A history of periodontitis may be associated with an increased risk of tumors positive for human papillomavirus (HPV) in persons with head and neck squamous cell carcinoma (HNSCC). Previous studies have suggested a link between this chronic inflammation of structures surrounding the teeth and increased risks of oral premalignant lesions and HNSCC. Research has also indicated that a history of periodontitis predicted poorly differentiated tumor status in the oral cavity.
As Mine Tezal, DDS, PhD, of the State University of New York at Buffalo, and colleagues explain in Archives of Otolaryngology—Head & Neck Surgery, a vaccine to prevent cervical HPV infection is recommended for females aged 9 to 36 years and males aged 9 to 21 years before potential exposure. However, oral HPV infection can be transmitted at birth or anytime thereafter, and no target population for the vaccine to prevent oral HPV infection has been defined.
The researchers noted that the incidence of oropharyngeal cancers in the United States has increased steadily since 1973 despite the significant decline in tobacco use since 1965, and oral HPV infection appears to be the main culprit. Because periodontitis is easy to detect and may represent a clinical high-risk profile for oral HPV infection, prevention or treatment of sources of inflammation in the oral cavity may be a simple yet effective way to reduce the development and persistence of oral HPV infection.
In their evaluation, Tezal and coinvestigators found that 50 of 124 patients (40.3%) aged 21 years and older with HNSCC and no history of other cancer had HPV-positive tumors. The relationship was stronger in those with oropharyngeal cancers (32 of 49 such patients, or 65.3%, had HPV-positive tumors) than among the 31 patients with oral cavity cancers (9, or 29%, had HPV-positive tumors) or the 44 patients with laryngeal cancers (9, or 20.5%, had HPV-positive tumors).
Periodontitis history was assessed by alveolar bone loss in millimeters, based on available dental records. This bone loss was significantly higher in persons with HPV-positive tumors than in those with HPV-negative tumors. Each millimeter of alveolar bone loss was associated with 2.6 times increased odds of HPV-positive tumor status after adjustment for age at diagnosis, sex, and smoking status. No other dental variables—caries, fillings, or missing teeth—were significantly associated with tumor HPV status after adjustment for explanatory variables. According to Tezal’s team, this points to the potential relationship between inflammation and tumor HPV status.