Associations Between Poor Oral Health and Risk of Squamous Cell Carcinoma of the Head and Neck: A Meta-Analysis of Observational Studies

Publication date: Available online 24 October 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Shuai Xu Resident, Gang Zhang, Chao Xia, Ying-hui Tan

Abstract

Purpose

Many epidemiological studies have reported an association of poor oral health, especially periodontal disease (PD) and tooth loss, with the risk of squamous cell carcinoma of the head and neck (SCCHN). However, these studies have yielded inconsistent results. Therefore, we investigated whether poor oral health is an independent predictor of SCCHN through a meta-analysis of observational studies.

Methods

We systematically searched the PubMed, EMBASE, and Cochrane Library databases for relevant observational studies of the association between oral health and risk of SCCHN conducted up to October 2017. The meta-analysis was conducted using STATA 12.0 software. A fixed- or random-effects model was applied to evaluate pooled risk estimates, and sensitivity and subgroup analyses were performed to identify sources of heterogeneity and pooled estimation. Publication bias was assessed using Begg's test, Egger's test, and funnel plots.

Results

We identified 27 relevant observational studies, comprising 24 case-control studies, two prospective studies, and one cross-sectional study, with 26,750 participants. Notably, oral health correlated significantly with SCCHN [odds ratio (OR) = 2.24; 95% confidence interval (CI), 1.77–2.82]. In subgroup analyses, subjects with PD (OR = 2.52; 95% CI, 1.43–4.44) had a higher risk of developing SCCHN, compared to those with tooth loss (OR = 2.13; 95% CI, 1.63–2.78). The risk estimates exhibited substantial heterogeneity. Evidence of publication bias was limited.

Conclusion

The results of this meta-analysis suggest that subjects with tooth loss or PD may face a significant and independent risk of SCCHN, even after adjusting for smoking and alcohol consumption. However, the pooled estimates from observational studies could not establish a causative relationship between PD, tooth loss, and SCCHN. Additional investigations of this correlation are warranted.

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