Poor oral health associated with increased risk for head and neck cancer

September 19, 2023

2 min read


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Key takeaways:

  • Patients with frequent dental visits before diagnosis had higher 5- and 10-year OS rates.
  • Results showed no association between OS and patient-reported gingival bleeding, tooth brushing or mouthwash use.

Better oral health appeared associated with higher survival rates among individuals diagnosed with head and neck cancer, results published in Journal of the National Cancer Institute showed.

More specifically, patients who more frequently visited the dentist appeared more likely to have their cancer diagnosed at an early stage, therefore increasing their chances of survival, according to researchers.



OS rate among those with head and neck squamous cell carcinoma

Data derived from Tasoulas J, et al. J Natl Cancer Inst. 2023;doi:10.1093/jnci/djad156.


“Our team has been working for many years to investigate the role of oral health in [patients with] head and neck cancer,” Antonio L. Amelio, PhD, vice chair for research in the head and neck oncology department at Moffitt Cancer Center, said in a press release.

“By working with the [International Head and Neck Cancer Epidemiology consortium], this study includes the largest cohort of patients, offering robust evidence for the association of oral health and survival in head and neck squamous cell carcinoma,” he added. “Consequently, we hope these findings will influence policies that govern the prevention and management of these cancers.”

Background and methodology

Poor oral health has been noted as a contributing factor to poor survival among patients with head and neck squamous cell carcinoma. However, most studies on the association include small or modest sample sizes, according to the investigators.

Therefore, researchers assembled a pooled analysis of 2,449 individuals (78% male; mean age, 59.8 years) with head and neck squamous cell carcinoma who participated in four studies conducted by the International Head and Neck Cancer Epidemiology Consortium.

Assembled data included information regarding periodontal disease, tooth brushing frequency, mouthwash use, number of natural teeth and number of dental visits over the 10 years prior to diagnosis of their respective cancer.

Researchers used multivariable generalized linear regression models to adjust for age, sex, race, geographic region, tumor site, tumor-node-metastasis stage, treatment modality, education and smoking to estimate risk ratios for associations between oral health measures and OS.

Results, next steps

Researchers noted significant associations between OS and number of remaining natural teeth (10-19 teeth: RR = 0.81; 95% CI, 0.69-0.95 vs. > 19 teeth: RR = 0.88; 95% CI, 0.78-0.99), as well as frequent dental visits (> 5 visits: RR = 0.77; 95% CI, 0.66-0.91) at time of diagnosis.

Patients who reported more than five dental visits in the decade before diagnosis had a higher OS rate at 5 and 10 years (74% and 60%) compared with those who had no dental visits over the same time span (54% and 32%).

Notably, investigators reported that the association with dental visits appeared strongest among patients with oropharyngeal head and neck squamous cell carcinoma.

Researchers reported no association between OS and gingival bleeding, tooth brushing or mouthwash use, as noted survival differences appeared to be less than 5%.

Further analysis showed an association between having no remaining natural teeth and 15% lower 5-year OS compared with those with more than 20 remaining natural teeth.

The researchers said the results suggest that good oral hygiene — as well as frequent dental visits — can help increase OS among patients with head and neck cancer.

“The findings of our study highlight the importance of dental care — not only for the prevention of treatment-related adverse outcomes and improved quality of life, but also for tertiary prevention of head and neck squamous cell carcinoma — and thus aim to improve patient survival and ameliorate disease impact,” Amelio said in the release. “Future studies aimed at understanding the mechanisms that underly the observed benefits of maintaining oral health on improved outcomes [are] merited.”

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