Protect Patient Health with Salivary Diagnostics

Persistent oral human papillomavirus (HPV) infections have been linked to an increased risk of oral and oropharyngeal cancer. According to the Center for Disease Control and Prevention (CDC), HPV is the most common sexually transmitted infection. Over 200 strains of HPV have been identified. The high-risk types, HPV-16 and HPV-18 are associated with oropharyngeal squamous cell carcinoma (OPSCC). The CDC reports that HPV is responsible for approximately 70% of oropharyngeal cancer in the United States.

Approximately 90% of oral HPV infections clear on their own within two years. Those that persist are linked to an increased risk of oral and oropharyngeal cancer. As a dental hygienist, I feel deeply that one of my most important responsibilities is the early detection of head and neck cancer. HPV infections are generally asymptomatic which makes early detection challenging. In addition, this is complicated by the fact that in dentistry, we don’t have the technology or expertise to fully visualize the oropharynx where approximately 70% of HPV-positive cancers are located. To overcome this impediment, we can monitor our patient’s HPV status with salivary diagnostic testing.

Many of my coaching clients have shared that they feel uncomfortable discussing a sexually transmitted disease with their patients, as if that’s outside of our scope of practice, which it is not. It is, however, outside of our comfort zone. Discussing sexually transmitted diseases was never taught when I was in dental hygiene school. Forty years ago, when I was in school, I never imagined having those conversations myself. Yet, I have learned to get over my own discomfort and have those straightforward conversations with my patients. I encourage my clients to step out of their comfort zones and share this important information with their patients, too. When we speak forthrightly and with confidence, we can help relieve our patient’s discomfort, as well.

While I’m performing my extra-oral and intraoral head and neck cancer screening, I typically share the following facts with patients to open the conversation:

• • The risks for oral and throat cancer have changed. It used to be that people who used tobacco or excessive alcohol were at highest risk for oral or oropharyngeal cancers. Now, the biggest risk is the Human Papillomavirus. (1)
  •  HPV infections have historically been associated with cervical cancer, but these same strains have been found to cause oropharyngeal cancer. (1)
  •  HPV is easily transmitted by skin-to-skin contact, and even with open-mouth kissing. (2)
  •  Just as women have an annual pap smear which includes screening for genital HPV, we recommend that all adults have a screening for oral HPV. (3)
  •  If there is a positive result, we must repeat the test to determine if the infection resolves or if it persists. If the immune system takes longer than 2 years to clear the infection, it is considered persistent. This indicates an increased risk for oropharyngeal cancer.
  •  The most effective ways to boost the immune system and have the best possible chance to clear the infection include eating whole, nutritious foods, staying well hydrated, getting good, restful sleep, daily exercise, nasal breathing and practicing stress reduction techniques. Testing for micronutrient deficiencies and supplementing with the direction of a qualified nutritionist is also recommended. (4)

By this point I have finished my intraoral screening with fluorescence and my extensive extra-oral screening with a very thorough neck examination. I will explain to my patient that while I have thankfully not found any sign of cancer, I can’t see viruses and that is why I recommend they have an oral HPV screening with the OralDNA® Labs OraRisk® HPV test. Collecting the sample takes 30 seconds of gargling and swishing a saline solution. The sample will be sent to the lab and screened for 51 types of HPV and the results will be available in about a week. Most patients are open to the test although some need time to process the information. 

OraRisk HPV gives providers, as preventive specialists, the opportunity to offer patients an easy way to determine their HPV status and monitor positive results until the infection clears. It gives us an opportunity to refer to a throat specialist if a patient has a persistent infection to determine if any other testing or treatment is required. By utilizing this technology, dental professionals can assist in the early detection of HPV-related oropharyngeal cancer and improve patient health outcomes.

References:

1. Elrefaey S, Massaro MA, Chiocca S, Chiesa F, Ansarin M. HPV in oropharyngeal cancer: the basics to know in clinical practice. Acta Otorhinolaryngol Ital. 2014 Oct;34(5):299-309. PMID: 25709145; PMCID: PMC4299160.
2. Wierzbicka M, San Giorgi MRM, Dikkers FG. Transmission and clearance of human papillomavirus infection in the oral cavity and its role in oropharyngeal carcinoma – A review. Rev Med Virol. 2023 Jan;33(1):e2337. doi: 10.1002/rmv.2337. Epub 2022 Feb 22. PMID: 35194874; PMCID: PMC10078185.
3. https://my.clevelandclinic.org/health/diagnostics/22163-human-papillomavirus-hpv-test
4. https://www.cuimc.columbia.edu/news/what-you-really-need-do-boost-your-immunity

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Kathryn Gilliam

Kathryn Gilliam is a certified biological dental hygienist, practicing clinician, writer, speaker, consultant, and lead clinical coach with Inspired Hygiene. Kathryn has been on the front lines of early detection of oral cancer throughout her over 30-year career as a clinical dental hygienist. She is passionate about influencing every hygienist with whom she works to elevate their standard of care and their standard of caring. Kathryn teaches all her client teams a spa-like and thorough head and neck cancer exam that both relaxes patients and raises their awareness of the importance of regular cancer screening. She is an active volunteer for and serves on the advisory board of the Oral Cancer Foundation, organizing volunteer dental hygienists to perform free cancer screenings during the annual Walk for Awareness. Kathryn can be reached at kathryn@inspiredhygiene.com.

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• Protect Patient Health with Salivary Diagnostics - April 4, 2025