About 50% of oral cancer of the world is found in Indian subcontinent. Oral cancer represents appropriate 15% of all malignancies in men and 5% in female. Early detection provides the best opportunity for successful management and possible care. If oral cancer is not treated, it is prone to be more fatal. So this prevention is very important.

Possible Aetiological Factors for Oral Cancer:

Possible carcinogens:

  • Tobacco
  • Alcohol
  • Betel nut/ Accra nut
  • Pan masala
  • Cigarette
  • Bidi
  • Hukka etc

Infections:

  • Syphilis
  • Candidiasis
  • Viral infections

Mucosal disease:

  • Dysplastic leison
  • Lichen planus
  • Oral sub mucous fibrosis
  • Sunlight (Lip only)

Physical factors:

  • Teeth with sharp edge
  • Fitting denture with sharp edge
  • Bridge/other appliance
  • Genetic disorders (rare):
  • Dyskeratosis congenita
  • Fanconi’s anemia

Other factor which also influence the causation of oral cancer as follows:

  • Biological alteration which may be due to chronic or surgical exposure leading to environment inductive cancer.
  • The relation is also influenced by genetic background, age, sex, the nutritional status, poor oral hygiene etc.
  • Small oral cancer is difficult to diagnose because of chances are so mild and minor alteration in function, colour, surface texture, consistency and continuity of affected tissue.
  • Mouth is the most vulnerable and major route of the contact with environment and abused part of the body.
  • Dietary slips, food and beverage etc induce oral cancer.
  • Many foods containing preservative, addition of fats linked to oral cancer.
  • We also ingested a number of chemical for medication, cosmetic or pleasure purpose.

As the definite cause of oral cancer is unknown, the steps taken to prevent oral cancer is limited. As cancer cause rapid destruction of the tissue and the teeth of the patient, it should be diagnosed and treated as early as possible.

Out of oral cancer, squamous cell carcinoma represent about 85%. About one half occur in the tongue and remaining in the palate, floor of the mouth, gingiva and buccal mucosa, so careful clinical examination of oral cancer is essential.

The community must be informed of the danger signals which are as follows:

Any persistent, scaly white patch.
Pigmented spot which suddenly increases in size.
Any non healing ulcer.
Progressive facial asymmetry.
Sudden loosening of teeth without history of trauma or blow of jaw.
Puffy bleeding gums.
Paresthesia, anaesthesia of oral mucous membrane.
Pain and trismus upon jaw movement.
A lump in the oral tissue.
An extracted wound that does not heal.
Altered taste.

Sequence of Preventive Regime:

Primary prevention focuses upon modifying habit associated with use of tobacco in 3 major ways.

  1. Encourage people never do adopt any tobacco habit.
  2. Encourage people who already use tobacco to stop.
  3. Encourage people who already use tobacco and cannot stop to at least decrease their use or modify behaviour in other ways to decrease the risk of cancer.

The process of being smoker, for example involves 4 stages :

  1. Awareness
  2. Initiation or experimentation
  3. Habituation
  4. Maintenance/dependence

So education is a important part to play in discouraging people from starting to use and for helping people to stop the habit, particularly during the adolescent period when tobacco use is most often begins.

Prevention can be done at 3 levels:

  1. Dental professional level.
  2. Individual level
  3. Community level in these case media can be helpful.

Prevention and control of oral cancer can be done in 3 stages:

1. Primary prevention:

By health education oral cancer can be prevented by the following aspects.

  • Programmes to educate adolescents including school children against tobacco use with the aim of preventing them from acquiring any tobacco taking in any form of habits.
  • Educational programmes for current tobacco users to stop or decrease their use of tobacco including their family members.
  • People should be educated about warning signals of oral cancers so that they can do the self examination.
  • The importance of regular oral checkups by a qualified dental surgeon should be emphasized.
  • Importance of good oral hygiene and role of diet and nutrition in oral cancer prevention should be emphasized.
  • Importance of various sources of protein, vitamins, minerals and trace elements, balance diet, the right method of cooking and preserving the nutrient of items is not well understood by people; hence these aspects should be stressed.

2. Secondary prevention:

  • Screening
  • Early detection and referral

Community level early detection of oral cancer programmes by primary health care givers should be taken to detect precancerous leisons and to educate those with such leisons against tobacco use.

3. Tertiary prevention:

  • Surgery: surgery may be a primary treatment or combined with radiotherapy. Surgery is generally indicated for tumours that lack sensitivity to radiation, recurrent tumours etc. Surgery may involve mandibulectomy, resection etc.
  • Radio therapy: Radiotherapy is the treatment of choice and it is main modality for treating malignant leisons. The general principle of radiotherapy is to deliver uniform dose of radiation to all parts of the tumour bearing areas.
    Four radio therapy techniques are there:
    • External radiation
    • Perioral radiation
    • Interstitial radiation
    • Surface radiation
  • Chemotherapy: It is the use of chemical substances to treat disease. It refers primarily to cytotoxic drugs used to treat cancer.
    Thus we can prevent and control oral cancer.

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