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ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 8  |  Page : 237-240

Correlation between periodontal disease and oral cancer risk: A meta-analysis


Department of Stomatology, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000, PR China

Date of Web Publication22-Feb-2017

Correspondence Address:
Lili Ye
Department of Stomatology, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.200746

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 > Abstract 

Objective: The purpose of this study is to investigate the correlation between periodontal disease and oral cancer risk by meta-analysis.
Methods: We searched the electronic databases of PubMed and Wanfang to include the articles related to periodontal disease and oral cancer risk. The association between periodontal disease and oral cancer risk was assessed by odds ratio (OR) and its corresponding 95% confidence interval (95% CI). The publication bias was evaluated by Begg's funnel plot and Egger's line regression test. All the data analysis was done by STATA12.0 software (Stata Corporation, College Station, TX, USA).
Results: Eleven case–control studies were included in our present meta-analysis. We found significant statistical heterogeneity was existed in our present meta-analysis (I2 = 99.8%, P < 0.05). Hence, the data were pooled by random effect model. The pooled results indicated a significant correlation between periodontal disease and oral cancer risk was found with OR = 3.21 and the 95% CI = 2.25–4.16 (P < 0.05). The Begg's funnel plot was obvious asymmetric indicating significant publication bias. Moreover, further Egger's line regression test also indicated significant publications (t = 3.35, P < 0.05).
Conclusion: Our present meta-analysis indicated that periodontal disease can increase the oral cancer risk by nearly 2-fold.

Keywords: Meta-analysis, oral cancer, periodontal disease


How to cite this article:
Ye L, Jiang Y, Liu W, Tao H. Correlation between periodontal disease and oral cancer risk: A meta-analysis. J Can Res Ther 2016;12, Suppl S4:237-40

How to cite this URL:
Ye L, Jiang Y, Liu W, Tao H. Correlation between periodontal disease and oral cancer risk: A meta-analysis. J Can Res Ther [serial online] 2016 [cited 2021 Nov 28];12:237-40. Available from: https://www.cancerjournal.net/text.asp?2016/12/8/237/200746


 > Introduction Top


Oral cancer originating in any of the tissues in the mouths or any cancerous tissue growth located in the oral cavity is a type of head and neck cancer.[1] It is reported that about 75% oral cancers were related to bad living habits such as tobacco use and excessive alcohol consumption.[2] Moreover, other risk factors for oral cancer are poor oral hygiene, irritation caused by ill-fitting dentures and other rough surfaces on the teeth, poor nutrition, and some chronic infections caused by fungi, bacteria, or viruses.[3]

Several studies have also found that periodontal disease may increase the risk of developing oral cancer.[4],[5],[6] However, the each related studies have small number of patients with limited statistical power. In the present study, we collected the published data further analysis evaluate the association between periodontal disease and oral cancer risk meta-analysis.


 > Methods Top


Paper searching

We searched the electronic databases of PubMed and Wanfang to include the articles related to periodontal disease and oral cancer risk using the text word of “oral cancer,” “mouth cancer,” “oral squamous cell carcinoma,” and “periodontal disease.” The searching process was performed by two reviewers independently.

Inclusion and exclusion criteria

Inclusion criteria as follows: (1) study type was case–control study or cohort study; (2) oral cancer diagnosis was confirmed by pathology; (3) the odds ratio (OR) and its 95% confidence interval (CI) was provided by each include studies; and (4) paper published in Chinese or English. Exclusion criteria as follows: (1) case report or reviewer study type; (2) duplicated publications; (3) not provided the OR and 95% CI or cannot calculated the OR with the original data; and (4) published in other languages.

Data extraction

Data of each included studies were extracted by two reviewers independently. The author name, year of the paper published, number of cases included in each study, study type, OR, and its corresponding 95% CI and adjusted factors were extracted.

Statistical analysis

The data analysis was performed by STATA12.0 software (Stata Corporation, College Station, TX, USA). The correlation between periodontal disease and oral cancer risk was demonstrated by OR and its corresponding 95% CI. P <0.05 was statistical significance.


