Title	Inconclusive Evidence Supporting a Significant Correlation Between Periodontal Disease and Tooth Loss with Esophageal Cancer Risk
Clinical Question	In an adult patient with periodontal disease, will excessive tooth loss result in an increased risk of esophageal cancer?
Clinical Bottom Line	Some studies seem to suggest an association between periodontal disease and tooth loss with an increased risk of esophageal cancer. However, current evidence does not yet support a clear link. This is due to the fact that many studies are not properly identifying patients with periodontal disease using the appropriate diagnostic parameters. Therefore, it is inconclusive whether a significant correlation between periodontal disease and tooth loss with esophageal cancer exists.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18990747 Abnet/2008 283 cases and 560 controls Case Control Study Key results Significantly increased risk of esophageal cancer with (OR, 2.36; 95% CI: 1.17-4.75; P= 0.002 ) in patients with poor oral hygiene and increasing numbers of missing teeth. Results were concluded after adjustments for tobacco. 17761691 Guha/2007 927 cases and 928 controls Case Control Study Key results Significantly increased risk of esophageal cancer when missing between 6 and 15 teeth (Central Europe: OR = 2.84, 95% CI: 1.26, 6.41; Latin America: OR = 2.18, 95% CI: 1.04, 4.59). Results were concluded after adjustments for tobacco and alcohol. 18462995 Michaud/2008 131 cases and 48,328 controls Prospective Cohort Study Key results No significant increase in risk for esophageal cancer with history of periodontal disease or increased number of teeth lost.
Evidence Search	"Periodontal disease"[Mesh] "Tooth loss"[Mesh] "Esophageal cancer"[Mesh]
Comments on The Evidence	Validity: It is important to note that current and past studies use tooth loss as an indicator for periodontal disease whether or not the disease is actually present. Therefore, controversy exists within the literature when determining a risk for esophageal cancer (and many other cancers for that matter). This is likely due to two main reasons. One reason being the fact that some studies relate only tooth loss with cancer whether or not periodontal disease is associated; when in actuality many of the cases are a result of caries related tooth loss. The second reason being many of the studies that examine the periodontal status of the patients do not use dentists for the oral exam; which may indicate why tooth loss is used as a marker for periodontal disease in numerous studies as opposed to bleeding on probing, loss of attachment and radiographic bone loss. While periodontal disease does result in tooth loss, not all missing teeth are a result of periodontal disease. That being said, the current evidence is controversial when relating periodontal disease to various forms of cancer.
Applicability	This information is applicable to patients suffering from periodontal disease and patients with generalized tooth loss who are interested in determining their risk for esophageal cancer. This information is also applicable to periodontal research personal seeking to establish a unified consensus on how to diagnostically examine periodontal disease in research studies.
Specialty	(General Dentistry) (Periodontics)
Keywords	Periodontitis, periodontal disease, tooth loss, esophageal cancer, oral hygiene, poor oral hygiene
ID#	3057
Date of submission	03/15/2016
E-mail	orn@livemail.uthscsa.edu
Author	Tyler Orn
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Adriana V. Green, DDS, MPH
Faculty mentor e-mail	greenav@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available