{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T07:20:21Z","timestamp":1778052021896,"version":"3.51.4"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["MOP\u201069062"],"award-info":[{"award-number":["MOP\u201069062"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["MOP\u201020100"],"award-info":[{"award-number":["MOP\u201020100"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>While there are plausible biological explanations for the association between oral health and head and neck cancers (HNC), existing studies have yielded conflicting results. A key concern is that these associations are influenced by mediators, unmeasured risk factors, and biases. To address this, a negative control exposure was used to evaluate whether the associations between oral health and HNC risk could be attributed to unmeasured confounding. Additionally, quantitative bias analysis (QBA) was performed to estimate the extent of non\u2010differential misclassification of exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The HeNCe study, a hospital\u2010based case\u2013control study, recruited incident HNC cases (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009389) frequency matched to controls (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009429) by sex and age (within 5\u2009years) from four major referral hospitals in Montreal, Canada. In\u2010person interviews collected information on life course exposures. Unconditional logistic regression estimated the odds ratios (OR) and 95% confidence intervals (CI) for the associations between oral health indicators and HNC, controlling for confounders identified using directed acyclic graphs (DAG). Sexually transmitted diseases (STD) were used as a negative control exposure to test for unmeasured confounding in the associations. QBA, using predetermined bias parameters from previous studies, estimated the magnitude and direction of exposure misclassification bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Complete denture use and having more than nine missing teeth were associated with an increased HNC risk [OR\u2009=\u20091.33, 95% CI (0.93\u20131.90) &amp; OR\u2009=\u20091.31, 95% CI (0.93\u20131.83)], respectively. Similar results were obtained when stratified by HNC subsite. Negative control analysis yielded a null finding, indicating no significant bias due to unmeasured confounders. Bias\u2010corrected estimates of the association between oral health indicators and HNC risk moved further from the null.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Negative control exposure analysis indicated that unmeasured confounding did not affect the association between oral health and HNC risk. QBA yielded corrected estimates of increased magnitude, suggesting that the crude associations may have been underestimated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cdoe.70046","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T10:21:31Z","timestamp":1765966891000},"page":"347-353","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oral Health\u2014Head and Neck Cancers: Addressing Confounding Through Negative Control and Quantitative Bias Analyses"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9201-3667","authenticated-orcid":false,"given":"P. K.","family":"Elango","sequence":"first","affiliation":[{"name":"Faculty of Dental Medicine and Oral Health Sciences McGill University  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2833-2317","authenticated-orcid":false,"given":"B.","family":"Nicolau","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine and Oral Health Sciences McGill University  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8762-2467","authenticated-orcid":false,"given":"N.","family":"Farsi","sequence":"additional","affiliation":[{"name":"Department of Preventive Dental Sciences King Abdul Aziz University  Jeddah Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. V.","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Faculty of Medicine and Health Sciences, Alan Edwards Centre for Research on Pain McGill University  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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