Oral HPV in Clinical Practice: Screening, Risk, and Early Detection

April is Oral Cancer Awareness Month – a timely reminder that HPV is the leading factor and part of the cause of oral cancers, with about 70% of cases linked to the virus.(1)

This marks a shift from the historical focus on tobacco and alcohol abuse as the cause. Today, understanding oral HPV transmission, persistence, and testing is an important stance in one’s ability to provide cutting edge patient care.

How Is Oral HPV Transmitted?

Oral HPV is a common virus that can be transmitted through:

    • Passage from mother to newborn
    • Oral sex
    • Deep (open-mouth) kissing

Most patients have no symptoms. In fact, 70–90% of HPV infections are asymptomatic and equally difficult to diagnose by clinical exam.(2) This is why early detection and regular screenings are particularly important.

The Impact of HPV

HPV can cause normal cells to turn abnormal – a process patients cannot see or feel occurring. In most cases, the immune system fights off the infection naturally, and infected cells return to normal. However, in cases when the body does not fight off the virus, HPV can cause visible changes to occur and certain types can cause oral cancer. 

Early oral HPV infections typically do not contribute to the development of clinical signs or symptoms. When symptoms do occur, they may include:

    • An ulcer or sore that does not heal within 2–3 weeks
    • Red, white, or black discoloration of oral soft tissues
    • Persistent sore throat
    • Difficulty or pain with swallowing
    • Swelling or a lump in the mouth, head, or neck
    • A swollen but painless tonsil

These findings warrant further evaluation – but waiting for symptoms alone can delay detection.

Who Should Be Tested?

Consider discussing oral HPV risk assessment with patients who have:

    • Traditional oral cancer risk factors (tobacco use, excessive alcohol consumption)
    • Been sexually active
    • A family history of oral cancer
    • Signs or symptoms of oral cancer
    • Suspicious oral lesions

Many patients with HPV-related oral cancer do not fit the traditional risk profile, making broader risk discussions important.

Adding Objective Data to the Clinical Exam

Visual and tactile exams remain essential, but they cannot detect viral presence when tissues appear normal. A simple saliva test can provide additional, objective information about a patient’s oral HPV status.

OralDNA’s OraRisk HPV test detects 50 types of oral HPV across all risk categories as defined by the International Agency for Research on Cancer (IARC), allowing for a more complete assessment alongside the clinical exam.

Why test beyond high-risk types?

While high-risk HPV types are most strongly associated with malignancy, limiting testing to only those strains may overlook a substantial portion of oral HPV infections.

Among positive OraRisk HPV test results, the distribution is:

    • High risk: 46%
    • Low risk: 29%
    • Unknown risk: 25%

Importantly, “low risk” and “unknown risk” do not mean “no risk.” Viral behavior, persistence, and host response vary. Broader detection provides a more complete picture of oral HPV presence and can support more informed monitoring and clinical decision-making.

A Shift in Clinical Mindset

As HPV-related oral cancers continue to rise, the traditional assumption that only tobacco and alcohol users are at significant risk is no longer sufficient. Oral Cancer Awareness Month is an opportunity to:

    • Reevaluate screening protocols to incorporate salivary testing
    • Update patient education materials 
      • At OralDNA, we offer free patient brochures through the OralDNA provider portal, including a digital version in Spanish!
    • Incorporate HPV risk discussions into routine visits

Are your patients at risk? Test. Don’t Guess!

References

  1. https://www.cdc.gov/cancer/hpv/basic-information.html
  2. https://asm.org/articles/2022/december/the-dangers-of-undiagnosed-sexually-transmitted-in

Diane Larson RDH, BSDH
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