The Role of Dental Providers in Preventing HPV-Related Oral Cancer

In the United States, about 3,200 new cases of oropharyngeal cancer are diagnosed each year in women, and about 13,200 in men. More than 70% of these cases are related to human papillomavirus (HPV) infection.

In a February 21^st symposium hosted by PreteenVaxScene and the Virtual Immunization Communication Network, a panel of speakers discussed how dental professionals can play an integral role in increasing HPV vaccination rates and decreasing HPV-related cancer. Dental providers should, thus, educate themselves about HPV and HPV vaccines, to gain the knowledge and competence to talk with patients and their parents about these topics.

Persistent, high-risk HPV infection—predominantly HPV-16—is associated with oropharyngeal cancer development, said Alessandro Villa, DDS, PhD, MPH, an instructor in Oral Medicine, Infection, and Immunity at Harvard School of Dental Medicine, Boston, Massachusetts.

Oral sex remains a major risk factor for its development, he emphasized, although other risk factors include cigarette smoking, alcohol use, immunosuppression, and age.

He also noted that, although most HPV infections spontaneously clear themselves within 1 year, no screening tests or treatments are currently available for oral HPV.

“Oropharyngeal cancer has now surpassed cervical cancer as the most common HPV-related cancer,” said Rebecca Vanucci, MA, from the Massachusetts Department of Public Health.

Because many patients see their dental providers more frequently than they see other healthcare providers (HCPs), Vanucci stressed that dental providers should play a key role in HPV prevention and vaccination among their adult and pediatric patients.

Recommendations for useful conversations about HPV focus on the dental provider-patient relationship, said Rosie Wagner, DDS, a private dental practitioner in Somerville, Massachusetts. However, she noted that these discussion points are generally applicable to any HCP.

Dr. Wagner recommends that the medical form should be the first time the topic of HPV is raised with the patient. This will take the form of a question asking whether the patient is “current on immunizations, including HPV.” The provider can then ask the patient or the patient’s parent to expand on the answer to this question.

Other opportunities to raise this topic include during the oral cancer examination, at which time the provider can discuss the signs and symptoms of oropharyngeal cancer.

However, providers should keep these discussions simple, said Dr. Wagner. They can simply tell patients and parents that “HPV is a virus that can cause cancers in several parts of the body, including the throat” and that “there is a vaccine that protects against many of the cancer-causing strains of HPV, and it is recommended for women aged 9 to 26 years, and for men aged 9 to 21 years.”

Providers can also refer patients and parents to the Centers for Disease Control and Prevention (CDC) website for additional information about HPV and HPV vaccines.

“HPV is a complex, emerging public health issue,” said Lisa Bennett Johnson, RDH, MS, MPH, a research registered dental hygienist from the Oral Medicine and Dentistry Division at Brigham and Women’s Hospital, Boston, Massachusetts. “And, despite being recommended since 2006, HPV vaccines are suboptimally used, particularly compared with other routine vaccines.”

She noted that although most adolescents have received the first dose of the vaccine, only 43% of teens are up-to-date on all the recommended doses of HPV vaccine. A lack of provider-recommendation is the main reason why parents do not have their children vaccinated against HPV, Dr. Wagner stressed.

Because registered dental hygienists are prevention specialists, Johnson emphasized that they have the potential to include HPV-related cancer prevention strategies within the education they already provide to their patients.

She advises providers to take a “matter-of-fact” approach when discussing HPV prevention. “Don’t preach, and avoid getting into the weeds with details,” she said. She also recommended using passive educational materials, including patient pamphlets or instructional videos in the waiting room.

Johnson also stressed the importance of supporting recommendations with evidence-based data, from peer-reviewed publications or from the CDC, for example.

In general, dental providers should encourage parents to vaccinate their children at a young age, said Vanucci, so that they are protected before exposure. A child only needs 2 doses if the course starts before the child’s 15^th birthday.

“It takes a village to vaccinate,” said Vanucci. But, one way for dental providers to encourage parents to have their children vaccinated against HPV is by asking them, “if there were a vaccine against cancer, wouldn’t you want your child to get it?”

“Well, there is a vaccine,” she concluded.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.