On World Oral Health Day 2021, Dr Hitesh R Singhavi tells us why oral hygiene is a must.

New Delhi, March 20, 2021: Did you know that people whose inner cheek, teeth and gums are in poor condition may be more susceptible to mouth and throat cancers? Well, here is what you should know. Oral cancer is one of India’s most common cancers amongst men (11.28% of all cancers), the fifth most frequently occurring cancer amongst women (4.3% of all cancers). The causes attributed to oral cancer are mainly tobacco chewing, areca nut, alcohol consumption, and poor oral hygiene (POH). We often associate poor oral hygiene with dental caries, Gingivitis, Periodontitis (gum disease) and foul smell. Still, poor oral hygiene, in the long run, can give rise to fatal diseases, including cancer. A British study has shown that patients with poor oral health index have an overall higher mortality rate (they die prematurely) compared to others. Let’s take a look at the frequently asked question related to poor oral hygiene and oral cancer.

WHAT ARE THE FACTORS CAUSING POOR ORAL HYGIENE? There are numerous common factors leading to poor oral hygiene, including tobacco chewing, alcohol, areca nut chewing, infrequent dental visits, immunocompromised status, low socio-economic status, and lower education level. Studies have shown that all these factors significantly deteriorate oral hygiene.

HOW DOES POOR ORAL HYGIENE CAUSE ORAL CANCER? POH is strongly associated with oral cancers. It aids the carcinogenic potential of other known carcinogens, like tobacco and alcohol. It causes easy conversion (faster endogenous nitration) of tobacco metabolite into cancer causing products (nitrosamines), leading to cancer development. POH also reacts with alcohol to form Aldehyde-also a class I carcinogen (Class I carcinogen are the product which can independently cause cancer).

HOW CAN YOU PREVENT ORAL CANCER BY MAINTAINING GOOD ORAL HYGIENE? One should not consume tobacco or tobacco products, which is one of Gingival Recession’s major causes (loss of gums), leading to loosening of teeth and the formation of a pre-cancerous lesion. Similarly, avoiding alcohol consumption may help maintain good oral hygiene, as evidence shows that an alcohol consumer has higher chances of foul-smelling mouth, more tar burdened teeth, and a greater possibility of bleeding gums.

WHICH ARE THE PARTS OF ORAL CAVITY YOU SHOULD LOOK FOR CANCEROUS LESION ASSOCIATED WITH POOR ORAL HYGIENE? Buccal Mucosa (inner cheek mucosa) is the most common oral cavity cancer site when POH is associated with tobacco chewing habit. When POH is associated with alcohol, then under the tongue’s surface, the floor of the mouth is the most common site.

CAN SHARP TOOTH OR ILL-FITTING DENTURE CAUSE ORAL CANCER? Chronic mucosal trauma due to a sharp tooth or ill-fitting dentures can cause oral cancer. A study conducted by Tata Memorial Centre (Singhavi et al) has concluded that chronic mucosa trauma has higher chances of developing oral cancer. It’s not an uncommon finding to have oral cancer in non-habitual patients, especially tongue cancers. Chronic mucosa trauma and poor oral hygiene are the front runners in such cases.

Evidence that ascertains the link between poor oral hygiene and oral cancer: Level 1 (direct causation) evidence to determine poor oral hygiene as the primary etiological factor of oral cancer is lacking. However, studies have shown that maintaining good hygiene reduces the chances of oral cancer by 200%. Also, 93 relevant articles published in the literature until the year 2020 concluded that poor oral hygiene contributes to oral cancer causation, in one way or the other. However, for more information, refer to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414580.

Thus, on the occasion of World Oral Health Day, which is observed on March 20th, 2021, let’s pledge to spread the word and educate people on the significance of oral health and sensitise people that maintaining good oral hygiene is a must to stay away from oral cancer.

(Dr Hitesh R Singhavi is Consultant, Head and Neck Surgeon, Fortis Hospital, Mulund; Image by Daniel Albany from Pixabay)