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Oral cancer and other
conditions
PDS 372
• Life and death implications
• Age-adjusted mortality rates
• International classification of diseases ninth revision
(ICD-9) 140-149
• Malignant neoplasms of lip, oral cavity and pharynx
(C00-C14)
• ‘Oral Cancer’ includes malignant neoplasms of the lip;
(ICD-10 C00),
intra-oral sites (ICD C01–C06) and the oro-pharynx (ICD
C09 & C10).
• Sites include:
– Tongue
– Lip
– Buccal mucosa
– Floor of the mouth
– Salivary glands
– Pharynx
– Does not include throat
• Squamous cell carcinoma
• Risk factors
– Tobacco
– Alchohol
– Sunray
– Ill fitting dentures
– Chronic inflammation, Lichen planus
– Viral infection
• Pre-cancerou lesions:
– Morphologically altered tissue in which cancer is more
likely to occur than its apparently normal counterpart

• Leukoplakia
– White patch that cannot be characterized clinically or
by pathological examination as anything else

• Erythroplakia
– Bright red or velvety plaque that cannot be
characterized clinically or pathologically as being due
any thing else
PROFILE OF CANCER IN RIYADH ARMED FORCES HOSPITAL
Osama M. Koriech, MBBCh, DMRT, FRCR; Rashid Al-Kuhaymi, FRCS (1994)

.

Overall distribution and ranking.
Number

Percentage (%)

Malignancy
Gastrointestinal

909

18

Lymphoma

660

13

Head and neck

497

10

Breast

465

9

Nervous system

410

8

Genitourinary

371

7

Leukemia

294

6

Sarcoma

281

6

Endocrine

250

5

Respiratory

239

5

Gynecologic

192

4

Unknown primary

153

3

Skin

85

2

Others

194

4

Total

5000
Primary sites of head and neck cancers.
Number
Primary Sites

Percentage
(%)

Nasopharynx

206

41

Oral cavity

121

24

Larynx

74

15

Salivary

30

6

Oro- and laryngopharynx

25

5

Sinuses

19

4

Ear

11

2

Conjunctiva

6

1

Nasal cavity

5

1

Total

497
CANCER IN THE GIZAN PROVINCE OF SAUDI ARABIA: AN ELEVEN
YEAR STUDY
Pradeep Tandon, MD; Ved P. Pathak, MD; Akhtar Zaheer, MD; Anup Chatterjee, MD;

.

Regional comparison of relative frequencies (% of total) of 10 common malignancies in females.

  

Present
Series 

Oral cavity 

22.33 

KFSH4 
referrals
(Mahboubi1987) 

Dhahran5
(Rabadi1987) 

Al-Baha6
(Willen1989) 

Asir7
(Khan1991) 

KKU,
Riyadh8
(Ajarim1992) 

5.91 

NA 

2.0 

41.0 

NA 
Most common malignancies in males and females: world comparisons (skin cancers excluded).

Western Africa 

North America 

China 

Indian subcontinent 

Eastern Europe 

Present series 

  

  

  

  

  

  

1 

Liver 

Lung 

Stomach 

Mouth/Pharynx 

Lung 

Liver 

2 

Lymphoid 

Prostate 

Esophagu
s 

Lung 

Stomach 

Lymphoma/Leukemia 

3 

Prostate 

Colorectal 

Liver 

Esophagus 

Colorectal 

Mouth 

4 

Stomach 

Bladder 

Lung 

Stomach 

Prostate 

Bladder 

5 

Mouth/Pharynx 

Lymphoid 

Colorectal 

Lymphoid 

Mouth/Pharynx 

Prostate 

  

  

  

  

  

  

1 

Cervix 

Breast 

Cervix 

Cervix 

Breast 

Mouth 

2 

Breast 

Colorectal 

Stomach 

Breast 

Stomach 

Lymphoma/Leukemia 

3 

Lymphoid 

Lung 

Esophagu
s 

Mouth/Pharynx 

Cervix 

Breast 

4 

Liver 

Lymphoid 

Breast

Esophagus 

Colorectal 

Liver 

  
Male 

Female 
ORAL AND UPPER AERO-DIGESTIVE TRACT MALIGNANCY:
A REVIEW OF A FIVE-YEAR EXPERIENCE
Aziza Al-Mobeerik, MD, BDS, MSc
Cleft lip and palate
• Of genetic origin
• Related to environment
• Correlation between late birth order and
presence of clefts
• Occurrence associated with:
• first trimester: spontaneous abortion, flu
and fever, maternal drugs.
• Second trimester: spontaneous abortion.
•
•
•
•

More facial cleft in boys
More isolated cleft palate in girls
More clefts in plural births
Clefts are associated with: low birth
weight, higher mortality rate, prematurity
and malformations.
Malocclusion
• Prevalence
• Case definition: difficult due to
– Different cultural perceptions
– Different perceptions of malocclusion among
orthodontists
– Examiner inconsistency

