EPIDEMIOLOGY ETHOLOGY AND PREVENTION OF ORAL (CANCER

EPIDEMIOLOGY ETHOLOGY
AND
PREVENTION OF ORAL (CANCER)


INTRODUCTION:-
Cancer is one of he major threats to public health in developed countries cancer is second most common cause of death.
According to W.H.O. report 2004, cancer accounted for 7.1 million death in 2003
The disease cancer in rest defined by four characteristic which describe how cancer cell act differently from normal counter part.
 Lonality- cancer originates from gentie changes in single cell, which modiferates to form a doen of malignant all.
 Autonomy- growth is not legulated by biochemical the and physical influences in the environment.
 Metastasin- There is a lack of normal co-ordinate cell differentiation.
 Anaplaria- there is a lack of normal co-ordinates cell dyfirtition.
 Materials- Cancer cell develop the capacity for discontinuous growth and disminatio to other of a bdy.

International classification of disease (WHO- quession)
Oral cancer is classified under
- Rulrics 140 (lips)
- 141 (Tongue)
- 143 (gingiua)
- 144 (Flour of the mouth)
- 145- Other part of the mouth)

EPIDEMIOLOGY:-
• The mevalance oforal cancer is particularly high among men anti dente rates for oral convex very in men from 1-10 cares net 1,00,000 population.
• South central Asia, lanler of the oral cavity ranks among the 3 most comman type of the cancer.
• The age standardized incidence late or 10000 population ranges from 0.7 in china to 4.6 in thialand and 12.6 in India.
• It is not worthy sharp increase in lates of oral / pharyngeal reported in france, germany, Scotland, Europe.

ETIOLOGY AND RISK FACTOR:-
Tobacco :- WHO estimate that there are about 1100 million regular smokers in the world today. About 300 million (of that 200 million are male and 100 million females).
The consumption of tobacco has reached the proportion of global epidemic.

Preparations :-
Tobacco is derived from the species of plant genus nicotinia named by carl linnacus in 1753.
The carcinogenic role of tobacco often in association with aleca nut in the form of retel quids or pen is most important cause of oral cancer.

Smoked Tobacco :- Bidi is the most popular. Bidi produces a smaller volume of smoke than cigaratte.
34% of tobacco grown for manufacture of bidi .
31% of tobacco grown for manufacture of cigarettes.
Reverse Smoking:-
Tobacco is smoked with the lighted and inside the mouth. Air is supplied to the burning some thought the unlighted end of the cigarette and the smoke is expelled through the mouth.
Reverse smoking modules temp of nalatal mucosa 58 0 c wid nalatal natches reported malignant change of 12 per 1000.
Bidi, chilium, chutta, cigarettes, dhumti, gudakhu, hookah, hookali.
Smokers Tobacoo:-
The two type of Smokers tobacco are chewing and snuff.
Type of chewing tobacco are :-
• paan
• mainpuri tobacco.
• Mawa.
• Mishri.
• Zarda.
• Gurakhu.
• Gutkha.
Snuff :-
Moist:- A Small amount of ground tobacco is held in the mouth between the chick and gum.
E.g :- Naswar, Khaini.
Dry:- It is powderd tobacco that is inhaled through the nose or taken by mouth (duline).


CONSTITUENT IN TOBACCO:-
Nicotine :-
Nicotine is the most poisan causes addiction among smokers.

It has capacity to trigger the release of dopamine.
• A chemical in brain associated with feeling of pleasure.
• Increase heart rate, B.P, damage to the lining of the blodd vessel , suggesting the role in cousing coronary diseces.
It enables the formation of nitrosamines potent carcinogens.
Tar:-
Sticky brown it stains to yellow brown the lung tissue.
Benzophylene as a carcinogen, is a prominent polycyclic aromatic hydrocarbon found in Tar.
• Carbon monoxide (reduce O2 capacity)
• Nitrogen oxide (lung damage )
• Hydrogen cynide
• Other ciliatoxic agent.(cilia is part of natural lung)
• Metal (Nikel and cradium)
• Radio Active Compound (Radium-226,polonium-210)

Dleohal :- Dehydratory effect of ale on mucosa. Increase mucosal permeabilalitty has carcinogenic effect. Mostly oropharyngel by pharangeal.
Dial by nutritional factor:- Decrease level of serum retinol reported case of oral cancer.
Fungal infection:- Hyphac of candida albicans (malignant tranceformation)
Ultra violet Radiation: - Skin cancer of face and exposed areas. e.g. seramous cell carcinoma.

