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Home Other HPV Cancers Other HPV Cancers HPV and Oral Diseases: Interview with Robert Fleisher, DMD

HPV and Oral Diseases: Interview with Robert Fleisher, DMD

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Evidence is mounting that oral sex is a risk for cancers of the oropharynx (tongue, soft palate, and tonsils). The American Cancer Society estimates there are about 34,000 cases of oropharyngeal cancer each year in the U.S. Heavy tobacco and alcohol use is strongly linked to these diseases, but “high risk” HPV may play a role in half or more of oropharyngeal cancers.

Robert Fleisher, DMD, a faculty member at the Albert Einstein Medical Center in Philadelphia, is an endodontist with more than 30 years experience in the field who says understanding the link between HPV and oral diseases is increasingly vital for dental professionals and their patients. Dr. Fleisher, who in his books Forty Something and Fifty Something maps the connection between dental health and one’s overall physical condition, as well as explores the aging process, recently chatted with ASHA to offer the dental clinician’s perspective on HPV.

HPV News: What is the role of dental health care providers in promoting general health?

RF: Oral health is an extension of our general health. A lot of people figure you go to the dentist when you need a filling or to have your teeth cleaned, and that’s about the extent of it. Dental health – and gum disease in particular –has been linked to numerous ailments including heart disease, diabetes, prostate cancer, and some lung disorders. There are even salivary markers now showing up that can help diagnose early stage prostate cancer. Another big connection is that gum disease has been shown to cause premature birth/low birth weight. So even young women considering getting pregnant, and those who already are pregnant, should visit their dentists to see if there are any signs of advanced gum disease in order to protect their babies.

There are a number of diagnostic tests that will help the dentist, who is familiar with the mouth and saliva, to diagnose many of these problems. As the link between gum disease and heart disease becomes more clear, I think we’ll see that people who don’t take care of their gums are more prone to heart problems, coronary events and complications of diabetes. It’s not that dentists will treat the heart disease and diabetes, of course, but they are going to diagnose and treat the gum disease that may prevent or lessen the effects it has on heart disease and diabetes.

Are dental professionals looking for signs of HPV diseases during routine exams?

They’re supposed to. I think our understanding of the HPV connection with oral cancer is so new that a lot of dentists aren’t aware that it exists. Just as some types of HPV cause cervical cancer, increasingly the evidence is mounting that indicates “high risk” types of the virus [especially HPV-16. ed.] play a large role in head and neck cancers, which include those of the oral cavity.

Dentists should routinely do an oral cancer screening to look for lesions. The exam involves extending the patient’s tongue and looking underneath as well as along the lateral borders. The lips, cheeks, palate and throat are observed as well. One of the main reasons oral and cervical cancers are often so deadly is because they are caught late. Being difficult for the patient to see early cancerous lesions, and because they don’t hurt and don’t cause symptoms, diagnosis is often made after the cancer has spread. Early diagnosis is the key to successful treatment, so, getting a dental exam on a regular basis may save many lives.

There’s even a new oral HPV test that just came out. It actually detects HPV in the mouth, and I’m hopeful this may offer some of the same benefits to oral cancer screening that we see with HPV tests used in the detection of cervical diseases.

When a dentist sees a lesion, a little lump or bump, or perhaps a red or white lesion, the only definitive way to know what’s happening is to remove it and do a biopsy. You can sometimes look in the mouth and say “This looks like it could be an oral wart” (all warts are caused by various types of HPV and are found in the mouth, genitals, and on any skin surface) at which point you might not even treat it, since about 10-20% of these warts will clear up on their own. However, sometimes removing the wart is the better choice, especially if the patient is sexually active and could transmit the HPV to their partners.

Are HPV diseases encountered often in dental practices?

No, which is why many dentists aren’t familiar with this area! You want to be careful, but you also don’t want to biopsy every little bump. There are lots of normal structures in the mouth; right below your lower lip, for example, there are little lumps and bumps which are just mucous or salivary glands, I don’t want people to become paranoid once they read this article and start feeling around their mouths! There are also papilla on the tongue, especially the back of the tongue that could be confused for being a lesion of sorts. If a dentist sees an isolated lesion that doesn’t look normal, he’ll generally remove it and send it for biopsy. If a dentist isn’t comfortable doing biopsies or offering treatment for oral lesions, they’ll often refer patients to an oral surgeon, or sometimes to an ear, nose, and throat specialist. Probably the best one to manage oral lesions is the oral surgeon, because he has the necessary equipment to do a biopsy in the mouth.

What would you tell your young students they need to be aware of about HPV?

Information about the oral HPV test I mentioned earlier just, literally, came to me within the last week. About five years ago I had a patient I wanted to test for oral HPV, and back then there was nobody who did such things. Dentists need to be aware of emerging technologies. While the best use of oral HPV tests are still being figured out, you can see one potential benefit might be to mirror the use of these tests in cervical cancer screening: If you see a suspicious lesion, an HPV test might help the dentist determine more quickly which patients need a referral for treatment.

Some oral lesions are located in difficult places to access. Oropharyneal lesions – those in the tract behind nose and back of the throat – are lesions that no one wants to biopsy, because the area is bloody, difficult to reach, and not a great place to work. It’s like getting your tonsils out again. If I knew HPV was present in such lesions, as the new test will be able to determine, I’d be much more likely to urge removal than to just monitor the situation.

Forty Something and Fifty Something can be purchased from Amazon.com, Barnesandnoble.com, and authorhouse.com