Alveolar Bone Loss, Tooth Loss and Oral Cancer Mortality in Older Patients: A Retrospective Cohort Study

Changing trend of oral cancer disease burden in China from 1990 to 2019 and the forecast for the next 20 years

OBJECTIVE

This study aimed to explore the trend of oral cancer (OC) disease burden in China from 1990 to 2019 and predict the disease burden in the next 20 years.

METHODS

OC data collected for 15 years old in China from 1990 to 2019 were obtained from the 2019 Global Burden of Disease Study. Estimated annual percentage changes (EAPCs), with respective 95% CI, were used to assess incidence, mortality, disability-adjusted life-year (DALY), and their trends.

RESULTS

From 1990 to 2019, the age-standardized rate of incidence, mortality, and DALY of OC in China showed an upward trend with EAPCs of 2.33 (95% CI = 2.01-2.63), 1.44 (95% CI = 1.15-1.73), and 1.24 (95% CI = 0.95-1.52), respectively. The main risk factors for OC in China were smoking and alcohol consumption. New cases, deaths, and DALYs due to OC are predicted to increase >1.5 times over the next 20 years.

CONCLUSION

The number of cases, deaths, and DALYs will continue to increase in the next 20 years. Therefore, the control of risk factors, such as tobacco and alcohol consumption, needs to be strengthened to reduce the burden of OC in China.

Alveolar bone loss and tooth loss contribute to increase in cancer mortality among older patients

BACKGROUND

Both cancer and periodontitis are more prevalent with age. Information on their relationship in older patients is limited. This study aims to examine whether periodontitis is associated with increased risk of cancer mortality with a ≥ 75-year age group cohort.

METHODS

A retrospective cohort study was conducted on 1146 patients who had digital radiographic examinations. Alveolar bone loss and loss of teeth were measured as indicators of periodontitis. Hazard ratio (HR) with 95% confidence interval (CI) were taken as the effect size to summarize the associations between periodontitis and risks of cancer mortality using the multivariate adjusted cox proportional hazards model and competing risk hazard model.

RESULTS

Totally, 104 total cancer, 28 lip, oral cavity and pharynx (LOP) cancer, 39 digestive cancer and 13 respiratory cancer cases were documented over 10 years of follow-up. Total cancer (HR 1.27, 95% CI 1.06-1.53) displayed statistically significant associations with alveolar bone loss and tooth loss after adjusting for relevant confounding variables. We also observed borderline significant association between alveolar bone loss and LOP cancer (HR 1.45, 95% CI 0.99-2.12). The above associations were consistent with the results observed from the competing risk hazard models.

CONCLUSION

Our results indicate that older patients suffering from tooth loss or alveolar bone loss are at increased risks of cancer mortality, especially for total cancer and LOP cancer.

The mortality of oral cancer attributable to tobacco in China, the US, and India

PURPOSE

Assessing the mortality rates associated with tobacco-related oral cancer (OC) is crucial for effective allocation of resources within healthcare and economic systems.

METHODS

In this study, data from the Global Burden of Disease Study (GBD) 2019 were utilized to analyze the burden of tobacco-attributable OC in China, the United States (US), and India from 1990 to 2019. Descriptive statistics and an age-period-cohort model were employed to examine and compare the effects on OC mortality.

RESULTS

1. Attributable to tobacco, the deaths remained stable in the US, but increased in China and India. The trend of age-standardized mortality rate of OC increased in China, and decreased in the US and India, whereas the rate in India was the highest. 2. According to the APC model, the risk of death increased with age in all three countries. The period and later birth cohort effects were identified as risk factors in China and India, while in the US, the previous cohorts were identified as a risk factor. Except for India, males faced higher death risk than females in China and the US.

CONCLUSIONS

The burden of OC attributable to tobacco remains substantial in China and India. Public health officials in these countries should implement prevention and treatment strategies for OC, and interventions aimed at regulating the tobacco industry. The elderly is at an elevated risk for OC, and medical resources and policies should be directed toward this population. The successes experience in tobacco control and OC prevention in the US may serve as a model for other countries.

The association between oral hygiene and head and neck cancer: a meta-analysis

OBJECTIVE

Oral hygiene has been suspected to contribute to the aetiology of head and neck cancer (HNC). Based on the meta-analysis, we evaluated the impact of oral hygiene on head and neck cancer (HNC) and its survival.

MATERIALS AND METHODS

Relevant case-control and cohort studies reporting survival data, oral hygiene data were searched via PubMed, Embase, Cochrane Library, and Web of Science databases. The odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were used. Subgroup analysis was performed.

RESULTS

Oral hygiene was associated with HNC. Tooth brushing ≥2 a day, dental floss use, denture wearing, caries ≥3, and dental visit ≥1 reduced the risk of oral cavity cancer while mouth wash use, missing teeth >5, gum bleeding, and periodontal disease increased the risk of oral cavity cancer. For oropharynx cancer, tooth brushing ≥2 and caries ≥3 were associated with reduced risk of it. Tooth brushing ≥2 and dental visits ≥1 decreased the risk of pharynx cancer risk and larynx cancer risk, however, missing teeth >5 increased both of them.

CONCLUSION

Oral hygiene was associated with HNC and its sub sites. Oral hygiene should be strengthened, a dental floss use and dentist's visits can be recommended.

