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Periodontal Disease May be Linked to Esophageal Cancer According to this Decade-long Study

Esophageal cancer is one of the most common cancers worldwide – eighth to be exact. Not only that but it is also the sixth most common cancer caused deaths.


Only 15-20% of all patients survive in 5 years.


Dr. Jiyoung Ahn is an associate professor and associate director for population science and the Laura and Isaac Perlmutter Center at New York University. She conducted a study, lasting a decade, that was focused on how oral bacteria can lead to periodontal disease and increase a patient’s chance of developing esophageal cancer.


What is Esophageal Cancer?

The esophagus is the long hollow tube within the body that connects the throat and mouth to the stomach.


Esophageal cancer is 3 times more likely to be found in men than women.


Esophageal cancer develops from malignant cells that form inside the esophagus, typically becoming a large tumor or mass that continues to grow.


There are two major types of esophageal cancer that develops in different ways and areas.

  1. Squamous cell carcinoma – cancer is formed inside the lining of the esophagus in thin flat cell. Usually it is found in the upper and middle part of the esophagus.
  2. Adenocarcinoma – within the glandular tissue is where a tumor forms. Typically, it forms in the lower section of the esophagus, near the stomach.

Those who have esophageal cancer may experience the following:

  • Chest pain
  • Heartburn
  • Difficulty swallowing
  • Coughing
  • Vomiting
  • Weight loss
  • Pain behind breastbone or throat region

The reason it has such a low survival rate is because it is caught in the late stages. When it is too far along. If left untreated, it can eventually spread to nearby organs such as lymph nodes, stomach, liver and lungs.


Periodontal Disease

Periodontal disease is an advanced form of gum disease. It stems from gingivitis, or inflammation of the gingival.


Healthy gums should be pale pink and tightly fitted around your teeth. With periodontal disease your gums become swollen or puffy, bleed when brushing or flossing and the gums are receding.


This occurs because of trapped bacteria under patient’s gums causes irritation. When plaque builds up to tartar, it requires professional care to remove.


While gingivitis is reversible, advanced periodontal disease is not. It leads to tooth decay and tooth loss.


With the leading cause of periodontal disease being poor oral health, make sure you have good oral habits. This includes brushing twice and flossing daily and regular dental checkups.


Dr. Ahn's Study

This study was based on prior research on how periodontal disease was associated with cancers in the mouth, head and neck. The study was primarily based specifically on the oral microbiota found as a result of periodontal disease.


Dr. Ahn’s goal was to identify whether the oral microbiota increased the chances of developing either adenocarcinoma or squamous cell carcinoma later.


The study was conducted using 122 000 different samples from patients who participated in the American Cancer Society Cancer Prevention Study II Nutrition and the Nation Cancer Institute Prostate, Lung, Colorectal and Ovarian Cancer Screen Trial.


Dr. Ahn found that after a decade, 106 patients developed esophageal cancer. They extracted their oral DNA and compared to the previous test.


Certain types of bacteria were linked to higher rates of esophageal cancer. Porphyromonas gingivalis connected to squamous cell carcinoma and Tannerella forsythia caused a higher risk of adenocarcinoma.


Both of these bacteria are linked to periodontal disease.


However, there was an interesting discovery regarding other types of bacteria. Several bacteria actually helped lower the chances of patients being diagnosed in the future.


Dr Ahn hopes to conduct more research in the future. She believes that learning more about the different bacteria will allow doctors to identify the disease predictively. It will help diagnose patients earlier and prevent the later stages of the cancer from occurring.

Christopher Zielinsky at 12:06 PM
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The Importance of Discussing Health with Patients

It’s important to keep an open conversation with your patients.


Nutrition is the process of providing or obtaining the food necessary for health and growth. But not everyone is the same. You can’t give the same diet to every person. Based on their existing health and genetics requires varying compositions of healthy diets.


As dental hygienists, we can often see early signs of several different makeups. Because we can see these things, it is up to us to start a discussion with patients and highlight details that otherwise may not have considered from you.


Enamel Erosion Signs and Causes

For example, patients often are found with enamel erosion. On the surface of teeth, the hypoplastic enamel could be slick or smoother-looking. This is a result of your enamel being worn down from several dietary related causes like:

  • GERD
  • Alcoholism
  • Eating Disorders
  • Drug Abuse
  • Highly Acidic diets

Teeth may appear discoloured or even transparent, or they are overly sensitive. If this occurs, it is important to have open up a conversation with your dentist for potential causes or solutions.


Recommendations for Enamel Erosion

The problem with the enamel is that is it not a living tissue, so it cannot be regenerated naturally. It can’t be regrown artificially either actually.


Once enamel is gone, it’s gone.


There are however a few things that doctors will suggest minimizing further damage:


1. Use straws

By using straws, patients minimize the contact of liquid to teeth. This helps with sensitive teeth for particularly cold beverages too.


2. Wait 30+ minutes to brush your teeth after eating or drinking

When eating or drinking something, especially something particularly acidic, the tooth enamel softens from the foods. Brushing too soon after eating or drinking can damage the enamel when it is already in a sensitive or weak state.


3. Use a toothpaste without whitening or tartar control

Fluoride toothpaste is the best option because it is known to strengthen teeth and prevent tooth decay.


4. Chew gum with xylitol or fluoride mouthwash

Since xylitol is a natural sweetener and have shown signs that it reduces the amount of bacteria in your mouth that causes cavities. This is because xylitol cannot provide suitable nutrition for the organisms to flourish. The less cavity-causing bacteria in your mouth, the better environment for healthy teeth.


Similarly, fluoride mouthwash is great for protecting your teeth from acids and cavities. It is especially important for children with developing teeth because it can be a preventative.


5. Adapt to a carbohydrate-free or highly hypoglycidal diet

A study investigated the correlation with diet and enamel erosion and found an interesting correspondence. Patients with a carbohydrate-free diet (sugars, starches) reduce acid reflux and clinical manifestations were almost eliminated.


Tooth Decay Signs and Causes

The second example found commonly that dictates a conversation about diet with the dentist is signs of caries.


A high caries rate is related to a diet high in sugar and 51% of Americans have a sweet tooth.


Some signs of tooth decay:

  • Tooth aches or sensitivities
  • Visible holes in teeth
  • Staining on teeth (black, brown or white in colour)
  • Pain when biting

When dental hygienists notice signs of tooth decay, it is time to discuss the patient’s diet. This could lead to further discussions on daily foods consumed.


It’s important to gain insight into when the most sugar is being consumed. Even having one meal high in sugar will increase the likelihood of tooth decay.


Some foods that increase your likelihood of caries are:

  • Soda, juice and sports drinks
  • Candy
  • Fruit snacks
  • Frequent intake of starchy foods
  • Sugar in coffee

In 2014, the World Health Organization reduced the recommended daily sugar intake to 5%. The average adult should be consuming approximately 25 grams or 6 teaspoons of sugar per day. This not only helps prevent caries but also the risk of heart disease and diabetes.


Starting the Conversation

There are countless resources to open up the conversation about the importance of sugar or acidic free diets.

  • Contacting public health and nutrition department for local resources and pamphlets
  • Utilizing to evaluate a patient’s needs

For most patients, they just don’t know what to look for or where to start. So, it is up to dental hygienists to educate and work with the patients so they can have a happier and healthier smile.


It can’t just be one conversation either. Working closely with patients is the key to ensuring they have a well-balanced diet fit for their needs.


The more we communicate with patients the more comfortable they will be. By opening up, it may also alleviate stress and anxiety that often is associated with the dentist.


Christopher Zielinsky at 12:00 PM
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