Periodontal Disease and Overall Health: A Clinician's Guide

198 Periodontal Disease and Overall Health: A Clinician's Guidefor oral cancer was a case study by Grahamet al. 4 In this study the cases consisted of584 males with cancer of the oral cavityat the Roswell Park Memorial Institute,Buffalo, New York. The controls consistedof 1,222 males with no neoplastic diseasesat the same institute. Interviews werecarried out to obtain information regardingdentition, diet, tobacco, and alcoholconsumption.From this study it was reported that ahigher risk of developing cancer was notedin heavy smokers and heavy drinkers. Poororal hygiene was also associated with increasedrisk for oral cancer. When controlledfor other factors, each of these three factorsdemonstrated a higher risk. When combined,heavy smokers and heavy drinkers with apoor dentition had a risk 7.7 times that ofmen with none of these features.In another case-control study carriedout in Beijing, Zheng et al. 5 investigated thedentition and oral hygiene status for risk oforal cancer. The cases consisted of 404 patientswith histologically confirmed oral cancerand a similar number of control patientswhose hospitalizations were for minor conditions.Subjects were interviewed to obtaininformation regarding alcohol, tobacco use,dentition, and oral hygiene. An oral exam -ination included recording the total numberof teeth, jagged teeth, filled teeth, decayedteeth, and presence of gingivitis or perio -dontal disease. After adjustment for tobaccosmoking, alcohol intake, years of education,gender, and age, males who had lost teethhad an increased risk for oral cancer withan odds ratio (OR) of 2.4 (95% confidenceinterval [CI]:1.3–4.5) if they had replacementteeth, and an OR of 3.7 (CI: 2.2–6.4)if they had no tooth replacement. The datafor females showed an even stronger effectof tooth loss on increased risk for oralcancer, with an OR of 5.6 (CI:12.2–14.5)if they had replacement teeth and an ORof 8.3 (CI:3.5–19.6) if they had no toothreplacement. When oral hygiene was assessed,according to whether the teeth werebrushed or not, men had an adjusted OR of6.9 (CI: 2.5 –19.4) and women an adjustedOR of 2.5 (CI: 0.9–7.5) for increased risk oforal cancer if they did not brush their teeth.The findings were inter preted to indicate thatmissing teeth and poor oral hygiene were riskfactors for oral cancer independent of theknown risks associated with smoking andalcohol consumption.In a study aimed primarily at investigatingthe effect of mouthwash use on oralcancer, Winn et al. 6 studied 1,114 oral cancerpatients from four population-based registriesin the US. Control subjects (n = 1,268) werenoncancerous individuals selected by randomdialing to select individuals of suitableage and gender-matched status. Interviewswere carried out to obtain information regard -ing tobacco use, alcohol use, diet, occupation,and oral health status. The oral health param -eters included the number of teeth, use ofdentures, tooth brushing frequency, andbleeding gingiva. The presence of other oraldiseases as well as the frequency, intensity,duration, and reason for use of mouthwasheswere recorded. A highly significant relationshipbetween mouthwashes of high alcoholcontent and oral cancer was noted for bothmales (OR:1.5; CI:1.1–2.1) and females(OR: 2.0; CI:1.3–3.1). In contrast to mostother studies, this study found no relationshipbetween oral/dental conditions and oralcancer.In another US investigation, Marshall etal. 7 carried out a case-control study in threewestern New York counties to investigatethe contribution of alcohol, dentition, anddiet to oral cancer. The cohort consisted of290 pathologically confirmed cases of oralcancer selected from hospital records, whilematched controls were obtained throughneighborhood matching. Cases and controlswere interviewed to gather information concerningsmoking and tobacco use, alcohol