Alcohol-containing mouthwash and oropharyngeal cancer: A review of the epidemiology
Section snippets
GENERAL CONSIDERATIONS
In 1979, a combined case-series report and case-control study raised concern that use of alcohol-containing mouthwash, or ACM, also causes oropharyngeal cancer, or OPC.6 We review that report below, as well as all of the other available epidemiologic studies. In addition, we describe four general considerations that bear on epidemiologic studies of the ACM-OPC relationship.
First, relative risks, or RRs, for OPC up to 5 commonly are seen for smoking7 and up to 15 for the synergistic effect of
OVERVIEW OF EPIDEMIOLOGIC STUDIES
Nine epidemiologic studies relating to mouthwash use and OPC have appeared in the literature since 1979. Three included some positive results and six had results that were entirely negative. Eight of the studies are reviewed in chronological order. The ninth, a large and broadly based study, has been seen as providing some support for a causal relationship between ACM and OPC. We review it in detail in the next section of this report.
In 1979, Weaver and colleagues6 first suggested a link
THE NATIONAL CANCER INSTITUTE STUDY
Investigators at the National Cancer Institute, or NCI, and at four cancer registries in the United States conducted a large, population-based case-control study of OPC. The purpose of the study was to describe in quantitative terms the effects of known and strongly suspected causes of OPC. The study also attempted to identify new causes of the disease. Cases were diagnosed between January 1984 and March 1985. Control subjects younger than age 65 years were selected via random-digit dialing of
A REASSESSMENT OF THE NATIONAL CANCER INSTITUTE STUDY
After publication of the report by Winn and colleagues,20 an oral pathologist reviewed the histologic appearance of the subjects’ diseases. He found that among men, the histologic appearance of 38 (6.6 percent) of the tumors was nonmucosal, while among women, the histologic appearance of 37 (12.6 percent) of the tumors was nonmucosal. The 75 nonmucosal cases consisted of 11 adenocarcinomas, 12 adenoid cystic carcinomas, 17 mucoepidermoid carcinomas, 13 sarcomas and 22 cases of Hodgkin’s disease
CONCLUSION
During the past 25 years, nine epidemiologic studies have been conducted of the relationship between alcohol-containing mouthwash use and the risk of developing OPC. While two of these studies include some positive findings, the weight of the evidence strongly suggests that use of ACM does not increase the risk of OPC.
Practicing dentists may recommend to their patients that they use the mouthwashes of their choice, including those that contain alcohol.
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Cytogenetic analysis of oral mucosa cells, induced by chlorhexidine, essential oils in ethanolic solution and triclosan mouthwashes
2014, Environmental ResearchCitation Excerpt :Zamora-Perez et al. (2013) observed that subjects exposed to alcohol-containing mouthwash for 30 days exhibited an increase in frequency of micronuclei and nuclear anomalies in oral mucosal cells, which is directly related to DNA damage. Cole et al. (2003) reported that it was unlikely that the use of alcohol-containing mouthwashes increased the risk of developing oropharyngeal cancers. In a literature review, McCullough and Farah (2008) state that there is sufficient evidence to indicate that the risk of developing oral cancer is increased with the use of alcohol-containing mouthrinses.
A review of the relationship between alcohol and oral cancer
2011, SurgeonCitation Excerpt :Alcohol consumption has long been recognized as one of the major modifiable risk factors for the development of oral cancer.1,2 The excessive consumption of alcohol-containing beverages is also associated with an increased risk of developing other cancers of the head and neck such as pharyngeal and laryngeal cancer,3,4 as well as other chronic diseases including heart disease, Alzheimer’s disease, stroke, liver disease, cancer, chronic respiratory disease, diabetes mellitus and bone disease.4,5 Despite the definite association between chronic alcohol consumption and oral cancer, the exact role of alcohol in the pathogenesis of the disease is not fully understood, and the following point should be considered: Not all oral cancer patients consume alcohol, and not all people who drink alcoholic beverages develop oral cancer.6
Comparative clinical evaluation of two essential oil-based mouthwashes with and without alcohol
2011, Prevenzione e Assistenza DentaleAnti-discoloration system: a new chlorhexidine mouthwash
2021, Journal of Biological Regulators and Homeostatic Agents
Dr. Cole received financial support for this study from the Warner-Lambert Company, Morris Plains, N.J., a Pfizer company.
The authors are grateful to Jack Vincent, D.D.S., Ph.D., for his assistance in performing the histologic review of the case material.
- 1
Dr. Cole is a professor emeritus at the Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, 1665 University Blvd., Birmingham, Ala. 35294-0022.
- 2
Dr. Rodu is a professor, Department of Pathology, School of Medicine, The University of Alabama at Birmingham.
- 3
At the time of this study, Dr. Mathisen was a biostatistician at the Warner-Lambert Company. She now lives in Ambler, Pa.