Association between oral health and gastric precancerous lesions

Abstract

Although recent studies have suggested that tooth loss is positively related to the risk of gastric non-cardia cancer, the underlying oral health conditions potentially responsible for the association remain unknown. We investigated whether clinical and behavioral measures of oral health are associated with the risk of gastric precancerous lesions. We conducted a cross-sectional study of 131 patients undergoing upper gastrointestinal endoscopy. Cases were defined as those with gastric precancerous lesions including intestinal metaplasia or chronic atrophic gastritis on the basis of standard biopsy review. A validated structured questionnaire was administered to obtain information on oral health behaviors. A comprehensive clinical oral health examination was performed on a subset of 91 patients to evaluate for periodontal disease and dental caries experience. A total of 41 (31%) cases of gastric precancerous lesions were identified. Compared with non-cases, cases were significantly more likely to not floss their teeth [odds ratio (OR) = 2.89, 95% confidence interval (CI): 1.09-7.64], adjusting for age, sex, race, body mass index, smoking status, educational attainment and Helicobacter pylori status in serum. Among participants who completed the oral examination, cases (n = 28) were more likely to have a higher percentage of sites with gingival bleeding than non-cases [OR = 2.63, 95% CI: 1.37-5.05 for a standard deviation increase in bleeding sites (equivalent to 19.7%)], independent of potential confounders. Our findings demonstrate that specific oral health conditions and behaviors such as gingival bleeding and tooth flossing are associated with gastric precancerous lesions.

Association between Selected Oral Pathogens and Gastric Precancerous Lesions

“…We have previously reported a significant positive association between active gingival bleeding and presence of gastric precancerous lesions in a cross-sectional study of an endoscopic population [20], consistent with the hypothesis that periodontal disease may increase the risk of gastric cancer. However, these studies lack information on specific oral pathogens necessary to elucidate the role of oral health in gastric cancer development.…”

“…A detailed description of the study has been presented elsewhere [20]. Briefly, subjects ≥40 years of age undergoing an upper endoscopy at Bellevue Hospital Center in New York City were invited to participate in the study.…”

“…Biopsy specimens were processed according to pre-established standardized protocols and reviewed by an experienced gastrointestinal histopathologist (Z.P.) designated to the study [20]. The pathologist reviewed all biopsy specimens and was blinded to questionnaire data and findings from the oral examination [20].…”

“…designated to the study [20]. The pathologist reviewed all biopsy specimens and was blinded to questionnaire data and findings from the oral examination [20]. Parameters evaluated for gastric biopsies in cluded (a) degree of acute inflammation (b) atrophy, and (c) intestinal metaplasia.…”

Neighborhood socio-economic characteristics, African ancestry, and Helicobacter pylori sero-prevalence

“…Thus, other potential factors related to neighborhood SES that might also explain differing H. pylori prevalence—such as sanitation practices, water source, refrigeration, and cooking and eating habits—were not accounted for, although these factors are most likely also associated with individual- and neighborhood-level education and income categories. It has also been suggested that poor oral health is associated with gastric cancer [30] and precancerous lesions [31], although the association with H. pylori infection specifically has not been found to be significant above and beyond individual SES parameters [32, 33]. Unfortunately, we did not have sufficient data on oral health to address this question in our population.…”