Author: Dr.Suchitra Gupta

The Invisible Tobacco – Case 2

Similar case of lesions without the use of tobacco was observed in a 52 year old lady. She had a mixed red and white lesion on right buccal mucosa and alveolar ridge, which was found to be malignant on investigation.

She belonged to a well to do family. Both her husband and son were ayurvedic specialists. She refused any form of tobacco use, at least not that she was aware of.

For the last 23 years following her marriage she had been using a special form of toothpaste which initially (as per her version) gave her dizziness, but later she felt good after using the tooth paste and could not brush her teeth without it every day. She loved to brush her teeth twice a day with the same paste and sometimes just applied the same in her oral cavity.

She was not aware what it contained but was definitely liking it. But now, it has caused her lesions and pre-cancerous changes are becoming prominently visible in other parts of her mouth. She will now have to undergo a major surgery where in her cheek as well as the lower jaw will have to be resected along with the lymph nodes of the neck.

This is yet another case of a tooth paste causing lesions and pre-cancerous changes. This case hints that we must understand what changes a product is causing in our body and mind. Anything unusual should be realized and stopped with immediate effect to prevent further damage to us. Any changes in the body should also be realized and screened to identify it and get it treated at the earliest so that it does not take any severe form later.

It is recommended that you screen your mouth every month to recognize any changes and get it screened immediately. Self-Care will ensure timely detection and treatment of the disease occurring in your body. Let’s try to adopt preventive care.

The Invisible Tobacco – Case 1

A 57 year old lady , with a good socio-economic background, had visited me for an ulcer on her lower lip around 3 months back, and it was increasing at a rapid pace.

Cancer on the Lower Lip of the Patient

She had consulted many hospitals, who confirmed the lesion to be a lip cancer. She did not use any form of tobacco yet she had developed lip cancer. What could be the cause?

None of the hospitals, which she had visited earlier for investigation of her ulcer, were able to diagnose the causative agent. Over and above she affirmed that she was not a tobacco user. Her oral cavity was not healthy and definitely some thing was missing. It did not also look that she was telling a lie, and it also seemed that she wouldn’t use tobacco knowingly.

White Plaque like Lesion on the Right Buccal Mucosa
White precancerous lesion in the lower labial vestibule plus tobacco stains on teeth
Some reversible changes in the left buccal mucosa

So we went ahead to ask her of her habit and any special toothpaste or gargle she would use. It was then that we came to know that since childhood all her family members including herself were using a special toothpaste. She also said that she feels good after using the toothpaste.

This toothpaste was the causative agent of lip cancer in her lower lips. She was shocked to know the real cause of her cancer. This was her invisible tobacco that made her feel refreshed and good after using it. It is therefore important to realize the effects of products we are using in everyday life. We need to be alert about the unusual pleasantness or any other change that is happening in the body with a product because it might be a reason for cancer.

My First Experience as a Tobacco Cessation Speaker

It was my 3rd day as an observer with Dr. Pawan Gupta, when he told me that I had to accompany him to a Rotary club function for a sensitization (awareness) talk on tobacco and its ill effects. Little did I know what was awaiting me!

We were busy the whole day with patients, and had no time, whatsoever to discuss about this talk. I was sure there must be few other members of the team as well, who will take turns to talk and I felt lucky to be able to get this opportunity to listen more to them and gain more knowledge on this topic “Tobacco cessation and oral cancer”, one of the topics, I felt, have been my favourite, since the early days of my college life.

We were supposed to leave around 2:30 pm, but just as we were waiting for our conveyance, I asked him as to who all are coming with us, and he replied “No one, as they are out of station giving sensitization talks elsewhere”!!! My heart skipped a beat, as a thought crossed my mind, “what if sir is expecting me too, to go up the stage and speak something”. Not that I haven’t talked on stage earlier. I have presented and published numerous papers, have been a Dental college lecturer for around 7 years, given numerous lectures, but I am somehow never too comfortable on stage. Although it would have been a huge honor for me to share a stage with him, but somehow I was too nervous for it.

I thought being direct would be the best option. “Sir please don’t ask me to give a talk as I am absolutely unprepared”, I told him bluntly, but politely, trying to explain that I was completely unaware that the other team members were not coming, and that I need some preparation before delivering any kind of a public speech. On this, sir, Dr. Pawan, replied, “Oh, that reminds me, even I am not prepared !!!!” Then he opened his laptop and started working, but as always, was interrupted within a few seconds and that preparation could never happen.

Our conveyance soon arrived and very soon we reached our destination. It was a small clubhouse for rotary function activities and we received a warm welcome. Very soon the function started. Dr. Pawan and I, were first asked to light up the lamps, along with other dignitaries, and then we were duly introduced and welcomed by the club secretary. During these introductions, I asked sir that how many other doctors are present in this function, to which he replied, “None, other than the two of us”!!!! I was again surprised but kept it to myself. Sir asked me, “Are you sure you wouldn’t be able to speak even for a few minutes?” It was a simple question, but I was feeling bad that he had expected me to help him & now he had to take the whole responsibility alone, so I replied, “Ok sir, I would speak a few lines about oral examination and diagnosis”, this being my specialty, I thought I will be able to talk on this topic even if not prepared. Sir was delighted. He gave a huge smile and his eyes lit up.

He was called up on stage. He started, not by talking about his work as an oncosurgeon, (which according to me, is THE NOBLEST PROFESSION, even among the noblest of the doctors) but, by introducing me and that how I am doing such a noble job of helping the tobacco addicts quit their habit, how I am travelling so much every day and that what a great person I am!!!!! I was totally embarrassed by his words, and kept thinking that how can a doctor of his experience, caliber and status be so polite, humble, and down to Earth. Instead of talking about his achievements, his miraculous surgeries and his passion to make India tobacco free, this man was talking about me, one who has just joined the organisation and just started making small efforts to bring some changes in society. I was totally floored!!! After what felt like a life-time, he finally stopped, and I could take my seat, but during that time, this great man made me take a pledge within, that now I must work really hard to prove his words true.

 He started by talking about how tobacco affects our lives, causes addiction and why it’s so difficult to leave. He was an interactive speaker as he kept asking the audience, engaging and mind boggling questions, some of them making the addicts think hard about how they are simply destroying not only their but their family’s lives as well. He spoke about the huge wastage of money by tobacco users and how they are a burden on their employer as well as the nation. He kept emphasizing that tobacco is not just a habit, it’s a disease, and that’s why it needs proper treatment, which includes repeated assessment, motivation, counselling, drugs and follow up, to help the user stay quit, as that’s the most difficult part.

When he came to the oral examination section, he proudly announced my name. Surprisingly, this time I didn’t feel nervous at all. I confidently marched up to the stage but requested him to stay upstairs as I was unaware of his slide presentation. As I opened up the first slide of this chapter, I got confused, as it was something written in Hindi, a slogan as simple as “Chhota dana bhool na jana”. There he was again, helping me by taking over and explaining the meaning in simple layman’s language. After that he again let me talk. I then talked from my own education and experience for around 5-10 minutes, after which he took over again as the next topic approached.

By the end of the session, he had successfully sensitized most of the audience, and many of them asked for his help, to which he modestly replied, “Ask madam, she would help you to quit”.

At the conclusion of the ceremony, we were felicitated & I was gifted  a beautiful potted plant, which I proudly brought back home.

Pawan sir, as he is fondly known as, is a mentor, in the true sense of the word, as he not only teaches you something, but also guides, inspires, motivates and promotes you, till the very end. And I must say that I am very fortunate to find him as my mentor. Thank you Pawan sir.