Viruses :- (Alpha) hepex virus 1.
Trouma and Dental irritation: - jagged teeth and dentures poor oral lygeine.

PRE CANCEROUS LESSION:-
Is defined as morphologically altered tissue in which cancer is most likely to develop.
e.g zeukoplakia
erythroplakia
Smokers palate.

ZEUKOPLAKIA:-
Defined as raised white part of the oral mucosa measuring 5mm or more which cannot be scrapped off and which cannot be attributed to nay other diagnosable disease.
Zeukoplakia may progress to oral cancer when a lesion develop cracks, bleeding or area of redness and erosion may indicate lesion is turning malignant.
ERYTHROPLAKIA:-
Defined as red lesion of oral mucosa. That cannot be characterized to any other definable lesion.
Appears as an eroded red area with a distinct derma reaction against normal mucosa.
Associated with reverse Smoking :-
Range of 0.02 - 0.1%
SMOKERS PALATE:-
Smokers palate is a comman reation of the palatal mucosa to smoking is known as stomatitis nicotina.
• A diffuse white palate with numerous central red dots, corresponding to orifice of minor salivary glands.
ET”IOLOGY:-
High temp, Chemical composition, synergetic effect might exist.
PRE CANCEROUS CONDITION :-
It is generalized state associated with a significantly increased risk of cancer.
E.g:- Oral submucous fibrosis, luken planus.
1) Oral Submucous Fibrosis :- It is a precancerous condition global incidence is estimated at 2.5 million indivisuals.
Clinical the fibrosis band occur is lullal mucosa, reima oris, tongue is affected neotrolession become impaired. Mouth become resticted there is progressive closure of oral opening .
Etiology :-
Reported that betal nuts can affect the mucosa . alecoline (alkoloide) can stimulate fibroblast proliferation synthesis
2) Zichen planus :- Oral lichen planus is a chronic mucocutanous condition in which the mucosal and skin manifestation can occur independently.
Clinical :- The most Commnaly affected site in oral cavity is buccal mucosa. Experience of burning sensation in paitent with pain in affected area.
Etiology :- A cell mediated, immunologically induced elegeneration of basal cell layer of the epithelium.
Prevalance :- 0.5% - 2.2%
1) Primary Prevention :-
• Health Education :- health education should be imported to masses with the help of various communication media like the television, radio, newspaper, films, posters, folks dramas, and lectures, demonstration slides.
• Programe to educate adolescents including school children against tobacco use with the aim of preventing them fum aquiring any tobacco talking .
• Education program for current tobacco users to stop or decrease their tobacco use enila then family
• People should be educated about wining signals of oral cancer.
2) Secondary prevention :-
• Screening :- community level early detection of oral cancer programes by primary health care gives should be taken to detech mecancocous lesion and to educate those with such lesion against tobacco use.
• Screening for oral cancer , key to early detection at community level.
3) Tertiary Prevention :-
• Surgery :- surgery may be a primary treatment or combined with radio therapy. Surgery is generally inducted for tumor.
• Radiotherapy :- Radiotherapy is the treatment of choice and it is a main modality for malignant lesion.
• Chemotherapy :- Chemotherapy is the use of chemical substance to treat disease.
e.g :- each decay in the combination shpuld have been demonstrated to have some activity on its own against the tumor.
There should be no known adverse reaction between the drugs.
ROLE OF DENTIST:-
Can spend more time with patient and the use this time to casual tobacco users to quit.
Treat women of child bearing age and inform them of the dangers of tobacco use during pregnancy.
Can reinforce massage gone to point by physician and other care givers about that dangerous of tobacco use of the need to quit.
Can speack with authority in the community about the dangers of tobacco use.