Human Papilloma Virus (HPV) is a sexually transmitted disease which can impact the oral cavity. Oral presentation of HPV can range from a milder presentation, such as oral or throat warts, to more severe disease including oral cancer, particularly oral and oropharyngeal cancers (OOPC) which affect the tonsils and throat.

According to the American Academy of Pediatric Dentistry (AAPD) in their Policy on Human Papilloma Virus Vaccination, 2019 saw 53,260 new cases of OOPC resulting in 10,750 deaths. The American Dental Association (ADA) further notes that approximately 9000 cases of HPV related oral cancers occur annually and that OOPC related to HPV impact men at a rate 4 times that of women. OOPC is also increasingly impacting younger age groups, which is also thought to be related to HPV.1

Oral Cancer Symptoms
Because oral cancers associated with HPV are generally in the back of the throat, they are often found in the folds of the tonsils or the back of the tongue making them hard to find. The ADA notes that patients may complain of persistent sore throat, feeling like something is caught in their throat, hoarseness, a change in voice, earaches, pain when swallowing and unexplained weight loss and or present with:

  • A sore, or soreness or irritation that doesn’t go away
  • Red or white patches, or pain, tenderness, or numbness in mouth or lips
  • Lumps, thickening tissues, rough spots, crusty or eroded areas

Vaccines for preventing HPV (ex. Gardasil) have been available for nearly 15 years; these have been shown to lead to a significant reduction in HPV infections in young adults. While a direct cause and effect has not yet been established between vaccination and a reduction in OOPC, there is thought to be a strong association with OOPC prevention.

How can dentists help?
In their policy statement the AAPD notes that dentists already provide anticipatory guidance on a range of topics including home care, nutrition and tobacco counseling. Specific to HPV the AAPD advises dentists:

  • Educate patients, parents, and guardians on the serious health consequences of OOPC and the relationship of HPV to OOPC.
  • Counsel patients, parents, and guardians regarding the HPV vaccination, in accordance with CDC recommendations, as part of anticipatory guidance for adolescent patients.
  • Routinely examine patients for oral signs of and changes consistent with OOPC.
  • Follow current literature and consider incorporating other approaches for HPV prevention in their practices so as to minimize the risk of disease transmission.2
 
Additional Resources
There are numerous excellent sources for further, more detailed information regarding HPV, its impact on OOPC and the potential role dentists can play in helping to mitigate both by counseling patients and their parents. An outstanding resource is The National HPV Vaccination Roundtable’s Cancer Prevention through HPV Vaccination: An Action Guide for Dental Health Care Providers. It contains excellent background information along with specific actions dentists can take to help their patients with what may be a difficult subject. Nevertheless, dentists can play an important part, and even save a life. 

November is Mouth Cancer Action Awareness Month, and Delta Dental of Virginia is partnering with the American Cancer Society to promote preventive actions. Through social media, we will encourage everyone to get regular oral health check-ups as a strategy to catch oral cancer at an early stage, where there is a greater rate of survival. We invite you to follow us on Facebook, Twitter or LinkedIn and share our posts with your social media community throughout the month of November.
 
Michael D Weitzner, DMD, MS
Dental Director, Delta Dental of Virginia
 
1American Dental Association, HPV: Head, Neck and Oral Cancers, https://www.mouthhealthy.org/en/az-topics/h/hpv-and-oral-cancer
2American Academy of Pediatric Dentistry, Policy on Human Papilloma Virus Vaccination, updated 2020
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