Chillum
• Chutta
• Cigarette
• Dhumti
• Hookah
• Hookli

SECOND HAND SMOKE:

• Combination of smoke emitted from burning end of cigarette+smoke exhaled by smoker

According to who 2020 :

• Half of the worlds children is affected by exposure to environmental tobacco smoke (ETS) and 65,000 die each year from illness attributable to second hand smoke 

There is no safe level of exposure to second hand smoke ,even brief exposure can be harmful.

SMOKELESS TOBACCO:

• Khaini 
• Mawa
• Mainpuri 
• Mishri
• Paan 
• Snuff
• Zarda
• Gutka
• Pan masala 
• Gudakhu 

TOBACCO CONSTITUENTS ;

NICOTINE :

• Average lethal dose for adult :30-60 mg 

TAR: 

• Particulate matter inhaled when smoker draws on a lighted cigarette

Carbon Monoxide 

• 200 times more affinity to bind to hemoglobin than oxygen- decreases oxygenated blood circulated to organ + tissue 

NITROGEN OXIDE :

• Responsible for initiating lung damage leading to emphysema 

Hydrogen cyanide and other ciliatoxic agents 

Metals 

Radioactive compounds 

HEALTH CONSEQUENCES OF TOBACCO :

• Slow wound healing after dental surgery 
• Increase risk for periodontal disease 
• Smoking causes cancer
• Smoking is known cause of cardiovascular disease
• Major risk factor of tuberculosis in India 

SQUAMOUS CELL CARCINOMA:
DEFINITION :

Invasive epithelial neoplasm with varying degree of squamous differentiation and a propensity to early and extensive lymph node metastases,occurring predominantly in alcohol and tobacco using adults in the 5th and 6th decade of life 

LEVELS OF PREVENTION OF ORAL CANCER:

LEVELS OF PREVENTION:

A)SERVICES PROVIDED BY THE INDIVIDUAL 

B)SERVICES PROVIDED BY THE COMMUNITY

C)SERVICES PROVIDED BY THE DENTAL PROFESSIONAL 

A) SERVICES PROVIDED BY THE INDIVIDUAL :

PRIMARY : 

HEALTH PROMOTION : 

• Periodic visit to dental office 
• Demand for preventive services 

SPECIFIC PROTECTION :

• Avoidance of known irrittants 

SECONDARY :

EARLY DIAGNOSIS AND PROMPT TREATMENT: 

• Self examination and referral 
• Utilization of dental services 

TERTIARY 

DISABILITY LIMITATION:

• Utilization of dental services 

REHAB

• Utilisation of dental services 

B)SERVICES PROVIDED BY THE COMMUNITY

PRIMARY : 

HEALTH PROMOTION :

•  Dental health education program 
• Promotion of research efforts 
• Lobby efforts

SPECIFIC PROTECTION :

• Avoidance of known irritants 

SECONDARY :

EARLY DIAGNOSIS AND PROMPT TREATMENT: 

• Periodic screening and referral 
• Provision of dental service 

TERTIARY 

DISABILITY LIMITATION

• Provision of dental service

REHAB

• Provision of dental service

C)SERVICES PROVIDED BY THE DENTAL PROFESSIONAL 

PRIMARY : 

HEALTH PROMOTION : 

• Patient education 

SPECIFIC PROTECTION :

• Removal of known irritants 

SECONDARY :

EARLY DIAGNOSIS AND PROMPT TREATMENT: 

• Complete examination 
• Biopsy 
• Complete excision 

TERTIARY 

DISABILITY LIMITATION:

• Chemotherapy 
• Radiotherapy 
• Surgery 

REHAB

• Plastic surgery 
• Speech therapy 

5 A's and 5 R'S :

5 A MODEL :

• Ask 
• Advise
• Assess
• Assist 
• Arrange 

5 R MODEL : 

• Relevance of quitting
• Risk of continuing tobacco use 
• Rewards of quitting 
• Roadblocks to quitting
• Repeat these at each visit 

CONCLUSION :

• NO TOBACCO DAY - 31ST MAY 
• Bloomberg  initiative to reduce tobacco use 

M POWER PACKAGE :

• Monitor tobacco use and prevention polices 
• Protect people from tobacco use
• Offer help to quit tobacco use 
• Warn about the dangers of tobacco 
• Enforce bans on tobacco advertising ,promotion and sponsorship
• Raise taxes on tobacco 

                  THANK YOU