New Delhi: Oral healthcare plays a significant role in enhancing health-related outcomes, including those associated with cancer, researchers from AIIMS Delhi said, underscoring the necessity of integrating oral care practices not only at the primary level but throughout all health management.
Emerging evidences indicate that poor oral health is closely associated with several health problems, including cardiovascular disease, diabetes, adverse pregnancy outcomes and Alzheimer’s disease, oncologists Dr Abhishek Shankar and Dr Vaibhav Sahni from All India Institute of Medical Sciences (AIIMS), Delhi said in an article published in The Lancet Regional Health – Southeast Asia earlier this month.
Oral hygiene has been implicated in cancer risk and its prediction, particularly in head and neck cancers (HNC).
The current literature also suggests a link between periodontal disease, also known as gum disease, and cancers of the digestive tract, prostate, breast, pancreas, oropharynx, uterus, and lungs.
The international head and neck cancer epidemiology (INHANCE) consortium, through a pooled analysis of 13 studies involving 12,527 controls and 8,925 HNC cases, reported that good oral hygiene (defined by annual dental visits, fewer missing teeth and daily tooth-brushing) was associated with a modest reduction in the risk of HNC, the researchers said.
Presence of pathogenic oral bacteria such as Porphyromonas gingivalis and Prevotella intermedia has been shown to elevate cancer incidence and adversely affect overall survival whether with specific-cancer or disease-free, they said.
Oral health is crucial in the context of cancer therapy. A recent systematic review concluded that radiotherapy (RT) to the head and neck region significantly alters the oral microbiome, typically reducing beneficial bacteria while increasing potentially harmful species, leading to post RT complications, the research suggested.
Patients with severe periodontal disease undergoing intensity-modulated radiotherapy (IMRT), with or without chemotherapy, have shown higher susceptibility to post-treatment bone healing complications, the researchers said.
These findings make it imperative to maintain optimal oral hygiene before, during and after RT, given its role in influencing survivorship outcomes, they added.
Data from the CHANCE study revealed that routine dental visits over the past 10 years were associated with reduced cancer mortality, according to the research.
Dr Shankar and Dr Sahni, however, pointed out that there is a dearth of original data from Southeast Asia reporting on the association between oral health and cancer, as most original studies tend to limit their scope to epidemiological findings.
“It is abundantly clear that oral healthcare plays a significant role in enhancing health-related outcomes, including those related to cancer survivorship. This evidence underscores the necessity of integrating oral health practices not only at the primary care level but throughout all healthcare settings,” the doctors said.
Efforts should focus on innovating and implementing point-of-care diagnostics in oral health that are evidence-based, economical, validated, and offer sufficient sensitivity and specificity, they stressed.
The researchers stated that the World Health Organisation (WHO) – South East Asia Region (SEAR) could benefit from public health initiatives to improve oral health.
Researchers also pitched for supervised tooth-brushing programmes for children alongside sensitising teachers and families regarding the importance of oral health and providing free toothbrush and toothpaste to foster behavioural change.
In England, supervised tooth-brushing programmes for children have proven to be an economical intervention, reducing health-related inequalities and tooth decay, they said.
“Implementing a similar programme in India may provide comparable oral health benefits and, given its effectiveness in resource-constrained settings, is particularly encouraging,” they said.
Various operational challenges like the economic viability of families, leading to unintentional health neglect, low priority to oral health, inadequate incentives and motivation among teaching staff to ensure their effective involvement.
Oral health has been shown to significantly influence cancer outcomes and survivorship; however, research in this domain could be more relevant if supported by data from the SEAR, the researchers stated.
Public health interventions like labels of ‘nutrition’ and ‘sugar warning’ may assist consumers in making informed decisions.
It is essential to enforce policies against proxy advertisements for tobacco products while also implementing measures to prohibit the use of likable characters promoting sugar-laden snacks and beverages to children, they said.
