BACKGROUND: Poor oral health has been identified as a prognostic factor potentially affecting the survival of patients with head and neck squamous cell carcinoma. However, evidence to date supporting this association has emanated from studies based on single cohorts with small-to-modest sample sizes. METHODS: Pooled analysis of 2449 head and neck squamous cell carcinoma participants from 4 studies of the International Head and Neck Cancer Epidemiology Consortium included data on periodontal disease, tooth brushing frequency, mouthwash use, numbers of natural teeth, and dental visits over the 10 years prior to diagnosis. Multivariable generalized linear regression models were used and adjusted for age, sex, race, geographic region, tumor site, tumor-node-metastasis stage, treatment modality, education, and smoking to estimate risk ratios (RR) of associations between measures of oral health and overall survival. RESULTS: Remaining natural teeth (10-19 teeth: RR = 0.81, 95% confidence interval [CI] = 0.69 to 0.95; ≥20 teeth: RR = 0.88, 95% CI = 0.78 to 0.99) and frequent dental visits (>5 visits: RR = 0.77, 95% CI = 0.66 to 0.91) were associated with better overall survival. The inverse association with natural teeth was most pronounced among patients with hypopharyngeal and/or laryngeal, and not otherwise specified head and neck squamous cell carcinoma. The association with dental visits was most pronounced among patients with oropharyngeal head and neck squamous cell carcinoma. Patient-reported gingival bleeding, tooth brushing, and report of ever use of mouthwash were not associated with overall survival. CONCLUSIONS: Good oral health as defined by maintenance of the natural dentition and frequent dental visits appears to be associated with improved overall survival among head and neck squamous cell carcinoma patients.

Bristol Dental School University of Bristol Bristol UK

Cancer Institute of the State of São Paulo São Paulo Brazil

Department of Cancer Epidemiology and Prevention M Sklodowska Curie National Research Institute of Oncology Warsaw Poland

Department of Environmental Epidemiology Nofer Institute of Occupational Medicine Lodz Poland

Department of Epidemiology Gillings School of Global Public Health The University of North Carolina at Chapel Hill Chapel Hill NC USA

Department of Head and Neck Endocrine Oncology H Lee Moffitt Cancer Center and Research Institute Tampa FL USA

Department of Head and Neck Heliopolis Hospital São Paulo Brazil

Department of Medical and Surgical Sciences University of Bologna Italy

Department of Medical Sciences University of Turin Turin Italy

Department of Otolaryngology Head and Neck Surgery University of North Carolina at Chapel Hill Chapel Hill NC USA

Department of Otolaryngology Head and Neck Surgery University of Pittsburgh PA USA

Department of Pathology and Laboratory Medicine School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC USA

Department of Surgery University of North Carolina at Chapel Hill Chapel Hill NC USA

Department of Tumor Biology H Lee Moffitt Cancer Center and Research Institute Tampa FL USA

Division of Hematology Oncology Department of Medicine The University of North Carolina at Chapel Hill Chapel Hill NC USA

Division of Oral and Craniofacial Health Sciences Adams School of Dentistry University of North Carolina at Chapel Hill Chapel Hill NC USA

Division of Pediatric and Public Health Adams School of Dentistry University of North Carolina at Chapel Hill Chapel Hill NC USA

Division of Public Health Department of Family and Preventive Medicine and Huntsman Cancer Institute University of Utah School of Medicine Salt Lake City UT USA

Epidemiology Department School of Public Health University of São Paulo São Paulo Brazil

Institute of Hygiene and Epidemiology Charles University Prague Prague Czech Republic

Institute of Oncology Angel H Roffo University of Buenos Aires Buenos Aires Argentina

Lineberger Comprehensive Cancer Center The University of North Carolina at Chapel Hill Chapel Hill NC USA

Oncocentro Foundation of São Paulo São Paulo Brazil

Regional Authority of Public Health Banska Bystrica Slovakia

Section of Hygiene University Department of Life Sciences and Public Health Università Cattolica del Sacro Cuore Rome Italy

