【新聞評析】又是一篇關於漱口水恐致癌的報導。先前我們已經有評論過類似議題(漱口水酒精恐致癌? http://enttaiwan.pixnet.net/blog/post/211632317)，其實本篇研究(原研究論文摘要附於本文最後)重點在強調口腔健康不佳的人罹患口腔癌的機率較高(獨立危險因子)以及菸酒也是導致口腔癌的獨立風險因子，含酒精漱口水是否會致癌仍需進一步釐清(因為有許多干擾因子參雜其中)。另外在2009年的一篇綜合性研究(總共回顧10篇關於漱口水與口腔癌相關危險性的論文Mouthwash and oral cancer risk: an update. Oral Oncol. 2009 Mar;45(3):198-200)顯示目前並沒有流行病學上的證據顯示含酒精成分漱口水與口腔癌有相關(critical review of published data revealed that a link between mouthwash use, specifically alcohol-containing mouthwash, and oral cancers is not supported by epidemiological evidence.) 另外潄口水的酒精含量並不高，潄完也都吐掉，吸收量有限，因此不太可能因此致癌，反而口腔清潔衛生應該才是預防癌化的根本之道。當然有疑慮的民眾還是可以選擇不含酒精成分的藥品級漱口水(看包裝成份欄是否標示:酒精,alcohol或ethanol)。另外過酸漱口水可能傷害口腔黏膜，酸性環境容易造成蛀牙環境。主要是漱口水為了保存，大多偏酸。歐盟對於一般漱口水並無相關規範，國際標準組織ＩＳＯ則建議控制在PH值3.0到10.5。我國並無漱口水PH值國家標準。2013年3月消基會曾抽查15件市售漱口水(由於國內沒有漱口水的國家標準，因此參考牙膏國家標準進行檢測)後，結果只有7件以中文標示成分，其餘標示不完全。15件樣品中有6件漱口水pH值都低於5。同時1件漱口水所添加的「氯己定」含量為0.12%，超過0.1％的濃度標準，已可視為「成藥」，不適合作為一般商品販售。另外，還發現樣品中有次氯酸水、尿囊素、酒精等成分，都不在口腔用品的管理項目內，衛生單位有必要訂定相關規範。
備註:依據衛福部的規定，氯己定葡萄糖酸鹽（Chlorhexidine Gluconate Solution）濃度超過0.1％的漱口水，就須歸類為乙類成藥，應向衛福部申請許可。所謂「氯己定葡萄糖酸鹽」是漱口水常見的成分之一，有殺菌防腐功效，但長期使用超標的漱口水會使色素沉澱，反而讓牙齒變褐色，甚至產生口腔黏膜破損及味覺改變的副作用。
參考新聞:
研究：漱口水用太多恐易致癌
中央社 – 2014年4月4日下午9:25
（中央社台北4日電）專家宣稱，漱口水用得多可能會使罹患口腔癌的機率增加。
英國「每日郵報」（Daily Mail）報導，研究顯示，一天使用漱口水超過3次，會使罹患口腔癌和咽喉癌的機率升高。
英國格拉斯哥大學（University of Glasgow）牙醫學院資深講師康威（David Conway）表示，人們不應習慣性使用漱口水，而是應刷牙及使用牙線。
發表在期刊「口腔腫瘤學」（Oral Oncology）的這項最新研究報告中，格拉斯哥大學研究人員與歐洲同僚對9個國家的1962名癌症患者及1993名健康民眾進行評估。
他們發現，戴假牙及牙齦經常出血等口腔健康不佳的人，罹患口腔癌的機率較高。
康威說：「我不建議習慣性使用漱口水。」
他表示：「我認為，必要的是定期用含氟牙膏刷牙和用牙線，同時定期看牙醫。」
他並說，過度使用漱口水可能與希望掩蓋菸味與酒味有關，而菸酒也是導致口腔癌的獨立風險因子。
不過英國牙醫師公會（British DentalAssociation）顧問華姆斯利教授（Damien Walmsley）表示，這項研究結果並非「定論」。1030404
Oral Oncol. 2014 Mar 26. Oral oncology.2014.03.001. [Epub ahead of print]
Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: The ARCAGE study.
Abstract
OBJECTIVE:
We aimed to assess the association of oral health (OH), dental care (DC) and mouthwash with upper-aerodigestive tract (UADT) cancer risk, and to examine the extent that enzymes involved in the metabolism of alcohol modify the effect of mouthwash.
MATERIALS AND METHODS:
The study included 1963 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1993 controls. Subjects were interviewed about their oral health and dental care behaviors (which were converted to scores of OH and DC respectively), as well as smoking, alcohol drinking, diet, occupations, medical conditions and socio-economic status. Blood samples were taken for genetic analyses. Mouthwash use was analyzed in relation to the presence of polymorphisms of alcohol-metabolizing genes known to be associated with UADT. Adjusted odds ratios (ORs) and 95%-confidence intervals [CI] were estimated with multiple logistic regression models adjusting for multiple confounders.
RESULTS:
Fully adjusted ORs of low versus high scores of DC and OH were 2.36[CI=1.51-3.67] and 2.22[CI=1.45-3.41], respectively, for all UADT sites combined. The OR for frequent use of mouthwash use (3 or more times/day) was 3.23[CI=1.68-6.19]. The OR for the rare variant ADH7 (coding for fast ethanol metabolism) was lower in mouthwash-users (OR=0.53[CI=0.35-0.81]) as compared to never-users (OR=0.97[CI=0.73-1.29]) indicating effect modification (pheterogeneity=0.065) while no relevant differences were observed between users and non-users for the variant alleles of ADH1B, ADH1C or ALDH2.
CONCLUSIONS:
Poor OH and DC seem to be independent risk factors for UADT because corresponding risk estimates remain substantially elevated after detailed adjustment for multiple confounders. Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.