• Treatment needs
THE PATTERN OF MALOCCLUSIONS IN SAUDI ARABIAN PATIENTS
ATTENDING FOR ORTHODONTIC TREATMENT AT THE COLLEGE OF
DENTISTRY, KING SAUD UNIVERSITY, RIYADH
Khalid M. Al-Balkhi, BDS, MS*, Ahmed A. Zahrani, BDS, MSc, DFM**

• The prevalence of many orthodontic-related variables
was investigated and analyzed in the largest orthodontic
clinic in Saudi Arabia. The results of the study indicate
that the majority of the orthodontic cases were young
patients with females showing a marginally higher
percentage than males.
• ClassI molar relationship, permanent dentition, ovoid
arch form, crowding, asymmetrical tooth extraction and
asymmetrical arch were found most frequently. A very
strong correlation was found between asymmetrical
tooth extraction and the existence of dental arch
asymmetry. Crossbite, crowding and class III molar
relationship may be the principal reasons for patients to
seek orthodontic treatment.
TMJ disorders
• Case definition:
– no suitable case definition
– Group of extremely painful and distressing
conditions
– Diagnosis is difficult because it often accompanied
by generalized pain in the H&N

• Statistics:
– Women with TMD are three times the men.
– Common in children and adolescence as in adults
• Epidemiological studies:
Commonly measured signs and symptoms are:
– Pain with joint movement
– Limited mandible movement
– Deviation of mandible on movement
– Joint clicking or crepitus

• Treatment of TMJ disorders:
– no agreement on a standard treatment and outcomes
• Ortho treatment, attrition, premature
contact has no influence on TMD
• TMD is related to: depression, emotional
distress, lower SES, poorer health.
• Current and future approaches to treat
and manage cases:
– Multidisciplinary effort is required for its better
comprehension
Oral Cancer
Oral Cancer

