Tooth Loss and Lack of Regular Oral Hygiene Are Associated with Higher Risk of Esophageal Squamous Cell Carcinoma

Abstract

We tested the association between tooth loss and oral hygiene and the risk of esophageal squamous cell carcinoma (ESCC) in people living in a high-risk area of Iran. We used a case-control study of pathologically confirmed ESCC cases (n = 283) and controls (n = 560) matched on sex, age, and neighborhood. Subjects with ESCC had significantly more decayed, missing, or filled teeth (DMFT) with a median (interquartile range) of 31 (23-32) compared with controls 28 (16-32; P = 0.0045). Subjects with ESCC were significantly more likely than controls to fail to practice regular oral hygiene (78% versus 58%). In multivariate-adjusted conditional logistic regression models, having 32 DMFT compared with V15 conferred an odds ratio (95% confidence interval) of 2.10 (1.19-3.70). Compared with daily tooth brushing, practicing no regular oral hygiene conferred an odds ratio (95% confidence interval) of 2.37 (1. 42-3.97). Restricting the analysis to subjects that had never smoked tobacco did not materially alter these results. We found significant associations between two markers of poor oral hygiene, a larger number of DMFT and lack of daily tooth brushing, and risk of ESCC in a population at high risk for ESCC where many cases occur in never smokers. Our results are consistent with several previous analyses in other high-risk populations. (Cancer Epidemiol Biomarkers Prev 2008;17(11):3062-8)

Oral cancer aetiopathogenesis; past, present and future aspects

“…Periodontitis patients were also more likely to have poorly differentiated oral squamous cell carcinomas than did periodontally healthy patients (19). Interestingly, practicing no regular oral hygiene also conferred a risk for oesophageal cancer (20). Several oral micro-organisms can produce carcinogenic acetaldehyde from alcohol (21).This may explain why poor oral hygiene is often associated with oral cancer in heavy drinkers and smokers; namely their salivary acetaldehyde concentrations are significantly increased along with their poor oral hygiene (22).It remains to be shown if controlling these bacteria could affect the incidence of oral cancer.…”

Telomerase activity in the occurrence and progression of oral squamous cell carcinoma

“…Periodontopathic bacteria such as Porphyromonas gingivalis and Tannerella forsythensis cause chronic inflammatory lesions that result in the destruction of the paradentium. Because of the high incidence of carcinogenesis in non-smokers and non-drinkers who have periodontal disease, periodontitis is thought to be an independent risk factor for oral cancer (17)(18)(19). In periodontitis, pathogens produce butyric acid and many inflammatory cytokines, and these factors are assumed to cause cancer.…”

Multiple alcohol dehydrogenases but no functional acetaldehyde dehydrogenase causing excessive acetaldehyde production from ethanol by oral streptococci

“…The highest cancer risk is seen for the upper aerodigestive tract, including the oral cavity, throat, voice-box and oesophagus. Recently, poor oral hygiene and tooth loss have been associated with an increased risk of oesophageal cancer (Abnet et al, 2008), suggesting a role for oral micro-organisms in carcinogenesis. Although the oral fungus Candida albicans can produce acetaldehyde directly from glucose through the pyruvate-bypass pathway (Marttila et al, 2013), most oral bacteria, including Streptococcus, do not have pyruvate decarboxylase, the enzyme required for this pathway.…”