Risk factors for oral cancer in newly diagnosed patients aged 45 years and younger: a case–control study in Southern England

BACKGROUND: This case-control study aimed to identify the risk factors for oral cancer in patients aged 45 years and under. METHODS: Patients were recruited over a 3-year period between 1999 and 2001 from 14 hospitals in the southeast of England, UK. RESULTS: Fifty-three (80%) newly diagnosed patients with squamous cell carcinoma (SCC) of the oral cavity participated. The mean age of cases at diagnosis was 38.5 years (SD = 7.0) and 53% were male. Patients were interviewed about main risk factors of tobacco, alcohol, cannabis and their consumption of fresh fruit and vegetables in the past. Ninety-one matched control patients were also recruited. Odds ratios (ORs) and 95% confidence intervals (CI) were obtained from adjusted conditional logistic analyses. Significantly elevated ORs were evidenced amongst males who had started to smoke under the age of 16 years (OR = 14.3; 95% CI: 1.1-178.8). A significant reduction in risk was also shown for ex-smokers (OR = 0.2; 95% CI: 0.5-0.8). Consumption of alcohol in excess of recommended amounts also produced an eightfold risk in males (OR = 8.1; 95% CI: 1.6-40.1) and over a fourfold risk of oral cancer from the consumption of excessive amounts of alcohol and having ever smoked (OR = 4.4; 95% CI: 1.1-17.7). CONCLUSION: The study shows that the traditional behavioural risk factors are present in younger people diagnosed with oral cancer. The relatively short duration of exposure and the substantial number of cases without any known risk factors, particularly amongst females, however, suggest that factors other than tobacco and alcohol may also be implicated in the development of oral cancer in a proportion of these younger patients.     

The association between oral leukoplakia and use of tobacco, alcohol and that based on relative risks assessment in Kenya

A case-control study was conducted to determine the significance of tobacco, alcohol and Khat (Catlia edulis) chewing habits in the development of oral leukoplakia among Kenyans aged 15 yr and over. In a house-to-house survey, 85 cases and 141 controls matched for sex, age and cluster origin was identified and compared for these risk factors. Smoking unprocessed tobacco (Kiraiku) with a relative risk (RR) of 10.0 (95% confidence interval (CI)=2.9-38.4) and smoking cigarettes (RR = 8.4; 95% CI = 4.1-17.4) were the most significant factors. While the RR associated with smoking cigarettes alone was 4.5 (95% CI= 1.9-10.8), smoking of both products (RR= 15.2) suggested probable synergy or additive effects. Oral leukoplakia in 18 cases could not be attributed to smoking tobacco. Commercial beer, wines and spirits were relatively weak, but statistically significant, risk factors. Traditional beer, khat and chilies were not significantly associated with oral leukoplakia.     

Risk factors associated with oral lesions in HIV-infected heterosexual people and intravenous drug users in Thailand

This study aimed to identify factors associated with the presence of oral lesions in HIV-infected individuals in Thailand, to determine the influence of gender and route of HIV transmission on the prevalence of the lesions, and to investigate whether total lymphocyte cell counts can be used as a serologic marker to predict the occurrence of oral lesions. Two hundred and seventy-eight HIV-infected heterosexual persons and intravenous drug users (IVDUs) were enrolled (230 males, 48 females). Eighty-six HIV-free subjects from the same population were included as controls (61 males, 25 females). Oral candidiasis was the most common oral lesion among HIV-infected individuals (39.6%), followed by hairy leukoplakia (HL) (26.3%), exfoliative cheilitis (18.3%), and linear gingival erythema (LGE) (11.5%). Odds ratios (ORs) for factors associated with the presence of oral lesions were as follows for advanced HIV disease defined by clinical status: symptomatic stage [OR= 18.6; 95% confidence interval (CI) 7.3-47.2], AIDS stage [OR 7.3; 95% CI 3.4-15.7] and laboratory investigation of total number of lymphocyte cell counts of 1,000-2,000 cell/mm3 [OR 2.7; 95% CI 1.4-5.1] and <1,000 cell/mm3 [OR 4.0; 95% CI 2.3-7.0], alcohol consumption [OR 3.4; 95% CI 1.3-9.1], and poor oral health [OR 1.7; 95% CI 1.0-2.9]. Men were significantly more likely to have oral lesions than women. No statistically significant difference in the presence of oral lesions was observed between heterosexuals and IVDUs. This study should help predict the risk of acquiring various types of oral lesions, given that the person is exposed to multiple risk factors compared to another who is not exposed to these factors.     

