This study clarified that there was no significant difference between the periodontal pocket depth of patients with malignant colorectal disease and that of the other patients’ group.
This study was conducted in Fukui Prefecture, Japan; it reports that about the half of the preoperative patients with malignant disease had mobile teeth. There was a statistically significant correlation between age and number of teeth; however, there was no statistically significant correlation between age and number of mobile teeth. In addition, there was a statistically significant correlation between number of teeth and number of mobile teeth but no significant difference between the age of patients without mobile teeth and the age of patients with mobile teeth. These results suggested that age cannot be a predictor of the presence or absence of mobile teeth and that careful preoperative oral assessment is important for safe surgery under general anesthesia with endotracheal intubation, regardless of age.
Although the authors considered that their previous study about tongue-cleaning habits had shown increasing interest in oral care among the general public at various ages, this study clarified that those results did not necessarily reflect the actual oral health conditions, such as periodontal and caries management [3]. Regarding the divergence of these results obtained by studies performed in same target area, namely the increasing interest in oral care and little interest in periodontal disease, we had to take into account the difference in the ages of the participants between those studies. On the other hand, we thought this divergence may be related to the difference between the participants with malignant digestive diseases scheduled for surgery and the participants without it. In this study, there was no significant difference between periodontal pocket depth in the group of patients with colorectal malignant disease and that of the other patients’ group. Furthermore, the number of teeth, excluding residual tooth roots, was not significantly different between the group of patients with malignant colorectal disease and periodontal pocket depth of the other group of patients. For a discussion about the association between oral health and malignant diseases, the authors will have to conduct a larger study and population-based studies targeting the same patient groups on various aspects of those factors in the future.
Tooth mobility is an important risk factor for endotracheal intubation, and has been discussed in much of the literature, to perform safe surgery under general anesthesia [13,14,15,16,17]. Gaiser et al. reported that dental trauma was the most common complication of general anesthesia, and the incidence of dental injury under general anesthesia, when provided by an anesthesia resident, was 0.1% [14]. In addition, large-scale surveys about peri-anesthetic dental injury have reported that the incidence of such injuries ranges from 0.02 to 0.27%, and 75% of those occurred during intubation maneuvers for elective surgery [15,16,17]. Giraudon et al. reported that the most common type of dental injury was fracture of crowns and teeth, and the second was tooth avulsion or luxation [17]. A complete evaluation of the oral or dental conditions by an experienced anesthesiologist was recommended [15].
Recently, the establishment of centers for assessment and management of admitted patients, comprising related occupations, such as anesthesiologists, pharmacists, nurses, and so on, is progressing in Japan [18]. The results of the current study suggest that preoperative oral assessment, such as for periodontal disease, for patients with malignant digestive diseases can provide important information for avoiding oral complications during general anesthesia with endotracheal intubation to anesthesiologists. Thus, the authors consider that adding dental professionals to the centers for patient assessment may increase the accuracy of oral assessments and reduce oral complications during surgery under general anesthesia as well as reduce the burden on anesthesiologists. If it is impossible to extract affected teeth, or if surgery is near at hand, dental professionals can suggest making mouth guards when the preoperative patient has a high number of mobile teeth [19]. The authors consider that the management of mobile teeth in such departments, including tooth extraction, making mouth guards, and giving anesthesiologists warnings about mobile teeth, could contribute to preventing dental complications during surgery under general anesthesia.
Numerous studies suggest an association between periodontitis and malignant diseases. Komiya et al. reported that patients with colorectal cancer had identical strains of Fusobacterium nucleatum, associated with periodontitis, in their cancer and oral cavity [7]. In addition, Porphyromonas gingivalis is an important pathogen that causes periodontitis, and a relationship between it and some malignant digestive diseases, such as esophageal, gastric, hepatocellular, colorectal, and malignant pancreatic diseases, has been considered [8]. Moreover, the maintenance of the oral health environment may contribute to the prevention of systemic disease, including malignant disease, not only dental diseases such as periodontal disease and caries [8]. Further basic and clinical studies are necessary to clarify the effect of periodontal treatment on tumorigenesis.
The authors focused on patient with digestive cancer and performing safe surgery. The limitation of this study was a lack of dental history and periodontal parameters such as bleeding on probing, plaque index, clinical attachment level, and ranges of periodontal sites (e.g. shallow, moderate, and deep). And also, although the authors had understood the importance of evaluation the progression of periodontitis using longitudinal evidence of clinical attachment loss or bone loss described in the consensus report of classification of periodontal and peri-implant diseases and conditions reported by in 2018, periodontal pocket depth evaluated by traditional method was chosen in order to rule out the bias of examiner and the examination error in this study [20]. Additionally, because the authors did not divide the severity of periodontitis and cancer, this study could not analyze straight relationships with the presence of periodontitis and cancer. Further studies are needed in order to suggest the correlation between periodontal parameters and types of cancer, or between stages of periodontitis and stages of cancer. And then, results of those studies may clarify biological condition that would explain the prevalence of periodontal disease among persons with cancer. If future large-scale studies with multi-time examination at different times using new classification of periodontal diseases and conditions suggest the strong relationships between cancer and periodontitis, those results will raise interest in oral health including periodontitis among the general public [20]. In addition, those examinations will provide important information based on new classification to clinicians performed surgery under general anesthesia.
It is undesirable for patients with malignant diseases to be subjected to a delay associated with the presence of dental diseases when starting treatment. We consider that this study may help educate the general public in various age groups about the importance of maintaining good oral and dental health at all times.
