Presented by : dr shabeel  pn
<ul><li>INTRODUCTION </li></ul><ul><ul><li>Tobacco is responsible for a significant amount of morbidity & mortality among ...
 
<ul><li>What Is Smokeless Tobacco? </li></ul><ul><li>Smokeless tobacco / spit tobacco / chewing tobacco. </li></ul><ul><li...
<ul><li>Consumption </li></ul><ul><li>Chewed  :  gutkha, pan, mawa, mainpuri tobacco, khaini, zarda </li></ul><ul><li>Appl...
<ul><li>TYPES </li></ul><ul><li>Gutkha </li></ul><ul><li>Khaini  </li></ul><ul><li>Mainpuri tobacco </li></ul><ul><li>Mawa...
<ul><li>gutkhA </li></ul><ul><ul><li>Leads to Oral sub-mucous fibrosis (SMF). </li></ul></ul><ul><ul><li>Main component - ...
<ul><li>MAINPURI TOBACCO </li></ul><ul><li>Tobacco+ slaked lime + finely cut arecanut + camphor + cloves. </li></ul><ul><l...
<ul><li>Mixed & chewed excessively and kept in mandibular groove- causes oral cancer. </li></ul><ul><li>MISHRI </li></ul><...
<ul><li>PAN (BETEL QUID) WITH TOBACCO </li></ul><ul><li>Most common-ancient habit.  </li></ul><ul><li>Betel leaf + arecanu...
<ul><li>SNUFF </li></ul><ul><li>Finely powdered air-cured & fire-cured tobacco leaves. </li></ul><ul><li>Used orally/nasal...
<ul><li>ZARDA </li></ul><ul><li>Tobacco leaves + lime+spices – boiled in water. </li></ul><ul><li>Residual tobacco –dried ...
<ul><li>CONSTITUENTS OF TOBACCO </li></ul><ul><li>Polycyclic aromatic hydrocarbons </li></ul><ul><li>Nicotine    carcinoge...
<ul><li>EFFECTS OF TOBACCO </li></ul><ul><li>Oral cancer </li></ul><ul><li>Cracking & bleeding lips & gums. </li></ul><ul>...
 
 
<ul><li>Oral cancer refers to cancer of the mouth , lips, tongue, floor & roof of the mouth, cheek & the gums. </li></ul><...
<ul><li>ETIOLOGY & RISK FACTORS  </li></ul><ul><ul><ul><li>Genetic factors </li></ul></ul></ul><ul><ul><ul><li>Dental fact...
<ul><li>CLASSIFICATION OF ORAL CANCEROUS LESIONS </li></ul><ul><li>Benign tumours-Epithelial origin </li></ul><ul><li>Papi...
<ul><li>Malignant tumours-epithelial origin </li></ul><ul><li>Basal cell carcinoma </li></ul><ul><li>Epidermoid carcinoma ...
<ul><li>Peripheral central ossifying granuloma </li></ul><ul><li>Lipoma </li></ul><ul><li>Hemangioma </li></ul><ul><li>Myx...
<ul><li>Chondro/Osteosarcoma </li></ul><ul><li>Non-Hodkins lymphoma </li></ul><ul><li>Burkitt’s lymphoma </li></ul><ul><li...
<ul><li>RED & WHITE / PRECANCEROUS  LESIONS </li></ul><ul><ul><li>Leukoplakia </li></ul></ul><ul><ul><li>Erythroplakia </l...
<ul><li>Leukokeratosis/white patch formed by keratinization/ thickening of the mucosa. </li></ul><ul><li>Most common malig...
<ul><li>ETIOLOGY: </li></ul><ul><ul><li>S moking </li></ul></ul><ul><ul><li>S pirits </li></ul></ul><ul><ul><li>S pices </...
<ul><li>Resembles early leukoplakia </li></ul><ul><li>Opaque appearance of buccal mucosa –grayish white </li></ul><ul><li>...
<ul><ul><li>Erythroplasia of Queyrat </li></ul></ul><ul><ul><ul><li>“ Red –patch” </li></ul></ul></ul><ul><ul><ul><li>Rare...
<ul><li>Malignant transformations: </li></ul><ul><ul><li>Preleukoplakia </li></ul></ul><ul><ul><li>Leukodema </li></ul></u...