 > Results Top


Publication characteristics

Eleven papers were included in our present study as shown in [Table 1]. All the studies are designed as case–control study. All of the studies were published in English and carried out between 1990 and 2013. The subjects number range from 101 to 1361 with the highest OR of 5.23 and lowest of 1.06. Most of the included studies adjusted for age, gender, smoking, and drinking [Table 1].
Table 1: The general characteristics of included study

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Meta-analysis

First, we evaluated the statistical heterogeneity among the included 11 studies by Chi-square. We found significant statistical heterogeneity was existed in our present meta-analysis (I2 = 99.8%, P < 0.05). Hence, the data were pooled by random effect model. The pooled results indicated a significant correlation between periodontal disease and oral cancer risk was found with OR = 3.21 and the 95% CI = 2.25–4.16 (P < 0.05). This result indicated that periodontal disease can increase the oral cancer risk by nearly 2-fold [Figure 1].
Figure 1: The forest plot for evaluation the correlation between periodontal disease and oral cancer risk

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Publication bias

We use the Begg's funnel plot and Egger's line regression test to investigate the publication bias. The Begg's funnel plot was obvious asymmetric indicating significant publication bias. And further Egger's line regression test also indicated significant publications (t = 3.35, P < 0.05) [Figure 2].
Figure 2: The Begg's funnel plot for publication bias evaluation

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 > Discussion Top


Periodontal disease is a kind of disease caused by bacterial infection with the clinical features of gingivitis, periodontal tissue damage, and progressive resorption of alveolar bone. The prevalence of periodontal disease is different between races and regions, but its morbidity is increased with the increase of age. The epidemiology study indicated that the periodontal disease incidence was as high as 90%, but the severe periodontal disease incidence was about 10% for the general population.[15] It has been confirmed that the risk factors for periodontal disease were age, race, gender, body mass index, smoking, alcohol consumption, diabetes mellitus, etc.[16]

Oral cancer is the 15th most diagnosed malignant carcinoma with the incidence rate of 3.9/100,000.[9] Oral cancer has become a major public health problem in the worldwide for its increasing incidence and mortality, especially younger trends. In general, the 5-year survival rate for oral cancer was more than 50%.[17],[18] And recently, for the progress of chemoradiation therapy, the 5-year survival rate was on the raise. The early diagnosis and treatment for oral cancer are essential for prognosis. Thereafter, screening the risk factors for oral cancer is important for its prevention. It is reported that about 75% oral cancers were associated with bad living habits such as smoking and excessive alcohol consumption.[10] Moreover, other risk factors for oral cancer are poor oral hygiene, irritation caused by ill-fitting dentures and other rough surfaces on the teeth, poor nutrition, and some chronic infections caused by fungi, bacteria, or viruses. Several studies have also found that periodontal disease may increase the risk of developing oral cancer. However, the each related studies have small number of patients with limited statistical power. We searched the open published studies related to periodontal disease and oral cancer risk. We found 11 case–control studies in our present meta-analysis. We found significant statistical heterogeneity was existed in our present meta-analysis (I2 = 99.8%, P < 0.05). Hence, the data were pooled by random effect model. The pooled results indicated a significant correlation between periodontal disease and oral cancer risk was found with OR = 3.21 and the 95% CI = 2.25–4.16 (P < 0.05). This results indicated that periodontal disease can increase the oral cancer risk by nearly 2-fold.

However, several limitations were existed in our present meta-analysis. The first limitation is heterogeneity, because of the significant statistical heterogeneity; the results should be interpreted cautiously. The second limitation is publication bias; obvious publication made the results unstable. The third limitation is ununified adjusted factors. Thereafter, for the above limitations, well-designed cohort study is needed for further evaluate the correlation between periodontal disease and oral cancer risk.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

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Santosh AB, Jones T, Harvey J. A review on oral cancer biomarkers: Understanding the past and learning from the present. J Cancer Res Ther 2016;12:486-92.  Back to cited text no. 1
    
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Patel JB, Shah FD, Joshi GM, Patel PS. Clinical significance of inflammatory mediators in the pathogenesis of oral cancer. J Cancer Res Ther 2016;12:447-57.  Back to cited text no. 3
    
