1. What is S.P.O.T centre?
S.P.O.T. Centre stands for Spot and Prevent Oral Cancer Trauma Centre.
S.P.O.T. centres are clinics where dental professionals provide services for prevention and detection of oral cancers.
2. What is smokeless tobacco?
Smokeless tobacco is not smoked but used in another form such as chewing tobacco or snuff.
3. What are the types of smokeless tobacco?
Smokeless tobacco comes in two main types - chewing tobacco and snuff. Chewing tobacco is available in the form of loose leaf, twist or plug. A tobacco user usually puts a wad of tobacco leaf inside his cheek and spits out its juice along with saliva that builds up inside his mouth. Snuff is usually packaged in sachets or pouches in the form of dried, moist and finely grounded shredded tobacco.
4. What harmful chemicals are found in smokeless tobacco?
All tobacco, including smokeless tobacco, contains nicotine, which is addictive. The amount of nicotine absorbed from smokeless tobacco is 3 to 4 times the amount delivered by a cigarette. Nicotine is absorbed more slowly from smokeless tobacco compared to cigarettes, per dose nicotine absorbtion is higher from smokeless tobacco than from cigarettes. The nicotine stays in the bloodstream for a longer time.
Chewing tobacco and snuff contain 28 carcinogens (cancer–causing agents). The most harmful carcinogens in smokeless tobacco are the tobacco–specific nitrosamines (TSNAs). They are formed during the growing, curing, fermenting and aging of tobacco. Other cancer–causing substances in smokeless tobacco include N–nitrosamino acids, volatile N–nitrosamines, benzo(a)pyrene, volatile aldehydes, formaldehyde, acetaldehyde, crotonaldehyde, hydrazine, arsenic, nickel, cadmium, benzopyrene and polonium–210.
5. What cancers are caused by or associated with smokeless tobacco use?
Smokeless tobacco users increase their risk for cancer of the oral cavity. which includes cancer of the lip, tongue, cheeks, gums and the floor and roof of the mouth. People who use oral snuff for a long time have a much greater risk for cancer of the cheek and gum than people who do not use smokeless tobacco. The increased risk for other types of cancer from smokeless tobacco is being studied.
6. Is smokeless tobacco a good substitute for cigarettes?
The use of smokeless tobacco "is not a safe substitute for smoking cigarettes, doctors have stated. It can cause cancer and a number of non-cancerous conditions and can lead to nicotine addiction and dependence. Ministry of health’s "National Cancer Prevention and Control" in India, has officially recommended that the public avoid and discontinue the use of all tobacco products, including smokeless tobacco. National Cancer Prevention and Control also recognizes that nitrosamines, found in tobacco products is not safe at any level.
7. What about using smokeless tobacco to quit cigarettes?
Harm reduction strategies involve promoting a product that has less adverse health effects as a substitute for one that has more severe adverse health effects. Smokeless tobacco low in nitrosamine content,offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the use such products labeled as “less harmful” or “safe,” in the public eye but actually distracts from the public health goal of tobacco elimination. It is recommended that tobacco use be avoided and discontinued. Several non-tobacco methods have been shown to be effective for quitting cigarettes. These methods include individual and group Counselling and telephone quit-lines to motivate a smoker to opt for pharmaco-therapies such as nicotine replacement therapy and bupropion
8. Is supari/areca nut also harmful?
Certainly Yes! Areca nut in any form is harmful. Be it only eating supari or eating the combined forms such as Paan (betel quid), Gutkha (sweetened mixture of areca nut, tobacco) and Mainpuri tobacco.
9. What does betel nut contain that is harmful?
Betel nut (areca nut) constitutes nine active ingredients among which the most powerful is Arecoline. Arecoline is potent muscuranic agonists which crosses the blood brain barrier (BBB) and induces a range of parasympathetic effects.
10. What are the consequence of eating betel nut?
Regular eating of areca nut with betel (paan leave) is responsible for staining of teeth. Long term effects of arecanut is development of oral submucous fibrosis, which is pre malignant lesion.
11. What happens in Oral Submucous Fibrosis?
Oral submucous fibrosis (OSMF) is a pre malignant lesion. It has full potential to develop into oral cancer. It is characterized by inflammation and progressive fibrosis followed by stiffening of an otherwise yielding mucosa resulting in difficulty in opening the mouth.
12. How does areca nut initiate OSMF?
Arecoline, an active alkaloid found in betel nuts, stimulates fibroblasts to increase production of collagen by 150%. Flavanoid, catechin and tannin in betel nuts cause collagen fibers to cross-link, making them less susceptible to collagenase degradation. This results in increased fibrosis by causing both increased collagen production and decreased collagen breakdown.
13. Is there any other reason for oral cancer development other than tobacco and alcohol?
Oral Viral Infections are yet another major cause for oral cancer development in young individuals, even in those who do not use tobacco in any form.
14. Which are the viruses involved?
Human papillomaviruses (HPV): Are a diverse group of DNA-based viruses that infect the skin and mucous membranes within the human body. Studies suggest that infection with HPV 16 and 18 (sexually transmitted viruses) increase the risk for oral cavity cancer and oropharynx cancer.

