Oral health and its expanding role in systemic disease, cancer outcomes, and public health - Comment

Sep 29, 2026

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Evidence links oral health with systemic conditions including cardiovascular disease, diabetes, adverse pregnancy outcomes, and Alzheimer’s disease, and implicates oral hygiene in cancer risk and prognosis, particularly head and neck cancers. Pooled and observational data show that good hygiene relates to modestly reduced HNC risk and that pathogenic oral bacteria can worsen cancer incidence and survival. In radiotherapy, oral microbiome shifts drive post-treatment complications and poorer bone healing, making sustained oral care essential. Routine dental visits associate with reduced cancer mortality, and point-of-care oral testing may enable scalable, evidence-based diagnostics for primary care and public health programs.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

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Oral health and systemic associations

Oral hygiene, cancer risk, and prognosis

Periodontal disease and malignancies

Oral health during cancer therapy

Effects of radiotherapy on the oral microbiome

Dental care to support survivorship outcomes

Cancer mortality and dental visits

Dentition loss and prognosis

Evidence from composite scoring and confounders

Point-of-care diagnostics and public health initiatives

aMMP-8 mouthrinse testing

Supervised toothbrushing and implementation challenges

Comment Oral health and its expanding role in systemic disease, cancer outcomes, and public health Vaibhav Sahni and Abhishek Shankar∗ Department of Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India A growing body of evidence indicates that oral health is closely associated with several systemic conditions, including cardiovascular disease, diabetes, adverse pregnancy outcomes and Alzheimer’s disease. Oral hygiene has been implicated in cancer risk and prognosis, particularly in head and neck cancers (HNC) . The INHANCE consortium, through a pooled analysis of 13 studies involving 12,527 controls and 8925 HNC cases, reported that good oral hygiene (defined by annual dental visits, fewer missing teeth and daily toothbrushing) was associated with a modest reduction in the risk of HNC.1 The current literature also suggests a link between periodontal disease and cancers of the digestive tract, prostate, breast, pancreas, oropharynx, uterus, and lungs.2 Presence of pathogenic oral bacteria such as Porphyromonas gingivalis and Prevotella intermedia has been shown to elevate cancer incidence and adversely affect overall, cancer-specific and disease-free survival.2 Oral health is particularly crucial in the context of cancer therapy. A recent systematic review concluded that radiotherapy (RT) to the head and neck region significantly alters the oral microbiome, typically reducing beneficial bacteria while increasing potentially harmful species, leading to post RT complications.3 Patients with severe periodontal disease undergoing intensity-modulated radiotherapy (IMRT), with or without chemotherapy, have shown higher susceptibility to post-treatment bone healing complications.3 These findings make it imperative to maintain optimal oral hygiene before, during and after RT, given its role in influencing survivorship outcomes. Data from the CHANCE study revealed that routine dental visits over the past ten years were associated with reduced cancer mortality.4 A decrease in the risk of mortality has been reported with routine dental visits defined as greater than ten in the preceding ten years with oral cancer being most conducive to this effect.4 Further, there is evidence in literature which supportsan association between the loss of dentition and overall mortality.4 However, there is a dearth of original data from Southeast Asia reporting on the association *Corresponding author. E-mail address: [doc.abhishankar@gmail.com](doc.abhishankar@gmail.com) (A. Shankar).© 2025 The Author(s) . Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ([http://creativecommons](http://creativecommons). org/licenses/by-nc-nd/4.0/) . between oral health and cancer, as most original studies tend to limit their scope to epidemiological findings. German data comprising a case-only study demonstrated that a low composite score was associated with a deteriorated prognosis for head and neck squamous cell carcinoma.4 The composite score so utilised, comprised offactors such as daily maintenance of oral hygiene and yearly dental visits. This effect was, however, attenuated when accounting for sex, age, tumour site, stage, smoking, HPV status, alcohol consumption, education, and treatment.4 It is abundantly clear that oral healthcare plays a significant role in enhancing health-related outcomes, including those related to cancer survivorship. This evidence underscores the necessity of integrating oral health practices not only at the primary care level but throughout all healthcare settings. Efforts should focus on innovating and implementing point-of-care diagnostics in oral health that are evidence-based, economical, validated, and offer sufficient sensitivity and specificity. One example is the oral mouthrinsebased point-of-care (PoC) testing methodology involving the activated matrix metalloproteinase-8 (aMMP-8) enzyme, which demonstr

FAQs

How is oral health associated with systemic diseases in the text?

Oral health is reported to be closely associated with cardiovascular disease, diabetes, adverse pregnancy outcomes, and Alzheimer’s disease.

What evidence links oral hygiene with head and neck cancer risk?

A pooled analysis in the INHANCE consortium reports that good oral hygiene, including annual dental visits, fewer missing teeth, and daily toothbrushing, is associated with a modest reduction in head and neck cancer risk.

Why is maintaining oral hygiene important during radiotherapy for cancer?

Radiotherapy to the head and neck region alters the oral microbiome, typically reducing beneficial bacteria and increasing harmful species, which contributes to post-radiotherapy complications and affects bone healing after treatment.

Sep 29, 2026

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