Chronic Gum Disease May Increase Tongue Cancer Risk

Allison Gandey

May 23, 2007

May 23, 2007 — Doctors and patients have more reason to be concerned about unhealthy gums and teeth, a new study suggests. Reporting in the May issue of Archives of Otolaryngology — Head and Neck Surgery, researchers say periodontal viruses and bacteria could be toxic to surrounding cells and produce changes that may lead to oral cancer. Chronic gum disease may also indirectly contribute to cancer through inflammation. "Oral cancer is still very deadly," lead author Mine Tezal, PhD, from the Roswell Park Cancer Institute, in Buffalo, New York, told Medscape. "If the association we have identified can be confirmed by larger studies, we should be able to make a significant difference."

During an interview, Dr. Tezal said that several oral surgeons have long observed a suspicious link between oral health and cancers, but studies are only just now beginning to document these reports. Yet, she noted, substantial evidence exists supporting an association between chronic infections and increased cancer risk.

Periodontal disease is mostly a silent disease and tends to start and progress slowly. In time, alveolar bone loss can result and is irreversible and cumulative. Dr. Tezal recommended conscientious oral health including brushing, flossing, and regular dental exams. "It's important for patients to know that rinses are not as effective as brushing and flossing and should never be used as a substitute," she said.

Dr. Tezal also called for more interaction between oncologists and dentists and other oral healthcare providers. "Dentists have access to valuable clinical observations that can help with patient care," she said. Dr. Tezal noted that she worked at a cancer center that offered an unusual amount of collaboration between specialties. The oncology and dental departments were located in the same building, and the 2 chairs became very good friends a situation that led to unprecedented collaboration and information sharing.

In the present analysis, supported by a grant from the National Institute of Dental and Craniofacial Research and a grant from the National Cancer Institute, the researchers conducted a case-control study.

Alveolar Bone Loss Significantly Higher in Cancer Patients

The investigators used preexisting data frompatients admitted to the department of dentistry and maxillofacial prosthetics at Roswell Park Cancer Institute. They included 51 white men with newly diagnosed primary squamous-cell carcinoma of the tongue and 54 white men evaluated during the same period but with no malignancy to be used as controls.

"The mean alveolar bone loss was significantly higher in cancer cases compared with controls 4.21 vs 2.74 mm," the authors report. "After adjustment for the effects of age, smoking status, and the number of teeth, each millimeter of alveolar bone loss was significantly associated with a 5.23-fold increase in the risk of tongue cancer." Other oral variables such as the number of dental decays, fillings, crowns, and root-canal treatments were not significantly associated with cancer risk.

"This study presents, to our knowledge, the first evidence of a possible association between the history of chronic periodontitis and tongue cancer independent of smoking," the researchers write. "Considering the results of previous studies linking chronic infections and inflammation to cancer risk in several other organs, we expected to see a trend in this study. However, we did not expect to see such a clear association with a relatively small sample size."

The researchers point out that this link needs to be confirmed by larger studies that include other oral cancer sites, women, and subjects of other races, with a more comprehensive assessment of confounding. They conclude, "If this association is confirmed, it has a potential impact on understanding the etiology of oral cancer as well as on its prevention and control."

Arch Otolaryngol Head Neck Surg . 2007;133:450-454.

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