Tooth loss and cancer mortality in Cancer Prevention Study-I Open Access

Abstract

Background: Oral health has been associated with cancer risk, but prospective data are limited, and residual confounding by smoking remains a concern.

Methods: Cox proportional hazard regression was used to estimate multivariable-adjusted hazard ratios (HRs) for tooth loss associated with death from specific cancer types among 879,595 Cancer Prevention Study I participants who provided information about tobacco use and tooth loss and were cancer free at baseline in 1959.

Results: During follow up through 1972, there were 29,711 cancer-related deaths, including 14,041 in never smokers. Loss of eight teeth was associated with a higher risk of dying from cancers of the head and neck (HR=1.13; 95% confidence interval (CI), 1.07-1.20), esophagus (HR=1.12; 95%CI, 1.04-1.22), stomach (HR=1.06; 95%CI, 1.02-1.10), liver (HR=1.16; 95%CI, 1.08-1.24), pancreas (HR=1.04; 95%CI, 1.01-1.08), lung (HR=1.12; 95% CI, 1.10-1.15), cervix (HR=1.10; 95%CI, 1.02-1.19), and bladder (HR=1.13; 95%CI, 1.07-1.20). Among nonsmokers, tooth loss was positively associated with death from cancer of the head and neck (per 8 teeth lost, HR=1.13; 95% CI, 0.99-1.28), esophageal cancer (per 8 teeth, HR=1.22; 95%CI, 1.04-1.43), liver cancer (HR=1.11; 95%CI, 1.00-1.22), and lung cancer (per 8 teeth, HR=1.06; 95%CI: 1.00-1.12).   

Conclusions: Our results support an association, independent of smoking, between tooth loss and death from cancers of esophagus, head and neck, liver, and possibly lung. Increasing evidence that oral health affects cancer risk and mortality may indicate a possible role of dental care in the prevention of cancer. 

Table of Contents

Chapter 1: Background and Introduction                                                                 1-10

Chapter 2: Tooth Loss and Cancer Mortality in Cancer Prevention Study-I     11-25

Chapter 3: Public Health Implications                                                                      26

Tables                                                                                                                        27-33

References                                                                                                                 34-51

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Oncology Health Sciences, Epidemiology
Keyword	cancer tooth loss periodontitis
Committee Chair / Thesis Advisor	Veronika Fedirko, PhD, Emory University
Committee Members	Eric Jacobs, PhD, American Cancer Society

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