As a Total Health Dental Practice, there was one particular oral disease my team was not comfortable discussing—even though it is deadly and its epidemic has escalated to horrific proportions. You guessed it…HPV-related Oral Pharyngeal Cancer (OPC). Don’t get me wrong; our responsibility to complete our 9-point screen for oral cancer is routinely completed. But we knew the screening exam—was completely ineffective in screening for the risk of HPV-OPC.
In brainstorming about our weakness, we admitted to ourselves that it was just plain uncomfortable talking about a viral infection that is, let’s face it, our #1 most rampant sexually transmitted disease (STD). Oral HPV is transmitted primarily through oral sex, and who talks about that in the dental chair? We do now. We also confessed we felt powerless at the idea of alarming our patients about a deadly epidemic that we simply can’t see or detect.
Our HPV Awareness Campaign challenge in 2017 helped us make a difference. Our goal was to bring awareness to 100% of our adult patients, with hopes they would bring awareness to their children and grandchildren as well. Patients took home an informational placard and left a first-name-signed campaign emblem (in the shape of lips) that was proudly displayed in our hallway. (See photo below).
Our message basically resounded simple meters of repeatable advice:
• Spread the word…oral sex is not safe sex!
• If you haven’t been vaccinated, don’t wait!
• Consider a saliva test for HPV. It’s easy, safe and affordable!
That’s right, a saliva test! Most people have no idea that oral HPV infection is detectable in saliva. To the dental profession’s good fortune, OralDNA® Labs offers a highly sensitive test which detects the specific presence 51 HPV types. The report reveals the inherent risk values of each identified strain. It’s important to note, that 25 strains have been associated with oral cancer while HPV 16 and 18 are the most virulent.
As you might expect, when offered, many of our patients opted for the oral HPV test—and about 25% of those tested were positive for at least one HPV strain. We assured them that HPV infection doesn’t mean cancer. In fact, it is the persistent infection that poses a risk. In other words, any positive HPV test should be repeated in 12-18 months. Unlike some viruses (such as the Herpes Simplex Virus), humans can often “clear” an HPV infection, provided they have strong “host immune response”, meaning good overall health.
During our campaign, our team grew tremendously in their ability to help our patients understand this looming HPV-OPC crisis and take action. When someone couldn’t answer a particular question they would offer to investigate and get back with the curious patient.
One group of questions that arose frequently was the relationship between HPV cervical infection and HPV oral infection. Many women who have tested positive for HPV-16 or -18 cervically, assumed they would test positive orally. We informed patients that HPV is site specific so a positive cervical diagnosis doesn’t always equate to a positive oral HPV infection. Other questions circulated around the HPV vaccine and if it is too late to be vaccinated. (It’s not too late!) Although we can offer some answers many of the answers are still a bit confounding, more research is still needed.
For more answers we consulted with a leading HPV infectious disease specialist at the Michigan State University College of Human Medicine and met with his team of research assistants. We left with a slew of unanswered questions, and hoping for more research, and fast—while the prevalence of this potentially deadly infection soars. Once again I’m reminded that it’s not about what we know. It’s about the questions that emerge from what we don’t know that will make a difference.