8/6/2019 Accenture 26.05.11

1/30

TOBACCO-A GLOBAL EPIDEMIC

Dr. Hardik Thakker.

8/6/2019 Accenture 26.05.11

2/30

TOBACCO--???

Tobacco is an agricultural product processed from

the leaves of plants in the genus Nicotiana.

There are more than 70 species of tobacco in the

plant genus Nicotiana The word nicotiana (as well as nicotine) is in

honor ofJean Nicot, French ambassador to

Portugal

It is well known that tobacco is, by nature, anAmerican plant, the use of which, when

discovered by the Europeans, was rapidly spread

across the globe.

8/6/2019 Accenture 26.05.11

3/30

HISTORY OF TOBACCO IN INDIA

First brought to India by Portuguese Sailors

Used as a commodity for barter against Indian

Textiles

With the increase in demand and establishmentof British East India company, Tobacco wasstarted to be grown in India as a Cash Crop

Leaves were exported to America and wereimported back in the form of cigarettes

8/6/2019 Accenture 26.05.11

4/30

CONTD

In the late nineteenth century, the beedi industry began to grow

in India.

The price differential from cigarettes favored the use ofbeedis by

the working classes and this domestic product soon supplantedcigarettes as the major form of tobacco consumption.

Tobacco chewing was practised for many centuries, commercial

production and marketing have been markedly upscaled recently,

with the introduction of the gutka

Consumption of gutka has overtaken that of smoking forms of

tobacco

New and broader front in the battle between commercial tobacco

and public health in India.

8/6/2019 Accenture 26.05.11

5/30

TOBACCO IS CONSUMED AS

Smokeless Tobacco quid with tobacco Pan Masala Tobacco areca nut and

slaked lime preparation

Mainpuri tobacco Mawa Tobacco and slaked lime

(khaini) Chewing tobacco Suns

Mishri Gul Bajjar Gudhaku Creamy snuff Tobacco Water

Smoked Tobacco Beedis Cigarettes Cigars

Cheroots Chuttas Reverse chutta

smoking Dhumti Reverse dhumti

smoking Pipe Hooklis Chillum Hookah

8/6/2019 Accenture 26.05.11

6/30

Man !!!! I Could Just Burn A Human

8/6/2019 Accenture 26.05.11

7/30

IMMEDIATE AND RAPID EFFECTS ON THE

BRAIN - PART OF THE ADDICTIVE POWER OF NICOTINE COMES FROM ITS DIRECT EFFECT ON THE

BRAIN. IN ADDITION TO THE WELL-UNDERSTOOD CHEMICAL DEPENDENCY, CIGARETTE SMOKERSALSO SHOW

EVIDENCE OF AHIGHER RATE OF BEHAVIORAL PROBLEMSAND SUFFER THE FOLLOWING IMMEDIATE

EFFECTS:

Increases stress

Alters Brain Chemistry

8/6/2019 Accenture 26.05.11

8/30

IMMEDIATE AND RAPID EFFECTS ON THE

RESPIRATORY SYSTEM

Bronchospasm. This term refers to airway irritability orthe abnormal tightening of the airways of the lungs.

Increases phlegm production. The lungs producemucus to trap chemical and toxic substances.

Persistent cough. Coughing is the bodys natural responseto clear irritants from the lungs. Without the help of cilia (above),

a smoker is faced with the difficult task of clearing increased

amounts of phlegm with cough alone.

Decreases physical performance

8/6/2019 Accenture 26.05.11

9/30

IMMEDIATE AND RAPID EFFECTS ON THE

CARDIOVASCULAR SYSTEM

Adverse lipid profile- Nicotine increases the amount ofbad fats (LDL, triglycerides, cholesterol) circulating in the bloodvessels and decreases the amount of good fat (HDL) available.

Atherosclerosis.Atherosclerosis is a process in which fatand cholesterol form "plaques" and stick to the walls of an artery

Thrombosis. Thrombosis is a process that results in theformation of a clot inside a blood vessel.

Constricts blood vessels. It has been shown thatsmoking, even light smoking, causes the bodys blood vessels toconstrict (vasoconstriction). Decreased secretion of NO2 whichdilates the vessels

Increases heart rate. Heart rate is a measure of howfast your heart is pumping blood around your body. Young adultsmokers have a resting heart rate of two to three beats perminute faster than the resting heart rate of young adultnonsmokers.

Increases Blood pressure

8/6/2019 Accenture 26.05.11

10/30

SMOKING WOMEN

Greater Risk ofHeart Attacks Elevated Blood

Pressure- Due to Interaction with Oral

contraceptives

Menstrual abnormalities

Increased Risk of Pelvic Inflammatory diseases

Early Menopause

8/6/2019 Accenture 26.05.11

11/30

SMOKING WOMENPREGNANCY

Mothers who smoke during pregnancy are known

to have low birth-weight babies

Women smokers have around 72 percent of thefertility of nonsmokers.

Pregnancy to be difficult to achieve.

