A necessary challenge: How to talk to your patients about the connection between HPV and oral cancer

Dental Economics' Managing Editor Kevin Henry talks with Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University, about how dental professionals can broach the sensitive subject of HPV and its connection to oral cancer with their patients.

After speaking to dental professionals around the country, I have found that many are hesitant to talk to their patients about the link between HPV and oral cancer.

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According to the CDC, genital human papillomavirus (HPV) is the most common sexually transmitted infection. There are more than 40 types of HPV that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. That's where the dentist and the dental team play a big role.

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Take a few moments to read up on HPV in this link from the CDC. It's important that you and your team know the facts. It's also important for you to know that, as it says in this material from the CDC, "Anyone who is having (or has ever had) sex can get HPV. HPV is so common that nearly all sexually active men and women get it at some point in their lives. This is true even for people who only have sex with one person in their lifetime."

Yes, HPV is everywhere, and even though the conversation may be uncomfortable, it's a topic that must be discussed with your patients. Why? Because cases like what happened to my friend Eric Statler can happen to you and your patients. That's not a scare tactic. It's a fact.

With that thought in mind, I recently had the chance to talk to Dr. William Schaffner, the chairman of the Department of Preventive Medicine at Vanderbilt University. Dr. Schaffner was interviewed for a short article in a recent issue of Men's Journal, again highlighting the effort to educate the public about the HPV-oral cancer link, and I found the interview, although short, enlightening.

Kevin Henry: What are the main points that dental professionals need to know about HPV?

Dr. William Schaffner: The tricky thing for the everyday person is that your partner is completely normal to the eye and touch. There's nothing that indicates that HPV is there. Finding out if a person has HPV is difficult and the testing is elaborate and expensive. We're simply not at that point in our medical research yet. When women reach their 20s and 30s, more than half have an HPV infection and probably multiple HPV infections. The older we get, the more likely it is that the infection is there. That's why vaccination is so important in adolescents ... both male and female. This HPV vaccine protects against four types of HPV infection, and it will evolve into protecting against more in the future.

Vaccinations are becoming more routine in the U.S., but we are still lagging far behind the Canadians and Australians. It's something we have to keep educating the population about.

Henry: What would you say to a dentist or team member who is worried about talking to their patients about a sexually sensitive issue such as HPV?

Dr. Schaffner: I know it’s a bit of a challenge to talk about, but I think it needs to be phrased in the same conversation as oral hygiene upkeep. The focus needs to be on prevention and not scaring a patient. You can't really prevent HPV from happening, but you can certainly introduce the concept of preventive care. Talk to patients about your practice doing everything it can to detect and prevent the growth of tumors and lesions in the head and neck area. You want to make sure that patients know you care not only about keeping their teeth healthy, but also the entire head and neck area.

Henry: What do you feel is a good way to introduce the HPV conversation to a patient?

Dr. Schaffner: If they're under 30, ask them if they're aware of the vaccine for HPV. Certainly the dental office won't give the vaccine, but you can provide information about what it is and why it's important. Also, I believe dental practices could give a one-page information sheet about the link between HPV and oral cancer to every patient at the same time they are given the toothbrush, toothpaste, and floss. You can explain briefly why you’re giving them the paper, and they will read the information when they’re ready.

Henry: You feel this could be discussed in the same manner as helping a patient with smoking cessation?

Dr. Schaffner: Yes. Smoking and HPV are the two biggest risk factors for oral cancer. You talk to patients about quitting smoking, and you also want to make sure that your patients are aware of the rise of cancers from HPV.

Henry: How do you see the role of the dentist evolving when it comes to the overall health of the patient?

Dr. Schaffner: I know a recent dental school graduate who now has a position at the CDC. She was motivated to attend dental school after hearing a lecture on dental public health. Her dental school curriculum touched very briefly on the oral exam and the exam of the head and neck during a patient visit. She believes that there is an increasing interest within the CDC Division of Oral Health concerning dental practices that have high-risk or vulnerable patient bases offering and providing rapid HIV tests to their patients.

Henry: Is this something you could see happening?

Dr. Schaffner: Absolutely it could be done within the controlled environment of the dental practice. Dentists would need a strong link to HIV care providers, and the entire team would have to be trained on what to say and how to help patients access local care, but it is certainly a way to expand the dentist's scope of practice.

Henry: I'm curious about something. Does your dentist provide oral cancer screenings?

Dr. Schaffner: I've gone to my dentist for more than 20 years. I know when I visit him that he will do an exam, but we've never really talked about why he's doing it other than he's looking for anything suspicious. We don't discuss issues, but he examines my mouth and tongue and feels for any swollen lymph nodes. He also runs his finger along the inside of my cheeks. I feel like it is a thorough oral exam and am very pleased he does it.

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