Poor oral health affects survival in head and neck cancer

Abstract

Introduction Poor oral health has emerged as a risk factor for squamous cell carcinoma of the head and neck (HNSCC) but its impact on survival has not been examined. We sought to estimate the impact of oral health indicators on survival in a population-based HNSCC cohort. Materials and Methods Cases (n=1381) and age-, sex- and race-matched controls (n=1396) were participants in the Carolina Head and Neck Cancer Epidemiologic Study (CHANCE). Vital status was determined via linkage with the National Death Index. Survival was considered at 5 years post-diagnosis or study-enrollment for controls. Oral health was assessed using self-reported indicators including frequency of routine dental exams and tooth brushing. We used Kaplan-Meyer analyses and Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results Routine dental visits during the preceding 10 years were associated with decreased mortality risk (>10 visits: HR=0.6, 95% CI=0.4–0.8) after adjusting for confounders. This effect was most pronounced for oral cavity cancer—(e.g., >10 visits: HR=0.4, 95% CI=0.2–0.9). Dental visits were also positively associated with survival among controls. No other routine health screening (e.g., eye exams) was associated with survival. Conclusion We found significant associations between markers of oral health and survival among both HNSCC cases and controls. This association was most pronounced for sites closer to the dentition. Oral health may have a direct effect on tumor biology due to the associated immune or inflammatory response. It may also represent a proxy for wellness or unmeasured social determinants of health.

Hospital dental hygienist intervention improves activities of daily living, home discharge and mortality in post‐acute rehabilitation

“…Poor oral status, detected by a validated oral screening tool, is associated with age‐related outcomes, such as malnutrition, physical dependency, dysphagia and sarcopenia, in hospitalized older adults . Furthermore, poor oral hygiene is associated with mortality among healthy adults, middle‐aged male adults, institutionalized older adults, dialysis patients, and patients with head and neck cancer . Furthermore, poor oral status is common and associated with high mortality among patients with pneumonia in hospitals and nursing homes .…”

“…1,2 Furthermore, poor oral hygiene is associated with mortality among healthy adults, 3 middle-aged male adults, 4 institutionalized older adults, 5 dialysis patients, 6 and patients with head and neck cancer. 7 Furthermore, poor oral status is common and associated with high mortality among patients with pneumonia in hospitals and nursing homes. 8 Oral health management is thus an important social issue to consider, particularly given the increase in the older population.…”

Psychological symptoms in adult Saudi Arabian cancer patients: prevalence and association with self-rated oral health

“… 3 , 4 The psychological distress and poor oral health were negatively related with time, because of the diagnoses of cancer, 3 , 5 treatment, 4 , 6 and poor prognosis in cancer patients. 7 , 8 In Saudi Arabia, due to a wide array of national screening programs and diagnosis of new cancer cases at an early stage, 9 the survival rate among cancer patients continues to increase. 10 This necessitates routine assessment and intervention among cancer survivors to maintain quality of life 11 , 12 and better health management and outcomes.…”

Oral health of high-cost patients and evaluation of oral health measures as predictors for high-cost patients in South Korea: a population-based cohort study

“…This positive association can partly be explained by prior studies that show positive associations between periodontal disease and various chronic and severe diseases 8–10. Other studies also find that the frequency of toothbrushing and the use of secondary oral hygiene products are associated with diseases such as hypertension, diabetes mellitus, cardiovascular disease, and head and neck cancers 11–14. In a recent study, researchers found that flossing and brushing of interdental spaces may reduce the risk for new cardiovascular events among patients with coronary heart disease 24.…”

“…For example, studies show associations between periodontal disease and a higher risk of Alzheimer’s disease, coronary heart disease, rheumatoid arthritis, glomerulonephritis, inflammatory bowel disease and prostate cancer 8–10. Other studies show that poor oral hygiene is associated with hypertension, diabetes mellitus, cardiovascular disease, and head and neck cancers 11–14. Still other studies have found a positive association between poor oral health and mortality 4 7 15…”