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Oral Cancer

  • 1. Oral cancer and other conditions PDS 372
  • 2. • Life and death implications • Age-adjusted mortality rates • International classification of diseases ninth revision (ICD-9) 140-149 • Malignant neoplasms of lip, oral cavity and pharynx (C00-C14) • ‘Oral Cancer’ includes malignant neoplasms of the lip; (ICD-10 C00), intra-oral sites (ICD C01–C06) and the oro-pharynx (ICD C09 & C10).
  • 3. • Sites include: – Tongue – Lip – Buccal mucosa – Floor of the mouth – Salivary glands – Pharynx – Does not include throat
  • 4. • Squamous cell carcinoma • Risk factors – Tobacco – Alchohol – Sunray – Ill fitting dentures – Chronic inflammation, Lichen planus – Viral infection
  • 5.
  • 6.
  • 7. • Pre-cancerou lesions: – Morphologically altered tissue in which cancer is more likely to occur than its apparently normal counterpart • Leukoplakia – White patch that cannot be characterized clinically or by pathological examination as anything else • Erythroplakia – Bright red or velvety plaque that cannot be characterized clinically or pathologically as being due any thing else
  • 8. PROFILE OF CANCER IN RIYADH ARMED FORCES HOSPITAL Osama M. Koriech, MBBCh, DMRT, FRCR; Rashid Al-Kuhaymi, FRCS (1994) . Overall distribution and ranking. Number Percentage (%) Malignancy Gastrointestinal 909 18 Lymphoma 660 13 Head and neck 497 10 Breast 465 9 Nervous system 410 8 Genitourinary 371 7 Leukemia 294 6 Sarcoma 281 6 Endocrine 250 5 Respiratory 239 5 Gynecologic 192 4 Unknown primary 153 3 Skin 85 2 Others 194 4 Total 5000
  • 9. Primary sites of head and neck cancers. Number Primary Sites Percentage (%) Nasopharynx 206 41 Oral cavity 121 24 Larynx 74 15 Salivary 30 6 Oro- and laryngopharynx 25 5 Sinuses 19 4 Ear 11 2 Conjunctiva 6 1 Nasal cavity 5 1 Total 497
  • 10. CANCER IN THE GIZAN PROVINCE OF SAUDI ARABIA: AN ELEVEN YEAR STUDY Pradeep Tandon, MD; Ved P. Pathak, MD; Akhtar Zaheer, MD; Anup Chatterjee, MD; . Regional comparison of relative frequencies (% of total) of 10 common malignancies in females.    Present Series  Oral cavity  22.33  KFSH4  referrals (Mahboubi1987)  Dhahran5 (Rabadi1987)  Al-Baha6 (Willen1989)  Asir7 (Khan1991)  KKU, Riyadh8 (Ajarim1992)  5.91  NA  2.0  41.0  NA 
  • 11. Most common malignancies in males and females: world comparisons (skin cancers excluded). Western Africa  North America  China  Indian subcontinent  Eastern Europe  Present series                    1  Liver  Lung  Stomach  Mouth/Pharynx  Lung  Liver  2  Lymphoid  Prostate  Esophagu s  Lung  Stomach  Lymphoma/Leukemia  3  Prostate  Colorectal  Liver  Esophagus  Colorectal  Mouth  4  Stomach  Bladder  Lung  Stomach  Prostate  Bladder  5  Mouth/Pharynx  Lymphoid  Colorectal  Lymphoid  Mouth/Pharynx  Prostate                    1  Cervix  Breast  Cervix  Cervix  Breast  Mouth  2  Breast  Colorectal  Stomach  Breast  Stomach  Lymphoma/Leukemia  3  Lymphoid  Lung  Esophagu s  Mouth/Pharynx  Cervix  Breast  4  Liver  Lymphoid  Breast Esophagus  Colorectal  Liver     Male  Female 
  • 12. ORAL AND UPPER AERO-DIGESTIVE TRACT MALIGNANCY: A REVIEW OF A FIVE-YEAR EXPERIENCE Aziza Al-Mobeerik, MD, BDS, MSc
  • 13. Cleft lip and palate
  • 14. • Of genetic origin • Related to environment • Correlation between late birth order and presence of clefts • Occurrence associated with: • first trimester: spontaneous abortion, flu and fever, maternal drugs. • Second trimester: spontaneous abortion.
  • 15. • • • • More facial cleft in boys More isolated cleft palate in girls More clefts in plural births Clefts are associated with: low birth weight, higher mortality rate, prematurity and malformations.
  • 16. Malocclusion • Prevalence • Case definition: difficult due to – Different cultural perceptions – Different perceptions of malocclusion among orthodontists – Examiner inconsistency • Treatment needs
  • 17. THE PATTERN OF MALOCCLUSIONS IN SAUDI ARABIAN PATIENTS ATTENDING FOR ORTHODONTIC TREATMENT AT THE COLLEGE OF DENTISTRY, KING SAUD UNIVERSITY, RIYADH Khalid M. Al-Balkhi, BDS, MS*, Ahmed A. Zahrani, BDS, MSc, DFM** • The prevalence of many orthodontic-related variables was investigated and analyzed in the largest orthodontic clinic in Saudi Arabia. The results of the study indicate that the majority of the orthodontic cases were young patients with females showing a marginally higher percentage than males. • ClassI molar relationship, permanent dentition, ovoid arch form, crowding, asymmetrical tooth extraction and asymmetrical arch were found most frequently. A very strong correlation was found between asymmetrical tooth extraction and the existence of dental arch asymmetry. Crossbite, crowding and class III molar relationship may be the principal reasons for patients to seek orthodontic treatment.
  • 18.
  • 19.
  • 20.
  • 21. TMJ disorders • Case definition: – no suitable case definition – Group of extremely painful and distressing conditions – Diagnosis is difficult because it often accompanied by generalized pain in the H&N • Statistics: – Women with TMD are three times the men. – Common in children and adolescence as in adults
  • 22. • Epidemiological studies: Commonly measured signs and symptoms are: – Pain with joint movement – Limited mandible movement – Deviation of mandible on movement – Joint clicking or crepitus • Treatment of TMJ disorders: – no agreement on a standard treatment and outcomes
  • 23. • Ortho treatment, attrition, premature contact has no influence on TMD • TMD is related to: depression, emotional distress, lower SES, poorer health. • Current and future approaches to treat and manage cases: – Multidisciplinary effort is required for its better comprehension

Editor's Notes

  1. Life and death matter Age adjusted oral cancer mortality rate among men has decreased. Female rates are low, but showed slight further reduction Oral cancer: lip, tongue, buccal mucosa, floor of mouth, salivary glands, and pharynx. But not throat cancer.
  2. Squamus cell carcinoma of the tongue, mucosa, lip: 80% of oral cancers Bet. 88~04: No. of new oral cancers dropped Mortality also dropped, in absolute no anf and in proportionate Oral caner is related to older age Mortality is related to low SES
  3. The standard measure for the severity is the 5-y-survival rate: % of people still alive after 5 y after diagnosis 5SR is decreased with increased consumptions of the alcohol and social deprivation Survival in higher if diagnosis made when cancer is confined, nor spread
  4. %SR is 4 times when tumors diagnosed at earlier stages, before metastasis. Tobacco use, heavy alcohol and poor diet is responsible for 90% of all cancers. Risk for oral cancer from tobacco is equal for men and women. Risk decrease after quitting Risk is more for pharyngeal cancer and less for lip cancer
  5. Etio for submucus fibrosis: betel SMF and nodular luekoplakia has a hi transformation rate Genetic role in oral caner is strong Other risk factors: Ill fitting dentures Long-term sun exposure Chronic inflammations: lichen planus leukoplakia
  6. Survival rate of oral cancer is low: Delay by patients seeking attention Delay in diagnosis by professionals Leukoplakia, erythroplakia are precancerous Hi rate of second primary cancers in patients of oral cancer Papillary hyperplasia is related to ill fitting dentures Little is known (distribution, prevelence, risk factors) about the pemphigus, pemphigoid, lichen planus, candidacies and herpes infections.