<ul><li>ORAL SUBMUCOSIS FIBROSIS (OSF) </li></ul><ul><ul><li>Chronic,progressive,scarring disease. </li></ul></ul><ul><ul>...
<ul><ul><li>Cheek mucosa & tongue become fibrosed-loses its elasticity. </li></ul></ul><ul><ul><li>Opening of mouth – rest...
<ul><li>BASAL CELL CARCINOMA </li></ul><ul><ul><ul><li>Most common malignancy. </li></ul></ul></ul><ul><ul><ul><li>Common ...
<ul><li>Clinical features: </li></ul><ul><ul><li>Age   –  after 40yrs </li></ul></ul><ul><ul><li>Sex   – male:female=3:2 <...
<ul><li>EPIDERMOID CARCINOMA  /SQUAMOUS CELL CARCINOMA </li></ul><ul><ul><li>Most common malignant neoplasm of oral cavity...
<ul><li>Clinical features: </li></ul><ul><ul><ul><li>Mainly-ulcerated & indurated margin </li></ul></ul></ul><ul><ul><ul><...
<ul><li>Carcinoma in situ </li></ul><ul><ul><ul><li>Intra-epithelial carcinoma. </li></ul></ul></ul><ul><ul><ul><li>Cancer...
<ul><li>DISCOID LUPUS ERYTHEMATOSIS( DLE) </li></ul><ul><ul><ul><li>A chronic , scarring , atrophy producing, photosensiti...
<ul><li>LICHEN PLANUS /LICHEN RUBBER PLANUS </li></ul><ul><ul><ul><li>Common mucocutaneous disease. </li></ul></ul></ul><u...
<ul><li>FORMS OF LICHEN PLANUS </li></ul><ul><ul><ul><li>Reticular form </li></ul></ul></ul><ul><ul><ul><li>Plaque form </...
<ul><li>STAGING OF CANCER  </li></ul><ul><li>TNM  CLASSIFICATION - 3 main  parameters: </li></ul><ul><li>T  - extent  of t...
<ul><li>‘ T’- primary tumour </li></ul><ul><li>Tx – primary tumour cannot be assessed </li></ul><ul><li>To – no evidence o...
<ul><li>N2 – metastasis in a single ipsilateral lymph node, >3cm but not  >6cm in greatest dimension,or in multiple ipsila...
<ul><li>PREVENTION & CONTROL OF ORAL CANCER </li></ul><ul><ul><li>3  well–known approaches to public health: </li></ul></u...
 
<ul><li>References: </li></ul><ul><ul><li>Essentials of Preventive and Community  Dentistry  -3 rd  edition- Soben Peter. ...
 
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Smokeless Tobacco & Oral Cancer New

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Smokeless Tobacco & Oral Cancer New

  1. 1. Presented by : dr shabeel pn
  2. 2. <ul><li>INTRODUCTION </li></ul><ul><ul><li>Tobacco is responsible for a significant amount of morbidity & mortality among middle aged adults. </li></ul></ul><ul><ul><li>India has one of the highest rates of oral cancer in the world. </li></ul></ul><ul><ul><li>Tobacco-related cancers - 1/2 of all cancers - men & 1/4 th among women. </li></ul></ul><ul><ul><li>Oral cancer - 1/3 rd total cancer ; 90% - tobacco chewers. </li></ul></ul><ul><ul><li>Men are affected 2-3 times than women due to higher use of alcohol & tobacco and higher exposure to sunlight . </li></ul></ul><ul><ul><li>Tongue & intra-oral cancer - equal in both as chewing tobacco among women is common. </li></ul></ul><ul><ul><li>Effects of tobacco use, heavy alcohol consumption , and poor diet together explain over 90% of head & neck cancers. </li></ul></ul>
  3. 4. <ul><li>What Is Smokeless Tobacco? </li></ul><ul><li>Smokeless tobacco / spit tobacco / chewing tobacco. </li></ul><ul><li>Mainly two forms: snuff and chewing tobacco . </li></ul><ul><li>Snuff - users &quot;pinch&quot; or &quot;dip&quot; between their lower lip and gum. </li></ul><ul><li>Chewing tobacco - users put between their cheek and gum. </li></ul><ul><li>The tobacco juice is sucked and chewed - nicotine -absorbed into the bloodstream through the oral tissues. </li></ul><ul><li>No need to swallow. </li></ul>
