Oral health connected to better head and neck cancer outcome

Anisha Hall Hoppe, Dental Tribune International

Thu. 2. November 2023

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CHAPEL HILL, N.C., US: Head and neck squamous cell carcinoma (HNSCC) is a global health concern, ranking as the sixth most common malignancy worldwide. Poor oral health has emerged as an independent risk factor for HNSCC. Various aspects of poor oral health, such as tooth loss, periodontal disease, infrequent toothbrushing and lack of dental visits, have been associated with a moderate increase in HNSCC risk. However, limited data exists on how oral health has an impact on HNSCC survival. A recent study aimed to address this gap by analysing data from the International Head and Neck Cancer Epidemiology Consortium, representing the largest analysis of its kind to date.

This comprehensive analysis included 10,042 HNSCC patients from various geographic regions and focused on demographics, clinical factors, oral health, treatment and survival. The majority of patients were male, and the participants had a mean age of 59.8 years. Most had late-stage cancer and received surgery-based treatments.

Regarding oral health, the majority had more than 20 natural teeth, brushed their teeth less than once daily, used mouthwash and had visited the dentist one to five times in the past decade. The study revealed that HNSCC patients with more than ten natural teeth had better survival compared with those with no teeth, and those with a history of more than five dental visits in the past decade had better survival compared with those with no dental visits. These associations were particularly pronounced in patients with hypopharyngeal, laryngeal and unspecified HNSCC. Other oral health factors like gingival bleeding, toothbrushing frequency and mouthwash use showed smaller survival differences.

These findings highlight the significance of natural dentition and frequency of dental visits as independent prognostic factors in HNSCC. Frequent dental visits were associated with early-stage HNSCC diagnosis, indicating the potential for early disease detection and improved survival. Geographic region was also found to be relevant to survival, patients in South America and Europe experiencing better outcomes than those in North America.

Despite its strengths, the study had limitations. There were variations in the definition and measurement of oral health parameters across studies and a lack of information on post-treatment oral hygiene and alcohol consumption for some participants. Nevertheless, these results emphasise the importance of maintaining oral health in HNSCC patients not only to prevent treatment-related complications, but also to potentially improve survival. Further prospective studies are needed to confirm and expand upon these findings and to explore the underlying mechanisms. Although the exact mechanisms linking oral health to cancer remain unclear, hypotheses include chronic trauma, oral inflammation and alterations in the oral microbiome.

In 2020, there were 878,348 newly diagnosed cases and 444,347 reported deaths associated with this cancer. There are regional variations reflecting differences in the distribution of known risk factors, including smoking, alcohol consumption, human papillomavirus infection and socio-economic status.

The study, titled “Poor oral health influences head and neck cancer patient survival: An International Head and Neck Cancer Epidemiology Consortium pooled analysis”, was published online on 19 September 2023 in the Journal of the National Cancer Institute, ahead of inclusion in an issue.