Using NHANES oral health examination protocols as part of an esophageal cancer screening study conducted in a high-risk region of China

Oral Health and Risk of Upper Gastrointestinal Cancers in a Large Prospective Study from a High-risk Region: Golestan Cohort Study

Tooth loss and periodontal disease have been associated with several cancers, and poor oral health may be an important risk factor for upper gastrointestinal (UGI, i.e., esophageal and gastric) cancers. We assessed the relationship between oral health and UGI cancers using a large prospective study of over 50,000 adults living in Golestan Province, Iran, a high-incidence area for these cancers. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated for the association between three different measures of oral health [frequency of tooth brushing; number of missing teeth; and the sum of decayed, missing, and filled teeth (DMFT)] and UGI cancers. During a median follow-up duration of 13 years, there were 794 incident UGI cancers (396 esophageal and 398 gastric cancers). Daily tooth brushing was associated with a decreased risk of developing both esophageal (HR = 0.670; 95% CI: 0.486-0.924) and gastric (HR = 0.741; 95% CI: 0.544-1.01) cancers (combined UGI cancer HR = 0.697; 95% CI: 0.558-0.871) compared with never brushing. Tooth loss in excess of the loess smoothed, age- and sex-specific median number of teeth lost was significantly associated with esophageal (HR = 1.64; 95% CI: 1.08-2.47) and gastric cancers (HR = 1.58; 95% CI: 1.05-2.38). There were some adverse associations between DMFT and UGI cancers but most were not statistically significant. These results suggest increased risk of developing UGI cancers among individuals with poor oral health, and those who do not perform regular oral hygiene. PREVENTION RELEVANCE: Poor oral health is associated with the risk of upper gastrointestinal cancers, and oral hygiene practices may help prevent these cancers.

Risk factors for precancerous lesions of esophageal squamous cell carcinoma in high-risk areas of rural China: A population-based screening study

Although many studies in China have found that environmental or lifestyle factors are major contributors to the etiology of esophageal cancer, most of the patients in the above studies are in the middle and late stages, the early-stage patients account for a small proportion. To clarify the risk/protective factors contributing to early lesions, we conducted the present cross-sectional study.A total of 2925 healthy controls and 402 patients with esophageal precancerous lesions were included in our study by endoscopic examination. Information on risk/protective factors was collected by personal interview, and unconditional logistic regression was used to determine adjusted odds ratios (AORs) by the maximum-likelihood method.Smoking >20 pack-years (AOR = 1.48), duration of drinking >30 years (AOR = 1.40), alcohol consumption >100 mL/d (AOR = 1.44), gastroesophageal reflux disease (AOR = 1.75), esophagitis (AOR = 1.25), a family history of esophageal cancer (AOR = 1.92), or stomach cancer (AOR = 1.92) were significant risk factors for esophageal precancerous lesions. There was a negative correlation between abdominal obesity and early esophageal cancer and precancerous lesions (AOR = 0.75). In addition, we found that there was a synergistic effect between a family history of esophageal cancer and drinking (AOR = 3.00) and smoking (AOR = 2.90).Lifestyle risk factors, genetic factors, and upper gastrointestinal diseases are associated with the development of esophageal precancerous lesions. These results highlight the need for primary prevention to reduce the future burden of cancer and other chronic diseases in high-risk areas of rural China.

Periodontal disease and cancer: Epidemiologic studies and possible mechanisms

Epidemiologic and cancer control studies on the association of periodontal disease and cancer risk mostly suggest a positive association with overall cancer risk and certain specific types of cancer. These findings are generally consistent among cross‐sectional and longitudinal studies. In this paper, we review epidemiologic studies and current knowledge on periodontal disease and cancer, with a focus on those studies conducted in the years following the Joint European Federation of Periodontology/American Academy of Periodontology Workshop on “Periodontitis and Systemic Diseases” in November 2012. This review also explores the role of chronic inflammation as a biologically plausible mechanistic link between periodontal disease and risk of cancer. Furthermore, it highlights studies that have examined the potential importance of certain periodontal pathogens in this association.