Stony Brook Cancer Center Department of Family Population and Preventive Medicine Stony Brook University Stony Brook NY USA

Unit of Cancer Epidemiology Centro di Riferimento Oncologico di Aviano IRCCS Aviano Italy

University of Padua Padova Italy

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Sung H, Ferlay J, Siegel RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. PubMed

Patterson RH, Fischman VG, Wasserman I, et al.Global burden of head and neck cancer: economic consequences, health, and the role of surgery. Otolaryngol Head Neck Surg. 2020;162(3):296-303. PubMed

Wyss A, Hashibe M, Chuang SC, et al.Cigarette, cigar, and pipe smoking and the risk of head and neck cancers: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Am J Epidemiol. 2013;178(5):679-690. PubMed PMC

Di Credico G, Polesel J, Dal Maso L, et al.Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration. Br J Cancer. 2020;123(9):1456-1463. PubMed PMC

Hobbs CG, Sterne JA, Bailey M, et al.Human papillomavirus and head and neck cancer: a systematic review and meta-analysis. Clin Otolaryngol. 2006;31(4):259-266. PubMed

Stanford-Moore G, Bradshaw PT, Weissler MC, et al.Interaction between known risk factors for head and neck cancer and socioeconomic status: the Carolina Head and Neck Cancer Study. Cancer Causes Control. 2018;29(9):863-873. PubMed PMC

Conway DI, McKinney PA, McMahon AD, et al.Socioeconomic factors associated with risk of upper aerodigestive tract cancer in Europe. Eur J Cancer. 2010;46(3):588-598. PubMed

O’Rorke MA, Ellison MV, Murray LJ, et al.Human papillomavirus related head and neck cancer survival: a systematic review and meta-analysis. Oral Oncol. 2012;48(12):1191-1201. PubMed

Osazuwa-Peters N, Adjei Boakye E, Chen BY, et al.Association between head and neck squamous cell carcinoma survival, smoking at diagnosis, and marital status. JAMA Otolaryngol Head Neck Surg. 2018;144(1):43-50. PubMed PMC

Giraldi L, Leoncini E, Pastorino R, et al.Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Ann Oncol. 2017;28(11):2843-2851. PubMed PMC

D’Souza G, Anantharaman D, Gheit T, et al.Effect of HPV on head and neck cancer patient survival, by region and tumor site: a comparison of 1362 cases across three continents. Oral Oncol. 2016;62:20-27. PubMed PMC

Hashim D, Sartori S, Brennan P, et al.The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium. Ann Oncol. 2016;27(8):1619-1625. PubMed PMC

Divaris K, Olshan AF, Smith J, et al.Oral health and risk for head and neck squamous cell carcinoma: the Carolina Head and Neck Cancer Study. Cancer. Causes & Control. 2010;21(4):567-575. PubMed PMC

Perry BJ, Zammit AP, Lewandowski AW, et al.Sites of origin of oral cavity cancer in nonsmokers vs smokers: possible evidence of dental trauma carcinogenesis and its importance compared with human papillomavirus. JAMA Otolaryngol Head Neck Surg. 2015;141(1):5-11. PubMed

Feller L, Altini M, Lemmer J.. Inflammation in the context of oral cancer. Oral Oncol. 2013;49(9):887-892. PubMed

Hayes RB, Ahn J, Fan X, et al.Association of oral microbiome with risk for incident head and neck squamous cell cancer. JAMA Oncol. 2018;4(3):358-365. PubMed PMC

Sczepanik FSC, Grossi ML, Casati M, et al.Periodontitis is an inflammatory disease of oxidative stress: we should treat it that way. Periodontol 2000. 2020;84(1):45-68. PubMed

Canli O, Nicolas AM, Gupta J, et al.Myeloid cell-derived reactive oxygen species induce epithelial mutagenesis. Cancer Cell. 2017;32(6):869-883 e5. PubMed

Al-Hebshi NN, Nasher AT, Maryoud MY, et al.Inflammatory bacteriome featuring Fusobacterium nucleatum and Pseudomonas aeruginosa identified in association with oral squamous cell carcinoma. Sci Rep. 2017;7(1):1834. PubMed PMC

