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In western countriesIn western countries-- Cigarettes, Cigars, PipesCigarettes, Cigars, Pipes

In IndiaIn India-- Chewing tobacco,Snuff dipping, Chewing tobacco,Snuff dipping, GutkaGutka, Quid , Quid

Carcinogens in TobaccoCarcinogens in Tobacco

Tobacco when kept in mouth leaches out Tobacco when kept in mouth leaches out carcinogens, which act on oral mucosa carcinogens, which act on oral mucosa causing causing neoplasticneoplastic changeschanges

Tobacco contains potent carcinogens including Tobacco contains potent carcinogens including Nitrosamines (nicotine), polycyclic Nitrosamines (nicotine), polycyclic aromatichydrocarbonsaromatichydrocarbons, , NitrosodiethanolamineNitrosodiethanolamine, , NitrosoprolineNitrosoproline, and polonium. Tobacco smoke , and polonium. Tobacco smoke contains carbon monoxide, contains carbon monoxide, ThiocyanateThiocyanate, , hydrogen cyanide, nicotine and metabolites of hydrogen cyanide, nicotine and metabolites of these constituents.these constituents.

Toxic substances in tobacco are absorbed through Toxic substances in tobacco are absorbed through the tissues of the mouth and into the body. These the tissues of the mouth and into the body. These substances include:substances include:

Cadmium Cadmium

Formaldehyde Formaldehyde

Lead Lead

Nicotine Nicotine

Uranium 235 Uranium 235

TobaccoTobacco-- associated Oral lesions includeassociated Oral lesions includeTooth stains, Tooth stains, abrasions, abrasions, smoker’s smoker’s melanosismelanosis, ,

acute necrotizing ulcerative gingivitis acute necrotizing ulcerative gingivitis

keratotickeratotic patches, patches,

black hairy tongue, black hairy tongue,

nicotinic nicotinic stomatitisstomatitis,,

leukoplakialeukoplakia, ,

epithelial epithelial dysplasiadysplasia and and

squamoussquamous--cell carcinoma. cell carcinoma.

AccoAcco’ to WHO 4 out of 10 are oral cancers’ to WHO 4 out of 10 are oral cancers

In India out of 7lakhs cancer cases, 3 In India out of 7lakhs cancer cases, 3 lakhslakhs are are due tobaccodue tobacco

-- Leukoplakia is the most common oral Leukoplakia is the most common oral precancerous lesion. precancerous lesion.

-- Within a time span of 10Within a time span of 10--20 years about four 20 years about four percent of the percent of the leukoplakiasleukoplakias transform transform to cancer. to cancer.

-- 20% shows 20% shows dysplasiadysplasia, 15 % of these , 15 % of these dysplasias dysplasias change into carcinoma in situchange into carcinoma in situ

-- 33--6% develop invasive cancer usually of the 6% develop invasive cancer usually of the squamoussquamous variety.variety.

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LEUKOPLAKIALEUKOPLAKIA

Color : Usually white or gray colored Color : Usually white or gray colored May be red (called May be red (called erythroplakiaerythroplakia))

Site: Tongue, inside of the cheek Site: Tongue, inside of the cheek

Texture : Thick , Slightly raised Hardened Texture : Thick , Slightly raised Hardened surface surface

Types: Homogenous, Non homogenousTypes: Homogenous, Non homogenous

HOMOGENOUS LEUKOPLAKIAHOMOGENOUS LEUKOPLAKIA

Mainly white, flat and thin lesion, possiblyMainly white, flat and thin lesion, possibly with with shallow furrows. The surface is smooth, wrinkled shallow furrows. The surface is smooth, wrinkled or corrugated, but has a homogenousor corrugated, but has a homogenoustexture throughout the lesion. texture throughout the lesion.

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NONNON--HOMOGENOUS LEUKOPLAKIA HOMOGENOUS LEUKOPLAKIA

Mainly white or white and red lesion Mainly white or white and red lesion ((erythroleukoplakiaerythroleukoplakia), which can be irregular, flat, ), which can be irregular, flat, nodular or nodular or xophyticxophytic. The nodular lesion displays. The nodular lesion displaysslightly elevated, rounded, red or white papules or slightly elevated, rounded, red or white papules or nodules, and the nodules, and the exophyticexophytic lesion has irregular, lesion has irregular, blunt or sharp projections.blunt or sharp projections.

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How is Leukoplakia treated?How is Leukoplakia treated?

Abstinence from tobacco Abstinence from tobacco

Surgical excision.Surgical excision.

Laser surgery Laser surgery

ERYTHROPLAKIAERYTHROPLAKIA

ErythroplakiaErythroplakia is a comparatively rare lesion and is a comparatively rare lesion and the most serious precancerous change in the oral the most serious precancerous change in the oral mucosa. mucosa.

In about 80 percent of the In about 80 percent of the erythroplakiaserythroplakias grave grave epithelial epithelial dysplasiasdysplasias can be found. can be found.

This is characterized by red velvety patch, which is This is characterized by red velvety patch, which is not associated with any trauma or inflammation. It not associated with any trauma or inflammation. It may present with or without may present with or without leucoplakialeucoplakia..

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ORAL LICHEN PLANUSORAL LICHEN PLANUSThe prevalence of oral lichen The prevalence of oral lichen planusplanus is 1.9 per is 1.9 per cent [3]. It is more frequent in women (2.2 %) cent [3]. It is more frequent in women (2.2 %) than in men (1.6 %). than in men (1.6 %).

The oral lichen The oral lichen planusplanus lesions exhibit a varied lesions exhibit a varied pattern from which six main types can be pattern from which six main types can be iscernediscerned. . Three of these are white and designated Three of these are white and designated papularpapular, , reticular, and plaque, respectively; three are red reticular, and plaque, respectively; three are red and designated atrophic, ulcerous, and and designated atrophic, ulcerous, and bullousbullous, , respectivelyrespectively

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The most common sites of the oral cancer are the The most common sites of the oral cancer are the tongue and the floor of the mouth. The other tongue and the floor of the mouth. The other common sites are common sites are buccalbuccal vestibule, vestibule, buccalbuccalmucosa, mucosa, gingivagingiva and rarely and rarely hardandhardand soft palate. soft palate. Cancer of Cancer of buccobucco--pharyngeal mucosa is common in pharyngeal mucosa is common in smokers.smokers.

Treatment is surgery, followed by radiation Treatment is surgery, followed by radiation therapy is performed. therapy is performed.

70% of the cases after treatment leads to relapse 70% of the cases after treatment leads to relapse and the result is death. and the result is death.

The treatment is successfully if the lesion is The treatment is successfully if the lesion is diagnosed early.diagnosed early.