  4. 5. <ul><li>Consumption </li></ul><ul><li>Chewed : gutkha, pan, mawa, mainpuri tobacco, khaini, zarda </li></ul><ul><li>Applied on gums and teeth : mishri, gudhaku, bajjar, tooth paste </li></ul><ul><li>Inhaled : snuff </li></ul>
  5. 6. <ul><li>TYPES </li></ul><ul><li>Gutkha </li></ul><ul><li>Khaini </li></ul><ul><li>Mainpuri tobacco </li></ul><ul><li>Mawa </li></ul><ul><li>Mishri </li></ul><ul><li>Paan </li></ul><ul><li>Snuff </li></ul><ul><li>Zarda </li></ul>
  6. 7. <ul><li>gutkhA </li></ul><ul><ul><li>Leads to Oral sub-mucous fibrosis (SMF). </li></ul></ul><ul><ul><li>Main component - arecanut along with tobacco . </li></ul></ul><ul><li>KHAINI </li></ul><ul><li>Paste of tobacco + slaked lime & is used with arecanut. </li></ul><ul><li>Mixed with the thumb to make the mixture alkaline-premolar region of mandibular groove. </li></ul>
  7. 8. <ul><li>MAINPURI TOBACCO </li></ul><ul><li>Tobacco+ slaked lime + finely cut arecanut + camphor + cloves. </li></ul><ul><li>Mainly-Uttar Pradesh. </li></ul><ul><li>High incidence of oral cancer & leukoplakia. </li></ul><ul><li>MAWA </li></ul><ul><li>Gujarathi preparation made from shavings of arecanut, tobacco and slaked lime. </li></ul><ul><li>Sold by tobacco vendors in cellophane papers tied like a small ball. </li></ul>
  8. 9. <ul><li>Mixed & chewed excessively and kept in mandibular groove- causes oral cancer. </li></ul><ul><li>MISHRI </li></ul><ul><li>Prepared by roasting tobacco on a hot metal plate-black-powdered-used with catechu. </li></ul><ul><li>Used to clean teeth. </li></ul><ul><li>Common in women –leads to low birth wt. babies . </li></ul>
  9. 10. <ul><li>PAN (BETEL QUID) WITH TOBACCO </li></ul><ul><li>Most common-ancient habit. </li></ul><ul><li>Betel leaf + arecanut + slaked lime + catechu. </li></ul><ul><li>Arecanut-vital component-drastically affects oral health. </li></ul><ul><li>Contains nitrosamines-carcinogenic. </li></ul><ul><li>Pan masala - mainly contains tobacco - causes oral cancer. </li></ul>
  10. 11. <ul><li>SNUFF </li></ul><ul><li>Finely powdered air-cured & fire-cured tobacco leaves. </li></ul><ul><li>Used orally/nasally. </li></ul><ul><li>Carried in a metal container-a twig is dipped into it-placed in oral vestibule. </li></ul><ul><li>Causes oral squamous cell carcinoma. </li></ul>
  11. 12. <ul><li>ZARDA </li></ul><ul><li>Tobacco leaves + lime+spices – boiled in water. </li></ul><ul><li>Residual tobacco –dried & coloured. </li></ul>
  12. 13. <ul><li>CONSTITUENTS OF TOBACCO </li></ul><ul><li>Polycyclic aromatic hydrocarbons </li></ul><ul><li>Nicotine carcinogenesis </li></ul><ul><li>Nitrosamine </li></ul><ul><li>Phenol tumour promotion& irritation </li></ul><ul><li>Benzopyrene </li></ul><ul><li>Carbon monoxide - impaired oxygen transport </li></ul><ul><li>Formaldehyde & oxides of N - toxicity </li></ul>
  13. 14. <ul><li>EFFECTS OF TOBACCO </li></ul><ul><li>Oral cancer </li></ul><ul><li>Cracking & bleeding lips & gums. </li></ul><ul><li>Receding gums –tooth falls out. </li></ul><ul><li>Increased heart rate, high B.P, irregular heartbeats - greater risk of heart attacks . </li></ul><ul><li>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. </li></ul>
