PPT is for primary care physicians and oral health specialist. Gives information about gravity of Tobacco addiction problem, oral cancer and its prevention.

1. Dr Madhu Oswal Thakkar
Muktaa Charitable Foundation
02/12/14
www.mcf.org.in
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2. Ramesh, 35 years ,
plumber, breadwinner,
only son of his old
mother.
Eating Khaini since
he was 12 years
Died after fighting
cancer for 2 years
02/12/14
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3. How will I live now?
02/12/14
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4. •Renu , 30 years old,
mother of 3 teenagers,
housemaid.
•Eating mishri since
childhood
•Non healing ulcer in
mouth
•When she presented at
TMH, case was
inoperable
•Died within 3 months
of diagnosis
02/12/14
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5. Who will look after these innocents?
02/12/14
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6. •Vinod, farmer from
Nagar, worked day
and night to see his
sister get married
•Ate 15 pouches of
“Manikchand”
everyday
•Today he can have
just liquid.
•Condition is
untreatable
02/12/14
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8. Tobacco truly kills

Tobacco kills 900,000 people every year

In india one people die every 40 seconds because of tobacco related problems

By 2020, 12 lakh people are estimated to die every year due to tobacco use

Tobacco users loose an average of 20-25 years of non-tobacco life expectancy

Out of 100 teenage smokers in India today, 50 out of them will eventually
die of tobacco- related disease.
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9. Tobacco Use In India

India is the third largest producer and consumer of tobacco in the world.

275million active tobacco users in India. i. e 35% of Indians consume some
form of tobacco

Smokeless tobacco use in India is the highest in the world.

25.9 percent of the adults( 32.9 percent of men and 18.4 percent women) use
smokeless tobacco.

Among smoking forms of tobacco, bidis are the most prevalent form (9.2 percent)
followed by cigarettes (5.7 percent).

Exposure to second-hand smoke remains high with 52.3 percent and 29.0 percent
of the population exposed to second-hand smoke at home and at public places
(mainly in public transport and restaurants) respectively.
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12. Misleading Advertising
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17. 14 MINUTES OF LIFE IS LOST FOR EACH CIGARETTE SMOKED
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18. Hazards of Tobacco
1. Chronic bronchitis
2. Emphysema
3. Cardiovascular disease
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19. 4. Lung and other cancers
5. Tuberculosis
6. Increases the risk of heart
stroke
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20. 7. Increasing vulnerability of sexual and reproductive health
8. Babies born with lower birth weight from habitual
smoker parent (s).
9. Kidney and liver diseases .
10. Blood pressure, exacerbates asthma and
causes impotence, infertility
02/12/14
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21. Pregnancy &
Secondhand Smoke
Pregnant women
exposed to ETS 6 hours
a day pass carcinogens to
the blood of unborn
ETS for 2 hours a day
causes 2 times risk of
low birth weight
02/12/14
Miscarriage
Sudden Infant
Death Syndrome
(SIDS)
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Prematurity
Low birth weight
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23. Tobacco and Oral Cancer
 India has the highest number of oral cancer cases in the world
 Of 7-8 lakh registered cancer cases every year, 40% are of oral cancer
 Annually 130,000 people succumb to oral cancer in India 1
 60 to 80 % present in advanced stage
14 deaths per hour
1: http://ocf.org.in
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24. How will the patient present?
Leukoplakia, Erythroleukoplakia or Erythroplakia
Difficulty in opening mouth
Non healing ulcer or nodule
Bleeding in the mouth.
Loose teeth
Dysphagia
Difficulty wearing dentures.
Lump in the neck.
Earache
Hoarseness
Most are asymptomatic
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26. Leukoplakia
White painless, bright white and sharply defined,
slightly raised plaque
Cannot be scraped
Malignant transformation: 3-33% over 10 years
Speckled or verrucous leukoplakias are more likely to
be premalignant
Clinical, not histological

27. Leukoplakia :3 Stages
Stage 1: Nonpalpable, translucent white
Stage 2 : Localized or diffuse, slightly elevated
plaques, irregular outline, opaque white ,fine,
granular texture.
Stage 3: Thickened, white lesions, showing
induration, fissuring, and ulcer formation.

28. Leukoplakia: When to worry?
Verrucous leukoplakia
Erosion or ulceration within the lesion
Nodule in lesion
Hard in its periphery
Anterior floor of the mouth and undersurface of the
tongue

29. Erythroplakia
•Asymptomatic red, smooth, soft, velvety texture macule/s or
patch/s
•In level with or depressed below the surrounding mucosa.
•Less than 1.5 cm well-demarcated
•Floor of mouth, tongue and palate
•High chance of frank malignancy or severe dysplasia.

30. Erythroleukoplakia

31. Erythroplakia
02/12/14
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32. Oral Sub Mucous Fibrosis
Areca nut (Arecoline, copper): Incresae production of
collagen
? Chilli
Genetic factor
Deficiencies of Iron, B complex
Progress : Unpredictable
No treatment

33. This patient of SMF has so much of limitation in opening of mouth that it is
difficult to put even 2 fingers in the mouth
02/12/14
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34. Diffential Diagnosis
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35. Common sites of oral cancer
Tongue –middle of lateral 1/3 rd
Floor of the mouth
Buccal vestibule and mucosa
Gingiva, hard and soft palate
Bucco-pharyngeal mucosa in smokers.
You tube: http://www.youtube.com/watch?v=q-W_RqQmnlk (Uni of Michigan School of Dentistry)

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37. Cancer of Tongue
90% SCC

38. Dr Suwas Darvekar

40. Cancer of Tongue
90% SCC

41. Dr Suwas Darvekar

42. Common sites of oral cancer
Tongue –middle of lateral 1/3 rd
Floor of the mouth
Buccal vestibule and mucosa
Gingiva, hard and soft palate
Bucco-pharyngeal mucosa in smokers.
You tube: http://www.youtube.com/watch?v=q-W_RqQmnlk (Uni of Michigan School of Dentistry)

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46. Steps to quit-tobacco
1. Deep Breathing
2. Drink lots of water and fluids
3. Stay away from alcohol, sugar and coffee and
avoid fatty foods
4. After dinner, instead of a cigarette, treat
yourself to a cup of mint tea or a peppermint
candy
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47. 5. Go to a gym and jog around the block or park
for to change your normal routine.
6. Ask friends and family members not to smoke
in your presence.
7. On your quit day, hide all ashtrays and destroy
all your cigarettes.
8. Write down ten good and bad things about being
a nonsmoker and smoker.
02/12/14
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48. Children &
Secondhand Smoke
Coughing and wheezing
Asthma
Ear infection
Sore throats and colds
Eye irritation
Hoarseness
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50. Acknowledgement
Many clinical slides from Dr Pankaj Chaturvedi’s slide-set
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