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Title Is There a Link Between Periodontal Disease and Oropharyngeal Cancer?
Clinical Question What is the likelihood of oropharyngeal cancer in adult patients with periodontal disease versus those without periodontal disease?
Clinical Bottom Line While there does seem to be a certain level of correlation between periodontal disease and oropharyngeal cancer, there is insufficient data to establish any true causality.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26343577Javed/2016Twelve Case ControlSystematic Review of Randomized and Non-Randomized Trials - High
Key resultsPeriodontal disease is positively associated (2-5 fold increase) with oral cancer, though that association is weakened when adjusted for tobacco and alcohol use.
#2) 24194957Zeng/2013Two Cohort, Six Case ControlMeta-Analysis
Key resultsPeriodontal disease shows a 2.63 fold increase in head and neck cancers as opposed to patients without periodontal disease.
Evidence Search ("periodontal diseases"[MeSH Terms] OR ("periodontal"[All Fields] AND "diseases"[All Fields]) OR "periodontal diseases"[All Fields] OR ("periodontal"[All Fields] AND "disease"[All Fields]) OR "periodontal disease"[All Fields]) AND ("mouth neoplasms"[MeSH Terms] OR ("mouth"[All Fields] AND "neoplasms"[All Fields]) OR "mouth neoplasms"[All Fields] OR ("oral"[All Fields] AND "cancer"[All Fields]) OR "oral cancer"[All Fields])
Comments on
The Evidence
Validity: Both the meta-analysis and systematic review list their search parameters as well as the screening method used, and the number of studies included in each respective review. They also have extensive data analysis and neither claims to have any conflict of interest. While both studies show a strong correlation between periodontal disease and oral cancer, it was noted in the systematic review that the correlation was weakened when adjusted for tobacco and alcohol use. Perspective: Both studies show a strong correlation between periodontal disease and oropharyngeal cancer, but this association is not without flaw. First, there is great variability in the parameters used to define periodontitis among the studies assessed. Second, while there is some mention of adjustment for tobacco and alcohol, there is never any mention of the fastest-growing cause of oral cancer, HPV. Thirdly, an estimated 46% of adults suffer from periodontitis and it is highly possible that periodontal disease is merely a surrogate marker for well-established risk factors such as tobacco and alcohol. Finally, causality between periodontal disease and oral cancer has yet to be proven.
Applicability Every dentist has an obligation to promote good periodontal health in their practice. However, the three main risk factors for oral cancer continue to be tobacco, alcohol and HPV.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Periodontics)
Keywords Periodontal disease, cancer, perio, neoplasm
ID# 2997
Date of submission: 03/06/2016spacer
E-mail parkerz@livemail.uthscsa.edu
Author Zachary Parker
Co-author(s) e-mail
Faculty mentor/Co-author Michaell Huber, DDS
Faculty mentor/Co-author e-mail HuberM@uthscsa.edu
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