 Hello everyone, welcome back to a new session on Dentistry and Mob. So today we have topic that is Epidemology of Oral Cancer. So so far we have covered Epidemology of Tensal Carias, Epidemology of Pedondrylicis and today we have Epidemology of Oral Cancer. So let's start with some basic facts that is Oral Cancer is one of the most fatal health problems faced by the mankind. So chronic diseases such as cancer and other non-communicable diseases are fast replacing communicable diseases in India and other developing countries because the third world countries like India are famous for the communicable diseases but as we progress in our health facilities and infrastructure, health infrastructure, we are shifting to the communicable to non-communicable lifestyle diseases and one among them lifestyle disease and the most dangerous one is cancer. So the burden of cancer is increasing worldwide despite advances for diagnosis and treatment. So let's see some historical data that is first documentation was around 1500 BC by Egyptians. The term cancer was coined by hypocrites because word cancer means crab. So the heart center and spiny projections of tumor observed by hypocrites remained him of the crustacean that is crab and cancer adheres to any part and ceases upon in an obstinate manner like a crab. So that's why that particular name came cancer it adheres to that tissues in an obstinate manner. So cancer may be regarded as a group of disease which is characterized by uncontrolled abnormal growth of cells and its ability to invert and metastasis to distant organs and ultimately death of the patient. It can occur at any site or tissues of the body and oral pre-cancer is an intermediate state with increased cancer rate but the advantages which can be recognized and treated obviously with much better prognosis than a full blonde malignancy. So identifying pre-cancers lesions are a crucial step in cancer diagnosis. So the next part will move on to the epidemiology of oral cancer in India. So India has the highest incidence of oral cancer in the world. Most common sites are tongue, buccal mucosa, floor of the mouth and the least are lip, chunjeeva and palate. So it construed around 12% of all cancer in men and 8% of all cancer in women and majority that is 95% are squamous cell carcinoma and approximately 90% of oral cancers are tobacco related. So in India around 200 million people use tobacco, 70% in this BD version and 10% is cigarettes and 20% and other smokeless version. So the last decade around 18 and 30% is increased in oral cancer incidence among males and females respectively. So it is estimated that among 400 million individuals aged 15 years and over and over 47% is used tobacco in one form or the other and it is buccal mucosa we have 65% of the total cancer and lower alveolus is 30% and retromolar region is 5%. So cinjeeva buccal complex is known as Indian oral cancer as they constitute more than 60% because of the peculiar patch keeping. In India around the world an estimate of 10 million workers employed in the tobacco industry. So that was all about the basic data in Indian scenario regarding the oral cancer and we know their promulgical trend, their promulgical trend in cancer it is not very much distinct each other because most of the factors are interlinked. We cannot just keep separate agent host and environment factors in oral cancer. So just the etiology of oral cancer the most common risk factors are chemical factors such as tobacco and alcohol, those who have habit of both smoking and drinking 15 times greater risk of developing cancer than the person without these habits physical factors like exposure to UV and X-rays, biological factors like viruses and fungi, human papilloma virus especially HPV16 and those includes like red and white lesions, deficiency of vitamin A, C, E, iron and other genetic predispositions. So establishes factors are smoking, tobacco chewing tobacco like oral snuff, heavy consumption of alcohol and other potential malignal lesions contributing factors are the deficiency of vitamin A, C and E, family history, viral infections, sunlight, dental trauma and immune deficiency diseases. So this is a common question to us asked once or twice in Kuha's exam, what weather smoking and smokeless tobacco which are present in India. So smoking forms are media cigarette, cigars, pipes and critics. So this has 0.2 to 0.3 gram tobacco flakes in tendu leaves. It is 1 gram tobacco cured and covered with pepper, non-pepper pepper, 1 to 1.4 gram of nicotine, cigars are air cured and fermented tobacco with tobacco wrapper, pipes made of slate, clay tobacco is placed in the bowl and inhaled through stem. Critics are clove favored cigars used in Indonesia which is not very popular in India but still it is popular to an extent. So smokeless tobacco are snuff keeping in buckled pads and lower lipid region. The one is Manipuri tobacco which is a mixture of tobaccos, slicked lime, finely cut arignet, camphor and cloves, mawa is thin shavings of arignet with tobacco and slicked lime, kaini which is powdered, sun