Clearing up confusion about HPV

By Angie Gribble Hedlund, DMD @AngieHedlund

I went to a great OSHA training seminar today.  That sounds like a funny thing to say about an OSHA seminar, but the presenter was more like a stand-up comedian than a lecturer and made the material really interesting and entertaining.  During the discussion of infectious pathogens, she devoted several minutes to Human Papillomavirus.  This is a considerable area of interest for me as we have been using the OraRiskHPV diagnostic test to detect oral HPV in our patients for over a year.

Some of the statistics that our presenter highlighted were:

1. 30-60% of all oral cancer is caused by HPV.  (Actually her figures may be slightly outdated- it’s 50-65%- oralcancerfoundation.org)
2. The 5 year mortality rate for oral pharyngeal cancer that is discovered in late stage is 50%.
3. Tragically, the fastest growing population for oral cancer is young adults ages 18-40.
4. By age fifty- 80% of people will have been infected with some strain of HPV.
5. On the positive side, 90-95% of HPV clears within one year.

These are alarming figures; and when you combine them with the following numbers that we know from other research, I think you will agree that this is an area of disease that needs our attention.

Additional facts to consider on HPV

• • 41,000 people are diagnosed yearly in the U.S
• • 66% of people will be diagnosed at late stage three or four
• • Resulting approximately 12,000 deaths per year- More than one person dies every hour of every day of oral cancer!
• • HPV infected individuals have up to 32x greater risk of developing oral cancer
    (Compared with traditional risk factors like: smokers– 3x greater risk and excessive alcohol 2.5x greater risk.)

The good news is that early discovery will decrease the mortality rate, and for the first time in history, dentists have at their disposal a reliable, accurate test to detect the presence of oral HPV- OraRisk HPV from OralDNA labs.  This simple chair side rinse and expectorate assessment tests for the presence of Human Papillomavirus and more specifically, classifies the strain/strains of HPV that are present.

Criticisms of the OraRiskHPV diagnostic test

Two complaints that my OSHA presenter had about this test were:

1. All of the studies that have been done on it are funded by the company, and she would like to see independent research.
2. She expressed concern about reports of false positive results.

Regarding the first concern, I agree.  I would love to see more independent studies performed, but this will take time and an increased use and awareness of the test and does not invalidate the results of the screening.

Regarding the second concern, this is simply misinformation. During extensive validation testing, there were no known false positives.  All DNA PCR (Polymerase Chain Reaction) processes are highly specific. There cannot be a false positive test because if HPV is detected, it is actively shedding virus.

Providing Oral HPV testing to patients

Let me be clear that I personally have no relationship with OralDNA labs financially or otherwise, nor does The Dawson Academy.  Furthermore, this is not designed to be another profit center for my practice. Although some clinicians charge more, I charge just enough for the test to cover my costs because I do not want the cost to be a deterrent for the patient.  If our desire is truly to be physicians of the masticatory system rather than tooth doctors, I believe we should be on the front lines of screening for oral HPV infections.  This is part of being advocates for our patients and at least offering them the opportunity to be tested in our dental offices.  The test is quick, non-invasive, affordable and accurate, and more importantly- early detection can save lives.

There is should be no stigma to having the presence of oral HPV.  It is not merely sexually transmitted; it can be transferred by skin-to-skin contact.  This includes hand-to-hand or hand-to-mouth contact.  This is a key point for clinicians and patients to understand, because when we offer to screen our patients for oral HPV, it does not infer that they are non-monogamous, promiscuous, or even sexually active.  This is an early detection device that should be offered regularly and repeated annually in patients who are positive for HPV-16 which is implicated in most oral pharyngeal cancers.  If it does not clear in one year like most oral HPV will, then they have a chronic, resistant infection and should be examined meticulously in our dental offices for any signs of precancerous lesions and, in my opinion, be seen for regular annual exams by an ENT with endoscopy if needed.

Our opportunity as Dawson Dentists

Currently this test is only available to dentists, but if we do not incorporate this into our practices, it will end up being offered to physicians.  It seems so logical that dentists should be at the forefront of fighting oral cancer; we see our patients more frequently, and examine their oral cavity at every visit.  Lack of public awareness about the link of HPV to oral cancer is very serious, and my hope is that Dawson dentists can help raise awareness about this HPV assessment in the dental community as well as among our patients.