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Chronic gum disease associated with tongue cancer

The JAMA Network Journals

Men with chronic gum disease may have an increased risk of tongue cancer, regardless of whether they smoke, according to a report in the May issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.

More than 7,300 Americans died from oral cancer in 2006, according to background information in the article. "Considerable evidence indicates that chronic infections and persistent inflammation are associated with increased cancer risk," the authors write. "Although viral infections have been associated with carcinogenesis [the development of cancer], the evidence for a connection between bacterial infections and carcinogenesis is also convincing." The gum disease periodontitis is an oral infection thought to be caused by bacteria, though recent evidence suggests the involvement of viruses as well.

Mine Tezal, D.D.S., Ph.D., and colleagues at the State University of New York at Buffalo and the Roswell Park Cancer Institute, Buffalo, compared 51 white men with tongue cancer to 54 white men without, all of whom were treated at the cancer institute between 1999 and 2005. Periodontitis was assessed in panoramic X-rays of the mouth by calculating the amount of bone loss in the tooth cavities (alveoli), an established measure of the disease's history and progression.

"The mean [average] alveolar bone loss was significantly higher in cancer cases compared with controls (4.21 vs. 2.74 millimeters)," the authors write. "After adjusting for the effects of age, smoking status and the number of teeth, each millimeter of alveolar bone loss was significantly associated with a 5.23-fold increase in the risk of tongue cancer. Other oral variables (the number of dental decays, fillings, crowns and root canal treatments) were not significantly associated with the risk for tongue cancer."

Periodontal viruses and bacteria could be toxic to surrounding cells and produce changes that lead directly to oral cancer, or could indirectly contribute to cancer through inflammation, the authors note. "We have presented preliminary data suggesting an independent association between history of periodontitis and the risk of tongue cancer. This association needs to be confirmed by larger studies that include other oral cancer sites, women and subjects of other races with a more comprehensive assessment of confounding," including factors such as lifelong tobacco use, they write. "If this association is confirmed, it has a potential impact on understanding the etiology of oral cancer as well as on its prevention and control."

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(Arch Otolaryngol Head Neck Surg. 2007;133:450-454. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by a grant from the National Institute of Dental and Craniofacial Research and a grant from the National Cancer Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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