  14. 17. <ul><li>Oral cancer refers to cancer of the mouth , lips, tongue, floor & roof of the mouth, cheek & the gums. </li></ul><ul><li>Cancer from chewing tobacco does not remain in the mouth itself & it spreads to the stomach,esophagus & bladder. </li></ul>
  15. 18. <ul><li>ETIOLOGY & RISK FACTORS </li></ul><ul><ul><ul><li>Genetic factors </li></ul></ul></ul><ul><ul><ul><li>Dental factors </li></ul></ul></ul><ul><ul><ul><li>Occupational risks </li></ul></ul></ul><ul><ul><ul><li>Tobacco use </li></ul></ul></ul><ul><ul><ul><li>Alcohol </li></ul></ul></ul><ul><ul><ul><li>Mouthwash </li></ul></ul></ul><ul><ul><ul><li>Viral & fungal infections </li></ul></ul></ul><ul><ul><ul><li>Diet & nutrition </li></ul></ul></ul>
  16. 19. <ul><li>CLASSIFICATION OF ORAL CANCEROUS LESIONS </li></ul><ul><li>Benign tumours-Epithelial origin </li></ul><ul><li>Papilloma </li></ul><ul><li>Squamous acanthoma </li></ul><ul><li>Pigmented cellular nevus </li></ul><ul><li>Premalignant lesions-Epithelial origin </li></ul><ul><li>Leukoplakia </li></ul><ul><li>Leukodema </li></ul><ul><li>Erythroplakia </li></ul><ul><li>Intraepithelial carcinoma </li></ul><ul><li>Oral submucous fibrosis </li></ul>
  17. 20. <ul><li>Malignant tumours-epithelial origin </li></ul><ul><li>Basal cell carcinoma </li></ul><ul><li>Epidermoid carcinoma </li></ul><ul><li>Carcinoma of lip, tongue, floor of mouth, gingiva, buccal mucosa, palate, maxillary sinus </li></ul><ul><li>Verrcous carcinoma </li></ul><ul><li>Adenoid squamous cell carcinoma </li></ul><ul><li>Malignant melanoma </li></ul><ul><li>Benign tumours - connective tissue origin </li></ul><ul><li>Fibroma </li></ul><ul><li>Giant cell fibroma </li></ul>
  18. 21. <ul><li>Peripheral central ossifying granuloma </li></ul><ul><li>Lipoma </li></ul><ul><li>Hemangioma </li></ul><ul><li>Myxoma </li></ul><ul><li>Chondroma </li></ul><ul><li>Codman’s tumour </li></ul><ul><li>Osteomas </li></ul><ul><li>Malignant tumours of connective tissue </li></ul><ul><li>Fibrosarcoma </li></ul><ul><li>Kaposis sarcoma </li></ul><ul><li>Ewings sarcoma </li></ul>
  19. 22. <ul><li>Chondro/Osteosarcoma </li></ul><ul><li>Non-Hodkins lymphoma </li></ul><ul><li>Burkitt’s lymphoma </li></ul><ul><li>Multiple myleoma </li></ul>
  20. 23. <ul><li>RED & WHITE / PRECANCEROUS LESIONS </li></ul><ul><ul><li>Leukoplakia </li></ul></ul><ul><ul><li>Erythroplakia </li></ul></ul><ul><ul><li>Oral lesions- tobacco/alcohol </li></ul></ul><ul><ul><li>Carcinoma-in-situ </li></ul></ul><ul><ul><li>Bowen’s disease </li></ul></ul><ul><ul><li>Oral submucous fibrosis </li></ul></ul><ul><ul><li>Actinic keratosis </li></ul></ul><ul><ul><li>Discoid lupus erythematosis </li></ul></ul><ul><ul><li>Dyskeratosis congenita </li></ul></ul><ul><ul><li>Lichen planus </li></ul></ul><ul><ul><li>Lichenoid reactions </li></ul></ul>
  21. 24. <ul><li>Leukokeratosis/white patch formed by keratinization/ thickening of the mucosa. </li></ul><ul><li>Most common malignant lesion of the oral mucosa. </li></ul><ul><li>Raised white part of the oral mucosa measuring 5cm / more which cannot be scraped off & which cannot be attributed to any other diagnosable diseases. </li></ul><ul><li>Definable white lesions: </li></ul><ul><ul><li>Hyperplastic candidiasis </li></ul></ul><ul><ul><li>Hairy leukoplakia </li></ul></ul><ul><ul><li>Tobacco-induced /smoker’s palate </li></ul></ul><ul><ul><li>Tobacco-associated </li></ul></ul><ul><ul><li>Idiopathic leukoplakia </li></ul></ul><ul><li>EPIDEMIOLOGY : </li></ul><ul><ul><li>Highest prevalence in Ernakulam </li></ul></ul>LEUKOPLAKIA
