J Korean Med Sci.  2021 Apr;36(15):e98. 10.3346/jkms.2021.36.e98.

Smoking and Drinking Adjusted Association between Head and Neck Cancers and Oral Health Status Related to Periodontitis: a Meta-Analysis

• Vu H
• Shin YJ
• Kong MS
• Kim HD

• KMID: 2515041
• DOI: http://doi.org/10.3346/jkms.2021.36.e98

Abstract

Background
Not so many reports about the association between head and neck cancer (HNC) and oral health status related to periodontitis (OHS-P) has been published in different countries with different methods. So, there is a need for an extensive meta-analysis with the total articles published until 2020. Hence, this study aimed to estimate the association between HNC and OHS-P through a meta-analysis.
Methods
Based on Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, 22 studies were selected through PubMed and Cochrane Library databases. Metaanalysis using them was performed to evaluate the association. The risk of bias assessment using the Newcastle-Ottawa Scale (NOS) was applied to evaluate the quality of nonrandomized studies. Publication bias was evaluated by funnel plot and Egger's regression test.
Results
Since heterogeneity was significant (I² = 88%, P < 0.001), we adopted the random effect model for 22 studies. Those with bad OHS-P, compared to those with good OHS-P, were more likely to have the risk of HNC by 2.4 times (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.88–3.13) for random effect model. The association included publication bias (Egger's regression, P value < 0.001). The association among five studies (I² = 39%, P = 0.16) using alveolar bone loss (ABL) or clinical attachment level (CAL) for assessing periodontitis increased to OR of 3.85 (CI, 3.04–4.88) in the fixed effect model without publication bias (Egger's regression, P = 0.66). Moreover, the association was higher in 10 fair or good NOS studies (OR, 3.08) and in 7 Asian studies (OR, 2.68), which were from the fixed model without publication bias.
Conclusion
Our meta-analysis showed that bad OHS-P was associated with the risk of HNC. The association was stronger in studies using ABL or CAL for assessing periodontitis.

Keyword

Meta-analysis; Oral Health Status; Periodontitis; Head and Neck Cancer

Figure

• 

  Fig. 1 Flow chart of study selection based on PRISMA guideline.

• 

  Fig. 2 Forest plot of the association of oral health status related to periodontitis with head and neck cancer. (A) Studies pooled with random effect using 22 studies. (B) Studies pooled with fixed effect in 5 studies using alveolar bone loss including clinical attachment loss for periodontitis assessment. Guha (2007) reported multicentric analyses in Central America (C) and Latin America (L), and we divided the literature into two studies, Guha (C) 2007 and Guha (L) 2007. Balaram (2002) conducted studies in male and female, so we consider in two studies, Balaram (M) 2002 and Balaram (F) 2002.OHS-P = oral health status related to periodontitis, CI = confidence interval, ABL = alveolar bone loss.

• 

  Fig. 3 Funnel plot of studies and Egger's regression for publication bias. (A) 22 studies included in meta-analysis. (B) 5 studies using ABL including clinical attachment loss for periodontitis assessment. A dot represents the result of each study in the funnel plot. When Egger's regression test is significant (P < 0.05), there is a publication bias.OHS-P = oral health status related to periodontitis, ABL = alveolar bone loss.

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