Tooth loss, denture use, and all-cause and cause-specific mortality in older adults: a community cohort study

Objectives

The available evidence on the connections between tooth loss, denture use, and mortality from all causes or specific causes among older adults is inconclusive. Therefore, we aimed to investigate the association between tooth loss, denture use, and all-cause and cause-specific mortality in older adults.

Methods

A cohort of 5,403 participants aged 65 and older were recruited in the 2014 Chinese Longitudinal Healthy Longevity Survey wave and followed up in the 2018 wave. Cox proportional hazard models were used to examine the association between the number of natural teeth, denture use, and all-cause and cause-specific mortality.

Results

During a mean (SD) follow-up of 3.1  years (1.3), 2,126 deaths (39.3%) occurred. Individuals with 0 and 1-9 teeth had higher mortality due to all-cause, cardiovascular disease (CVD), cancer, and other causes (all p-trend <0.05) than those with 20+ teeth. At the same time, no association was found with respiratory disease mortality. Participants who used dentures had lower mortality due to all causes [hazard ratios (HR) 0.79, 95% confidence intervals (CI) 0.71-0.88], CVD (HR 0.80, 95% CI 0.64-1.00), respiratory disease (HR 0.66, 95% CI 0.48-0.92), and other causes (HR 0.77, 95% CI 0.68-0.88) than those without dentures. Joint analysis revealed that older adults with fewer natural teeth and no dentures had higher mortality. Additionally, interaction analyses showed that the effects of the number of natural teeth on all-cause mortality were more pronounced in older adults aged <80  years (p-value for interaction = 0.03).

Conclusion

Having fewer natural teeth, particularly less than 10 teeth, is linked to an increased risk of mortality from all causes, including CVD, cancer, and other causes, but not respiratory disease. The use of dentures would mitigate the adverse impact of tooth loss on all-cause and some cause-specific mortality.

[Oral Microbiome and Systemic Diseases]

As one of the most diverse microbial communities within the human body, the oral microbiome is an important component that contributes to the maintenance of human health. The microbial composition of different sites in the oral cavity varies significantly and a dynamic equilibrium is maintained through communications with the environment and oral and distal organs of the host. It has been reported that there is significant correlation between dysbiotic oral microbiome and the occurrence or progression of a variety of systemic diseases. In this review, we summarized recent advances in research on the relationship between oral microbiome and systemic health, focusing on the interaction and pathological mechanisms between oral microbiome and systemic health and hoping to provide new avenues for the early prevention and clinical diagnosis and treatment of systemic diseases.

Periodontitis as a risk for oral cancer: a case-control study

Background

The aetiology of oral cancer is multifactorial, as various risk factors (genetics, socioeconomic and lifestyle factors) contribute to its development. Data in the literature suggest that people with periodontal disease have an increased risk of developing oral cancer, and the severity of periodontitis correlates with the appearance of oral squamous cell carcinoma. The aim of this study was to revise the non-genetic risk factors that may influence the development of OC, while focusing on the dental and periodontal status and OH.

Methods

Two hundred patients (hundred diagnosed with oral cancer and hundred without oral cancer) were enrolled in our case–control study, to evaluate the association between oral cancer and the presence and severity of periodontitis, while examining several risk factors that might be responsible for oral cancer formation. A questionnaire customised for oral cancer patients was used to obtain the socioeconomic and lifestyle risk factors that may influence the development of oral squamous cell carcinoma. The dental and periodontal status along with the level of oral hygiene was recorded quantitatively. The chi-square and Mann–Whitney tests and logistic regression were used for the statistical analysis.

Results

By considering both the case and the control groups, a significant correlation was found between the incidence of oral cancer and some socioeconomic factors and lifestyle habits, such as the sex, age, education and alcohol consumption of an individual. The mean value of the Silness-Löe plaque index was significantly higher in the case population. The number of completely edentulous patients was higher among the oral cancer population. The incidence of oral cancer was 57.1% in patients with periodontal disease. In comparison, the incidence of oral squamous cell carcinoma was only 28.6% among the patients without periodontitis. Most of the oral cancer patients (72.1%) had stage 4 periodontitis. On the other hand, the vast majority of the control group (51.6%) had stage 2 periodontitis.

Conclusion

Periodontitis can be an individual risk factor for oral cancer development. Periodontally compromised individuals should be strictly monitored, especially those with severe periodontitis and coexisting lifestyle risk factors. Maintaining their periodontal health in at-risk patients can minimize cancer risks.

Oral Equilibrium in Cachexia

Oral cancer, a part of head-and-neck cancer (HNC), is associated with a high risk of cancer-associated weight loss causing cachexia which is still an understudied illness. Cachexia is a host-phagocytic syndrome caused by the multiple factors, resulting in the severity of heterogenic fashion. For the current review, a bibliographic search was done in PubMed and other databases for the English articles published from the year 1980 to 2021. Recent studies have revealed that cachexia associated with 35%-60% of all the oral cancer patients is either due to the implication of the tumor or obstruction of food intake for which a strong need for nutritional assistance and hydration is desired. The health of cancer individuals undergoing chemotherapy or bone marrow transplant is negatively affected by poor oral health and reduced dentition status. The impact of a deficient oral condition is not clearly understood to date, possibly due to the limited number of studies and a lack of widely accepted clinical trials to prevent cachexia. The masticatory function of such patients is drastically affected thus contributing to the decreased nutritional status causing wasting of tissues. The aim of this article is to provide substantial evidence that poor oral hygiene with an altered dentition status negatively influences the energy balance of oral cancer patients who experience wasting.