  22. 25. <ul><li>ETIOLOGY: </li></ul><ul><ul><li>S moking </li></ul></ul><ul><ul><li>S pirits </li></ul></ul><ul><ul><li>S pices </li></ul></ul><ul><ul><li>S epsis </li></ul></ul><ul><ul><li>S harp tooth edge </li></ul></ul><ul><ul><li>S yphilis </li></ul></ul><ul><li>CLINICAL FEATURES: </li></ul><ul><ul><li>Age : after 30yrs. </li></ul></ul><ul><ul><li>Strong male predominance. </li></ul></ul><ul><ul><li>Site: buccal mucosa,commissures,tongue,alveolar mucosa,etc </li></ul></ul><ul><ul><li>Yellowish-white changes to brownish-yellow. </li></ul></ul><ul><ul><li>Types: </li></ul></ul><ul><ul><ul><li>Homogenous </li></ul></ul></ul><ul><ul><ul><li>Ulcerated </li></ul></ul></ul><ul><ul><ul><li>Nodular </li></ul></ul></ul>
  23. 26. <ul><li>Resembles early leukoplakia </li></ul><ul><li>Opaque appearance of buccal mucosa –grayish white </li></ul><ul><li>Common in occlusal line – bicuspid&molar region. </li></ul>
  24. 27. <ul><ul><li>Erythroplasia of Queyrat </li></ul></ul><ul><ul><ul><li>“ Red –patch” </li></ul></ul></ul><ul><ul><ul><li>Rare-most imp. precancerous lesion. </li></ul></ul></ul><ul><ul><ul><li>More dangerous than its white kin. </li></ul></ul></ul><ul><ul><ul><li>Bright red velvety plaques –cannot be characterized clinically/pathologically as due to any other condition. </li></ul></ul></ul><ul><ul><ul><li>No sex predilection. </li></ul></ul></ul><ul><ul><ul><li>Occur in 6 th &7 th decades. </li></ul></ul></ul><ul><ul><ul><ul><li>ETIOLOGY & CLINICAL FEATURES: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Smoking & alcohol abuse-same. </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Types: </li></ul></ul></ul><ul><ul><ul><ul><li>Homogenous </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Granular/Speckled </li></ul></ul></ul></ul>ERYTHROPLAKIA
  25. 28. <ul><li>Malignant transformations: </li></ul><ul><ul><li>Preleukoplakia </li></ul></ul><ul><ul><li>Leukodema </li></ul></ul><ul><ul><li>Smoker’s palate </li></ul></ul>
  26. 29. <ul><li>ORAL SUBMUCOSIS FIBROSIS (OSF) </li></ul><ul><ul><li>Chronic,progressive,scarring disease. </li></ul></ul><ul><ul><li>A chronic mucosal condition affecting any part of the oral mucosa characterized by mucosal rigidity of varying intensity due to fibro - elastic transformation of the juxta – epithelial connective tissue layer. </li></ul></ul><ul><ul><li>Etiology: Pan chewing </li></ul></ul><ul><ul><li>Clinical features : </li></ul></ul><ul><ul><ul><li>Onset is incidious - 2–5yrs. </li></ul></ul></ul><ul><ul><ul><li>Site – buccal mucosa. </li></ul></ul></ul><ul><ul><ul><li>Presence of palpable fibrous bands. </li></ul></ul></ul>
  27. 30. <ul><ul><li>Cheek mucosa & tongue become fibrosed-loses its elasticity. </li></ul></ul><ul><ul><li>Opening of mouth – restricted </li></ul></ul><ul><ul><li>Blanching of oral mucosa - impaired vascularity. </li></ul></ul><ul><ul><li>Difficult to tolerate both spicy & hot foods. </li></ul></ul><ul><ul><li>Pain on palpation at areas of submucosal fibrotic bands. </li></ul></ul><ul><li>Epidemiology: </li></ul><ul><ul><li>Prevalent in Ernakulam- Kerala. </li></ul></ul>