Early childhood caries prevalence and associated risk factors among Saudi preschool children in Riyadh

AimTo determine the prevalence of early childhood caries (ECC) and investigate the effect of associated risk factors on ECC prevalence in preschool children in Riyadh, Saudi Arabia.MethodsThis cross-sectional study included Saudi preschoolers aged 36–71 months. Parents/guardians completed a structured, self-administered questionnaire assessing sociodemographics; medical, dental, and dietary history; and oral hygiene practices. Children were orally examined for dental caries, oral hygiene, and plaque deposition.ResultsA total of 383 children were examined. ECC prevalence was 72.6%, with a mean decayed, missing, and filled teeth (dmft) score of 4.13 (±3.99) and a mean decayed, missing, and filled surfaces (dmfs) score of 7.0 (±9.1). Children from schools in northern Riyadh and those of fathers in professional jobs were less likely to have ECC [(OR: 0.203; 95% CI: 0.082–0.503)] and [(OR: 0.472; 95% CI: 0.256–0.871)], respectively. Children with a nocturnal feeding history and poor oral hygiene were more likely to have ECC [(OR: 2.281; 95% CI: 1.143–4.553)] and [(OR: 5.523; 95% CI: 2.269–13.441)], respectively.ConclusionsThe prevalence of ECC in preschool children in Riyadh is high and affected by parental socioeconomic factors, infant feeding practices, and children’s oral hygiene status.     

The human papilloma virus, the vaccines, and oral and oropharyngeal squamous cell carcinoma: what every dentist should know

High-risk human papilloma virus (HPV) strains 16 and 18 have been shown to cause cervical cancer as well as other benign and malignant disorders. Oral and oropharyngeal squamous cell carcinoma (OOSCC) has been linked to high-risk HPV strains. Recent developments in the field of immunology have resulted in a vaccine to treat patients with HPV against cervical cancer. The widespread use of the HPV vaccine should reduce the risk of cervical cancer and could decrease the risk of OOSCC as well. This article examines the virus as well as the vaccines and how they could be used. A possible reduction in oral and oropharyngeal cancers as a result of widespread vaccination is discussed.     

Human papillomavirus as a risk factor for oral squamous cell carcinoma: a meta-analysis, 1982-1997

