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Oral Health and Risk for Head and Neck Squamous Cell Carcinoma: The Carolina Head and Neck Cancer Study


Divaris, Kimon; Olshan, Andrew F.; Smith, Joanna C.; Bell, Mary Elizabeth; Weissler, Mark Christian; Funkhouser, William K.; & Bradshaw, Patrick T. (2010). Oral Health and Risk for Head and Neck Squamous Cell Carcinoma: The Carolina Head and Neck Cancer Study. Cancer Causes & Control, 21(4), 567-575. PMCID: PMC2925153


OBJECTIVE: Recent reports have linked oral health and periodontal disease indicators with increased risk of squamous cell carcinoma of head and neck (SCCHN). Thus far, evidence has been inconclusive; our objective was to study the association between oral health and SCCHN risk in the context of a large population-based study.
METHODS: A population-based case-control study of incident SCCHN, the Carolina Head and Neck Cancer Study was carried out in 2002-2006 in 46 counties in North Carolina. Controls (n = 1,361) were frequency matched with cases (n = 1,289) on age, race, and gender. Oral health was assessed using interview data on tooth loss and mobility, mouthwash use, and frequency of dental visits.
RESULTS: Subjects were 26-80 years old (median age = 61). The distribution of tooth loss among controls was 0-5 teeth = 60%; 5-14 = 15%; and 16-28 = 25%. After controlling for covariates, tooth loss did not yield any notable association with SCCHN (16-28 vs. 0-5 lost teeth: OR: 1.21, 95% CI: 0.94, 1.56). Self-reported history of tooth mobility was moderately associated with increased SCCHN risk (OR: 1.33, 95% CI: 1.07, 1.65); however, the association did not persist among never smokers. Routine dental visits were associated with 30% risk reduction (OR: 0.68, 95% CI: 0.53, 0.87).
CONCLUSIONS: These data provide support for a possible modest association of periodontal disease, as measured by self-reported tooth loss indicators, but not tooth loss per se, with SCCHN risk.


Reference Type

Journal Article

Year Published


Journal Title

Cancer Causes & Control


Divaris, Kimon
Olshan, Andrew F.
Smith, Joanna C.
Bell, Mary Elizabeth
Weissler, Mark Christian
Funkhouser, William K.
Bradshaw, Patrick T.