Oral health is gradually gaining acceptance as more than just a funny habit of brushing teeth or as ‘just’ an oral cavity problem: it is being acknowledged as a significant factor that can be modified and is responsible for the risk of developing cancer in the oral cavity or oropharyngeal area. Today, even though tobacco and alcohol are still the main reasons for developing this illness, oral hygiene practice is among the least recognised risk factors leading to the development of these cancers.
Clinicians treat lots of patients who demonstrate either an excessively poor oral hygiene practice, have inappropriate dentures, broken or sharp teeth, or poor immunity, and thus follow the cancer development path that can be easily prevented. This suggests that upholding good oral hygiene is much more important than just having healthy teeth.
The trauma pathway: When chronic irritation becomes dangerous
Chronic mechanical irritation is one of the lesser-known ways in which oral health problems can result in cancer.
Injuries like sharp teeth, broken teeth, badly fitted dentures, rough surfaces of dental restorations, or continuous injury to a particular area of the mouth lead to the constant occurrence of “bite ulcers.” The ulcers are usually formed on the tongue and inner cheek. Although they may look innocuous at the beginning, each of the ulcers triggers the body’s natural wound healing process.
If the cause of the irritation is not treated, this process goes on for months or even years. Chronic inflammation is regarded as a catalyst for abnormal changes in cells, also known as dysplasia, which may lead to oral cancer. Thus, a form of a small injury resulting in a simple ulcer may eventually become a malignant lesion if left unattended.
The microbial pathway: The role of the oral microbiome
The oral microbiome is another significant factor contributing to the risk of developing oral cancer, in addition to the physical trauma.
An adequately functioning mouth hosts a diverse population of microorganisms that have a protective role for the tissues of the mouth.
However, if oral hygiene is not good, this balance can be upset, leading to dysbiosis, when harmful microbes overtake the normal ones.
Studies suggest that some bacteria associated with gum disease (e.g., Fusobacterium nucleatum and Porphyromonas gingivalis) can also induce the development of cancer. These microorganisms secrete toxins and reactive oxygen species, damaging the DNA of oral epithelial cells, inhibiting tumour-suppressor genes (e.g. p53) and creating a persistently inflamed environment.
This way, chronic inflammation creates an environment that favours malignization even in people who do not smoke.
New advances: Genomic profiling of oral bacteria
Technological progress in molecular diagnostics is changing the face of oral cancer risk evaluation.
In the past, dentists and specialists had to rely on observation and biopsy for locating suspicious lesions in patients. But now, thanks to advances in genomic technologies, including 16S rRNA gene sequencing and salivary shotgun metagenomic sequencing, professionals have an opportunity to study the specific oral bacteria more effectively.
This means that even before necessary lesions become obvious, it is possible to find a dysbiotic microbial signature in saliva, which can be associated with high risk.
At present, scientists are trying to understand how useful these tools will be in estimating and predicting various oral potentially malignant diseases (PMD) and leukoplakia, as well as detecting them at the early stages of development.
The new techniques should not be viewed as alternatives to the classical examination methods, as they are a new shade in the overall process of risk assessment.
Diet can support oral health:
Nutrition plays a vital role in decreasing the risk of oral cancer by aiding in the healing processes of the mucosa and maintaining a healthy oral microbiome.
Certain foods may prove to be beneficial in terms of oral cancer prevention:
- Antioxidants found in fruits like berries, citrus, and leafy green vegetables provide vitamin C and beta-carotene, which aid in the restoration of epithelial tissues and elimination of oxidative DNA damage.
- Green tea is rich in catechins—natural polyphenols known for their anti-inflammatory and chemopreventive qualities in oral tissues.
- Turmeric (or curcumin) has been extensively studied in terms of its anti-inflammatory properties and may assist in relaxing inflammation pathways utilised by pernicious bacteria.
- Foods high in omega-3 fatty acids, such as walnuts, flax seeds, and fatty fish, can help reduce chronic inflammation, including that in oral cavities.
- Probiotic foods like yoghurt and other fermented foods can improve the oral and gut microbiome by stimulating the beneficial flora in the body.
- Vegetables belonging to the brassica genus, like broccoli and cauliflower, contain sulfur compounds that cause detoxification on a cellular level and protect against oxidative stress.
It is equally necessary to cut down on those foods and behaviours that cause constant irritation to the lining of the mouth. Eating extremely hot foods and drinks, overly processed foods, and consuming excessive amounts of salty or pickled foods form part of the chronic irritation to the mucosa of some people. The most essential aspect is that refraining from using tobacco and limiting alcohol consumption is the most effective way to minimise the risk of developing oral cancer, as these two mechanisms intensify the negative impact of chronic irritations and imbalance of microbes.
The importance of early detection:
It is vital to pay attention to any changes in the mouth, even for those with good dental hygiene. Any ulcer, white spot, or red patch that lasts for more than two or three weeks should be checked by a specialist. The earlier a condition is diagnosed, the better the chances of a successful recovery.
Oral hygiene is no longer just a matter of dental health—it is also a crucial cancer prevention measure. Scheduling regular dental checkups, maintaining routine oral hygiene, correcting sharp teeth or ill-fitting dentures promptly, and seeking timely treatment for non-healing ulcers can all help reduce the risk of oral cancer.
With the development of genomic technologies, oral bacteria profiling can be used as an additional measure of risk assessment. However, the basic principle still stays the same: by keeping the mouth clean and healthy, eating a balanced diet, and visiting the dentist regularly.
The author is the director – Surgical Oncology at the CK Birla Hospital®, Delhi.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
