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Chairside Oral guide for Prevention and patient management

Up to 70% of oral are preceded by premalignant oral lesions, such as persistent red or white patches in the . This chairside guide focuses on the most common sites of : the tongue, the insides of the cheeks, and the floor of the mouth.

TOBACCO FACTS ORAL CANCERTobacco F AuseCTS Types of tobacco use Effects of tobacco on oral health Smoking Smokeless Increases risk of: Facts about oral 800cancer million men smoke. Risk factors Profile of those at highest risk 200 million women smoke. • oral cancer cigarettes snu , dry 600,000 individuals die eac50%h yMAINear from Cigarette RISK smoking andFACTORS ismoist the most • smoker’s palateA typical high-risk profile for oral cancer OTHER RISK FACTORS TOTBheACCO ave rFageACTS 5-secondhandyear surv smoke:ival 156,000 men, commonbidis form of tobacco use, • periodontal diseaseis a man, over age 40, who uses tobacco 281,000 women and 166,000 children. Tobaccorate of use patients with oral Types of tobacco usebut all forms of tobaccoEffects of tobaccoare on oral health and/or is a heavy user of alcoholOral. TOBACCO FACTS At least 300 million people useTobacco Alcohol• premature tooth loss Environmental, infectious, cancer is about 50%. Smoking kreteksSmokeless chewing 800 million mensmokeless smoke. tobacco and 90% of these are linked with increasedIncreases risk risk of of: is HPV UV sun exposure Tobacco use Types of tobacco use tobaccoEffects ofAll tobacco three on forms•or algingi healthvitis of alcohol cancer ORAL CANCER FACTS 200 millionin wSoutheastomen smoke. Asia. oral cancer: regular• or aluse cancer of and other factors 800 million men smoke. cigarettesSmoking pipessnu ,Smokeless dry Increases (beer,risk of: spirits,• staining and wine) 10 600,000 individualsIn die 2011, eac hmanufacturers year from spent about pipes,and moist cigars, waterpipes• smoker’s, palateas However, the male–femaleamong ratio has the 95%200 millionUS$9.5 women smoke.billion on advertising snus• oral cancerhave been• halitosis associated (bad breath) Facts about oral cancer secondhandRisk factors smoke: 156,000 men, cigarettes Profilesnu , dry of those at highest risk dropped from 6 to 1 in 1950 Aboutcigarettes 95% and of smokeless all bidis tobacco. wellcigars as all forms of• periodontalsmokeless disease UV radiation 600,000281,000 w indiomenviduals and 166,000die each cyhildrenear from. and moist • smoker’withs oral cancer,• loss of tastealthough andto smell about 2 to 1 at present.most common 50% secondhand smoke:o r156,000alGo cancersvernments men, spendoccur less than tobacco (snus, cdissolvhewing• prematureable s tooth loss TOBACCO FACTS AtCigarette least 300 million smoking people is usethe most bidis A typical high-risk• profileperiodontalspirits for disease o randal cancer beer have a , but can • Poor oral hygiene 281,000 women and 166,000 children on. tobaccokreteks control wcaterpipeshewing The average 5-year survival smokeless tobaccoin and personsUS$1 90% billion of othesever are40 40 tobacco, etc.). • cancers Tobacco use common form ofTypes tobacco of tobacco use, use is tobaccoEffectsa man of, tobaccoover age on or 40al health, whigherho uses associated tobacco risk. rate of patients with oral Atin least Southeast 300 Asia.millioneac peopleh year use. • premature tooth loss but all formsyears of tobacco of age. are kretekspipes and/orchewing is a heavy •user staining of alcohol. • Chronic smokeless tobacco and 90Smoking% of these are Smokeless Increases risk of: • gingivitis largely be prevented cancer is about 50%. 800 million menIn smoke.2011, manufacturers spent about Alltobacco three forms of alcohol UVB rays UVA rays in linkedSoutheast with Asia. increasedFrom The Challenge risk ofof Oral Disease – Asmokeless call for global action by FDI World Dental• Federation.halitosis (bad breath) US$9.5 billion on advertising snus• oral cancer • staining 200 million women smoke. Maps and graphics © Myriadpipescigars snu ,Editions dry 2015 (beer, spirits and wine) by reducing • Herpes virus Incigarettes o2011,ral cancer:manufacturers and smokeless regular cigarettesspent tobacco. about use of • loss of taste and smell 600,000 individuals die each year fromThe average age and moist ha•v esmoker’ beens palateassociated• halitosis with (bad breath) US$9.5Governments billion spend on lessadv ertisingthan snusdissolvables secondhand smoke: 156,000pipes, men cigars,, waterpipes, as cigars However, the male–female ratio has exposure to risk 95% cigarettesUS$1 billion and smokeless onat tobacco thebidis tobacco. time control of diagnosiswaterpipes or•al periodontalcancer, althoughdisease• loss of taste and smell • Immunosuppressive 281,000 women and 166,000well aschildren all forms. of smokeless dropped from 6 to 1 in 1950 About 95% of all Goeacvernmentsh year60. spendis lessabout than 60. spiritsdissolvable ands beer have a factors At least 300 million people use waterpipes • premature tooth loss oral cancers occur US$1tobacco billion (snus, on tobacco ckretekshewing control chewing to about 2 to 1 at present. 1950 2015 conditions (HIV…) smokeless tobacco and 90% of these are higher associated risk. Fromeactobacco,h The year Challenge. etc.). of Oral Disease – A call for globaltobacco action by FDI World Dental• gingiFederation.vitis in persons over 40in Southeast40 Asia. Maps and graphics © Myriad Editions 2015 years of age. pipes • staining In 2011, manufacturersFromFrom spent The TheChallenge about Challenge of Oral Disease of Oral – A call Disease for global – action A call by FDIfor World global Dental action Federation. by FDI World Dental Federation. US$9.5 billion onMaps adAllv andertising three graphics forms© Myriad of Editions alcohol 2015 snus • halitosis (bad breath) Maps and graphics cigars© Myriad Editions 2015 cigarettes and smokeless(bee tobacco.r, spirits and wine) • loss of taste and smell The average age Governments spend less than dissolvables have been associatedwaterpipes with at the time of diagnosisUS$1 billion on tobacco control PATIENT MANAGEMENT each year. oral cancer, although 60 is about 60. spirits and beer have a From The Challenge of Oral Diseasehigher – A associated call for global action risk. by FDI World Dental Federation. 1950 2015 Maps and graphics © Myriad Editions 2015 BEFORE CANCER TREATMENT DURING CANCER TREATMENT AFTER CANCER TREATMENT