OBJECTIVE: Human papillomavirus (HPV) infection is a significant risk factor for uterine cervical carcinoma. However, the role of HPV infection in oral squamous cell carcinoma (OSCC) is less well defined. To determine the significance of the relationship of this virus in the progressive development of oral cancer, we estimated the risk of HPV detection in normal oral mucosa, precancerous oral tissue, and oral carcinoma using meta-analysis. STUDY DESIGN: Case reports and clinical series published in English-language journals were retrieved by searching MEDLINE (January 1980-August 1998). Review articles were also examined to identify additional studies. Studies that used biochemical, immunologic, microscopic, or molecular analyses to detect HPV in tissue or cells derived from normal oral mucosa (n = 25), benign leukoplakia (n = 21), intraepithelial neoplasia (ie, dysplasia and carcinoma in situ; n = 27), and oral cancer (n = 94) were included in the meta-analysis. Information on sample size, age, sex, method of tissue preservation (ie, fresh, frozen, paraffin-embedded), assay, primer amplification region (early, late), high-risk versus low-risk genotype, and use of tobacco or alcohol was abstracted by one author (C.S.M.). RESULTS: Data from 94 reports that analyzed 4680 samples were included in the meta-analysis. Analyses made by means of a random-effects model with and without adjustments for assay sensitivity showed increased probability of HPV detection in tissue with precancerous and cancerous features compared with normal mucosa. The likelihood of detecting HPV in normal oral mucosa (10.0%; 95% confidence interval [CI], 6.1%-14.6%) was significantly less than of detecting benign leukoplakia (22.2%; 95% CI, 15.7%-29.9%), intraepithelial neoplasia (26.2%; 95% CI, 19.6%-33.6%), verrucous carcinoma (29.5%; 95% CI, 23%-36.8%), and OSCC (46.5%; 95% CI, 37.6%-55.5%). Adjustment of findings for differences in assay sensitivity indicated that these estimates may be conservative. Overall, HPV was between 2 and 3 times more likely to be detected in precancerous oral mucosa and 4.7 times more likely to be detected in oral carcinoma than in normal mucosa. The pooled odds ratio for the subset of studies directly comparing the prevalence of HPV in normal mucosa and OSCC was 5.37, confirming the trend observed in the overall sample. The probability of detecting high-risk HPVs in OSCCs was 2.8 times greater than that of low-risk HPVs. CONCLUSION: This meta-analysis indicates that HPV is detected with increased frequency in oral dysplastic and carcinomatous epithelium in comparison with normal oral mucosa. The findings provide further quantitative evidence that oral infection with HPV, particularly with high-risk genotypes, is a significant independent risk factor for OSCC.     

Human papillomaviruses in oral squamous cell carcinoma and pre-cancerous lesions detected by PCR-based gene-chip array

Human papillomavirus (HPV) infection is a significant risk factor for uterine cervical carcinoma. Many studies have also demonstrated the presence of HPV in oral epithelia tissue, but the role of HPV infection in oral squamous cell carcinoma (OSCC) is still controversial. The aim of this study was to determine the frequency and type of HPV in OSCC and oral pre-cancerous lesions. DNA samples were collected by cytobrushing from 51 patients with OSCC, 46 with oral pre-cancerous lesions and 90 normal controls. Nested polymerase chain reaction and gene-chip arrays were used to identify the HPV types in the samples. In pre-cancerous lesions, there was a higher frequency of HPV of any type (14/46, OR = 2.844, CI = 1.186-6.816, P = 0.0216) and of low-risk HPV types (9/46, OR = 5.529, CI = 1.597-19.14, P = 0.0096) than in control samples. The prevalence of high-risk types was significantly higher in OSCC than in control lesions (11/51 vs 8/90, OR = 2.819, CI = 1.051-7.558, P = 0.0420) but this was not the case for HPV of any type (13/51 vs 12/90, OR = 2.244, CI = 0.9266-5.337, P = 0.1066). High-risk HPV types are prevalent in OSCC and may play a role in its progression, while low-risk types are associated with oral pre-cancerous lesions.     

Cigarette smoking, alcohol drinking, and oral and pharyngeal cancer mortality in Japan

Objectives:  To prospectively examine the association of cigarette smoking and alcohol drinking with oral and pharyngeal carcinogenesis, we analyzed data from a nation-wide large-scale cohort study in Japan.
Methods:  A total of 34 136 men and 43 711 women aged 40–79 years were included in the study. The Cox proportional hazard model was used to estimate the relative risk (RR) and 95% confidence interval (95% CI) of oral and pharyngeal cancer for smoking and drinking by sex, while adjusting for age, consumption of green tea, preference for salty foods, and consumption of green yellow vegetables.
Results:  Current smokers were found to have a higher risk of death caused by oral and pharyngeal cancer compared with non-smokers in both sexes: the RR was 2.6 (95% CI: 1.0–6.7) in men and 8.2 (95% CI: 2.1–32.1) in women. Men who drank more than 46 g ethanol per day had an approximately threefold increased risk of oral and pharyngeal cancer. Simultaneous exposure to both factors was significantly associated with an elevated risk of oral and pharyngeal cancer (RR: 3.3, 95% CI: 1.1–9.6).
Conclusions:  The result supports the carcinogenic effect of cigarette smoking and alcohol drinking on the oral cavity and pharynx.     

