Differences in oral health status between cancer patients: a case-control observational study

The aim of this observational case‒control study was to compare the oral health (OH) status of Bone metastatic cancer (BMC) patients (case Group 1), head and neck cancer HNC patients (case Group 2) and systemically healthy patients (control group). The secondary objective was to identify any risk factors associated with poor OH status.

This study was conducted from 2018-2024, and all patients were evaluated at the Oral Medicine, Head and Neck Department-Fondazione Policlinico Universitario A. Gemelli-IRCSS, Rome. The OH status was clinically and radiographically evaluated using the DMFT index, a full periodontal chart and a radiological examination (orthopantomography). The OH status was defined as "poor" in patients with stage III or IV periodontitis and/or a DMFT score ≥ 13. The study protocol was approved by the Ethics Committee of the Università Cattolica del Sacro Cuore (ID-5746). Univariate statistical analysis was performed to detect associations between different clinical variables and OH. The associated variables were subjected to multivariate logistic regression to retrieve the independent risk factors for poor OH.

A total of 510 (170 per group) patients were analyzed. Logistic regression analysis revealed that HNC patients showed significantly worse oral conditions when compared to BMC patients and controls. HNC patients showed an OR of 2.36 (95% CI: 1.35-4.13, p = 0.003) for poor OH when compared to control group. No differences were found between BMC patients and control group. Smoking habits (OR: 3.22, 95% CI: 1.93-5.35, p < 0.0001), and age > 70 years (OR: 17.44, 95% CI: 8.78-34.66, p < 0.0001) were other significant risk factors for poor OH. The risk decreased for younger patients: for patients aged 60-69 years, the OR was 5.17 (95% CI: 2.74-9.75, p < 0.0001); for patients aged 50-59 years, it was 4.22 (95% CI: 2.30-7.76, p < 0.0001).

HNC patients exhibit significantly poorer OH than BMC patients and healthy controls, highlighting the need for enhanced dental care in oncologic management. Nevertheless, smoking habits and age remain important risk factors.