It is imperative that dentists adopt to what is known as two distinct, separate causes of oral cancer. Tobacco / alcohol use which is traditionally identified as a leading risk factor for the development of oral cancer and the infection of HPV-16 which is rising rapidly especially in the younger ages that are non-smokers between the ages of 25-50.
Oral cancer is on the rise in all age groups regardless of tobacco and alcohol decline due to the spread of the spread of a particular strain of human papilloma virus, HPV-16. In fact, “HPV may contribute to the development of approximately 20% to 30% of all oral cancer case” worldwide and 40 to 80% of all oral cancer case in the US.
Because there are two distinct causes for oral cancer, and therefore are two different important protocol for detecting them. For example, recent data tells us the HPV related oral cancer is more elusive than the tobacco / alcohol related cancer. Unlike tobacco and alcohol which occur mostly in the anterior floor of the mouth and the lateral borders of the tongue, HPV lesions are buried deep within the tissues, possibly below the basement membrane barrier at the base of the tongue, in the tonsillar area, and in the oropharynx.
For this reason HPV cannot be detected with traditional tools. Moreover, HPV can cause oral cancer with no signs until the disease is very advanced.
Most Americans will have some version of HPV in their lifetimes. The HPV virus infects at least 50% of all people who have had sex at some time in their lives. It is “likely that changes in sexual behaviors of young adults over the last few decades and which are continuing to spread HPV and the oncogenic versions of it.” This, while distressing, are not surprising because there are 130 strains of HPV viruses. Only a handful are oncogenic (correlated with cancer growth), and HPV-16 is the one that causes cervical cancer in women and oral cancer as well.
Of this HPV-16 most of us (99%) possess an immune system. Because HPV related oral cancer develop via transmission of HPV-16 over moist epithelial cells, sexual contact, including but not limited to open mouth kissing and genital-oral contact, is a risk factor for HPV-related oral cancer. Other risk factors are lichen planus and other auto-immune, inflammatory diseases of the mouth; periodontal disease: diets lower in fruits and vegetables; and genetic predispositions such as inherited defects in genes contributing to DNA repair.
In order to do a thorough oral cancer screening it’s imperative that your doctor do at least the following;
- Extra-oral visual and tactile examination, including but not limited to the palpation of the neck.
- Intra-oral visual and tactile examination.
- Use of screening tools.
- Asking patients appropriate and revealing questions and waited for their responses.
- Patient education, particularly provision of information on benefits of vaccinating against HPV
The following should be included in your dentists protocol:
- Can you tell me about any swelling or pain you’ve experienced in your face, mouth, neck, tonsils or throat?
- Any painless, non-moving firm bumps on your neck?
- Mouth sour lasting more than two weeks?
- Any oral bleeding?
- Changes in taste?
- Changes in voice sounds?
- Changes in the surface of your mouths?
- Problems with eating or swallowing?
- Recent changes in weight?
- Numbness or tingling in your face?
- Recent changes in vision?
An answer to any of these questions may indicate a viral infection with HPV, and needs a further investigation. “The HPV positive group is the fastest growing segment of the oral population.” One hundred people are diagnosed with oral cancer every day. Screening for oral cancer is all about saving lives. Telling your patients how much you care about them by telling them about HPV-oral cancer.
Call The San Marcos Dental Center at 760 734-4311 and make an appointment today!