HPV DNA in clinically different variants of oral leukoplakia and lichen planus

OBJECTIVES: Our objectives were to determine the prevalence of human papillomavirus (HPV) infection in oral leukoplakia (OL) and oral lichen planus (OLP) in comparison with that in healthy oral mucosa, also conditionally to age, gender, smoking, and drinking habits of patients, so as to investigate any possible association of HPV infection with a specific clinical variant of OL or OLP. STUDY DESIGN: We did research on HPV DNA in 68 cases of OL (homogeneous form [H] in 45 cases and nonhomogeneous form [non-H] in 23 cases), and in 71 cases of OLP (nonatrophic/erosive form [non-AE] in 27 cases, atrophic/erosive form [AE] in 44 cases). HPV DNA was investigated in exfoliated oral mucosa cells by nested PCR (nPCR: MY09-MY11/GP5-GP6) and the HPV genotype determined by direct DNA sequencing. RESULTS: HPV DNA was found in 17.6% of OL, in 19.7% of OLP, and in 5.6% of controls, with a statistically significant higher risk of HPV infection in both lesion groups (for OL: P=.01; Odds Ratio [OR]=3.64; 95% CI: 1.21-10.80; for OLP: P=.005; OR=4.17; 95% CI: 1.41-12.18). Demographic variables analysis showed that the only significant association was between HPV status and current smoking in OL patients (OR'=3.40; 95% CI: 1.0-11.59). HPV DNA was found in 20% of H OL and 13% of non-H OL, without any association with the clinical variant (P=.73; OR=0.60; 95% CI: 0.14-2.48). HPV DNA was found in 18.5% of non-AE OLP and 20.4% of AE OLP, without any significant association with the clinical variant (P=.84; OR=1.13; 95% CI: 0.335-3.816). HPV-18 was the most frequently detected genotype (9/12 and 10/14 of HPV-positive OL and OLP, respectively), followed by HPV-16 (2/12 OL and 2/14 OLP), HPV-33 (1/12 OL), HPV-31 (1/14 OLP), and HPV-6 (1/14 OLP). CONCLUSIONS: An increased risk of HPV infection was found in OL and OLP; however, no specific clinical variant of OL or OLP was noted to be associated with HPV infection. It is not possible to predict the likelihood of HPV infection from the clinical features of OL and OLP.     

Relationship between cognitive impairment and oral health: results of the Health 2000 Health Examination Survey in Finland

OBJECTIVE: The aim was to study oral health in relation to cognitive impairment in the general population. MATERIAL AND METHODS: The study population comprised 2320 persons aged 55 years or older who participated in a nationally representative Health 2000 Health Examination Survey in Finland. The data were collected by interviews and clinical oral examinations. Cognition was assessed using a shortened version of the Mini-Mental State Examination (score 0-16). Poisson regression models were used to estimate the relative risk (RR) for continuous variables and logistic regression models to estimate the odds ratio (OR) for dichotomized variables. RESULTS: The results show that individuals with cognitive impairment have more carious teeth (MMSE 11-10: RR: 1.3, CI: 0.9-1.7, MMSE 9-0: RR: 1.5 CI: 1.0-2.4) than healthy persons. Furthermore, compared to cognitively healthy subjects, those with MMSE 9-0 more often have no teeth and no dentures (OR: 5.2, CI: 1.0-26.6) and less often good denture hygiene (OR: 0.4, CI: 0.2-0.7). CONCLUSION: Cognitively impaired subjects among older adults in Finland have more carious teeth, are more often edentulous without using a denture, and have poorer denture hygiene than cognitively healthy persons.     

