Most dental patients believe that coming to our office is all about the health of their teeth and gums. So naturally, they are sometimes surprised when we start talking about systemic health. As a dental professional, you are likely familiar with some of the many connections between oral health and systemic health, and hopefully you are already passing this important information along to your patients.
One awkward topic of conversation, however, that all dental professionals must discuss with every patient is the risk of oral cancer from HPV. The human papillomavirus is the single most prevalent sexually transmitted infection in the United States. It’s transmitted primarily through oral sex, and that can be a difficult topic to bring up with your patients.
HPV-related oral pharyngeal cancer (OPC) is now considered an epidemic, causing three-quarters of all oral cancers. HPV is usually linked with cervical cancer in women, though it probably causes more oropharynx cancer, according to the CDC. Most of our public awareness has come from Gardasil advertisements. But since the Food and Drug Administration has been delayed in assigning its indication for OPC, this message is absent from those ads.
To help our clinical team grow in our ability to talk about HPV-OPC risks, we developed an HPV awareness campaign designed to inform 100% of our adult patients with hopes they would bring the message appropriately to their children as well. These seven tips are the best methods we can share to overcome the awkwardness, discuss early HPV detection, and promote HPV vaccination among your patients.
Start During Your Routine Oral Cancer Screening
Honesty is the best policy. We informed our patients that we were screening for oral cancer, but much of the time we can’t see it because of where it’s located. Say something like, “I’m doing a routine oral cancer screening by looking for early signs of cancer. Unfortunately, oral cancer is a growing epidemic because of a group of viruses called HPV, and most of it is hiding in the back of the mouth, behind the tonsils, in the back of the throat, or at the base of the tongue where you can’t see it. That makes screening for oral cancer very difficult these days, and watching it grow among our population is frustrating.”
State the Cause with Confidence
You must lead by example on private topics with your patients. If you act strange, they will feel strange. Continue your explanation with these words. “HPV is transmitted primarily through oral sex, and until we get most of our adolescent and adult population vaccinated, this rise will continue.”
Continue to use a professional tone and give the information matter-of-factly. You are talking to adult patients, and you are the professional. This may be the first time they hear about the condition, and your foundational information will establish their basic understanding.
If you have established a professional and trusting relationship, they may ask you more questions about HPV-OPC and its risk factors. If there are questions you can’t answer, let them know you will find out and get back to them.
Always Use Evidence-Based Facts
With the advent of the internet and word-of-mouth, no one can really be sure of the validity of the information they hear these days. State the facts for your patients, and don’t be afraid to utilize a printed pamphlet or leaflet to further illustrate the factual points. The best way to fight the rising epidemic of HPV-related oral cancers is to spread evidence-based truth.
Encourage Your Patients to Spread the Word
How oral cancers develop in conjunction with HPV is not a commonly known issue. Encourage your patients to discuss this growing epidemic with their friends and family, reminding them that oral sex is not safe sex!
Help Deescalate the Epidemic by Recommending Vaccination
The medical community has fallen short on pushing the Gardasil vaccine. This year we will vaccinate just over half of all teenagers, leaving thousands more exposed to the virus. Dental professionals can help. Whether your patient is infected with HPV or not, it is a good idea to recommend the vaccine.
The vaccine, Gardasil 9, protects both men and women from the nine most dangerous strains of the HPV infection. Insurance covers young adults until the ages of 21 for males and 26 for females, but it is advised for anyone under 45, and there is nothing prohibiting adults over 45 from receiving it.
Encourage HPV testing
Of the more than 200 types of HPV, including the ones that cause warts on your fingers and feet, 51 have been identified in the mouth, and 25 of those have been linked to oral pharyngeal cancer. If you want to offer a saliva test to help your patients better assess their current risk level for OPC, it’s easy. Oral DNA labs offer an affordable saliva test that identifies all 51 types.
Remember that a positive HPV test does not mean cancer. In fact, it’s the persistent HPV infection that poses the real risk. That’s why HPV positive patients will want to repeat the test in 12 to 18 months. That gives them adequate time to hopefully “clear” their virus by improving their host immune response.
It’s a great opportunity to encourage healthy lifestyle changes such as healthy eating, improved sleep quality and quantity, quitting smoking, reducing alcohol consumption, and refraining from unprotected sex.
Take Your Time
While these conversations may be sensitive, they get easier with experience. Like all the health advocacy dialogues we have, your patients will see how much you care about them and their well-being. There remains a mountain of evidence that patients’ “treatment” choices and outcomes are greatly improved as a result of face-to-face heartfelt relationships with their professional providers.
Don’t just fly through the discussion about HPV-OPC. Everyone is responsible for themselves, and your genuine approach as a knowledgeable and caring dental professional makes a difference.
Dr. Maples is a dentist, author, and health educator. She is the creator of Total Health Academy, a complete online learning curriculum for creating a total health dental practice of your own, and author of Blabber Mouth! 77 Secrets Only Your Mouth Can Tell You to Live a Healthier, Happier, Sexier Life. She is a board member of the American Academy for Oral and Systemic Health and an expert on the many connections between the mouth and the body. For more information, visit drsusanmaplesspeaker.com and drsusanmaples.com.