  28. 31. <ul><li>BASAL CELL CARCINOMA </li></ul><ul><ul><ul><li>Most common malignancy. </li></ul></ul></ul><ul><ul><ul><li>Common site – exposed surface of skin, face,scalp. </li></ul></ul></ul><ul><ul><ul><li>Age – middle-aged/elderly </li></ul></ul></ul><ul><ul><ul><li>People with fair complexion-high rate. </li></ul></ul></ul><ul><ul><li>Etiology: </li></ul></ul><ul><ul><ul><li>UV radiation-shorter wavelength-more </li></ul></ul></ul><ul><ul><ul><li>Chronic sun exposure </li></ul></ul></ul><ul><ul><ul><li>X-ray exposure / arsenic. </li></ul></ul></ul>
  29. 32. <ul><li>Clinical features: </li></ul><ul><ul><li>Age – after 40yrs </li></ul></ul><ul><ul><li>Sex – male:female=3:2 </li></ul></ul><ul><ul><li>More in fair skin individuals , rare in dark. </li></ul></ul><ul><ul><li>Common in middle – third of face. </li></ul></ul><ul><ul><li>Does not arise in the oral mucosa –arrives by invasion & infiltration from a skin surface. </li></ul></ul><ul><ul><li>Begins as a small, elevated papule –ulcerates-heals-crusts down-develops a rolled border. </li></ul></ul>
  30. 33. <ul><li>EPIDERMOID CARCINOMA /SQUAMOUS CELL CARCINOMA </li></ul><ul><ul><li>Most common malignant neoplasm of oral cavity. </li></ul></ul><ul><ul><li>Etiology: </li></ul></ul><ul><ul><li>Tobacco </li></ul></ul><ul><ul><li>Alcohol </li></ul></ul><ul><ul><li>Syphilis </li></ul></ul><ul><ul><li>Nutritional deficiencies </li></ul></ul><ul><ul><li>Sunlight </li></ul></ul><ul><ul><li>Trauma , sepsis </li></ul></ul><ul><ul><li>Viruses-EBV,CMV, immunocompromised. </li></ul></ul>
  31. 34. <ul><li>Clinical features: </li></ul><ul><ul><ul><li>Mainly-ulcerated & indurated margin </li></ul></ul></ul><ul><ul><ul><li>Occurs as carcinoma of lip , tongue, floor of mouth, gingiva,etc. </li></ul></ul></ul>
  32. 35. <ul><li>Carcinoma in situ </li></ul><ul><ul><ul><li>Intra-epithelial carcinoma. </li></ul></ul></ul><ul><ul><ul><li>Cancer which involves only the place in which it began & that has not spread. </li></ul></ul></ul><ul><ul><ul><li>Early - stage tumour. eg: Bowen’s disease. </li></ul></ul></ul><ul><ul><ul><li>Common site- floor of mouth , tongue , lips. </li></ul></ul></ul><ul><ul><ul><li>More common in males /elderly. </li></ul></ul></ul>
  33. 36. <ul><li>DISCOID LUPUS ERYTHEMATOSIS( DLE) </li></ul><ul><ul><ul><li>A chronic , scarring , atrophy producing, photosensitive dermatosis. </li></ul></ul></ul><ul><ul><ul><li>Red-atrophic , white - keratotic , red - telangiectatic zones provide a characteristic appearance. </li></ul></ul></ul><ul><ul><ul><li>Sites - cheeks, gingiva, labial mucosa, lip. </li></ul></ul></ul><ul><ul><ul><li>Age – 3 rd & 4 th decades. </li></ul></ul></ul>
  34. 37. <ul><li>LICHEN PLANUS /LICHEN RUBBER PLANUS </li></ul><ul><ul><ul><li>Common mucocutaneous disease. </li></ul></ul></ul><ul><ul><ul><li>Affects skin /mucosa /both. </li></ul></ul></ul><ul><ul><ul><li>Causes bilateral white striations, papules/plaques on the buccal mucosa, tongue & gingiva. </li></ul></ul></ul><ul><ul><li>Epidemiology: </li></ul></ul><ul><ul><li>Prevalent in Ernakulam. </li></ul></ul><ul><ul><li>Clinical features: </li></ul></ul><ul><ul><li>Common site in oral cavity – buccal mucosa. </li></ul></ul><ul><ul><li>Affects all racial groups/older people. </li></ul></ul><ul><ul><li>Flat papules covered by grayish white lines – WICKHAM’S STRIAE. </li></ul></ul><ul><ul><li>Association of lichen planus, diabetes & vascular hypertension -triad - GRINSPAN’S SYNDROME. </li></ul></ul>