Hierarchizing caries risk factors among first-year university students in Nice (France): a cross-sectional study

Background

The purpose of this study was to rank the risk factors for dental caries among first-year university students in Nice (France).

Methods

All first-year students are required to undergo a compulsory preventive medical examination. Among these students, volunteers were offered a dental visit. Information was collected through an interview followed by an oral examination. We assessed the volunteers’ oral hygiene habits (daily toothbrushing frequency, type of toothbrush used, frequency of toothbrush replacement, place of toothpaste purchase, and flossing), daily health-related behaviors (number of main daily meals, daily sugary intakes, smoking, alcohol consumption, consumption of cannabis or other drugs), oral-health-related behaviors (self-reported oral health, dental visits during the past year, reason for the last dental consultation, and failure to seek dental care due to financial reasons), and oral health issues (dental crowding, oral hygiene, presence of caries, presence of pit and fissure sealant remnants). The dependent variable was the presence of at least one untreated carious lesion. The data were subjected to univariate analyses to select explanatory variables, and subsequently, a logistic regression was performed.

Results

Six hundred twenty-nine students aged 18.8±1.6 years were enrolled in this study. The sex ratio was 0.72, with a strong predominance of the female gender. Only 59.3% of the students had never experienced dental caries, while 22.4% had already undergone restorative procedures and did not have any carious lesion at the time of the examination, and 11.6% presented with carious lesions and had never been treated by a dentist. Lastly, 6.7% had carious lesions despite evidence of prior restorative procedures. The multivariate analysis revealed the following pejorative risk factors: failure to seek dental care due to financial reasons (OR:3.06, 95% CI: 1.40–6.70), poor oral hygiene revealed during the oral examination (OR:2.59, 95% CI: 1.60–4.20), and poor self-reported oral health (OR:2.43, 95% CI: 1.24–4.77). Conversely, the analysis revealed the following protective factors: preventive visits to the dentist (OR:0.63, 95% CI: 0.41–0.99), the use of an electric toothbrush (OR:0.36, 95% CI: 0.17–0.77), and sealant remnants (OR:0.22, 95% CI: 0.05–0.97).

Conclusions

The highest-ranking caries risk factor for the study population was the financial barrier.

     

Assessment of risk factors for oral leukoplakia in West Virginia

OBJECTIVE: To assess risk factors associated with oral leukoplakia in a US population with high use of smoked tobacco and smokeless tobacco. METHODS: The RJ Gorlin Leukoplakia Tissue Registry was used to identify individuals with oral leukoplakia in West Virginia, USA. This case-control study consisted of 90 cases with oral leukoplakia and 78 controls with periapical cysts. Univariate-univariable (one dependent variable and one independent variable) and univariate-multivariable (one dependent variable and multiple independent variables) logistic regression modeling quantified the association between oral leukoplakia and potential explanatory variables. RESULTS: Unadjusted measures of association indicate that those with oral leukoplakia were more likely to be older [odds ratio of crude: OR(Crude) = 2.72; 95% confidence interval (CI): 1.45-5.11], more likely to currently use smokeless tobacco (OR(Crude) = 3.16; 95% CI: 1.10-9.07), and more likely to currently use snuff (OR(Crude) = 8.32; 95% CI: 1.83-37.80). Individuals currently using smokeless tobacco or currently using snuff were more likely to have oral leukoplakia [adjusted odds ratio, OR(Adj) = 9.21 and 30.08; 95% CI: 1.49-57.00 and 2.67-338.48, respectively], after simultaneously adjusting for age, gender, currently using smoked tobacco, currently using alcohol daily, and dental prostheses use. CONCLUSIONS: Generalizability is an issue when studying risk factors associated with oral leukoplakia because of geographical variations in the composition of smokeless tobacco (i.e. betel, lime, ash, and N-nitrosamines) and cultural variations in the use of tobacco (i.e. reverse smoking). Snuff was the main smokeless tobacco product currently used in West Virginia, and was strongly associated with oral leukoplakia, after adjusting for potential explanatory variables.     

