Oral Health May Be Linked to Survival in Patients With Head and Neck Squamous Cell Carcinoma

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Investigators have revealed that oral health may be associated with survival in patients with head and neck squamous cell carcinoma, according to a novel study published by Tasoulas et al in the Journal of the National Cancer Institute.


While survival has improved during the past decades as a result of advances in treatment, head and neck squamous cell carcinoma is the sixth most common malignancy in the world and accounts for about 4% of all U.S. cancer cases. In 2023, an estimated 66,920 patients will be diagnosed with the disease in the United States. The main environmental risk factor for the disease is tobacco use; however, alcohol consumption and testing positive for the human papillomavirus may also increase the risk of developing the disease.

Study Methods and Results

In the new study, investigators asked patients with head and neck squamous cell carcinoma 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 diagnoses.

The investigators found that compared with those who had no dental visits, the patients who had frequent dental visits totaling to more than five in a decade had a higher rate of overall survival at 5 and 10 years (74% vs 54% and 60% vs 32%, respectively). The results were most pronounced among the patients with oropharyngeal cancer. Further, having no natural remaining teeth was associated with a 15% lower 5-year overall survival rate compared with having more than 20 natural teeth. Survival differences of less than 5%, which were not found to be statistically significant, were found for patient-reported gum bleeding, tooth brushing, and mouthwash use.

The investigators noted that the patients who had more frequent dental visits were more likely to have their cancer diagnosed at an earlier, less deadly stage of the disease than those who had few or no dental visits.


“The [International Head and Neck Cancer Epidemiology] consortium’s patient data allowed us to be as thorough as possible and identify robust associations between oral health and survival,” explained lead study author Jason Tasoulas, MD, DMD, a PhD candidate at the University of North Carolina at Chapel Hill. “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,” he added.

“[W]e 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,” emphasized senior study author Antonio L. Amelio, PhD, Adjunct Associate Professor at the University of North Carolina at Chapel Hill Department of Otolaryngology–Head and Neck Surgery as well as Vice Chair of Research in Department of Head and Neck Oncology and Associate Member of the Department of Tumor Biology at the Moffitt Cancer Center. “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,” he underscored.

“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,” concluded Carole Fakhry, MD, MPH, the Charles W. Cummings MD Professor of Otolaryngology at the Johns Hopkins School of Medicine, who was not involved in the study.

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