Iceberg phenomena in dentistry

ICEBERG PHENOMENON

PRATIK YADAV

ICEBERG

• An iceberg is a large piece of ice that has broken off from a snow-formed glacier or ice shelf and is floating in open water.

• only one-ninth of the volume of an iceberg is above water.

• The shape of the underwater portion can be difficult to judge by looking at the portion above the surface

CONCEPT OF CAUSATION OF DISEASE

• EPIDEMIOLOGICAL TRIAD• MULTIFACTORIAL CAUSATION• NATURAL HISTORY OF DISEASE• WEB OF CAUSATION• RISK FACTORS & RISK GROUPS• SPECTRUM OF DISEASE• ICEBERG OF DISEASE

ICEBERG PHENOMENON

• The iceberg phenomenon is a metaphor emphasizing that every health problem the number of known cases of disease is outweighed by those that remain undiscovered, much as the unseen part of an iceberg is much larger than the part that is visible above the water.

• Floating tip of iceberg represents what the physician sees in the community – Clinical cases

• Submerged portion of the iceberg represents the hidden mass of disease- like Pre-symptomatic and undiagnosed cases or The carriers in the community.

• Waterline represents the demarcation between apparent and unapparent disease.

• Patients who are at the tip of the iceberg are more likely to have multiple health problems than other

The iceberg concept in the form of a pyramid

1 Diseased, diagnosed & controlled

2 Diagnosed, uncontrolled

3 Undiagnosed or wronglydiagnosed disease

4 Risk factors for disease

5 Free of risk factors

Diagnosed disease

Undiagnosed orwrongly diagnosed disease

Blocks 1 and 2 correspond to the iceberg above the sea-level and 3 to 5 below sea level.

• Unidentified cases may be different from identified ones, both in terms of the natural history or spectrum of disease.

• Where symptoms and disease progression are

related, the undiagnosed cases are likely to be less severe.

• When symptoms and signs are not evident in the early stages of disease, as in high blood pressure or diabetes , undiagnosed cases may be just as severe as diagnosed ones.

• Epidemiological studies based on selected

cases from the tip of the iceberg may give an incorrect view.

CARIES

• Dental caries, also known as tooth decay or a cavity,it is an irreversible microbial disease of the calcified tissue of teeth characterized by demineralization of inorganic portion & destruction of organic substance of tooth which often lead to cavitation

Factor affecting caries

ICEBERG OF DENTAL CARIES

PERIODONTITIS• Periodontits is an

inflammatory diseases affecting the periodontium,

Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth.

Signs & Symptom

• Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food

• Gum swelling. • Halitosis, or bad breath, and a persistent metallic

taste in the mouth.• Gingival recession, resulting in apparent

lengthening of teeth.• Deep pockets between the teeth and the gums• Loose teeth, in the later stages .

ICEBERG OF PERIODONTITIS

• Gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume that painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that patient.

Loose tooth & tooth elongation

Gingival recessionBleeding gums

pockets

Sub clinical initial Bone destruction & gingival inflammation

diagnosed

Radiographic and Clinical aids

Un diagnosed

ORAL CANCER

• Oral cancer is cancer of the mouth• Oral cancer most commonly involves the lips or the

tongue.

It may also occur on the:• Cheek lining• Floor of the mouth• gingiva• palate• Most oral cancers are a type called squamous

cell carcinomas

Factors

• Smoking and tobacco use are linked to most cases of oral cancer. Alcohol also increases risk for oral cancer.

• Other factors :o Chronic irritationo Human papilloma virus (HPV) infectiono Taking medications that weaken the immune

system (immunosuppressant)o Poor dental and oral hygiene.

Signs & Symptoms

Sore, lump, or ulcer in the mouth:• May be a deep, hard-edged crack in the tissue & Most often pale colored,

but may be dark or discolored.• Usually painless at first (may develop a burning sensation or pain when the

tumor is advanced)

Other symptoms that may occur with oral cancer include:• Chewing problems• Speech difficulties• Swallowing difficulty• Swollen lymph nodes in the neck• Woody tongue• Weight loss

Woody tongue, Chewing problems,

Difficulty in swallowing

Sore ,leukoplakiaLichen planus,

lump,ulcers

Lymph node enlargementWeight loss

diagnosed

Aspiration & biopsy

Un diagnosed or Wrong diagnosed

CONCLUSION

• The ultimate purpose of iceberg phenomena is to spread awareness in people that disease may not look as sever as they are & thus iceberg phenomenon contribute to form a uniform classification that can be used throughout the world to make accurate comparisons of morbidity and mortality data for decision making in prevention , management and in facilitating research on particular health problems.