title: The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium.
abstract: Poor oral hygiene has been proposed to contribute to head and neck cancer (HNC) risk, although causality and independency of some indicators are uncertain. This study investigates the relationship of five oral hygiene indicators with incident HNCs.
  
  
  
  In a pooled analysis of 8925 HNC cases and 12 527 controls from 13 studies participating in the International Head and Neck Cancer Epidemiology Consortium, comparable data on good oral hygiene indicators were harmonized. These included: no denture wear, no gum disease (or bleeding), <5 missing teeth, tooth brushing at least daily, and visiting a dentist ≥once a year. Logistic regression was used to estimate the effects of each oral hygiene indicator and cumulative score on HNC risk, adjusting for tobacco smoking and alcohol consumption.
  
  
  
  Inverse associations with any HNC, in the hypothesized direction, were observed for <5 missing teeth [odds ratio (OR) = 0.78; 95% confidence interval (CI) 0.74, 0.82], annual dentist visit (OR = 0.82; 95% CI 0.78, 0.87), daily tooth brushing (OR = 0.83, 95% CI 0.79, 0.88), and no gum disease (OR = 0.94; 95% CI 0.89, 0.99), and no association was observed for wearing dentures. These associations were relatively consistent across specific cancer sites, especially for tooth brushing and dentist visits. The population attributable fraction for ≤ 2 out of 5 good oral hygiene indicators was 8.9% (95% CI 3.3%, 14%) for oral cavity cancer.
  
  
  
  Good oral hygiene, as characterized by few missing teeth, annual dentist visits, and daily tooth brushing, may modestly reduce the risk of HNC.
authors.affiliation: The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA dana.hashim@mssm.edu.
authors.forename: D
authors.initials: D
authors.lastname: Hashim
authors.affiliation: The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sartori
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Brennan
authors.affiliation: Epidemiology-CIPE/ACCAMARGO, Sao Paulo.
authors.forename: M P
authors.initials: MP
authors.lastname: Curado
authors.affiliation: School of Public Health, University of São Paulo, São Paulo, Brazil.
authors.forename: V
authors.initials: V
authors.lastname: Wünsch-Filho
authors.affiliation: Department of Pediatric Dentistry.
authors.forename: K
authors.initials: K
authors.lastname: Divaris
authors.affiliation: Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill.
authors.forename: A F
authors.initials: AF
authors.lastname: Olshan
authors.affiliation: Department of Otolaryntology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill.
authors.forename: J P
authors.initials: JP
authors.lastname: Zevallos
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Winn
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Franceschi
authors.affiliation: Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Catalonia CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Castellsagué
authors.affiliation: Department of Cancer Epidemiology and Prevention, The M. Sklasodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Lissowska
authors.affiliation: National Public Health Center, Budapest, Hungary.
authors.forename: P
authors.initials: P
authors.lastname: Rudnai
authors.affiliation: Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Epidemiology Department of Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor.
authors.forename: H
authors.initials: H
authors.lastname: Morgenstern
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle.
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle.
authors.forename: T L
authors.initials: TL
authors.lastname: Vaughan
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda.
authors.forename: J N
authors.initials: JN
authors.lastname: Hofmann
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore.
authors.forename: G
authors.initials: G
authors.lastname: D'Souza
authors.affiliation: Dana Farber Cancer Institute, Harvard Medical School, Boston.
authors.forename: R I
authors.initials: RI
authors.lastname: Haddad
authors.affiliation: The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: H
authors.initials: H
authors.lastname: Wu
authors.affiliation: Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA.
authors.forename: M
authors.initials: M
authors.lastname: Hashibe
authors.affiliation: Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
authors.forename: C La
authors.initials: CL
authors.lastname: Vecchia
authors.affiliation: The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: P
authors.initials: P
authors.lastname: Boffetta
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D009910:Oral Hygiene; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
keywords: head and neck neoplasms; oral hygiene; oral neoplasms; pharyngeal neoplasms; pooled analyses