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Marshall JR, Graham S, Haughey BP, Shedd D, O'Shea R, Brasure J, et al. Smoking, alcohol, dentition and diet in the epidemiology of oral cancer. Eur J Cancer B Oral Oncol 1992;28B:9-15.  Back to cited text no. 4
    
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Talamini R, Vaccarella S, Barbone F, Tavani A, La Vecchia C, Herrero R, et al. Oral hygiene, dentition, sexual habits and risk of oral cancer. Br J Cancer 2000;83:1238-42.  Back to cited text no. 5
    
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Guha N, Boffetta P, Wünsch Filho V, Eluf Neto J, Shangina O, Zaridze D, et al. Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: Results of two multicentric case-control studies. Am J Epidemiol 2007;166:1159-73.  Back to cited text no. 6
    
7.
Zheng TZ, Boyle P, Hu HF, Duan J, Jian PJ, Ma DQ, et al. Dentition, oral hygiene, and risk of oral cancer: A case-control study in Beijing, People's Republic of China. Cancer Causes Control 1990;1:235-41.  Back to cited text no. 7
    
8.
Bundgaard T, Wildt J, Frydenberg M, Elbrønd O, Nielsen JE. Case-control study of squamous cell cancer of the oral cavity in Denmark. Cancer Causes Control 1995;6:57-67.  Back to cited text no. 8
    
9.
Garrote LF, Herrero R, Reyes RM, Vaccarella S, Anta JL, Ferbeye L, et al. Risk factors for cancer of the oral cavity and oro-pharynx in Cuba. Br J Cancer 2001;85:46-54.  Back to cited text no. 9
    
10.
Rosenquist K, Wennerberg J, Schildt EB, Bladström A, Göran Hansson B, Andersson G. Oral status, oral infections and some lifestyle factors as risk factors for oral and oropharyngeal squamous cell carcinoma. A population-based case-control study in southern Sweden. Acta Otolaryngol 2005;125:1327-36.  Back to cited text no. 10
    
11.
Tezal M, Sullivan MA, Reid ME, Marshall JR, Hyland A, Loree T, et al. Chronic periodontitis and the risk of tongue cancer. Arch Otolaryngol Head Neck Surg 2007;133:450-4.  Back to cited text no. 11
    
12.
Tezal M, Sullivan MA, Hyland A, Marshall JR, Stoler D, Reid ME, et al. Chronic periodontitis and the incidence of head and neck squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 2009;18:2406-12.  Back to cited text no. 12
    
13.
Divaris K, Olshan AF, Smith J, Bell ME, Weissler MC, Funkhouser WK, et al. Oral health and risk for head and neck squamous cell carcinoma: The Carolina Head and Neck Cancer Study. Cancer Causes Control 2010;21:567-75.  Back to cited text no. 13
    
14.
Ansai T, Takata Y, Yoshida A, Soh I, Awano S, Hamasaki T, et al. Association between tooth loss and orodigestive cancer mortality in an 80-year-old community-dwelling Japanese population: A 12-year prospective study. BMC Public Health 2013;13:814.  Back to cited text no. 14
    
15.
Ebersole JL, Graves CL, Gonzalez OA, Dawson D 3rd, Morford LA, Huja PE, et al. Aging, inflammation, immunity and periodontal disease. Periodontol 2000 2016;72:54-75.  Back to cited text no. 15
    
16.
Chatzopoulos G. Smoking, smokeless tobacco, and alcohol consumption as contributing factors to periodontal disease. Northwest Dent 2016;95:37-41.  Back to cited text no. 16
    
17.
Buglione M, Cavagnini R, Di Rosario F, Maddalo M, Vassalli L, Grisanti S, et al. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement. Crit Rev Oncol Hematol 2016;102:47-54.  Back to cited text no. 17
    
18.
Sultana J, Bashar A, Molla MR. New management strategies of oral tongue cancer in Bangladesh. J Maxillofac Oral Surg 2014;13:394-400.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]


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