dried tobacco, slicked lime mixture, Mishri or Masheri is roasting tobacco in a hot metal plate until it is uniformly black, powdered and used with or without catatube. Siddha is tobacco leaf boiled in water lime and spices with evaporation residual tobacco is dried, colored with dyes. Racco is paste of powdered tobacco and molasses used to clean teeth which is commonly used in Bihar. So these were the smoking and smokeless tobacco. It was asked once as a short note so at least the names you should remember the smoking and smokeless tobacco which is prevalent in Indian scenario. So somewhere we have seen this reverse smoking especially in the coastal sites of Andhra Pradesh because they don't want to expose burning site to wind or water and it also helps them to take and halitose leaf, don't know what exactly the reason they are keeping but one thing is they don't want to get exposed this lighter end by wind or water because they are all the time on the sea coast or on the sea. So smokeless tobacco stuff which is finely powdered tobacco there are two types basically moist type which is placed in mouth between cheek and gum and dry type or finely pulverized which is used orally or nasally. So what are the basic constituents of tobacco that is fully acrylic aromatic hydrocarbon which is proven carcinogen nicotine also a carcinogen phenols which stimulate and stimulation and depression causing tumor, promoting stuffs and carbon monoxide which impairs oxygen transport and requires pomalhyde and oxides of nitrogen, celery, toxicity and irritation causes nitrosamine which is very potent carcinogen. So these are the products which is inside a tobacco. So alcohol which is the second most risk factor which has a synergistic effect when it is used with tobacco that is around 75 percentage which causes dehydrating effect on oral mucosa increases mucosal permeability and it has effects on potential carcinogens in creating oral cancer. So constant exposure to these alcohol containing rinses even in the absence of smoking and drinking may also lead to have an increased risk of developing oral cancer. So but there is not much evidence for this but still it is an increased chances are there. So you can say that it is a risk factor. So deficiency of iron which causes clumber, vinscent, syndrome, copper, zinc, manganese. So increased reduction of tumor enhancing free radicals so vitamin A, C, E deficiency and increased consumption of ridgelys also a factor for oral cancer and genetic factors, debilitating of genome and DNA repair, precancerous lesion or lichen planus has 0.4 to 3.7% risk for malignant transformation whereas erythroplicate is 0.1, oisephate is 2.3 to 4.5 and ropoplicate is 1 to 3 percentage of lase of malignant transformation. So commas commonly which is seen in gastro-morphid, gastro-morphid tongue, gastro-morphid cochlemicosa and customer flow of the mouth, even gingiva and alet. So now we need to study about the prevention. So we have already seen in detail about the levels of prevention that is primordial, primary, secondary, tertiary. So how do we apply these preventive strategies? The modes of intervention all we covered in detail. So it will be very easy when we apply the same thing into oral cancer prevention. So primordial prevention is nothing but prevention of risk factors, not the prevention of disease. Prevention of emergence of any risk factors. We need to teach from, teach students or children at very young age that you won't get a habit of smoking or tobacco chewing so that you won't get a disease. So we need to prevent the emergence of risk factors. Students can identify such risk factors of oral cancer and they should be educated not to have any risk factors. So primary prevention is different, primary prevention is like prevention of risk factors so that not prevention of risk factors, modifying risk factors so that the disease will not occur. Primordial is different prevention of risk factors, that is risk factor will not be there in patients or the people but primary the disease will not be there because we are modifying the risk factors so we can ban tobacco, we can do behavioral modifications. So primary prevention by habit intervention is the most effective approach to the management of oral cancer. So first we need to do ban on tobacco, we have already done increased taxes and law enforcement, text and graphic warning on the packets of cigarettes and ban sale display and advertising is banned completely in public media or electronic media and public places also which is banned and we have a bill that is Cotpa Bill that is cigarettes and other tobacco products, Rubition of Advertisement Regulation of Trade and Commerce Promotion of Distribution which was passed in 2003 Cotpa Bill and it is preventing smoking in public places, forbidding sale of tobacco to minors and more warning health warning on the packets and banning advertising at sports and cultural events. So we need to put such regulations as we seen in earlier slides to prevent the usage by minors and we have completely restricted in public