HPV and your Oral Health
Eric G. Jackson, DDS, MAGD, FICOI, FICD, FAD
Actor Michael Douglas' recent announcement that his throat cancer was caused by human papillomavirus (HPV) has raised public awareness about a health trend medical professionals have been alarmed about for years. Throat cancer, more properly known as oropharyngeal cancer, refers to a variety of different tumors that occur in the tonsils, base of the tongue and upper throat. Smoking and alcohol use have long been associated risk factors with this type of cancer, but in recent years throat cancers related to the sexually transmitted HPV have been on the rise. The 2013 “Annual Report to the Nation on the Status of Cancer” found about 13,000 new cases of oropharyngeal in both men and women linked to HPV in 2009 (the last year of available data), more than 10,500 of which were in men. More than 60 percent of oropharyngeal cancers are caused by HPV, according to the National Cancer Institute, which was an author in the report. Amazingly, HPV-related throat cancers are now more common in men than cervical cancer (which is caused by the same virus) in women. These cancers are more commonly found in younger populations (adults between 40 & 65 years old) than those typically affected by smoking-related throat cancers.
HPV is one of the most common sexually transmitted diseases in the world and the most common STD in the United States. It is transmitted through a variety of means, most commonly through oral and genital contact, or a combination of the both. Astonishingly, at least half of all sexually active men and women will contract HPV at some time in their lives. Fortunately, not everyone with HPV will develop cancer. According to one report, seventy percent of HPV infections are naturally cleared by the body in 1 year and ninety percent in 2 years.[i] The 10 percent that do not clear it however are left with a chronic disease and greater cancer risk. Over 120 different HPV strains have been identified, and two of the most notorious are HPV -18 & HPV-16. Combined, these two strains are responsible for 70 percent of all cervical cancers. Additionally, HPV-16 is responsible for half of the oropharyngeal cancer cases. Other strains more commonly cause skin warts, genital warts, or lead to cancers of other bodily areas. Fortunately, HPV-related throat cancers have a high cure rate, more so than the stage IV equivalents of throat cancers caused by drinking and smoking. They are prognostically far better than their smoking/alcohol counterparts.
What can, and should, be done to combat HPV related cancers of the throat? Like cervical cancer, outward signs and symptoms of oropharyngeal cancer are uncommon until the cancer is advanced. Some of these symptoms may include:
- Persistent sore throat or feeling that something is caught in the throat
- A lump on the lip, mouth, neck, or throat or feeling of thickening in the cheek
- Hoarseness or change in voice
- Numbness of the mouth or tongue
- Ear and/or jaw pain
- Changes in speech
- Dentures that no longer fit
- Unexplained weight loss
- Loss of appetite, especially when prolonged
Future generations may be protected by the HPV vaccine, which is now given to both boys and girls as young as 11 through the time they turn 21 (for males) and 26 (for females). According to the CDC website, vaccines are given as a series of three shots over 6 months to protect against HPV infection and the health problems that HPV infection can cause. Two vaccines (Cervarix and Gardasil) protect against cervical cancers in women. One vaccine (Gardasil) also protects against genital warts and cancers of the anus, vagina and vulva. Both vaccines are available for females. Only Gardasil is available for males. HPV vaccines offer the best protection to girls and boys who receive all three vaccine doses and have time to develop an immune response before becoming sexually active in any capacity with another person.
Oral testing is another means to combat the HPV virus. In 2010, Quest Diagnostics released OraRisk HPV, a test to identify which HPV types are present in saliva. I am proud to offer this test as a treatment option to my patients. Like the OralCDx Brush Biopsy test I discussed in the 4th Quarter 2012 newsletter, The OraRisk HPV test is a non-invasive, easy-to-use screening tool. OraRisk HPV enables a dentist to establish increased risk for oral cancer and determine appropriate referral and monitoring conditions. While the test is most commonly performed when a lesion or questionable area of the mouth/throat is identified, it can also be performed prophylactically prior to any symptoms. Collecting a sample takes only minutes and is quickly and easily administered in the comfort of our office. Here is the process:
- Patient vigorously swishes and gargles a saline solution for 30 seconds
- Patient then spits into the funneled collection tube
- Funnel is removed, cap is secured to top of collection tube
- The sample is then sent overnight to the OralDNA Labs for DNA-PCR analysis
- An email notification is sent to the dentist when electronic result report is available
The resulting report identifies any HPV strains detected, and assigns a relative risk for developing precancerous or cancerous growths in the ororespiratory tract (i.e. mouth, throat, lungs). A positive OraRisk HPV test does not necessarily mean that cancer is present, nor does it mean that you will definitely develop cancer. The earlier the risk for oral cancer is detected, or the earlier oral cancer is detected, the more likely it can be treated successfully. Generally when a result returns positive/high risk, close observation is kept throughout the mouth and retesting is recommended annually for at least several years to determine if the HPV virus has been cleared by the body, or if it remains in a chronic state.
Prevention and early detection are the two staples of any cancer program. Regular dental appointments not only allow for detection of cavities but other conditions such as cancer and hypertension (aka high blood pressure) as well. This is why I recommend that even my patients without any teeth schedule a brief annual examination appointment. All too often these patients assume they have no need for a dentist since they no longer have teeth. These annual exams are essential to screen for oral cancers and maintain a proper fit of the patient’s denture. Of course, patients who still possess teeth should maintain their recommended 3, 4, or 6 month hygiene appointment interval to allow for proper cleanings and examination.
If you would like to speak about HPV, Oral Cancer, or any other dental topic, please feel free to call the office and schedule a complimentary appointment with me. Email and Twitter are also available options. I am extremely passionate about modern dentistry and love discussing it with patients, so don’t hesitate to contact me.
Eric G. Jackson, DDS, MAGD, FICOI, FICD, FADI
Goldstein MA, Goodman A, del Carmen MG, Wilbur DC (March 2009). "Case records of the Massachusetts General Hospital. Case 10-2009. A 23-year-old woman with an abnormal Papanicolaou smear". N. Engl. J. Med. 360 (13): 1337–44.