Recent studies have investigated the association between periodontal disease, tooth loss, and several systemic diseases including cancer, cardiovascular disease, and preterm birth. Periodontal disease, a chronic inflammatory condition, is highly prevalent in adult populations around the world, and may be preventable. Estimates of prevalence vary between races and geographic regions, with a marked increase in the occurrence of periodontal disease with advancing age. Worldwide estimates for the prevalence of severe periodontal disease generally range from 10 to 15 percent.The relationship between oral health and cancer has been examined for a number of specific cancer sites. Several studies have reported associations between periodontal disease or tooth loss and risk of oral, upper gastrointestinal, lung, and pancreatic cancer in different populations. In a number of studies, these associations persisted after adjustment for major risk factors, including cigarette smoking and socioeconomic status. This review provides a summary of these findings, discusses possible biological mechanisms involved, and raises methodological issues related to studying these relationships.Studies investigating the association between periodontal disease and cancer have used a variety of measures to define periodontal disease and the manner in which disease progression is ascertained. There is no standardized definition or clinical criteria for periodontal disease used consistently in periodontal epidemiologic research, making comparisons of studies examining the association between periodontal disease and cancer difficult.[2] Various methods of assessing periodontal status include self-reported or medical history of periodontal disease; measuring several sites on each tooth to assess pocket depth and attachment loss; and measuring alveolar bone height with radiographs. Since periodontitis is a primary cause of tooth loss in adults, the number of lost adult teeth has also been used as a marker of periodontal disease in epidemiologic literature.[3, 28] However, population and age at which tooth loss occurs influences whether or not the tooth loss was caused by periodontal disease. Tooth loss at an older age is more likely to be caused by chronic periodontal disease, while teeth lost at younger ages may most likely be the result of dental caries.[1] It is estimated that between 30 and 35% of all tooth extractions are due to periodontitis, while approximately one-half are the result of dental caries.[1] Since the association between tooth extraction and dental caries has been shown to considerably vary with age,[29] assessing the presence of periodontal disease by extent of tooth loss alone may be inadequate to examine the link between periodontal disease and cancer; studies in this area may, however, provide some insights into the overall role of oral health in relation to malignant neoplasms. If clinical exams are not feasible, or are not carried out in a standardized manner, measures such as reported history of periodontal disease, self-reported tooth loss due to periodontal disease, or bitewing radiographs may provide a better assessment of the presence of periodontal disease.
Recent epidemiologic research has linked periodontal pathogens to several systemic diseases, including cardiovascular disease, diabetes mellitus, and preterm birth, possibly mediated through markers of systemic infection and inflammation.[] Associations with osteoporosis, respiratory disease, and systemic infections have also been observed.[] In addition, the results of several epidemiologic studies have suggested a possible positive association between periodontal disease and cancer risk in different tissues, most notably in the mouth, upper gastrointestinal system, lung, and pancreas.[] In light of recent findings between periodontal disease, oral health, and carcinogenesis, a review of the current literature in this area is presented. This review includes only studies that directly assessed and quantitatively measured tooth loss or periodontal disease as a potential risk factor for carcinogenesis in humans, and that included some assessment of potential confounding factors.
.