Infants and children exposed to Environmental

Tobacco Smoke (ETS) are at increased risk for

death and disease

8/6/2019 Accenture 26.05.11

12/30

ADVERSE EFFECTS ON ORAL TISSUES

Periodontal disease

Staining of Teeth and Gums

Pigmentation

Halitosis

Precancerious Lesions

Oral cancer

8/6/2019 Accenture 26.05.11

13/30

TOBACCO & PRECANCEROUS LESIONS

Oral Leukoplakia

Erythroplakia

Oral Submucous Fibrosis - OSMF

8/6/2019 Accenture 26.05.11

14/30

ORAL LEUCOPLAKIA

It is characterized by white patch on the buccal

mucosa or any place in the mouth and is adjacent

to the place where the tobacco quid is kept. The

less likely place is floor of the mouth and tongue

although 93% of leucoplakia at this sites turn

malignant.

8/6/2019 Accenture 26.05.11

15/30

ERYTHROPLAKIA

This is characterized by red velvety patch which

is not associated with any trauma or

inflammation. It may present with or without

leucoplakia. This lesion is easily missed out but

is considered to have great malignancy potential

8/6/2019 Accenture 26.05.11

16/30

ORAL SUB MUCOUS FIBROSIS

This condition is characterized by limited

opening of mouth and burning sensation on

eating of spicy food. This is a progressive lesion

in which the opening of the mouth becomes

progressively limited, and later on even normal

eating becomes difficult.

It occurs almost exclusively in Indians and

Indian communities living abroad.

8/6/2019 Accenture 26.05.11

17/30

8/6/2019 Accenture 26.05.11

18/30

Ifyoucant stop smoking, cancer will.

8/6/2019 Accenture 26.05.11

19/30

COMMON SITES FOR ORAL CANCER

The most common sites of the oral cancer is the

tongue and the floor of the mouth. The other

common sites are buccal vestibule, buccal

mucosa, gingiva and rarely hard and soft palate.

Cancer of bucco-pharyngeal mucosa is common in

smokers

8/6/2019 Accenture 26.05.11

20/30

DIAGNOSIS

Initially oral cancer may be asymptomatic but acheck up of a small ulcerative lesion from aprofessional is recommended. But patients normallypresents when pain and discomfort is predominant

and then the prognosis becomes poor. Diagnosis is established by many ways like

applying dyes like toluidine blue which may givefalse positive results in inflammatory lesion butnever false negative, using X rays and scans to see

the extension of the lesion and the bonyinvolvement and the most confirmatory test isbiopsy of the lesion and its histo-pathologicalexamination

8/6/2019 Accenture 26.05.11

21/30

SQUAMOUS CELL CARCINOMAOF TONGUE

8/6/2019 Accenture 26.05.11

22/30

CARCINOMAOF FLOOR OF MOUTH &

TONGUETheimage cannotbedisplayed. Your computer may nothave enough memory toopen theimage,or theimagemay havebeen corrupted.Restartyour computer,and then open thefileagain. Ifthe red x stillappears, you may havetod eletetheimage and then insertit again.

8/6/2019 Accenture 26.05.11

23/30

CARCINOMAOF CHEEK

8/6/2019 Accenture 26.05.11

24/30

CARCINOMAOF GUMS

8/6/2019 Accenture 26.05.11

25/30

CARCINOMAOF UPPER JAW

8/6/2019 Accenture 26.05.11

26/30

WHEN YOU SMOKE, YOU ARE NOT COOL. IN THE END,HOWEVER, YOU ARE EXTINCT

8/6/2019 Accenture 26.05.11

27/30

PREVALENCE OF TOBACCO USAGE IN

INDIA

According to the Global Youth Tobacco Survey

2006, a total of 36.9% children in India initiate

smoking before the age of 10.

4.2 % students currently smoke cigarettes withrate for boys significantly higher than girls.

11.9% students currently use other tobacco

products.

Cigarette smoking among youth is higher in

central, southern and north-eastern regions

(12%).

Exposure to second-hand smoke (SHS) in public

places is as high as 40%.

8/6/2019 Accenture 26.05.11

28/30

DEATH TOLL IN INDIADUE TO TOBACCO

USE

India has the highest number of oral cancers inthe world and 90% of these are tobacco-related.Also, 40% of all cancers are tobacco-related.

By 2010, tobacco use will cause 10 lakh deathseach year in India.

More than 2,200 Indians die each day from a

tobacco-related disease.

Every day, 55,000 Indian youth start tobaccouse.

8/6/2019 Accenture 26.05.11

29/30

FREQUENTLYASKED QUESTION

How do I prevent oral cancer ?

Why is that not all people consuming tobacco have oral cancer ?

Who is more susceptible to oral cancer ?

I have a precancerous lesion in my mouth, would I get cancer ?

How is the diagnosis established ?

I Occasionally chew tobacco/smoke, and keep tobacco only for very shorttime. Am I susceptible for cancer ?

My friend has been told that he has oral cancer, but he does not believe it.what to do?

My dentist has recommended the biopsy of the premalignant lesion. Whatshould I do?

I have oral cancer and I am taking ayurvedic medicine. Will that help?

My Friend had cancer after tooth extraction. Was the doctor negligent?

8/6/2019 Accenture 26.05.11

30/30

If God had wanted us to smoke, hewould have given us a separate hole forit.

Thank You