Familial risk in oral and pharyngeal cancer

We examined the relationship between a family history of cancer and risk of roal and pharyngeal cancer using epidemiological data from a large case-control investigation of these tumours. 487 (45.7%) of the cases and 485 (41.0%) of the controls reported cancer in a parent or a sibling. After controlling for age, race, sex, study location, respondent status and smoking and alcohol use, the OR associated with any cancer in the family was 1.1 [95% confidence interval (CI) 0.9–1.3]. Risks were non-significantly elevated among those with a history of cancers arising from the oral cavity/pharynx (OR = 1.2, 95% CI 0.7–2.3), oesophagus/larynx (OR = 1.6, 95% CI 0.7–3.8) and lung (OR = 1.2, 95% CI 0.8–1.8), with the excess risk primarily among those for whom a male relative, particularly a brother, was affected with these smoking-related cancers. In addition, an elevated risk of oral/pharynx cancer was found among those whose sisters developed other cancers (OR = 1.6, 95% CI 1.1–2.2). Subsite analyses revealed stronger elevated risks of smoking-related cancers in relatives of pharyngeal cancer cases (OR = 1.7, 95% CI 1.1–2.8) than of oral cancer patients. The data indicate that there is at most a weak familial aggregation of oral/pharynx cancers. Furthermore, since the excess familial risk of oral/pharynx cancer was associated with smoking-related cancers among male but not female relatives, it seems likely that environmental factors (notably smoking and drinking) contribute to the familial tendency observed in this study. The results underscore the need to collect risk profile information on relatives in future studies to disentangle genetic from environmental determinants.     

Interaction between the MTHFR C677T polymorphism and alcohol--impact on oral cancer risk and multiple DNA methylation of tumor-related genes

Several studies have reported Oral Squamous Cell Carcinoma (OSCC) association with etiological factors, such as smoking and alcohol. The aim of the present study was to establish whether the methylenetetrahydrofolate reductase (MTHFR) C677T genotype and a high alcohol intake, solely or in interaction, have an impact on the oral cancer risk, DNA methylation, or multiple methylation of tumor-related genes. MTHFR C677T genetic polymorphism was determined by the PCR/RFLP method, and DNA methylation was assessed by nested methylation-specific PCR. The risk for multiple methylation was significantly increased in heavy-drinking patients with the TT genotype, compared with CC and CT patients (OR = 10.873; 95% CI, 1.134-104.24). Multiple methylation was significantly associated with tumor stage (p = 0.018), and showed a trend of association with the presence of nodal metastases (p = 0.058). A significant association was found between TT genotype and methylation status of the RASSF1A gene in OSCC patients (p = 0.012). Heavy-drinking individuals with the TT genotype showed increased oral cancer risk compared with the CC genotype (OR = 3.601; 95% CI, 1.036-12.513), and compared with the CC and CT genotypes (OR = 4.288; 95% CI, 1.325-13.877). Our study suggested gene-environment interactions between high alcohol intake and the MTHFR 677TT genotype for elevated oral cancer risk, with a significant impact on multiple methylation of cancer-related genes.     

