Abstract
Objective: The main aim of this study was to test whether the use of mouthwash is associated with subtypes of squamous cell carcinoma of the head and neck (SCCHN) and to test the potential risk of SCCHN depending on the mouthwash use duration, frequency, or alcoholic content. Materials and methods: We performed a meta-analysis using Web of Science and Scopus databases to detect the risk change associated with mouthwash use depending on the alcohol content, duration and frequency of use, and anatomical location. We used a random-effects model with the Sidik–Jonkman estimator for effect size model measures. Results: We included 17 studies in the meta-analysis containing 17,085 cases and 20,032 controls. The risk difference for SCCHN between mouthwash users and non-users was minimal, with a value of −0.02 [−0.05, 0.01]. Alcoholic mouthwash use was associated with a minimal decrease in risk (of −0.01 [−0.07, 0.05]). Frequent usage of mouthwash was associated with a statistically significant risk increase for SCCHN but the risk increase was marginal (0.04, [0.01, 0.06]). Conclusions: Overall, our study failed to show a statistically significant correlation between mouthwash use and the risk of SCCHN. The only statistically significant correlation that we could identify was between frequent usage and SCCHN, potentially caused by prolonged contact between some constituents of mouthwash (possibly alcohol) and the oral epithelium.
Highlights
Squamous cell carcinoma of the head and neck (SCCHN—which includes neoplasms of the oral cavity, pharynx, and larynx) is one of the most common tumor types, causing significant morbidity and mortality, especially in the Middle East, Asia, and Africa [1,2].The most important risk factors for SCCHN, namely tobacco, alcohol, and HPV infection [3], can be controlled—through lifestyle choices for the first two and vaccination for the latter [4]
Mouthwashes are liquid antiseptic solutions that decrease the microbial load in the oral cavity, there are unique formulations for other uses as well, including analgesic, anti-inflammatory, anti-fibrinolytic, antifungal, or cosmetic
We considered high alcohol-content mouthwashes to contain over 25% alcohol and low alcohol-content mouthwashes to contain less than 25% alcohol
Summary
The most important risk factors for SCCHN, namely tobacco, alcohol, and HPV infection [3], can be controlled—through lifestyle choices for the first two and vaccination for the latter [4]. Other risk factors include infections with Candida albicans [5], Epstein–. Mouthwashes are liquid antiseptic solutions that decrease the microbial load in the oral cavity, there are unique formulations for other uses as well, including analgesic, anti-inflammatory, anti-fibrinolytic, antifungal, or cosmetic. The carcinogenic effects of alcohol in oral cancers are known. They are generated through multiple mechanisms, in which alcohol is involved either directly or through acetaldehyde, formed in the oral
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