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UB study links gum disease with oral cancer risk
By LOIS BAKER
Contributing Editor
UB dental researchers have found a significant association between one measure of periodontal disease and oral pre-cancerous lesions and tumors.
Analyzing data from the Third National Health and Nutrition Examination Survey (NHANES III), researchers found that persons with serious periodontal disease were at double the risk of having a pre-cancerous lesion and at four times the risk of having an oral tumor of any kind than persons without serious gum disease.
Results of the study were presented recently at the American Association of Dental Research meeting in San Antonio.
"This is the first finding of a potential link between oral cancer and oral infection," said Sara Grossi, a co-author on the study, "but there is evidence of an infection link in other cancers." She noted research showing an association between H. pylori and stomach cancer, human papillomavirus and cervical cancer, and cytomegalovirus and Kaposi's sarcoma.
"The potential implications of this association of gum disease and oral cancer is enormous," said Grossi, clinical assistant professor of oral biology in the School of Dental Medicine.
"Survival from oral cancer, as with most cancers, depends on the stage of the disease at diagnosis. If further studies demonstrate that periodontal disease is a significant risk and a warning sign, screening and examinations for oral cancer can be targeted in order to improve prevention and early detection of oral cancer."
NHANES III was conducted in the general U.S. population from 1988-94 by the Centers for Disease Control and Prevention. Physical examinations of participants included an assessment of oral health, including the amount of clinical attachment loss, a measure of gum detachment from the underlying bone and a standard indicator of periodontal disease.
For this study, persons in the NHANES III database who were at least 20 years old and had a minimum of six natural teeth—a total of 13,798—were placed into one of two groups based on clinical attachment loss (a measure of gum detachment from the tooth): less or more than an average of 1.5 mm for all teeth.
Researchers then determined the presence of oral tumors (any unusual growth), pre-cancerous lesions or any kind of soft-tissue lesion (including canker sores, abrasions, redness, irritations and general sore spots) in the two groups.
Results showed that oral tumors were four times more prevalent and pre-cancerous lesions were twice as prevalent in people with periodontal disease (as assessed by clinical attachment loss) than in those without periodontal disease.
Researchers controlled for various conditions known to be risk factors for oral cancer, such as smoking, alcohol consumption, age, gender, race, education, occupation, diet and number of dental visits.
"These findings suggest strongly that infection is associated with oral cancer," Grossi said, "but they don't prove that oral infection is causally related to oral cancer. If clinical studies prove that to be true, the implications for public health would be tremendous. Additional research in this area could significantly improve oral-cancer screening and early detection programs, and help reduce mortality from oral cancer."
The first author on the study, Mine Tezal, is a doctoral student in dental epidemiology affiliated with Grossi's lab. Additional researchers were Alex Ho, oral biology statistician, and Robert J. Genco, SUNY Distinguished Professor and director of UB's Office of Science, Technology Transfer and Economic Outreach. Genco is a former chair of the Department of Oral Biology.