  35. 38. <ul><li>FORMS OF LICHEN PLANUS </li></ul><ul><ul><ul><li>Reticular form </li></ul></ul></ul><ul><ul><ul><li>Plaque form </li></ul></ul></ul><ul><ul><ul><li>Erosive form </li></ul></ul></ul><ul><ul><ul><li>Annular & Linear form </li></ul></ul></ul>
  36. 39. <ul><li>STAGING OF CANCER </li></ul><ul><li>TNM CLASSIFICATION - 3 main parameters: </li></ul><ul><li>T - extent of the primary tumour </li></ul><ul><li>N - condition of regional lymph nodes. </li></ul><ul><li>M - absence/presence of distant metastasis. </li></ul><ul><li>New parameters: “P” - Pathology & </li></ul><ul><li>“ S” - Site of the tumour </li></ul>
  37. 40. <ul><li>‘ T’- primary tumour </li></ul><ul><li>Tx – primary tumour cannot be assessed </li></ul><ul><li>To – no evidence of primary tumour </li></ul><ul><li>Tis - carcinoma in situ </li></ul><ul><li>T1 – tumour 2cm / less in greatest dimension </li></ul><ul><li>T2 – tumour >2cm but not more than 4cm in greatest dimension </li></ul><ul><li>T3 – tumour >4cm in greatest dimension </li></ul><ul><li>T4 – tumour invades adjacent structures </li></ul><ul><li>‘ N’ – regional lymph nodes </li></ul><ul><li>Nx – regional lymph nodes cannot be assessed </li></ul><ul><li>N0 – no lymph nodes </li></ul><ul><li>N1 – metastasis in a single ipsilateral lymph node,3cm/less in greatest dimension </li></ul>
  38. 41. <ul><li>N2 – metastasis in a single ipsilateral lymph node, >3cm but not >6cm in greatest dimension,or in multiple ipsilateral lymph nodes , none >6cm in greatest dimension </li></ul><ul><li>N2a – metastasis in a single ipsilateral lymph node ,>3cm ,but not >6cm in greatest dimension </li></ul><ul><li>N2c - metastasis in bilateral / contralateral lymph nodes, none >6cm in greatest dimension </li></ul><ul><li>N3 – metastasis in a lymph node >6cm in greatest dimension </li></ul><ul><li>M – distant metastasis </li></ul><ul><li>Mx – presence of distant metastasis cannot be assessed </li></ul><ul><li>M0 - no distant metastasis </li></ul><ul><li>M1 - distant metastasis </li></ul>
  39. 42. <ul><li>PREVENTION & CONTROL OF ORAL CANCER </li></ul><ul><ul><li>3 well–known approaches to public health: </li></ul></ul><ul><ul><ul><li>Regulatory / legal approach </li></ul></ul></ul><ul><ul><ul><li>Service approach </li></ul></ul></ul><ul><ul><ul><li>Educational approach </li></ul></ul></ul><ul><ul><ul><li>Regulatory approach : </li></ul></ul></ul><ul><ul><ul><li>Health – warning displays. </li></ul></ul></ul><ul><ul><ul><li>Ban on tobacco advertisements. </li></ul></ul></ul><ul><ul><ul><li>Service approach : </li></ul></ul></ul><ul><ul><ul><li>Active search for the disease & its treatment. </li></ul></ul></ul><ul><ul><ul><li>Educational approach : </li></ul></ul></ul><ul><ul><ul><li>4 stages – </li></ul></ul></ul><ul><ul><ul><li>Awareness </li></ul></ul></ul><ul><ul><ul><li>Initiation /Experimentation </li></ul></ul></ul><ul><ul><ul><li>Habituation </li></ul></ul></ul><ul><ul><ul><li>Maintenance / Dependence </li></ul></ul></ul>
  40. 44. <ul><li>References: </li></ul><ul><ul><li>Essentials of Preventive and Community Dentistry -3 rd edition- Soben Peter. </li></ul></ul><ul><ul><li>Shafer’s textbook of Oral Pathology – 6 th edition </li></ul></ul><ul><ul><li>Indian Dentist Research and Review. </li></ul></ul>
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