Poor Oral Health and Esophageal Cancer Risk: A Nationwide Cohort Study

Abstract

Background: Previous research indicates that poor dental health increases risks for certain types of cancers, including esophageal cancer. This study aimed to investigate the association with esophageal cancer using Swedish Dental Health Register. Methods: This is a prospective cohort study. The exposures were dental diagnoses classified into healthy, caries, root canal infection, mild inflammation, and periodontitis, as well as number of remaining teeth, at baseline and during multiple visits. The outcome was the incidence of esophageal cancer, which was further divided into esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). Cox proportional hazards models were used to estimate hazard ratios (HRs) and its corresponding confidence intervals (CIs). Results: A total of 5,042,303 individuals were included in the study and 1,259 EAC and 758 ESCC cases were identified. Root canal infection at baseline was associated with 41% higher risk for EAC (HR=1.41, 95% CI: 1.10-1.82), while periodontitis at baseline was linked to 32% and 45% higher risks for respective histopathological subtypes (HR for EAC=1.32, 95% CI: 1.13-1.53; HR for ESCC=1.45, 95% CI: 1.20-1.75). Fewer remaining teeth at baseline also increased the risks for both histopathological types of esophageal cancer, with a dose-response effect (Ptrend < 0.01). Cox regression analyses with time-varying exposures corroborated the above-mentioned results. Conclusions: Impaired dental health prior to cancer diagnosis is associated with excess risks for both histopathological subtypes of esophageal cancer. Impact: Our study provided corroborating evidence for the association between poor oral health and esophageal cancer risk.

Current Status and Future Prospects for Esophageal Cancer

“…Different indicators of poor oral health and oral hygiene, including tooth loss, an index of the sum of decayed, missing, and filled teeth (DMFT), and less frequent or no tooth brushing, have been linked to increased ESCC risk in high-risk regions [16,43,80,98,[133][134][135][136][137][138][139], while inconsistent results (for both ESCC and EAC subtypes) were obtained from studies in low-risk regions [140][141][142][143]. A recent prospective cohort of five million individuals who underwent dental examinations in Sweden found an increased risk for both ESCC and EAC subtypes with increasing tooth loss and periodontitis at baseline [144]. Meta-analyses indicate more than two-fold increased EC risk in the lowest vs. highest frequency of tooth brushing and a 20% to 30% increase in EC risk in the highest vs. lowest categories of the tooth loss [145][146][147][148].…”

An Overview of Systemic Health Factors Related to Rapid Oral Health Deterioration among Older People

“…The connection between oral health and these diseases is largely attributed to inflammation, although there are two other pathways that may explain the association [ 19 , 20 , 21 ]. Firstly, some systemic diseases have direct links to negative impacts on oral health and oral health-related quality of life (OHRQoL), such as Crohn’s disease [ 22 , 23 ], Beçhet’s disease [ 24 , 25 , 26 ], scleroderma [ 27 , 28 ], oral cancer [ 29 , 30 , 31 , 32 ], head and neck cancer [ 33 ], and Sjögren’s syndrome [ 34 , 35 , 36 , 37 ]. Secondly, some chronic diseases may indirectly affect oral health, as they can lead to reduced motivation regarding oral hygiene and care.…”

Systemic Health Factors Related to Rapid Oral Health Deterioration Among Older People

“…The connection between oral health and these diseases is largely attributed to inflammation, although there are two other pathways that may explain the association [19][20][21]. Firstly, some systemic diseases have direct links to negative impacts on oral health and oral health-related quality of life (OHRQoL), such as Crohn's disease, Beçhet's disease, oral cancer, Sjögren's syndrome, and scleroderma [22][23][24][25][26][27][28][29][30][31][32]. Secondly, some chronic diseases may indirectly affect oral health because they can lead to reduced motivation regarding oral hygiene and care.…”