Epstein-Barr virus: Is a virus from the herpes family that causes an asymptomatic infection called infectious mononucleosis (a medical condition common among young adults and adolescents, characterized by fever, sore throat, muscle soreness, fatigue and sometimes, development of white patches on the tonsils or in the back of the throat). The connection between the Epstein-Barr virus and oral cancer is still under investigation.

Herpes simplex viruses:Cause a viral infection. The connection between this virus and oral cancer is still being investigated.

15. What are the consequences of reverse smoking?
Reverse smoking has detrimental effects on the palatal mucosa, which is clinically characterized by the presence of palatal keratosis, excrescence, patches, red areas, ulceration and pigmentation. It is more harmful than the normal smoking.
16. Do all premalignant lesions and conditions turn into cancer?
NO! Early diagnosis and correct treatment at the right time can prevent the premalignant lesions and conditions to turn into oral cancer. Another important step is to stop tobacco habit in any form.
17. How Is Oral Cancer Diagnosed?
As part of your routine dental exam, your dentist will conduct an oral cancer screening exam. More specifically, your dentist will feel for any lumps or irregular tissue changes in your neck, head, face and oral cavity. When examining your mouth, your dentist will look for any sores or discoloured tissue as well as check for any signs and symptoms mentioned above.

Your dentist may perform an oral brush biopsy if he or she sees tissue in your mouth that looks suspicious. This test is painless and involves taking a small sample of the tissue and analyzing it for abnormal cells. Alternatively, if the tissue looks more suspicious, your dentist may recommend a scalpel biopsy. This procedure usually requires local anesthesia and may be performed by your dentist or a specialist. These tests are necessary to detect oral cancer early, before it has had a chance to progress and spread.

18. What is the Brush Test?
The Brush Test is a diagnostic test used to detect precancer or early oral cancer. A dentist uses a small brush to take a sample from the tissue in your mouth and then sends it to a laboratory for computer-assisted analysis.
19. When should Brush Test be used?
Precancers and early cancers have no distinctive clinical features and often appear to be benign, harmless looking lesions. Clinical inspection at this stage cannot identify which lesions may pose a potential problem. Brush Test was developed precisely to evaluate these benign-appearing oral lesions.
20. How does a velscope act?
The Velscope examination takes less than five minutes. The Velscope gives off a blue light on the inside of a patient’s mouth. Oral tissues then react to that flourescent light. Through the scope, a healthy mouth turns light green. Problem areas shine maroon.
21. How long will the biopsy lesion take to heal?
Most biopsy lesions be it 0.5cms or 1.5cms take 7-10 days to heal.
22. How long will it take to get the results of the biopsy?
Routine biopsy and cytology results may be ready as soon as 1 or 2 days after the sample is received in the laboratory. But there are many reasons why some cases take considerably longer to complete.
23. Are radiotherapy and chemotherapy worth?
Although there are side effects to radiation therapy and chemotherapy, the benefits of it far outweigh the damages done if you don't undergo such treatments. While people have argued that both radiation and chemotherapy kill healthy cells, the damages to tumour cells are far greater than healthy cells due to the nature of cancer cells.
24. Why does chemotherapy have deleterious effects on our body?
The whole purpose of chemotherapy is to kill dividing cells. Current chemotherapy drugs affect every dividing cell in the body and not just cancer. So that is why you vomit and your hair falls out during chemotherapy. Your stomach lining and your hair roots are parts of your body that divides rapidly everyday. It is the most obvious side effect of chemotherapy.

At the same time stop and consider the fact that with each chemotherapy treatment, you are also killing off a constant percentage of cancer cells that would otherwise spread to other parts of your body and form secondary tumours which will cause more damage to you. In the balance between life and death, sometimes the treatment can be as bad as the disease itself, but one of them lets you live. The other doesn't.

It's not a choice that's hard to make, but it is one that is painful to endure all the same.
25. What are the side effects of radiation therapy?
Radiation may cause the following effects on the oral cavity:
  • Dry mouth or Xerostomia.
  • Tooth decay or Radiation caries.
  • Sore throat or mouth.
  • Sore gums and infections of the oral cavity.
  • Delayed wound healing and thus increased chances of osteoradionecrosis post dental extraction.
  • Changes in taste, smell and voice quality.
  • Skin changes in the radiated area.
26. Is removal of the jaw only option of surgery?
No. Removal of part or whole jaw and other associated structure depends on the staging as well as the metastatic aspect of the oral cancer.
27. If due to surgery a part of the tongue, lining of the mouth or the jaw bone has been removed then is it possible for that person to regain normal life function?
When areas such as part of the tongue or jaw bone are removed as part of the cancer treatment then reconstructive surgery can rebuild the structures. Partial removal does not interfere with normal function such as eating but even if they do then the doctor places a feeding tube through which food can be passed.
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