Cancer Causes & Control

, Volume 21, Issue 4, pp 567–575 | Cite as

Oral health and risk for head and neck squamous cell carcinoma: the Carolina Head and Neck Cancer Study

  • Kimon Divaris
  • Andrew F. OlshanEmail author
  • Joanna Smith
  • Mary E. Bell
  • Mark C. Weissler
  • William K. Funkhouser
  • Patrick T. Bradshaw
Original Paper



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.


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.


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).


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.


Case–control studies Population-based studies Head and neck cancer Oral cancer Oropharyngeal cancer Laryngeal cancer Risk factors Oral health Periodontal disease Dental attendance 



Carolina Head and Neck Cancer Study


Confidence interval


Hazard ratio


Interaction contrast ratio


Odds ratio


Oral/oropharyngeal cancer


Squamous cell carcinoma of the head and neck



This study was supported in part by grants R01-CA90731 from the National Cancer Institute and P30ES10126 from National Institute of Environmental Health Sciences.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Kimon Divaris
    • 1
    • 2
  • Andrew F. Olshan
    • 1
    • 3
    Email author
  • Joanna Smith
    • 1
  • Mary E. Bell
    • 1
  • Mark C. Weissler
    • 3
  • William K. Funkhouser
    • 4
  • Patrick T. Bradshaw
    • 1
  1. 1.Department of Epidemiology, CB#7435, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Pediatric Dentistry, School of Dentistry, CB#7450University of North CarolinaChapel HillUSA
  3. 3.Departments of Otolaryngology/Head and Neck SurgeryUniversity of North CarolinaChapel HillUSA
  4. 4.Departments of Pathology and Laboratory Medicine, School of MedicineUniversity of North CarolinaChapel HillUSA

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