title: Influence of oral hygiene and its interaction with standard of education on the risk of oral cancer in women who neither smoked nor drank alcohol: a hospital-based, case-control study.
abstract: We know of only limited data about the role of oral hygiene and the risk of oral cancer with different standards of education. The aim of this study was to assess the association between oral hygiene and risk of oral cancer, with stratification by standard of education, in Chinese women. We organised a case-control study with 250 women with oral cancer and 996 age-matched controls in Fujian, China. Data were collected by personal interview using a structured questionnaire. We used unconditional logistic regression with stratification by educational standard to estimate the odds ratios (OR) and 95% CI. Tooth-brushing twice a day or more was inversely related to the risk of oral cancer in women with high school education or above (OR 0.50; 95% CI 0.25 to 0.98), but not in those who were illiterate or had primary-middle school education. Wearing dentures showed an increased risk only in less well-educated women: the OR were 2.23 (95% CI 1.14 to 4.34) for the illiterate and 1.68 (95% CI 1.08 to 2.62) for the primary-middle school group. The loss of more than five teeth and oral ulceration were associated with increased risks of oral cancer in all three groups. There was also a multiplicative interaction between oral hygiene and standard of education for risk of oral cancer (p=0.001). Our results suggest that oral hygiene seems to have a critical role in the risk of oral cancer in Chinese women, but this effect may be modified by their educational standard.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fujian, China.
authors.forename: F
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fujian, China. Electronic address: hbc517@163.com.
authors.forename: B-C
authors.initials: BC
authors.lastname: He
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fujian, China.
authors.forename: L-J
authors.initials: LJ
authors.lastname: Yan
authors.affiliation: Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fujian, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fujian, China.
authors.forename: L-S
authors.initials: LS
authors.lastname: Lin
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fujian, China. Electronic address: prof_cailin@sina.com.
authors.forename: L
authors.initials: L
authors.lastname: Cai
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D016022:Case-Control Studies; D002681:China; D004522:Educational Status; D005260:Female; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology*; D009910:Oral Hygiene; D012306:Risk; D012907:Smoking
keywords: Case-control study; Educational level; Females; Oral cancer; Oral hygiene