A review of the relationship between tooth loss, periodontal disease, and cancer

Abstract

Recent studies have investigated the association between periodontal disease, tooth loss, and several systemic diseases including cancer, cardiovascular disease, and preterm birth. Periodontal disease, a chronic inflammatory condition, is highly prevalent in adult populations around the world, and may be preventable. Estimates of prevalence vary between races and geographic regions, with a marked increase in the occurrence of periodontal disease with advancing age. Worldwide estimates for the prevalence of severe periodontal disease generally range from 10 to 15%. The relationship between oral health and cancer has been examined for a number of specific cancer sites. Several studies have reported associations between periodontal disease or tooth loss and risk of oral, upper gastrointestinal, lung, and pancreatic cancer in different populations. In a number of studies, these associations persisted after adjustment for major risk factors, including cigarette smoking and socioeconomic status. This review provides a summary of these findings, discusses possible biological mechanisms involved, and raises methodological issues related to studying these relationships.

Figure 1

All estimates are from case-control studies and adjusted for multiple factors including age, gender, tobacco, and alcohol. ^o tooth lost with replacement; ¹ ≥ 11 teeth lost; ² ≥ 28 teeth lost; ³ ≥ 16 teeth lost;• >20 teeth lost.

Figure 2

All estimates are adjusted for multiple factors including age. ^o ≥ 10 teeth lost, case-control study; ¹ Median number of teeth lost, cohort study; ² 11–31 teeth lost, cohort study.