Evid Based Dent. 2009;10(1):6-7.
Oral health, mouthwashes and cancer--what is the story?
- Dental Public Health Unit, Dental School, Medical Faculty, University of Glasgow, Glasgow, Scotland, UK.
Abstract
DESIGN:
Two hospital-based case-control studies were conducted in central and eastern Europe and Latin America. CASE / CONTROL SELECTION: Cases and controls were recruited in Moscow (Russia), Bucharest (Romania) and Lodz and Warsaw (Poland) from 1998 to 2002, and from 1998 to 2003 in Buenos Aires (Argentina), La Habana (Cuba) and the Brazilian towns Rio de Janeiro, São Paulo, Pelotas, Porto Alegre and Goiânia. Incident cases of squamous cell carcinoma of the head and neck (oral cavity, pharynx, larynx) and oesophagus, as well as age- (in quinquennia) and sex frequency-matched controls, were enrolled from 1998 to 2003. Control subjects included residents of the study areas for at least 1 year who were admitted to the same hospitals as the cases or in a comparable catchment area (controls in São Paulo were not recruited from oncology hospitals, and population-based controls were enrolled in Warsaw). Controls were hospitalised for prespecified conditions thought to be unrelated to tobacco use or alcohol consumption. Both studies were coordinated by the International Agency for Research on Cancer according to an identical protocol for both case and control recruitment.
DATA ANALYSIS:
Data from the central European and Latin American studies were analysed separately. Multivariable logistic regression models, including terms for oral health indicators, age, sex, education, country (central Europe) or centre (Latin America), tobacco pack-years and cumulative alcohol consumption, were used to obtain odds ratios (OR) and 95% confidence intervals (CI). All oral hygiene indicators and covariates were analysed as categorical variables, except for age, cumulative alcohol consumption, tobacco pack-years, and age when full-time education was completed, which were analysed as continuous variables. Case-control comparisons were made using t tests for continuous variables and chi-square tests for categorical variables; two-sided P values were obtained. Effect modification was assessed by stratifying on smoking (never/ former/ current) and drinking (never/ ever) habit. Heterogeneity between centres was tested.
RESULTS:
Risk factors for head and neck cancer, independent of tobacco use and alcohol consumption, were as follows: poor condition of the mouth [central Europe OR, 2.89 (95% CI, 1.74-4.81); Latin America OR, 1.89 (95% CI, 1.47-2.42)]; lack of toothbrush use [Latin America OR, 2.36 (95% CI, 1.28-4.36)], and daily mouthwash use [Latin America OR, 3.40 (95% CI,1.96-5.89]. Missing six to 15 teeth was an independent risk factor for oesophageal cancer [central Europe OR, 2.84 (95% CI, 1.26-6.41); Latin America OR, 2.18 (95% CI, 1.04-4.59)].
CONCLUSIONS:
These results indicate that periodontal disease (as indicated by poor condition of the mouth and missing teeth) and daily mouthwash use may be independent causes of cancers of the head, neck and oesophagus.
Oral Oncol. 2009 Mar;45(3):198-200. doi: 10.1016/j.oraloncology.2008.08.012. Epub 2008 Oct 25.
Mouthwash and oral cancer risk: an update.
- Istituto di Ricerche Farmacologiche Mario Negri Milano e Istituto di Statistica Medica e Biometria G.A. Maccacaro, Università degli Studi di Milano, Milano, Italy. lavecchia@marionegri.it
Abstract
The possible relationship between mouthwash use and oral cancer risk has been the subject of at least 10 case-control studies published over the last three decades. Three of these reported relative risks above unity and seven no consistent association. Only a few studies, moreover, included information on different types of mouthwash, and addressed the issue of alcohol-containing mouthwash. Thus, critical review of published data revealed that a link between mouthwash use, specifically alcohol-containing mouthwash, and oral cancers is not supported by epidemiological evidence.
Am J Epidemiol. 2007 Nov 15;166(10):1159-73. Epub 2007 Aug 30.
Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: results of two multicentric case-control studies.
Guha N1, Boffetta P, Wünsch Filho V, Eluf Neto J, Shangina O, Zaridze D, Curado MP, Koifman S, Matos E, Menezes A, Szeszenia-Dabrowska N, Fernandez L,Mates D, Daudt AW, Lissowska J, Dikshit R, Brennan P.
- 1International Agency for Research on Cancer, Lyon, France.
Abstract
Poor oral health has been reported as a risk factor in the etiology of head and neck cancer. Data on oral health were ascertained as part of two multicenter case-control studies comprising 924 cases and 928 controls in central Europe and 2,286 cases and 1,824 controls in Latin America. Incident cases of squamous cell carcinoma of the head and neck (oral cavity, pharynx, larynx) and esophagus, as well as age (in quinquennia)- and sex frequency-matched controls, were enrolled from 1998 to 2003. Poor condition of the mouth (central Europe: odds ratio (OR) = 2.89, 95% confidence interval (CI): 1.74, 4.81; Latin America: OR = 1.89, 95% CI: 1.47, 2.42), lack of toothbrush use (Latin America: OR = 2.36, 95% CI: 1.28, 4.36), and daily mouthwash use (Latin America: OR = 3.40, 95% CI: 1.96, 5.89) emerged as risk factors for head and neck cancer, independent of tobacco use and alcohol consumption. Missing between six and 15 teeth was an independent risk factor for esophageal cancer (central Europe: OR = 2.84, 95% CI: 1.26, 6.41; Latin America: OR = 2.18, 95% CI: 1.04, 4.59). These results indicate that periodontal disease (as indicated by poor condition of the mouth and missing teeth) and daily mouthwash use may be independent causes of cancers of the head, neck, and esophagus.
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