Nowadays, most people recognize HPV as either innocuous warts, or from TV commercial ads about vaccinating preteens to prevent cervical cancer. HPV is caused by the DNA virus from the papilloma family. Like typical viral infections they hijack our cells, forcing the host cells to stop our DNA replication and instead start producing the viral DNA- all at an incredible fast rate. HPV doesn’t take over just any cells: they exclusively select the basal layer of body surface tissues. This preferential is known as cell or tissue tropism – the virus has evolved to target specific cells or tissues.
So why are we talking about all this? Because April is National Oral Cancer Awareness Month.
Human Papilloma Virus is the number one cause of oropharyngeal cancer. By oropharyngeal, we mean the back of the throat, including the tonsils and base of the tongue. HPV causes 70 percent of oral cancer. There are more than 100 types of HPV and 40 strains of HPV can be spread through sexual contact or through direct contact with the mouth, throat and genital areas. According to the CDC, about 10 percent of men and 3.5 percent of women have oral HPV. Contrast that with genital HPV — nearly one in two adults have it! Most people clear the virus within a few years, but for some people the virus remains. The National Cancer institute reports that the number of new cases of oral cancer in 2010–2014 was 11.2 per 100,00 men and women, with a mortality rate of 2.5 per 100,000. They report that new oral cavity and pharynx cancer cases have been rising on average 0.6 percent each year over the last 10 years.
As health professionals who are mainly focus on the oral cavity, we are very concerned. We are Dr. Edna Buckle, an oral and maxillofacial surgeon based in Maryland, and Dr. Zahra Omar, a general and cosmetic dentist based in NYC.
Dr. Buckle: “As strange as it may sound, I always keep my patient’s sex lives in the back of my mind when I do an initial dental exam. Whether the chief complaint is TMJ pain, pressure from wisdom teeth, or toothache, I always do as thorough of an oral exam as possible. The reason is that I know that likely my adult patients are sexually active, and I know that of those sexually active adult patients, more than 80% of them have had or currently do engage in oral sex acts, putting them at risk for HPV and thus oral cancer. It is estimated that a huge percentage of people in America will contract HPV at some point in their lives. The majority will clear the HPV but in a very small percentage of people it will persist, and in an even smaller percentage the virus will cause mutations that can lead to cancer. Roughly forty thousand people contract oral cancer in the United States each year and about ten thousand dies from their disease each year. Out of a population of over 300 million Americans, it is a miniscule percentage but the physical and psychological toll of oral cancer is devastating, so the earlier small lesions are caught, the better the overall prognosis. So, I peel back lips and check throats and lift tongues on every patient every day as a quick oral cancer screening and recommend biopsy for anything that seems suspicious.”
Dr. Omar: “Yes, I agree. With every dental exam I also do a thorough exam to check out anything that looks out of the ordinary. You would be surprised at the number of people who never actually look inside their mouth when they brush their teeth. For most people brushing is just a routine thing that is done very quickly. I look for any bumps, patches of red or white lesions, or complaints of trouble swallowing. These are possible signs that something is not right. We don’t want to scare people but early detection is the best.
Most of all, know your status and that of your partner. If you are sexually active, get tested for STI’s at least annually or every three months if you have multiple sexual partners.
We are not here to regulate or restrict people, but we do want people to be aware of oral cancer. Our best pieces of advice would be:
1. See your dentist regularly, and don’t procrastinate if you feel something is off.
2. If you are engaging in oral sex, use a condom or dental dam.
3. Reduce smoking and alcohol consumption because alcohol and tobacco work synergistically to increase the risk and severity of any kind of cancer, but especially Oral Cancer.
And most of all reduce stress and enjoy life. Be safe, be well and hope to see you soon in our offices!
Dr. Zahra Omar is a general and cosmetic dentist and owner of Zara Dental on the upper west side of Manhattan (zaradentalnyc.com). Dr. Edna Buckle is a board certified Oral and Maxillofacial Surgeon and the owner of Avie Oral Surgery Group in Odenton, MD (www.avieoralsurgery.com). Together they have nearly twenty years of experience working with patients and evaluating potentially cancerous lesions.