Tooth loss and cancer risk: a dose-response meta analysis of prospective cohort studies

Conflicting results to identify the relationship between tooth loss and cancer risk. Therefore, a dose-response meta-analysis was performed to clarify and quantitative assessed the correlation between tooth loss and cancer risk. Up to March 2017, 25 observational epidemiological studies were included in current meta-analysis. Tooth loss was significantly associated with a higher risk of cancer. Additionally, tooth loss was associated with significantly a higher risk of esophageal cancer, gastric cancer, head and neck cancer, colorectal cancer, pancreas cancer, lung cancer, prostate cancer, bladder cancer and hematopoietic cancer. Subgroup analysis showed consistent findings. Furthermore, a significant dose-response relationship was observed between tooth loss and cancer risk. Increasing per 10 of tooth loss was associated with a 9% increment of cancer risk, 14% increment of esophageal cancer risk, 9% increment of gastric cancer risk, 31% increment of head and neck cancer risk, 4% increment of colorectal cancer risk, 7% increment of pancreas cancer risk, 19% increment of lung cancer risk, 2% increment of bladder cancer risk and 3% increment of hematopoietic cancer risk. Considering these promising results, tooth loss might be harmful for health. Large sample size, different ethnic population and different cancer type are warranted to validate this association.

Association between tooth loss and risk of oesophageal cancer: a dose-response meta-analysis

Many epidemiological studies have found that tooth loss is associated with susceptibility to oesophageal cancer. However, a definitive answer is yet to be discovered, and the findings are inconclusive. We performed a meta-analysis to assess the relationship between tooth loss and oesophageal cancer risk. We searched PubMed and Embase databases to screen eligible studies up to June 2015. Nine observational studies (eight articles) involving 2604 patients and 113,995 participants were included in the meta-analysis. The combined odds ratio for tooth loss and oesophageal cancer was 1.53 (95 % CI 1.02-2.29) for the high versus lowest teeth loss categories. However, inconsistent results were detected in the stratified and sensitivity analysis. In dose-response analysis, the summary odds ratio for each one tooth loss increment was 1.01 (95 % CI 1.00-1.02). The current evidence, based solely on six case-control studies and three cohort studies, suggests that tooth loss is a potential marker of oesophageal cancer. However, no firm conclusion can be drawn at this time that tooth loss may play a causal role in development of oesophageal cancer. Additional large-scale and high-quality prospective studies are required to evaluate the association between tooth loss and risk of oesophageal cancer.

Tooth loss is associated with increased risk of esophageal cancer: evidence from a meta-analysis with dose-response analysis

Epidemiological studies have revealed the association between tooth loss and the risk of esophageal cancer (EC); however, consistent results were not obtained from different single studies. Therefore, we conducted the present meta-analysis to evaluate the association between tooth loss and EC. We conducted electronic searches of PubMed until to February 10, 2015 to identify relevant observational studies that examined the association between tooth loss and the risk of EC. Study selection and data extraction from eligible studies were independently performed by two authors. The meta-analysis was conducted using Stata 12.0 software. Finally eight eligible publications with ten studies involving 3 cohort studies, 5 case-control studies, and 1 cross-sectional study were yielded. Meta-analysis identified tooth loss increased risk of EC 1.30 times (Relative risk = 1.30, 95% confidence interval = 1.06–1.60, I² = 13.5%). Dose-response analysis showed linear relationship between tooth loss and risk of EC (RR = 1.01, 95%CI = 1.00–1.03; P for non-linearity test was 0.45). Subgroup analysis proved similar results and publication bias was not detected. In conclusion, tooth loss could be considered to be a significant and dependent risk factor for EC based on the current evidence.

Beta-diversity metrics of the upper digestive tract microbiome are associated with body mass index

OBJECTIVE

Studies of the fecal microbiome have implicated the gut microbiota in obesity, but few studies have examined the microbial diversity at other sites. The association between obesity and the upper gastrointestinal (UGI) microbial diversity was explored.

METHODS

The UGI microbiome of 659 healthy Chinese adults with a measured body mass index (BMI) range of 15.0 to 35.7 was characterized using the 16S rRNA gene DNA microarray (HOMIM).

