慢性牙龈疾病提高舌癌风险


  May 23, 2007— 最新研究指出,不健康的牙龈和牙齿,对医病而言都值得关注;于《耳鼻喉学档案—头颈外科手术》期刊五月号发表的报告中,研究人员指出,牙周病毒和细菌对其周边的细胞是有害的,伴随而来的是可能会导致口腔癌的不良影响;慢性牙龈疾病可能会经由发炎反应,而间接地造成癌症。报告主笔Mine Tezal博士向Medscape表示,口腔癌的致死率仍相当高,若我们所发现的其间关联性能被更大规模的研究确认,可以说是耳鼻喉科领域的创见;Tezal博士服务于纽约州水牛城的Roswell Park治癌中心。
  
  Tezal博士于访谈中表示,数名口腔外科医师长期以来观察到,口腔卫生和癌症之间有不寻常的关联性,然而,研究到现在才开始纪录这些报告;她也指出,甚至有大量的证据支持慢性感染和癌症风险升高之间的关联性。
  
  牙周病基本上是隐而不发的,且病程缓慢,罹病愈久,结果则是齿槽骨流失愈多,病况为不可逆性且是累积性的;Tezal博士建议能持之以恒地保持口腔卫生,包括刷牙、使用牙线,并定期接受牙医检查。Tezal博士表示,让患者了解漱口不如刷牙和使用牙线来得有效,且不应看轻刷牙和使用牙线的重要性,是很重要的。
  
  Tezal博士也呼吁肿瘤科医师、牙医师和其它口腔卫生保健人员之间能有更多的专业交流,她表示,牙医师具有接触极具价值之临床观察的管道,那将有益于患者的照护;Tezal博士提到,她在一间治癌中心服务,该中心提供各专科之间进行共同研究的独特机会,肿瘤科和牙科位在同一栋建筑内,且两位科主任成了好友,这么一来将带来空前的研究案和专业信息的分享。
  
  就目前的分析中,由美国国家牙科暨颅颜研究院及美国癌症研究院两个单位所授权支持,研究团队执行了一项病例-对照研究。
  
  【癌症患者的齿槽骨流失严重】
  研究团队运用事先存在的资料,这些资料来自病患同意提供给Roswell Park治癌中心牙科部和的颚面假体,研究团队招募51名刚诊断罹患原发性鳞状细胞癌的白人男性,以及54名于同期接受评估而未发现恶性肿瘤白人男性作为对照组。
  
  研究报告执笔群表示,平均而言,相较于对照组,癌症病患的齿槽骨流失高出甚多,前者比后者为2.74毫米比4.21毫米;在调整过年龄、吸菸状况和牙龄数的影响之后,齿槽骨每流失1毫米,即有提高舌癌风险5.23倍的重大影响;其它口腔变因,象是龋齿、补牙、烤瓷牙冠和根管治疗牙齿等的数目,则与舌癌风险无太大的关系。
  
  研究团队表示,就我们所知,本研究提出除了吸菸之外,慢性牙周病史和舌癌之间可能关联性的首件证据;参酌前人研究的结果,将慢性感染和发炎对其它数种器官造成癌症风险作出连结,我们预计能在此研究中看出趋势;然而,我们并不期待能以相对小规模的样本数找出清楚的关联性。
  
  研究团队指出,此关联性需要更大规模的研究再作确认,其中得包括口腔癌发病部位、女性及其它人种为研究对象的研究,以对混淆不明之处进行更广泛的评估;他们总结指出,若确定其间的关联性,则将对口腔癌病因学的理解,以及口腔癌的预防和控制产生潜在性影响。
  
  《耳鼻喉科学档案—头颈外科手术》期刊2007;133:450-454.
  
  

Chronic Gum Disease May Increa

By Allison Gandey
Medscape Medical News

May 23, 2007 — Doctors and patients have more reason to be concerned about unhealthy gums and teeth, a new study suggests. Reporting in the May issue of Archives of Otolaryngology — Head and Neck Surgery, researchers say periodontal viruses and bacteria could be toxic to surrounding cells and produce changes that may lead to oral cancer. Chronic gum disease may also indirectly contribute to cancer through inflammation. "Oral cancer is still very deadly," lead author Mine Tezal, PhD, from the Roswell Park Cancer Institute, in Buffalo, New York, told Medscape. "If the association we have identified can be confirmed by larger studies, we should be able to make a significant difference."

During an interview, Dr. Tezal said that several oral surgeons have long observed a suspicious link between oral health and cancers, but studies are only just now beginning to document these reports. Yet, she noted, substantial evidence exists supporting an association between chronic infections and increased cancer risk.

Periodontal disease is mostly a silent disease and tends to start and progress slowly. In time, alveolar bone loss can result and is irreversible and cumulative. Dr. Tezal recommended conscientious oral health including brushing, flossing, and regular dental exams. "It's important for patients to know that rinses are not as effective as brushing and flossing and should never be used as a substitute," she said.

Dr. Tezal also called for more interaction between oncologists and dentists and other oral healthcare providers. "Dentists have access to valuable clinical observations that can help with patient care," she said. Dr. Tezal noted that she worked at a cancer center that offered an unusual amount of collaboration between specialties. The oncology and dental departments were located in the same building, and the 2 chairs became very good friends — a situation that led to unprecedented collaboration and information sharing.

In the present analysis, supported by a grant from the National Institute of Dental and Craniofacial Research and a grant from the National Cancer Institute, the researchers conducted a case-control study.

Alveolar Bone Loss Significantly Higher in Cancer Patients

The investigators used preexisting data from patients admitted to the department of dentistry and maxillofacial prosthetics at Roswell Park Cancer Institute. They included 51 white men with newly diagnosed primary squamous-cell carcinoma of the tongue and 54 white men evaluated during the same period but with no malignancy to be used as controls.

"The mean alveolar bone loss was significantly higher in cancer cases compared with controls — 4.21 vs 2.74 mm," the authors report. "After adjustment for the effects of age, smoking status, and the number of teeth, each millimeter of alveolar bone loss was significantly associated with a 5.23-fold increase in the risk of tongue cancer." Other oral variables such as the number of dental decays, fillings, crowns, and root-canal treatments were not significantly associated with cancer risk.

"This study presents, to our knowledge, the first evidence of a possible association between the history of chronic periodontitis and tongue cancer independent of smoking," the researchers write. "Considering the results of previous studies linking chronic infections and inflammation to cancer risk in several other organs, we expected to see a trend in this study. However, we did not expect to see such a clear association with a relatively small sample size."

The researchers point out that this link needs to be confirmed by larger studies that include other oral cancer sites, women, and subjects of other races, with a more comprehensive assessment of confounding. They conclude, "If this association is confirmed, it has a potential impact on understanding the etiology of oral cancer as well as on its prevention and control."

Arch Otolaryngol Head Neck Surg. 2007;133:450-454.

    
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2007/4/16 上午 09:03:00

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