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Meta-Analysis
. 2013 Nov 15;8(11):e79074.
doi: 10.1371/journal.pone.0079074. eCollection 2013.

Tooth loss and head and neck cancer: a meta-analysis of observational studies

Xian-Tao Zeng  1 , Wei Luo, Wei Huang, Quan Wang, Yi Guo, Wei-Dong Leng
Affiliations
Meta-Analysis

Tooth loss and head and neck cancer: a meta-analysis of observational studies

Xian-Tao Zeng et al. PLoS One. .

Abstract

Background: [corrected] Epidemiological studies have shown that tooth loss is associated with risk of head and neck cancer (HNC); however, the results were inconsistent. Therefore, we conducted a meta-analysis to ascertain the relationship between tooth loss and HNC.

Methods: We searched for relevant observational studies that tested the association between tooth loss and risk of HNC from PubMed and were conducted up to January 30, 2013. Data from the eligible studies were independently extracted by two authors. The meta-analysis was performed using the Comprehensive Meta-Analysis 2.2 software. Sensitivity and subgroup analyses were conducted to evaluate the influence of various inclusions. Publication bias was also detected.

Results: Ten articles involving one cohort and ten case-control studies were yielded. Based on random-effects meta-analysis, an association between tooth loss and HNC risk was identified [increased risk of 29% for 1 to 6 teeth loss (OR = 1.29, 95% CI = 0.52-3.20, p = 0.59), 58% for 6 to 15 teeth loss (OR = 1.58, 95% CI = 1.08-2.32, p = 0.02), 63% for 11+ teeth loss (OR = 1.63, 95% CI = 1.23-2.14, p<0.001), 72% for 15+ teeth loss (OR = 1.72, 95% CI = 1.26-2.36, p<0.001), and 89% for 20+ teeth loss (OR = 1.89, 95% CI = 1.27-2.80, p<0.001)]. The sensitivity analysis shows that the result was robust, and publication bias was not detected.

Conclusions: Based on the current evidence, tooth loss is probably a significant and dependent risk factor of HNC, which may have a dose-response effect. People who lost six or more teeth should pay attention to symptoms of HNC, and losing 11 teeth or 15 teeth may be the threshold.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart from identification of eligible studies to final inclusion.
HNC, head and neck cancer.
Figure 2
Figure 2. Forest plot of 15+ teeth loss and risk of head and neck cancer, studies are pooled with random-effects model.
Guha E 2007, the study conducted in Europe; Guha LA 2007, the study conducted in Latin-America.
Figure 3
Figure 3. The plot of trend of simulative dose-response effect based on the ORs and corresponding CIs of the numbers of lost teeth and risk of head and neck cancer.
Figure 4
Figure 4. Forst plot of sensitivity analysis by removing each study in each turn for 15+ teeth loss and risk of head and neck cancer.
Figure 5
Figure 5. Filled funnel plot with pseudo-95% CIs of results of 11 studies based on the result of 15+ teeth loss and risk of head and neck cancer.
See this image and copyright information in PMC

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