RESULTS

In multivariate-adjusted models, alpha diversity was not associated with BMI. However, beta diversity, assessed by principal coordinate vectors generated from an unweighted UniFrac distance matrix of pairwise comparisons, was associated with BMI (third and fourth vectors, P = 0.01 and P = 0.03, respectively). Moreover, beta diversity, assessed by cluster membership (three clusters), was also associated with BMI; individuals in the first cluster [median BMI 22.35, odds ratio (OR) = 0.48, 95% confidence interval (CI) = 0.05-4.34] and second cluster [median BMI 22.55, OR = 0.26, 95% CI = 0.09-0.75] were significantly less likely to be obese (BMI ≥ 27.5) than those in the third cluster (median BMI 23.59).

CONCLUSIONS

A beta-diversity metric of the UGI microbiome is associated with a four fold difference in obesity risk in this Asian population. Future studies should address whether the UGI microbiome plays a causal role in obesity.

Prevalence of dental caries and oral hygiene status of a screened population in Port Harcourt, Rivers State, Nigeria

Objectives:

The study was designed to determine the prevalence of dental caries and partial edentulism, in addition to assessing the oral hygiene status and restorative care among adults in a community-based outreach program in Port Harcourt.

Materials and Methods:

A cross-sectional study was conducted among adults who participated in oral health screening program, which took place in Alakahia and Obigbo rural communities in Port Harcourt, Rivers State, Nigeria. After a brief oral health education, clinical examination was conducted and the diagnosis of caries was made based on the guidelines laid down by World Health Organization. Prevalence of caries was measured using decayed missing and filled teeth (DMFT) index, and oral hygiene status was assessed using the OHI-S. The restorative index [(F/F + D) ×100] was also calculated and the sociodemographic factors of the subjects were noted. Chi-square test, independent t-test and descriptive statistic were employed for analysis.

Results:

One fifty-five females (53.8%) and 133 males (46.2%) attended the events and their mean age was 29.3 ± 10.5 years. About one-third of the participants (35.1%) presented with dental caries. The mean DMFT for the whole group was 0.67 ± 2.0. The restorative index for the subjects was 26.8%. The oral hygiene status of most of the participants was fair. This was significantly better in females than in males (P = 0.002).

Conclusion:

Although about one-third of the participants had dental caries, only a quarter of them had received restorative care. Most of the respondents had fair and poor oral hygiene, this suggests the need to educate and motivate the community toward adopting and maintaining positive oral health attitudes and practices.

Association between tobacco use and the upper gastrointestinal microbiome among Chinese men

PURPOSE

Tobacco causes many adverse health conditions and may alter the upper gastrointestinal (UGI) microbiome. However, the few studies that studied the association between tobacco use and the microbiome were small and underpowered. Therefore, we investigated the association between tobacco use and the UGI microbiome in Chinese men.

METHODS

We included 278 men who underwent esophageal cancer screening in Henan Province, China. Men were categorized as current, former, or never smokers from questionnaire data. UGI tract bacterial cells were characterized using the Human Oral Microbial Identification Microarray. Counts of unique bacterial species and genera estimated alpha diversity. For beta diversity, principal coordinate (PCoA) vectors were generated from an unweighted UniFrac distance matrix. Polytomous logistic regression models were used for most analyses.

RESULTS

Of the 278 men in this study, 46.8% were current smokers and 12.6% were former smokers. Current smokers tended to have increased alpha diversity (mean 42.3 species) compared to never smokers (mean 38.9 species). For a 10 species increase, the odds ratio (OR) for current smoking was 1.29 (95% CI 1.04-1.62). Beta diversity was also associated with current smoking. The first two PCoA vectors were strongly associated with current smoking (PCoA1 OR 0.66; 95% CI 0.51-0.87; PCoA2 OR 0.73; 95% CI 0.56-0.95). Furthermore, Dialister invisus and Megasphaera micronuciformis were more commonly detected in current smokers than in never smokers.

