Perry Brendan J, Zammit Andrew P, Lewandowski Andrew W, Bashford Julia J, Dragovic Adrian S, Perry Emily J, Hayatbakhsh Reza, Perry Christopher F L
Princess Alexandra Hospital, Brisbane, Queensland, Australia.
University of Queensland School of Medicine, Brisbane, Queensland, Australia.
JAMA Otolaryngol Head Neck Surg. 2015 Jan;141(1):5-11. doi: 10.1001/jamaoto.2014.2620.
The relatively high and possibly rising incidence of mouth squamous cell carcinoma in nonsmokers, especially women, without obvious cause has been noted by previous authors. Is chronic dental trauma and irritation a carcinogen, and what is its importance compared with human papillomavirus (HPV) oropharyngeal cancer in nonsmokers?
To determine whether oral cavity cancers occurred more commonly at sites of dental trauma and how the position of these cancers varied between nonsmokers lacking major identified carcinogens and smokers. If these cancers occurred more frequently at sites of chronic trauma, especially in nonsmokers, it would suggest chronic dental trauma as a possible carcinogen.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 881 patients with oral cavity or oropharyngeal cancers seen through a tertiary referral hospital between 2001 and 2011 was performed.
Patient medical records were analyzed to determine the location of the tumor within the oral cavity and oropharynx and how it relates to patient demographics, smoking and alcohol histories, and comorbidities. Dental histories were also sought, including use of dentures.
Nonsmokers comprised 87 of 390 patients with mouth cancer (22%) and 48 of 334 patients with oropharyngeal cancer (14%). Female nonsmoking patients included 53 with oral cancer (61%) but only 12 with oropharyngeal squamous cell carcinoma (25%). Oral cancers occurred on the lateral tongue, a potential site of chronic dental trauma, in 57 nonsmokers (66%) compared with 107 smokers/ex-smokers (33%) (P < .001). Gingival and floor of mouth lesions occurred in older patients, possibly from chronic denture rubbing. Twenty-six patients had dental abnormalities recorded in close proximity to where their tumor developed.
Oral cavity cancers occur predominantly at sites of potential dental and denture trauma, especially in nonsmokers without other risk factors. Recognizing teeth irritation as a potential carcinogen would have an impact on prevention and treatment strategies.
先前的作者已经注意到，无明显病因的非吸烟者，尤其是女性，口腔鳞状细胞癌的发病率相对较高且可能呈上升趋势。慢性牙齿创伤和刺激是一种致癌物吗？与非吸烟者的人乳头瘤病毒（HPV）口咽癌相比，其重要性如何？
确定口腔癌是否更常见于牙齿创伤部位，以及在缺乏主要已知致癌物的非吸烟者和吸烟者中，这些癌症的位置有何不同。如果这些癌症在慢性创伤部位更频繁发生，尤其是在非吸烟者中，这将表明慢性牙齿创伤可能是一种致癌物。
设计、设置和参与者：对2001年至2011年期间通过一家三级转诊医院就诊的881例口腔或口咽癌患者进行了回顾性分析。
分析患者的病历，以确定肿瘤在口腔和口咽中的位置，以及它与患者人口统计学、吸烟和饮酒史以及合并症的关系。还询问了牙科病史，包括假牙的使用情况。
在390例口腔癌患者中，非吸烟者有87例（22%）；在334例口咽癌患者中，非吸烟者有48例（14%）。女性非吸烟患者中，口腔癌有53例（61%），但口咽鳞状细胞癌只有12例（25%）。57例非吸烟者（66%）的口腔癌发生在舌外侧，这是慢性牙齿创伤的一个潜在部位，而107例吸烟者/既往吸烟者中只有33%（P < 0.001）。牙龈和口腔底部病变发生在老年患者中，可能是由于慢性假牙摩擦。26例患者在肿瘤发生部位附近记录有牙齿异常。
口腔癌主要发生在潜在的牙齿和假牙创伤部位，尤其是在没有其他危险因素的非吸烟者中。认识到牙齿刺激是一种潜在的致癌物将对预防和治疗策略产生影响。
