Poor oral health could lessen survival from head and neck cancer

 

 

IMAGE: “THE INHANCE CONSORTIUM’S PATIENT DATA ALLOWED US TO BE AS THOROUGH AS POSSIBLE AND IDENTIFY ROBUST ASSOCIATIONS BETWEEN ORAL HEALTH AND SURVIVAL,” SAID LEAD AUTHOR JASON TASOULAS MD, DMD, A CURRENT PHD CANDIDATE. “WE ASSEMBLED A DIVERSE AND EXPERIENCED TEAM TO EXAMINE RECORDS OF APPROXIMATELY 2,500 PATIENTS FROM EIGHT COUNTRIES TO CARRY OUT OUR STATE-OF-THE-ART STATISTICAL ANALYSES.” view more 

CREDIT: JASON TASOULAS

An international study has revealed strong associations between oral health and survival among people diagnosed with head and neck cancer. Specifically, better oral health, as evidenced by the number of natural teeth and dental visits prior to the time of diagnosis, was associated with increased survival. Importantly, those who had more frequent dental visits were more likely to have their cancer diagnosed at an earlier, and less deadly, stage of the disease than those who had few or no dental visits.

The study, by researchers at UNC Lineberger Comprehensive Cancer Center and UNC Adams School of Dentistry, Chapel Hill, North Carolina, and Moffitt Cancer Center, Tampa, Florida, in partnership with the International Head and Neck Cancer Epidemiology (INHANCE) consortium, appeared Sept. 19, 2023, in the Journal of the National Cancer Institute.

“The INHANCE consortium’s patient data allowed us to be as thorough as possible and identify robust associations between oral health and survival,” said lead author Jason Tasoulas M.D., DMD, a current Ph.D. candidate. “We assembled a diverse and experienced team to examine records of approximately 2,500 patients from eight countries to carry out our state-of-the-art statistical analyses.”

Head and neck cancer patients were asked to self-report aspects of their oral health and hygiene, including gum bleeding, tooth brushing frequency and mouthwash use, as well as the number of natural teeth and frequency of dental visits they had during a 10-year period prior to their cancer diagnosis.

Those who had frequent dental visits (more than five visits in a reported decade) had higher overall survival at five and 10 years (74% and 60%, respectively) compared to those with no dental visits (54% at five years and 32% at 10 years). This finding was most pronounced among people with cancers of the oropharynx, which consists of the structures in the back of the throat, including the base of the tongue, tonsils and soft palate. Having no natural remaining teeth was associated with a 15% lower five-year overall survival compared to those with more than 20 natural teeth. Survival differences of less than 5%, which were not significant, were found for patient-reported gum bleeding, tooth brushing and mouthwash use.

While survival has improved during the past decades due to treatment advances, head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide and accounts for about 4% of all cancers in the United States. In 2023, an estimated 66,920 people will be diagnosed with the disease in the U.S. The main environmental risk factor for the disease is tobacco use but alcohol consumption and testing positive for the human papillomavirus also increase a person’s risk for the disease.

“This current research effort capitalizes on previous data collection efforts by our team in North Carolina through the Carolina Head and Neck Cancer Epidemiology (CHANCE) study to investigate the role of oral health in patients with head and neck squamous cell carcinoma. The present report is based on a larger-scale study, accounting for geographic variability and capturing more oral health variables,” said Kimon Divaris, DDS, Ph.D., study author and James Bawden Distinguished Professor at the UNC Adams School of Dentistry and UNC Gillings School of Global Public Health.

“Inspired by Dr. Divaris’ previous work, we sought out opportunities to collaborate with a larger network of epidemiologists, surgeons, physicians, dentists and scientists from all over the world to address an important but often overlooked problem for patients with head and neck squamous cell carcinoma,” said corresponding author Antonio L. Amelio, Ph.D., vice chair of research in the Head and Neck Oncology Department and associate member of the Tumor Biology Department at Moffitt Cancer Center, and an adjunct associate professor at the UNC Department of Otolaryngology-Head and Neck Surgery. “Our hope is that these findings become a standard part of guidelines implemented for the prevention and management of head and neck squamous cell carcinomas in the near future.”

Carole Fakhry, M.D., MPH, the Charles W. Cummings M.D. Professor of Otolaryngology at Johns Hopkins School of Medicine, who was not involved in the research, called the findings significant. “This is an important study that highlights the interplay between oral health and head and neck squamous cell carcinoma and overall survival. While we seek biomarkers to predict which patient will do well, this study points out features of a history and examination that are associated with survival. Additionally, this may lead us down the road of prevention of these cancers.”

New at-home test for gingivitis protects oral health

 

 

IMAGE: UNIVERSITY OF CINCINNATI ENGINEERS HAVE DEVELOPED A TEST THAT USES SALIVA TO WARN CONSUMERS ABOUT PERIODONTAL DISEASE, WHICH IF LEFT UNTREATED CAN LEAD TO TOOTH LOSS, STROKE, HEART DISEASE AND OTHER ILLNESSES. view more 

CREDIT: ANDREW STECKL AND DAEWOO HAN

Engineers at the University of Cincinnati have developed a new device that can warn consumers about early risks of tooth decay from diseases such as gingivitis and periodontitis.

Gingivitis, the earliest form of gum disease, is caused by bacteria. But not just any bacteria.

The problem for researchers was getting a device to single out the particular type responsible for the disease, said Andrew Steckl, an Ohio Eminent Scholar and distinguished research professor in UC’s College of Engineering and Applied Science.

“It’s been quite the challenge to get to the point where we can detect this toxin created by the bacteria responsible for gingivitis,” he said.

Steckl and UC Senior Research Associate Daewoo Han collaborated with Sancai Xie, a principal scientist at Procter & Gamble Co., and described their results in a paper published in the Royal Society of Chemistry journal Sensors and Diagnostics.

Steckl’s research team has been exploring biosensing for various applications. They studied stress hormones in sweat in collaboration with the Air Force Research Lab at Wright-Patterson Air Force Base. Now they are studying saliva.

“There are good reasons to use saliva,” he said. “It’s relatively plentiful and easy to obtain through noninvasive methods. And saliva has a lot of important elements that can act as indicators of your health.”

Bacteria from gingivitis can travel through the bloodstream, leading to cardiovascular disease and other serious health problems, Steckl said.

But saliva is a complicated biofluid, said Han, the study's lead author.

Researchers pretreated the sample using potato starch to remove a protein called amylase that could interfere with the test results. Their test uses antibodies that react to the endotoxins found in the bacteria.

“Daewoo worked very hard on many dead-ends before he had success,” Steckl said. “I tell my students that research is search, search and re-search until you find the answer.”

At-home health testing has been available for generations in niche uses such as detecting pregnancy. But the COVID-19 pandemic introduced a wide audience of consumers to the concept of monitoring their health with new technology.

The at-home testing industry is expected to generate $45 billion annually by 2031, according to Allied Market Research.

Steckl said he sees a lot of opportunity for new consumer products.

“Our results definitely show promise,” Steckl said. “Sometimes it comes easy. Most of the time you have to persevere.”