title: Mouthwash in the etiology of oral cancer in Puerto Rico.
abstract: OBJECTIVE
  To determine if the risk of cancers of the mouth and pharynx is associated with mouthwash use in Puerto Rico, an area of relatively high risk.
  
  
  METHODS
  Interviews were conducted with 342 cases of oral and pharyngeal cancer registered in Puerto Rico and diagnosed between 1992 and 1995 and with 521 population-based controls regarding mouthwash use and other factors. Mouthwash-related risks were estimated using unconditional logistic regression controlling for potential confounders.
  
  
  RESULTS
  The adjusted odds ratio associated with using mouthwash with an alcohol content of 25% or greater was 1.0. Risks were not higher with greater frequency, years of use, or lifetime mouthwash exposure. Among tobacco and alcohol abstainers the odds ratio associated with mouthwash use was 2.8 (CI = 0.8-9.9), in contrast to 0.8 (CI = 0.4-1.7) and 0.9 (CI = 0.6-1.3) among those with light and heavy cigarette smoking/alcohol drinking behaviors, respectively.
  
  
  CONCLUSIONS
  There was no overall increased risk of oral cancer associated with mouthwash use. An elevated, but not statistically significant, risk was observed among the small number of subjects who neither smoked cigarettes nor drank alcohol, among whom an effect of alcohol-containing mouthwash would be most likely evident. Our findings indicate the need to clarify the mechanisms of oral carcinogenesis, including the possible role of alcohol-containing mouthwash.
authors.affiliation: Division of Cancer Control and Population Sciences, Bethesda, MD 20892-7395, USA. Winnde@mail.nih.gov
authors.forename: D M
authors.initials: DM
authors.lastname: Winn
authors.forename: S R
authors.initials: SR
authors.lastname: Diehl
authors.forename: L M
authors.initials: LM
authors.lastname: Brown
authors.forename: L C
authors.initials: LC
authors.lastname: Harty
authors.forename: E
authors.initials: E
authors.lastname: Bravo-Otero
authors.forename: J F
authors.initials: JF
authors.lastname: Fraumeni
authors.forename: D V
authors.initials: DV
authors.lastname: Kleinman
authors.forename: R B
authors.initials: RB
authors.lastname: Hayes
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000209:etiology*; D009067:Mouthwashes / Q000009:adverse effects* / Q000032:analysis*; D016017:Odds Ratio; D011647:Puerto Rico; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects*
chemical_list: D009067:Mouthwashes