title: Is dental care utilization associated with oral cavity cancer in a large sample of community-based United States residents?
abstract: OBJECTIVE
  Cancer of the oral cavity and pharynx remains one of the 10 leading causes of cancer deaths in US. Besides smoking and alcohol consumption, there are no well-established risk factors. While poor dental care had been implicated, it is unknown if lack of dental care, implying poor dental hygiene predisposes to oral cavity cancer. This study aimed to assess the relationship between dental care utilization during the past 12 months and the prevalence of oral cavity cancer.
  
  
  METHODS
  A cross-sectional design of the National Health Interview Survey of Adult, noninstitutionalized US residents (n=30 475) was used to assess the association between dental care utilization and self-reported diagnosis of oral cavity cancer. Chi-square statistic was used to examine the crude association between the explanatory variable, dental care utilization and other covariates, while unconditional logistic regression was used to assess the relationship between oral cavity cancer and dental care utilization.
  
  
  RESULTS
  There were statistically significant differences between those who utilized dental care during the past 12 months and those who did not with respect to education, income, age, marital status, and gender (P<0.05), but not health insurance coverage (P=0.53). In addition, those who utilized dental care relative to those who did not were 65% less likely to present with oral cavity cancer, prevalence odds ratio (POR), 0.35, 95% confidence interval (CI), 0.12-0.98. Further, higher income, advanced age, people of African heritage, and unmarried status were statistically significantly associated with oral cavity cancer (P<0.05), but health insurance coverage, alcohol use, and smoking were not, P>0.05. After simultaneously controlling for the relevant covariates, the association between dental care and oral cavity cancer did persist but imprecise. Thus, when compared with those who did not use dental care, those who did were 62% less likely to be diagnosed with oral cavity cancer, adjusted POR, 0.38, 95% CI, and 0.13-1.10.
  
  
  CONCLUSIONS
  Among US adults residing in community settings, use of dental care during the past 12 months was marginally statistically significantly associated with oral cavity cancer, but clinically relevant in assessing oral cavity cancer prevalence in this sample. However, because of the nature of our data, which restricts temporal sequence, a large sample prospective study that may identify modifiable factors associated with oral cavity cancer development, namely poor dental care is needed.
authors.affiliation: College of Pharmacy, Institute of Community Health, University of Houston, Houston, TX, USA. lholmes@nemours.org
authors.forename: L
authors.initials: L
authors.lastname: Holmes
authors.forename: M
authors.initials: M
authors.lastname: desVignes-Kendrick
authors.forename: J
authors.initials: J
authors.lastname: Slomka
authors.forename: S
authors.initials: S
authors.lastname: Mahabir
authors.forename: S
authors.initials: S
authors.lastname: Beeravolu
authors.forename: S R
authors.initials: SR
authors.lastname: Emani
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology*; D009910:Oral Hygiene / Q000706:statistics & numerical data; D010518:Periodontitis / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology