title: Pretreatment oral hygiene habits and survival of head and neck squamous cell carcinoma (HNSCC) patients.
abstract: BACKGROUND
  The survival time of patients with head and neck squamous cell carcinoma (HNSCC) is related to health behavior, such as tobacco smoking and alcohol consumption. Poor oral health (OH), dental care (DC) and the frequent use of mouthwash have been shown to represent independent risk factors for head and neck cancerogenesis, but their impact on the survival of HNSCC patients has not been systematically investigated.
  
  
  METHODS
  Two hundred seventy-six incident HNSCC cases recruited for the ARCAGE study were followed through a period of 6-10 years. Interview-based information on wearing of dentures, gum bleeding, teeth brushing, use of floss and dentist visits were grouped into weighted composite scores, i.e. oral health (OH) and dental care (DH). Use of mouthwash was assessed as frequency per day. Also obtained were other types of health behavior, such as smoking, alcohol drinking and diet, appreciated as both confounding and study variables. Endpoints were progression-free survival, overall survival and tumor-specific survival. Prognostic values were estimated using Kaplan-Meier analysis and Cox proportional hazards regression models.
  
  
  RESULTS
  A good dental care score, summarizing annual dental visits, daily teeth cleaning and use of floss was associated with longer overall survival time (p = .001). The results of the Cox regression models similarly suggested a higher risk of tumor progression and shortened overall survival in patients with poor dental care, but the results lost their statistical significance after other types of health behavior had been controlled for. Frequent use of mouthwash (≥ 2 times/day) significantly increased the risk of tumor-specific death (HR = 2.26; CI = 1.19-4.32). Alcohol consumption and tobacco smoking were dose-dependently associated with tumor progression and shorter overall survival.
  
  
  CONCLUSIONS
  Frequent mouthwash use of ≥ 2 times/day seems to elevate the risk of tumor-specific death in HNSCC patients. Good dental care scores are associated with longer overall survival.
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Friemel
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany.
authors.forename: Ronja
authors.initials: R
authors.lastname: Foraita
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Günther
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Heibeck
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany.
authors.forename: Frauke
authors.initials: F
authors.lastname: Günther
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany.
authors.forename: Maren
authors.initials: M
authors.lastname: Pflueger
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Pohlabeln
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Behrens
authors.affiliation: Center for Human Genetics, University of Bremen (ZHG), Bremen, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Bullerdiek
authors.affiliation: Center for Human Genetics, University of Bremen (ZHG), Bremen, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Nimzyk
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany. ahrens@bips.uni-bremen.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ahrens
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality*; D016022:Case-Control Studies; D006258:Head and Neck Neoplasms / Q000401:mortality*; D006801:Humans; D009067:Mouthwashes / Q000627:therapeutic use; D009910:Oral Hygiene; D016019:Survival Analysis
chemical_list: D009067:Mouthwashes
keywords: Alcohol consumption; Dental care; Head and neck squamous cell carcinoma (HNSCC); Mouthwash use; Oral health; Tobacco smoking