Risk indicators for tooth loss due to periodontal disease

BACKGROUND: Several risk indicators for periodontal disease severity have been identified. The association of these factors with tooth loss for periodontal reasons was investigated in this cross-sectional comparative study. METHODS: All extractions performed in 21 general dental practice clinics (25% of such clinics in Kuwait) over a 30-day period were recorded. Documented information included patient age and gender, medical history findings, dental maintenance history, toothbrushing frequency, types and numbers of extracted teeth, and the reason for the extraction. Reasons were divided into periodontal disease versus other reasons in univariate and binary logistic regression analyses. RESULTS: A total of 1,775 patients had 3,694 teeth extracted. More teeth per patient were lost due to periodontal disease than for other reasons (2.8 +/- 0.2 versus 1.8 +/- 0.1; P <0.001). Factors significantly associated with tooth loss due to periodontal reasons in logistic regression analysis were age >35 years (odds ratio [OR] 3.45; 95% confidence interval [CI] 2.79 to 4.26), male gender (OR 1.42; 95% CI 1.17 to 1.73), never having periodontal maintenance (OR 1.48; 95% CI 1.23 to 1.78), never using a toothbrush (OR 1.81; 95% CI 1.49 to 2.20), current or past smoking (OR 1.56; 95% CI 1.28 to 1.91), anterior tooth type (OR 3.23; 95% CI 2.57 to 4.05), and the presence of either of the following medical conditions: diabetes mellitus (OR 2.64; 95% CI 2.19 to 3.18), hypertension (OR 1.73; 95% CI 1.41 to 2.13), or rheumatoid arthritis (OR 4.19; 95% CI 2.17 to 8.11). CONCLUSION: Tooth loss due to periodontal disease is associated with the risk indicators of age, male gender, smoking, lack of professional maintenance, inadequate oral hygiene, diabetes mellitus, hypertension, rheumatoid arthritis, and anterior tooth type.     

A prospective study of social support, anger expression and risk of periodontitis in men

BACKGROUND: Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance and potentially increased risk of periodontitis. METHODS: The authors examined the association between social support, anger expression and periodontitis in 42,523 male, U.S.-based, health professionals. Subjects were aged 40 to 75 years in 1986, and more than half were dentists. The men were free of a diagnosis of periodontitis at the start of follow-up in 1996. RESULTS: Subjects who reported having at least one close friend had a 30 percent lower risk of developing periodontitis compared with those who did not have a close friend (relative risk, or RR = 0.70; 95 percent confidence interval, or CI, 0.51-0.96). Men who participated in religious meetings or services had a 27 percent lower risk of developing periodontitis compared with men who did not participate in religious meetings (RR = 0.73; 95 percent CI, 0.64-0.83). After the authors adjusted for potential confounding variables, men whose anger scores were in the top quintile were 72 percent more likely to report having periodontitis compared with men whose scores were in the lowest quintile (RR = 1.72; 95 percent CI, 1.39-2.12). Men who reported being angry on a daily basis had a 43 percent higher risk of developing periodontitis compared with men who reported being angry seldom. CONCLUSION: Reduced social isolation and anger expression may play an important role in maintaining oral health, as well as general health and well-being. CLINICAL IMPLICATIONS: When treating patients with periodontitis, clinicians should be cognizant of the social and behavioral factors that may affect oral health.     

The effect of alcohol consumption on periodontal disease

BACKGROUND: Alcohol consumption, like smoking, may be related to periodontal disease independently of oral hygiene status. This study assessed the relationship between alcohol consumption and severity of periodontal disease. METHODS: A cross-sectional study of 1,371 subjects ages 25 to 74 in the Erie County, NY population was performed. Alcohol intake was assessed by means of previously validated self-reported questionnaires. Outcome variables were gingival bleeding, clinical attachment loss, alveolar bone loss, and presence of subgingival microorganisms. RESULTS: Logistic regression analyses adjusting for age, gender, race, education, income, smoking, diabetes mellitus, dental plaque, and presence of any of 8 subgingival microorganisms showed that those consuming > or =5 drinks/week had an odds ratio (OR) of 1.65 (95% CI: 1.22 to 2.23) of having higher gingival bleeding, and OR of 1.36 (95% CI: 1.02 to 1.80) of having more severe clinical attachment loss compared to those consuming <5 drinks/week. Those consuming > or =10 drinks/week had an odds ratio (OR) of 1.62 (95% CI: 1.12 to 2.33) of having higher gingival bleeding and OR of 1.44 (95% CI: 1.04 to 2.00) of having more severe clinical attachment loss compared to those consuming <10 drinks/week. Alcohol consumption was not significantly related to alveolar bone loss nor to any of the subgingival microorganisms. CONCLUSIONS: The results suggest that alcohol consumption is associated with moderately increased severity of periodontal disease. Longitudinal studies are needed to determine whether alcohol is a true risk factor for periodontal disease.     

