The Relationship Between Periodontal Disease and Neoplasms of the Oral Cavity: A Review Article

Oral cavity is one of the most common sites for neoplasms with a multifactorial etiology. Tobacco and alcohol are the main risk factors. Periodontal disease is an inflammatory disease affecting periodontal tissues such as gingiva, periodontal ligament and alveolar bone. Periodontal disease is linked to many systemic diseases. Recently a link between periodontal disease and cancer is suggested. The current review article aimed to evaluate the association between periodontal disease and risk of cancer in the oral cavity and some related factors.

 Evidence suggests that oral cavity cancer is significantly more prevalent in patients with periodontal disease, poor oral hygiene or more missing teeth. Clinically, gingival squamous cell carcinoma (GSCC) usually appears as an exophytic mass with a granular, papillary or verrucous surface or presents as an ulcerative lesion. Some reported cases of GSCC mimicking periodontal disease include gingival enlargement with no bone invasion, dentoalveolar abscess, erosive erythematosus lesion with keratotic papules, root exposure and tooth mobility, verrucous leukoplakia, verruciform xanthoma and development of hyperplastic granulation tissue after tooth extraction. Greater burden of oral flora that produce carcinogenic metabolites, human papilloma virus (HPV) and other viruses that are residents of periodontal pocket, increased amount of inflammatory mediators and markers and some periodontal pathogens affecting cell cycle leading to mutation and dysplasia are considered as the rational for the relationship between malignant lesions of oral cavity and periodontal disease.

Cancer of the oral cavity and periodontal disease are related from different aspects. Periodontal disease and tooth loss are considered as independent risk factors for cancer. Gingival squamous cell carcinoma can also mimic periodontal disease leading to misdiagnosis and delayed commencement of appropriate treatment.

Based on evidence, dentists and dental health care professionals should consider periodontal disease as a risk factor for the development of neoplasms in the oral cavity. It also seems a good idea to provide periodontal therapy for patients with cancer to achieve ideal therapeutic results.