As the number of cases of human papillomavirus (HPV)-related cancers continues to rise, the American Dental Association (ADA) has identified how oral health professionals can help educate patients about using the HPV vaccine to help prevent oropharyngeal cancers. The ADA’s new policy, which urges dentists to support use and administration of the HPV vaccine, was adopted shorty after the U.S. Food and Drug Administration approved expanded use of Gardasil 9 to include men and women ages 27 to 45 in October.
The American Cancer Society estimates there will be more than 50,000 new cases of oral and oropharyngeal cancers in 2018, of which 70% to 80% will be attributable to HPV. These numbers are a call to action for dental teams in the prevention of HPV. Oral health professionals are in a unique position to begin conversations about the HPV vaccine. Unlike primary care physicians who will focus on the vaccine’s prevention of cervical cancer and cancers directly related to sexual activity, clinicians can focus on oral health, as many patients are unaware of the association between HPV and oral cancer.
One of the reasons the vaccine is underutilized is because patients and parents/caregivers often do not realize it does more then prevent cervical cancer and cancers associated with HPV commonly transmitted through sexual activity, including cancers of the penis, vulva, vagina, and anus.
“Other health care professionals sometimes forget to talk about the oral cavity,” says Marcelo Araujo, DDS, MS, PhD, vice president of the ADA Science Institute. “Dental providers have a very good point of view when we have that conversation about HPV vaccination, because we talk about oropharyngeal cancer, so we don’t even have to go to the other types of cancer that make some patients or their parents uncomfortable.”
Discussing sensitive topics such as the risk of HPV-associated oropharyngeal cancers is within the dental team’s purview. According to the ADA Council on Scientific Affairs, an excellent predictor of whether a young person or adolescent will receive the vaccine is a recommendation from a health care provider. “Dental professionals have the ability to have the conversation with patients when they come for a cleaning, as well as with their parents, who make the decision on whether the teenager will be vaccinated or not,” says Araujo.
The visual diagnosis is also an important step in the identification of HPV-related cancer. The ADA published “Evidence-Based Clinical Practice Guideline for the Evaluation of Potentially Malignant Disorders in the Oral Cavity” to assist clinicians in this space. The first clinical signs of HPV infections in the oral cavity is in the form of a very small lesion in the back of the mouth, throat, or on the back of the tongue, that may display as a white patch. A biopsy must be taken to diagnose oropharyngeal cancer.
In 2016, the U.S. Centers for Disease Control and Prevention (CDC) updated HPV vaccine dosing recommendations to two doses, starting the series before the individual’s 15th birthday, and three doses for those receiving the vaccine at ages 15 to 26. The CDC, American Academy of Pediatrics, American Academy of Family Physicians, and American Academy of Obstetricians and Gynecologists recommends boys and girls receive the HPV vaccine during adolescence.
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