CONCLUSIONS

Current smoking was associated with both alpha and beta diversity in the UGI tract. Future work should consider how the UGI microbiome is associated with smoking-related diseases.

The association between the upper digestive tract microbiota by HOMIM and oral health in a population-based study in Linxian, China

BACKGROUND

Bacteria affect oral health, but few studies have systematically examined the role of bacterial communities in oral diseases. We examined this relationship in a large population-based Chinese cancer screening cohort.

METHODS

Human Oral Microbe Identification Microarrays were used to test for the presence of 272 human oral bacterial species (97 genera) in upper digestive tract (UDT) samples collected from 659 participants. Oral health was assessed using US NHANES (National Health and Nutrition Examination Survey) protocols. We assessed both dental health (total teeth missing; tooth decay; and the decayed, missing, and filled teeth (DMFT) score) and periodontal health (bleeding on probing (BoP) extent score, loss of attachment extent score, and a periodontitis summary estimate).

RESULTS

Microbial richness, estimated by number of genera per sample, was positively correlated with BoP score (P = 0.015), but negatively correlated with tooth decay and DMFT score (P = 0.008 and 0.022 respectively). Regarding β-diversity, as estimated by the UniFrac distance matrix for pairwise differences among samples, at least one of the first three principal components of the UniFrac distance matrix was correlated with the number of missing teeth, tooth decay, DMFT, BoP, or periodontitis. Of the examined genera, Parvimonas was positively associated with BoP and periodontitis. Veillonellacease [G-1] was associated with a high DMFT score, and Filifactor and Peptostreptococcus were associated with a low DMFT score.

CONCLUSIONS

Our results suggest distinct relationships between UDT microbiota and dental and periodontal health. Poor dental health was associated with a less microbial diversity, whereas poor periodontal health was associated with more diversity and the presence of potentially pathogenic species.

Iodine in evolution of salivary glands and in oral health

The authors hypothesize that dietary deficiency or excess of iodine (I) has an important role in oral mucosa and in salivary glands physiology. Salivary glands derived from primitive I-concentrating oral cells, which during embryogenesis, migrate and specialize in secretion of saliva and iodine. Gastro-salivary clearance and secretions of iodides are a considerable part of "gastro-intestinal cycle of iodides", which constitutes about 23% of iodides pool in the human body. Salivary glands, stomach and thyroid share I-concentrating ability by sodium iodide symporter (NIS) and peroxidase activity, which transfers electrons from iodides to the oxygen of hydrogen peroxide and so protects the cells from peroxidation. Iodide seems to have an ancestral antioxidant function in all I-concentrating organisms from primitive marine algae to more recent terrestrial vertebrates. The high I-concentration of thymus supports the important role of iodine in the immune system and in the oral immune defence. In Europe and in the world, I-deficiency is surprisingly present in a large part of the population. The authors suggest that the trophic, antioxidant and apoptosis-inductor actions and the presumed antitumour activity of iodides might be important for prevention of oral and salivary glands diseases, as for some other extrathyroidal pathologies.

Caries is Associated with Asthma and Epilepsy

OBJECTIVES

There is evidence of association between systemic diseases and oral conditions, although it is not clear if these are direct or mediated by underlying factors such as health behaviors. The aim of this work was to evaluate whether self-reported systemic diseases were associated with caries experience.

METHODS

Medical history data and caries experience (DMFT and DMFS; Decayed, Missing due to caries, Filled Teeth/Surface) were obtained from the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository. Information on 318 subjects (175 females and 143 males) was evaluated. Regression analysis was used to test for association between caries experience and disease status.

RESULTS

The stronger associations were found between caries experience and asthma and epilepsy. With respect to asthma, DMFT above 15 (R(2) = 0.04) and DMFS above 50 (R(2) = 0.02) were associated. After controlling for gender differences in asthma, the associations remained strong (R(2) = 0.05 for both DMFT and DMFS). For epilepsy, DMFT above 15 (R(2) = 0.18) and DMFS above 50 (R(2) = 0.14) were associated.

CONCLUSIONS

Asthma and epilepsy are associated with higher caries experience.