 Hi everyone, welcome back to Dentistry and More. So today's session we will be seeing about iceberg phenomenon. So in the cover pic I have put a picture of a iceberg which caused destruction of the unsinkable ship Titanic. So that's the idea of iceberg. So why the ship sank because the captain of the ship couldn't see the underwater ocean of this iceberg. He was just seeing the above water level and he tried to turn the ship but what happened was the lower ducts hit with the underwater portion of iceberg and it sank. So that's the idea of iceberg phenomena. So let's apply this idea into disease. So in today's class I'll be talking about iceberg phenomena and disease. So as we know iceberg is a piece of ice that is broken off from snow. The main point is just one ninth volume of an iceberg is seen above the water. So that means the majority, the 90% of the iceberg is below the water. So we'll apply the iceberg phenomena into concept of causation. So we have a lot of concepts that is epidermological, triad, multifactorial, natural history of disease, web of causation, risk factors, spectrum of disease. So today's session will be covering just iceberg of disease. So all these sessions will be covered in future classes. So let's see what is iceberg of disease. So it is just a metaphor which says that every health problem has a non-case and an unknown case. So if we take a population, if we take a country, we're checking any particular disease, let's take diabetes or let's say cardiac disease, there is a very small portion which is very visible, the non-cases, the people who are diagnosed with the diabetes, people who are taking treatment or people who are taking insulin or under other medications. And there is a lot of majority, they are not diagnosed, they are just there in the society, they are around us just being undiagnosed. That is the concept of iceberg. Okay, majority of the people are undiagnosed, only very few are diagnosed. So we'll just go into detail of an iceberg. The floating tip of an iceberg represents the clinical cases, that is a non-case, what the physician sees, the non-cases because they might express some symptoms. So they go to the clinician and they diagnosed as a diabetes. The submerged portion that is the vast portion represents a hidden mass of disease, that is they are not showing any symptoms. So they are not being diagnosed. They might be diagnosed accidentally when they go for checkup for any other, clean blood checkup for any other thing, that time they'll come to the tip of iceberg. Otherwise, they'll be submerged because they are pre-symptomatic most of the time. And they are undiagnosed cases or the carriers of community that is submerged portion. So, let's take the example of Coronavirus. More we screen the patients, more the cases we get because majority are still being undiagnosed or act as a carrier in our society. So the more tests we do, the more cases we get. What we are seeing now is just the tip of an iceberg. The majority of the cases are submerged. So more actively we do screening, more cases and the tip of the iceberg will be more and more visible. So the water line represents a demarcation between apparent and unapparent cases, that is clinical and undiagnosed cases. And patient who are at the tip of iceberg are more likely to have severe health problems because more and more it goes to the tip. The severity and the mobility are more and more it is going on a higher fashion. And as we go down to the iceberg, the patient becoming more and more healthy. Okay, but they will be gradient of disease. So just see the, let's break down this iceberg. You can see the tip disease diagnosed and controlled and this water level diagnosed, but it is uncontrolled. They know that they have disease, but they are not on communication. And whatever is below the water line is undiagnosed or wrongly diagnosed. Some may have the risk factors, some may are exposed to a lot of diabetic prone food items and majority and that is free of risk factors this part. So that's what I was saying. As you go to the tip of the iceberg, you have a lot of problems when you go down, you are more likely to be healthy. Okay, so the block one and two corresponds to the iceberg, these two are icebergs. And this is a submerged portion. So underwater is unidentified cases. They are very different from identified cases because the spectrum and natural history is very different and symptoms and progression since it is related to undiagnosed cases are likely to be less severe. So that's the idea of iceberg that is not very very crucial thing. It is identifying the undiagnosed cases from a population that is it basically stress the emphasis the screening part of a disease because it is not very contagious diseases mostly hidden. It will be mostly chronic or lifestyle diseases. So when we do more screening and we get more diseases, we can reduce the morbidity of that particular disease. Okay, so let's see the scenario of caries. So we know what is caries. So this is a caries iceberg. So this tip of this caries, these two blocks are the diagnosed caries. Okay, so this is lesions which involved into a pulp and this is the little severe cases. And these are caries involved to enamel and this is just beginning lesions and they are subclinical lesions or free of caries. So these are we are treating these people because these people are coming to dentist or for a dental treatment. These people are having diseases but they are not coming to dentist or for a dental treatment because of their unawareness or they are not producing any symptoms. So this is case of um dental caries iceberg. So our idea is the clinician or a researcher or a health sector people what we need to do is we have to bring more and more cases from the underwater to tip of the iceberg so they can get a treatment. So as early we find the disease at the bottom level they will not go to the severe state because anyway when the disease is coming from this to this to this they will turn up to the clinician or a dentist. So our idea is to detect the cases as early as possible so we can give them a better prognosis. So this is about the treatment part. So early we diagnose the disease that is part of screening better will be the prognosis. So here we can do preventive care but this part of the preventive care is not possible. So if we diagnose the patient here by help of screening we can do preventive treatment rather than just like a piton fissure seal and so fluoride instead of big frustrations and other pulp therapy. Okay so if we see the paradigm that is uh iceberg so we know that uh the iceberg what the patients are coming with symptoms just like using tooth or the tooth elongation where the bone support is lost. So our idea is to conduct more and more uh radiographs and other clinical aids and find out the gingeral recession bleeding gums and pocket cases so that they get better prognosis. They diagnosed at the very early stages of disease so get a better prognosis so they don't eventually turn up to the tip of the disease. We have to pick them up underwater and give the treatment so that they don't turn up here. So this is automatically patients with symptoms so we need to find out people without symptoms by active screening and give them better treatment to get a prognosis. So similarly in oral cancer people turn up only with symptoms just like chewing problems, difficulty in swallowing or other tongue problems. So we need to do aspiration biopsy and other procedures and find out the cancers at early stages. Okay and active screening will find out the underwater diseases. I mean the asymptomatic or diseases which is not having very severe severity. So that's the idea of iceberg phenomena. So iceberg phenomena is all about detecting the underwater diseases or the asymptomatic diseases by active screening. So a clinician cannot do active screening it is epidemiologist or other community medicine people or community dentists or community doctors. They can go to the public and do active screening. They can do examination on apparent healthy people and find out the disease because not all cases will show symptoms some will not show symptoms and they produce symptoms at very late stage of the disease. So we need to do active screening on the apparent healthy people and find out the cases before they actually show symptoms. So we can reduce the mobility of such cases and such patients. Okay so that's the idea of iceberg phenomena. So I'll come up with the other concept of causation in my next classes. So thank you.