From The Challenge of Oral Disease – A call for global action by FDI World Dental Federation. Maps and graphics © Myriad Editions 2015 Prepare patients Minimize the side effects of Monitor the healing process and before cancer treatment radiotherapy possible recurrence of oral cancer

STEP 1 Eliminate oral infectious focus • Use local antiseptic, anaesthetic gel and • Follow-up and recall at least twice a year. STEP 2 Conduct non-invasive treatment non-alcoholic alkaline rinses in case of • Use therapy in case post radiotherapy mucositis. STEP 3 Apply fluoride dental tray of traumatic dental procedures • Prevent caries by recommending brushing after radiotherapy. STEP 4 Recommend maxillofacial twice daily with a soft toothbrush and prosthesis if indicated • Conduct non-traumatic prosthetics for fluoride toothpaste between 2800ppm rehabilitation within 6 to 12 months. and 5000ppm and/or apply fluoride dental tray. • Recommend sugar-free chewing gum and salivary substitutes in case of xerostomia. Oral screening STEP 1 STEP 2 STEP 3 STEP 4 Oral health professionals are well-placed to Examine the Examine the Examine the floor Examine the screen high-risk patients for early signs of inner cheek lateral border of of the mouth palate oral cancer. Survival rates can be improved the tongue with early detection and timely referral to multi-disciplinary treatment centres. STEP 5 Diagnosis WHITE LESIONS UNIQUE ULCERATION

It is recommended SCREENING BY PALPATION SCREENING BY PALPATION Ask patient if he/she is a smoker to use two mirrors and to palpate in all oral REMOVABLE TRAUMATIC LESIONS APHTHOSIS NON-REMOVABLE screening steps (tuberculosis, HIV, , etc.)

Eliminate all traumatic factors and timely Local or systemic SWAB TEST , Tobacco Idiopathic Leukoplakia and conduct two week follow-up referral treatment

Homogenous Non-homogenous (smooth and (thick, white with red spots, rugous) If no candidiosis, translucent) Biopsy to confirm if If candidiosis, consultation oral cell carcinoma and anti-fungal needed regarding timely referral treatment oral hygiene is needed (plaque bacteria)

Stop tobacco Stop tobacco Biopsy: OIN, Dysplasia, SCC and regular follow-up () DISCLAIMER Please note that in this document ‘oral cancer’ refers to squamous cell carcinoma. NOTE Please consult national guidelines and recommendations on oral cancer management and prevention.

FDI World Dental Federation This chairside guide was Avenue Louis-Casaï 51 • 1216 Genève • Switzerland www.fdiworlddental.org/oral-cancer made possible through an unrestricted grant from T +41 22 560 81 50 • [email protected] ©2018 FDI World Dental Federation