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Chronic mechanical irritation enhances the effect of tobacco and alcohol on the risk of oral squamous cell carcinoma: a case-control study in Argentina

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Oral squamous cell carcinoma (OSCC) is a multifactorial disease. The individual effect of each risk factor for OSCC may be conditioned by the frequency of other factors. The objective of this study was to identify the association between chronic mechanical irritation (CMI) and OSCC and to analyse the influence of CMI on other important risk factors for OSCC.

Materials and methods

A prospective and age/sex-matched case-control study was performed in two institutions from Argentina between 2009 and 2019, with consecutive and newly diagnosed OSCC. The frequencies of tobacco, alcohol, and CMI were analysed using conditional logistic regression. Cumulative tobacco consumption and the presence of CMI were analysed using the Mann-Whitney test.


CMI and OSCC were associated with an OR of 7.02 (95% CI 3.57–13.78, p < 0.001). The combination of CMI and alcohol demonstrated the highest risk of OSCC (OR 53.83, CI 95% 8.04–360, p < 0.0001), followed by the combination of CMI, tobacco, and alcohol (OR 48.06, CI 95% 8.47–272, p < 0.0001). The combination of CMI and tobacco was also significant (OR 5.61, CI 95% 1.07–29.54, p = 0.042). Patients with CMI developed OSCC with less cumulative tobacco use compared with those without CMI.


CMI is an independent risk factor for OSCC, and it could act as a risk modifier among tobacco and alcohol users having an enhancing effect.

Clinical relevance

Elimination of CMI could decrease the risk of OSCC.

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Authors and Affiliations



Conceptualization: EDP and SW. Methodology: EDP and SW. Formal analysis and investigation: EDP, JPL, GMG, RLP, LCW, Y-HY, and SW. Writing — original draft preparation: EDP, JPL, GMG, and SW. Writing — review and editing: EDP, JPL, GMG, RLP, LCW, Y-HY, and SW. Funding acquisition: EDP and GMG. Resources: EDP, JPL, and GMG. Supervision: SW.

Corresponding author

Correspondence to Eduardo David Piemonte.

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Ethics approval

This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the Council of Ethical Evaluation of Health Research under the Ministry of Health of the Province of Córdoba (N° 1378), by the Institutional Committee of Ethics in Health Research of the Faculty of Dentistry of the University of Córdoba (11T/2016), and by the Research Ethics Committee of the Hospital Alemán, Buenos Aires, Argentina (registration code 3674).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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Piemonte, E.D., Lazos, J.P., Gilligan, G.M. et al. Chronic mechanical irritation enhances the effect of tobacco and alcohol on the risk of oral squamous cell carcinoma: a case-control study in Argentina. Clin Oral Invest 26, 6317–6326 (2022).

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