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An inflammatory problem? Deborah Lyle – Waterpik

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  Posted by: The Probe      29th January 2019

Breast cancer is the most common cancer in the UK with around 55,200 people affected each year. It effects both men and women, but is more prevalent in women. In fact one in eight women in the UK will be diagnosed with breast cancer during their lifetime.[i]Being the second leading cause of death in women, dental professionals should be aware of the latest findings and how survivors’ oral health could be affected from treatment.

Evidence is continuing to accumulate showing an association between periodontitis and breast cancer. In a recent study, women who suffered from periodontitis were up to three times more likely to develop breast cancer.[ii]Researchers believe that systemic inflammation originating from the infected gums could be the trigger. It has also been suggested that oral bacteria may enter the circulatory system through the gums which may affect breast tissue.2

Inflammation is a key feature in many chronic diseases and seems to be the most important preventable cause of cancer in humans. Periodontitis is an advanced inflammatory gum disease caused by oral bacterial dysbiosis, affecting both the local and systemic immune response.[iii]Numerous oral bacterial species have been associated with periodontal disease. Human cytomegalovirus (HCMV), Epstein-Barr virus (EBV) and HCMV-EBV co-infection seems to be closely associated with disease-active periodontitis. Infection by HCMV or EBV has been shown to inhibit the macrophages to respond to bacterial challenge, and therefore have pathogenic role in the development of periodontal disease.[iv]It has also been observed that microbial DNA is present in the breast and that bacteria or their components may influence the local immune microenvironment.[v]

Breast cancer most commonly starts in the cells that line the ducts of the breast. It develops as a result of damaged cells, which can grow uncontrollably to form a lump or thickening called a tumour.[vi]As it develops it begins to grow into the body structures nearby, and cancer cells can move about more easily than normal cells. Excitingly, researchers have discovered a substance made by cancer cells which is responsible for their movement – if scientists can find ways to stop the cells making this matter, the hope is they will be able to stop cancers spreading and make them easier to cure.[vii]

Although further research is required in this area, breast cancer survival rates have been improving, with more than 90% of women diagnosed during the earliest stage surviving the disease for at least five years. However, only around 15% of women who are diagnosed during the more advanced stages survive.5These statistics highlight the importance of early detection and the significance of raising awareness of the disease.

Cancer treatment and oral health

Significant advancement has been made in the field of cancer treatment and with the advent of precision medicine, therapy with new chemotherapeutic agents targeting specific biology of cancers is becoming more widely available. Despite these developments, surgical resection, radio-, and chemotherapy remain the main modalities of cancer management. Although effective in treating cancer, these modalities may cause significant morbidity from direct damage and indirect effects from systemic toxicity.[viii]

There is a high risk of multiple dental problems and oral complications resulting from the complexities of cancer treatment, including mucositis, infection, hyposalivation, taste change and pain. More permanent complications such as dental caries, trismus/tissue fibrosis, osteonecrosis and salivary gland dysfunction can also occur following or during treatment.[ix]In severe cases of pain or discomfort in the teeth or gingiva, cancer treatment may have to be delayed or stopped so preventative measures are vital throughout the process.[x]The patient’s ability to maintain oral hygiene is also likely to be influenced by cancer therapy, and the recommendation of easy to use adjunctive options can help.

As you are aware, the best way to avoid developing gingivitis is to ensure you have an effective oral health routine, which includes removing bacteria interdentally at least once a day. Recommending effective adjuncts, such as the Waterpik®Ultra Professional Water Flosser can help patients to maintain optimal hygiene throughout their lives. The Waterpik®Water Flosser is proven safe and effective in numerous studies and has been shown to reduce pro-inflammatory mediators measured in the gingival crevicular fluid and blood, along with a reduction in bleeding on probing and probing pocket depths compared to traditional oral hygiene.[xi]

Breast cancer remains a serious problem that affects the lives of thousands of individuals. Further research is required in order to identify the specific relationship between periodontitis and breast cancer and if there is a causal link. Additional research is also needed to evaluate whether periodontal disease prevention and treatment can alleviate cancer burden.

For more information on Waterpik®please visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Asda, Costco UK, Boots, and Superdrug stores across the UK and Ireland.

References

[i]Cancer Research UK. Available online: http://www.cancerresearchuk.org/about-cancer/breast-cancer[Accessed 17th January 2018].

[ii]Sfreddo CS, Maier J, De David SC, Susin C, Moreira CH. Periodontitis and breast cancer: a case-control study. Community Dentistry and Oral Epidemiology. 2017;45(6):545-551.

[iii]Michaud DS, Lu J, Peacock-villada AY, et al. Periodontal disease assessed using clinical dental measurements and cancer risk in the ARIC study. Journal of the National Cancer Institute. 2018;110(8):1-12.

[iv]Söder B, Yakob M, Meurman JH, et al. Periodontal disease may associate with breast cancer. Breast Cancer Research and Treatment, 2010;127(2):497-502.

[v]Xuan C, et al. Microbial dysbiosis is associated with human breast cancer. PLOS ONE, 2014;9(1):1-7.

[vi]World Cancer Research Fund. Cancer prevention, linkhttp://www.wcrf-uk.org/index.php[Accessed 17th January 2018].

[vii]Cancer Research UK. How cancer grows, link http://www.cancerresearchuk.org/cancer-help/about-cancer/what-is-cancer/grow/how-a-cancer-grows#moving[Accessed 17th January 2018].

[viii]Hong C, Hu S, Haverman T, et al. A systematic review of dental disease management in cancer patients. Supportive Care in Cancer. 2018;26(1):155-174.

[ix]National Institute of Dental and Craniofacial Research. Oral complications of cancer treatment: what the dental team can do. Last updated 6 January 2014, link www.nidcr.nih.gov[Accessed 17th January 2018].

[x]Mouth Cancer Foundation. Joshi, V. K. How to treat patients with mouth cancer. Published online 31 January 2014, link http://www.mouthcancerfoundation.org/professionals-guide/dentists-role-ii[Accessed 17th January 2018].

[xi]Cutler C, Stanford TW, Abraham C, et al. Clinical benefits of oral irrigation for periodontitis are related to a reduction of pro-inflammatory cytokine levels and plaque. Journal of Clinical Periodontology 2000;27:134-143


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