The risk factors for oral cancers are presented below, with the level of evidence that supports them. As can be seen, alcohol in mouth rinses is rated as having inconsistent evidence as a risk factor in oral cancer.1

Proven risk factors

Tobacco use (smoking/chewing)1
Alcohol consumption1
Betel-quid chewing1

Emerging risk factors

Human papillomavirus (HPV) infection
Diet and nutrition
Mate drinking
Low socioeconomic status

Controversial factors, limited evidence

Ethnicity and race
Poor oral hygiene and dentition
Indoor air pollution

Controversial factors, inconsistent evidence

Heredity/familial risk
Cannabis smoking
Qat chewing
Nicotine replacement therapy (NRT)
HIV infection
Alcohol in mouth rinses


A study published in December 2011 estimated that, based on UK data, about 93% of oral and pharyngeal cancers in men and 85% in women are linked to lifestyle and environmental factors.2


  1. Warnakulasuriya S. Causes of oral cancer - an appraisal of controversies. Br Dent J 2009; 207: 471–475.
  2. Parkin DM et al. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Summary and conclusions. Br J Cancer 2011; 105 (S2): S77–S81.