Pretreatment oral hygiene habits and survival of head and neck squamous cell carcinoma (HNSCC) patients

Abstract

BackgroundThe survival time of patients with head and neck squamous cell carcinoma (HNSCC) is related to health behavior, such as tobacco smoking and alcohol consumption. Poor oral health (OH), dental care (DC) and the frequent use of mouthwash have been shown to represent independent risk factors for head and neck cancerogenesis, but their impact on the survival of HNSCC patients has not been systematically investigated.MethodsTwo hundred seventy-six incident HNSCC cases recruited for the ARCAGE study were followed through a period of 6–10 years. Interview-based information on wearing of dentures, gum bleeding, teeth brushing, use of floss and dentist visits were grouped into weighted composite scores, i.e. oral health (OH) and dental care (DH). Use of mouthwash was assessed as frequency per day. Also obtained were other types of health behavior, such as smoking, alcohol drinking and diet, appreciated as both confounding and study variables. Endpoints were progression-free survival, overall survival and tumor-specific survival. Prognostic values were estimated using Kaplan-Meier analysis and Cox proportional hazards regression models.ResultsA good dental care score, summarizing annual dental visits, daily teeth cleaning and use of floss was associated with longer overall survival time (p = .001). The results of the Cox regression models similarly suggested a higher risk of tumor progression and shortened overall survival in patients with poor dental care, but the results lost their statistical significance after other types of health behavior had been controlled for. Frequent use of mouthwash (≥ 2 times/day) significantly increased the risk of tumor-specific death (HR = 2.26; CI = 1.19–4.32). Alcohol consumption and tobacco smoking were dose-dependently associated with tumor progression and shorter overall survival.ConclusionFrequent mouthwash use of ≥ 2 times/day seems to elevate the risk of tumor-specific death in HNSCC patients. Good dental care scores are associated with longer overall survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-016-0185-0) contains supplementary material, which is available to authorized users.

Poor oral health affects survival in head and neck cancer

“…25 The German case-only study used a composite score for oral health, including information on annual dental visits, daily tooth cleaning and use of dental floss. A low score was associated with a poor prognosis; however, this association was attenuated after controlling for age, sex, tumor stage, tumor site, treatment, education, HPV status, smoking and alcohol consumption (HR=1.30; 95% CI=0.78 – 2.15).…”

Patterns of concurrent cigarette, alcohol, and e‐cigarette use: Off‐setting or additive behaviors?

“…18 The prognosis and management of patients with head and neck malignancies arising in the setting of high risk cigarette and alcohol use may be different than those without these risk factors because these cancers may be less responsive to therapy. 19,20 In addition, these risky behaviors tend to create a field cancerization effect whereby patients are more likely to develop second primary malignancies of the head and neck and may need to be more closely followed for longer periods of time. 21,22 Thus, we here examine the patterns of the concurrent use of conventional tobacco cigarettes (Ccigs), e-cigarettes (Ecigs), and alcohol in a large adult sample.…”

A comprehensive study of smoking-specific microRNA alterations in head and neck squamous cell carcinoma

“…However, despite strong clinical evidence implicating smoking in HNSCC, the full spectrum of molecular mechanisms underlying tobacco-induced HNSCC onset and progression have not been fully elucidated [4, 5]. Currently, it is widely accepted that tobacco smoke promotes HNSCC pathogenesis via the genotoxic effects of its constituents, including nitrosamines and polycyclic hydrocarbons [6, 7].…”