places it will fetch fines. So we have increased taxes on tobacco and we are celebrating days like not tobacco day on 31st May to increase awareness. That is a regulatory approach means by putting some law we need to control the habit. Service approach is different approach that is active search for disease. So we are going to search in healthy people that is apparently healthy people for the disease. So dentist can do a very significant role in service approach that is treatment in early stage can be done if it is detected at a very preliminary stages or stage one in asymptomatic patients we can find out early lesions or violations or regulations in oral cavity. So the screening part is very important screening is very easy and very cheap oral cavity is easily accessible and its examination process very little discomfort unlike other other cancers in the body. So it provides opportunity to identify and consult patients about the increase of risk of cancer. So pre-symptomatic cancers or pre-cancerous lesions which can be treated early to prevent the disease and its progression. So behavioral modification we need to conduct tobacco cessation programs by health education advocate healthy eating and all age groups should be targeted. So these are aimed to modify the behaviors. So health education approaches should be aimed at all the things not to adopt any tobacco habits and encourage individuals to stop and encourage individuals who use tobacco and cannot stop at least decrease their use, encourage people not to retain kid in the mood. So all these should be considered health education and we can tobacco cessation clinic we need to educate patient and we need to do counseling cessation like 15 minutes for 4 to 6 weeks. So this cessation programs always should be based on five is that is ask, advice, assess, assist and arrange. Ask means all patients should have their smoking status checked should be advised based on the value of quitting and should be assessed for attitude and motivation they should be assist if somebody wants to stop and arrange they need to be monitored, followed up and should be referred. So nicotine dependence if we have patient with nicotine dependence it will affect their mood and performance there will be physical and psychological dependency. So withdrawal may cause a lot of problems. So we have nicotine replacement therapy can use for less than eight weeks for managing withdrawal symptoms, cravings and urges. So nicotine replacement therapy actually doubles smoking stance of quitting it successfully. So we have various patches, various tablets, various gums. The second prevention is different method we can use chemotherapy disease is already occurred we are trying to prevent its progression. So we have diagnosed it and the stage is very important second stage or third stage we need to prevent its progression by providing radiotherapy chemotherapy. So chemo prevention we can provide vitamin A saline influence and other nutrients. Toaster prevention we know disability limitation and rehabilitation. It is a multidisciplinary approach can do surgery and develop to make a section of radial neck resection, radiation therapy and chemotherapy. So rehabilitation for speech following control of saliva and mastication and if the cosmetic and functional impairments are not corrected the patient may be unable to resume a normal working and social life. So we have a national control program that is national program for prevention and control of cancer, diabetes and cardiovascular disease and stroke started in 1975 and 76. It's a focusing primarily on tobacco related cancer in India Kerala was the first state formulate cancer control program in 1988. So they have palliative care network throughout the country that they do prevention early detection diagnosis and palliative care are the four steps. So national control program which is in India and worldwide also there is many programs like Bloomberg initiative, FTC convention, FTCT convention. So such programs aim to prevent oral cancer. So this is what we have seen in dental careys and bedrounder disease the levels of prevention that is primary, secondary, tertiary, health promotion, specific protection, early diagnosis and prone treatment, disability limitation, rehabilitation, individual community and professional. So we can apply it patient education removal of the irritant by the professional, complete examination, biopsy, cytology, dysentery, secondary, here we have chemo therapy, radiation, surgery and processes and tertiary. So that's all about oral cancer, eplomology. So we don't have a very clear distinction of age and post and environmental factors. We mainly stress on the prevention and various level primary, secondary and tertiary and the legislative methods and the programs which is present on the cancer prevention, service approach, regulatory approach what are the regulatory approach and the law, the cocktail law. So these are the important elements in eplomology of oral cancer. I'll come up with a new session on dental careys channel. Thank you.