Comparison between Erich arch bars and intermaxillary screws in maxillofacial fractures involving the dental occlusion: a meta-analysis

This systematic review aimed to compare the Erich arch bars (EABs) with intermaxillary fixation (IMF) screws in maxillofacial fractures involving dental occlusion on perioperative parameters. Four electronic databases were searched: MedLine (Pubmed), Web of Science, VHL, and Cochrane Library. Inclusion criteria comprised clinical trials comparing the two IMF methods, assessing at least one of the outcomes: occlusal stability, oral hygiene, quality of life, time to apply and remove IMF appliances, and complications. Risk of bias was evaluated through the Cochrane risk of bias tool. Fifteen papers were included in the qualitative analysis and 12 of those in the meta-analysis. Times for EABs application (mean difference (MD) 46.83; 95% confidence interval (CI): 30.63–63.02) and removal (MD 22.89; 95% CI 14.61–31.17) were longer compared with IMF screws. There is higher risk of glove perforation (risk ratio (RR) 3.81; 95% CI 2.41–6.04) and lower risk of iatrogenic injuries (RR 0.21; 95% CI 0.09–0.48) when placing EABs compared with IMF screws. No significant differences in plaque index were found (MD 1.07; 95% CI -0.17 to 2.31). The quality of this evidence ranged from very low to low and was mainly compromised by risk of bias assessment. Further studies are necessary to evaluate transurgical IMF stability and postoperative occlusal quality and quality of life when comparing EABs with IMF screws.     

Chronic stress, depression, and cortisol levels as risk indicators of elevated plaque and gingivitis levels in individuals aged 50 years and older

BACKGROUND: The role of psychoneuroimmunological factors in oral hygiene has been overlooked in the dental literature. Our objective was to evaluate the effects of stress, depression, and cortisol levels in dental plaque accumulation and gingivitis in a population of individuals aged >or=50 years. METHODS: In this cross-sectional study, 230 subjects, selected from caregivers of demented patient groups and from social activities groups of Porto Alegre, Brazil, were evaluated. Stress was evaluated with the Lipp stress inventory, whereas depressive symptoms were assessed using the Beck depression inventory. Three saliva samples (at 8, 12, and 20 hours) were collected for cortisol analysis by means of radioimmunoassay. Cortisol levels were expressed as the area under the curve of the three samples for each patient. Multivariate logistic regression was performed with the visible plaque index and gingival bleeding index as outcomes. RESULTS: The mean age of subjects was 61.6 +/- 8.2 years, mean monthly income in United States dollars (US dollars) was US 668 +/- 590, and mean cortisol level was 22.1 +/- 33.7 nmol/l. A total of 51.5% of the individuals were caregivers; 9.4% were smokers, and 25.5% used interdental floss/brush. Being a caregiver (odds ratio [OR] = 3.97; 95% confidence interval [95% CI] = 2.08 to 7.54), using an interdental brush (OR = 0.23; 95% CI = 0.11 to 0.47), cortisol (OR = 2.03; 95% CI = 1.09 to 3.81), and stress (OR = 1.45; 95% CI = 1.03 to 2.02) were all significantly associated with visible plaque index >mean (43%). Being a caregiver (OR = 2.35; 95% CI = 1.13 to 4.86), using an interdental brush (OR = 0.32; 95% CI = 0.13 to 0.77), smoking (OR = 0.26; 95% CI = 0.08 to 0.89), stress (OR = 1.78; 95% CI =1.31 to 2.38), and visible plaque index (mean) (OR = 12.87; 95% CI = 6.29 to 26.31) were significantly associated with a gingival bleeding index > mean (37%). CONCLUSION: Stress was a significant risk indicator of elevated levels of plaque and gingivitis, whereas cortisol was a risk indicator of plaque in the sample after controlling for confounders.