Zhao H, Chu M, Huang Z, et al.Variations in oral microbiota associated with oral cancer. Sci Rep. 2017;7(1):11773. PubMed PMC

Hashimoto K, Shimizu D, Ueda S, et al.Feasibility of oral microbiome profiles associated with oral squamous cell carcinoma. J Oral Microbiol. 2022;14(1):2105574. PubMed PMC

Michikawa C, Gopalakrishnan V, Harrandah AM, et al.Fusobacterium is enriched in oral cancer and promotes induction of programmed death-ligand 1 (PD-L1). Neoplasia. 2022;31:100813. PubMed PMC

Chang CC, Lee WT, Hsiao JR, et al.Oral hygiene and the overall survival of head and neck cancer patients. Cancer Med. 2019;8(4):1854-1864. PubMed PMC

Farquhar DR, Divaris K, Mazul AL, et al.Poor oral health affects survival in head and neck cancer. Oral Oncol. 2017;73:111-117. PubMed PMC

Friemel J, Foraita R, Gunther K, et al.Pretreatment oral hygiene habits and survival of head and neck squamous cell carcinoma (HNSCC) patients. BMC Oral Health. 2016;16:33. PubMed PMC

Conway DI, Hashibe M, Boffetta P, et al.; for the INHANCE Consortium. Enhancing epidemiologic research on head and neck cancer: INHANCE–the international head and neck cancer epidemiology consortium. Oral Oncol. 2009;45(9):743-746. PubMed

Hashibe M, Brennan P, Benhamou S, et al.Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst. 2007;99(10):777-789. PubMed

Toporcov TN, Znaor A, Zhang ZF, et al.Risk factors for head and neck cancer in young adults: a pooled analysis in the INHANCE consortium. Int J Epidemiol. 2015;44(1):169-185. PubMed PMC

Ness AR, Waylen A, Hurley K, et al.; for the Head and Neck 5000 Study Team. Establishing a large prospective clinical cohort in people with head and neck cancer as a biomedical resource: head and neck 5000. BMC Cancer. 2014;14:973. PubMed PMC

Machiels JP, Rene Leemans C, Golusinski W, et al.; for the ESTRO Executive Board. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(11):1462-1475. PubMed

Owosho AA, Kadempour A, Yom SK, et al.Radiographic osteoradionecrosis of the jaw with intact mucosa: proposal of clinical guidelines for early identification of this condition. Oral Oncol. 2015;51(12):e93-6-e96. PubMed PMC

Nekhlyudov L, Lacchetti C, Davis NB, et al.Head and neck cancer survivorship care guideline: American Society of Clinical Oncology clinical practice guideline endorsement of the American Cancer Society guideline. J Clin Oncol. 2017;35(14):1606-1621. PubMed

Lingen MW, Abt E, Agrawal N, et al.Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity: a report of the American Dental Association. J Am Dent Assoc. 2017;148(10):712-727 e10. PubMed

Moyer VA; for the U.S. Preventive Services Task Force. Screening for oral cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(1):55-60. PubMed

Liu J, Zong X, Vogtmann E, et al.Tooth count, untreated caries and mortality in US adults: a population-based cohort study. Int J Epidemiol. 2022;51(4):1291-1303. PubMed PMC

Greten FR, Grivennikov SI.. Inflammation and cancer: triggers, mechanisms, and consequences. Immunity. 2019;51(1):27-41. PubMed PMC

Clarke JA, Despotis AM, Ramirez RJ, et al.Head and neck cancer survival disparities by race and rural-urban context. Cancer Epidemiol Biomarkers Prev. 2020;29(10):1955-1961. PubMed PMC

Kwok J, Langevin SM, Argiris A, et al.The impact of health insurance status on the survival of patients with head and neck cancer. Cancer. 2010;116(2):476-485. PubMed PMC

Louie KS, Mehanna H, Sasieni P.. Trends in head and neck cancers in England from 1995 to 2011 and projections up to 2025. Oral Oncol. 2015;51(4):341-348. PubMed