by Brandi Soldano, RDH
Human Papilloma Virus (HPV) is the most common sexually transmitted disease, and the American Cancer Society estimates that it affects more than 50 percent of sexually active adults. This information also reveals that one out of every two sexually active people infected with HPV is unaware that he or she has contracted it.
Therefore, it will not appear on a patient's medical history for review by the dental professional. HPV infection is the cause of 99.7 percent of cervical cancers worldwide(1) — and the primary reason women age 21 and older are urged to have annual Pap smears(2). However, HPV has also been linked to oral cancer. HPV strains 16 and 18 are the highest risk types and are capable of promoting genetic alterations of the squamous epithelium of both the genital and upper respiratory tract into potentially cancerous lesions. It is estimated that HPV 16 alone may contribute to more than 20 percent (6,820 cases) of oral cancers. Comparatively, according to SEER data, approximately 70 percent of the 9,710 cervical cancer cases are related to HPV strains 16/18; so there will be approximately as many HPV-related oral cancers as those related to cervical cancer. Based on the American Cancer Society's estimated 10,810(3) new cases of oral cancer for females, when compared to cervical cancer (9,710 cases) in the United States, we have a greater likelihood of being diagnosed with oral cancer than cervical cancer — and personally, I wouldn't think of skipping an annual Pap smear.
Public awareness of HPV has recently been heightened with the FDA approval of Gardasil®, a vaccine that has been clinically proven to reduce the occurrence of cervical cancer. This vaccine may take decades to prove efficacy in reducing head and neck cancer statistics; however, it is a step in the right direction toward decreasing the incidence of HPV-related oral cancers. In the meantime, dental providers should use the increased public awareness of HPV to educate their patients, especially their younger, sexually active patients, about this virus as it relates to oral cancer risk.
With this information in mind, we need to be screening our patients for oral cancer in the same manner we use "universal precautions" in protecting ourselves from HIV, hepatitis, and other infectious diseases. We need to assume that every patient is a possible carrier of HPV with the potential of having a premalignant lesion or cancerous lesion, and we need to screen accordingly. It is incumbent upon dental professionals to recognize the need for more thorough oral cancer screenings for all of our adult patients and to employ adjunctive screening technologies — not as an option, but as an annual service to the clients in our practices. The ViziLite Plus with TBlue630 Oral Lesion Identification and Marking System is such an adjunct.
ViziLite Plus is the only medical device cleared by the FDA to improve the visualization of oral lesions in a patient population at increased risk for cancer. ViziLite Plus with TBlue630, when used in conjunction with a standard head and neck exam, gives a dental professional added confidence that potentially cancerous and precancerous abnormalities will not go undetected. It is the ONLY screening technology clinically proven to detect premalignant lesions. ViziLite Plus with TBlue630 can identify epithelial changes from just above the basement membrane up to the epithelial surface. This fact is a key to reducing oral cancer incidence and mortality rates.
As a dental hygienist in private practice, I perform a conventional oral cancer examination on all of my patients every time I see them for treatment. Once a year, however, I combine a ViziLite Plus exam with my conventional visual exam. I do this because my goal is not to find oral cancer. My goal is to find lesions before they even progress to oral cancer. I know from the clinical data pertaining to the ViziLite Plus with TBlue630 technology, and the experience of other medical professionals with adjunctive cancer screening technologies such as the mammogram and Pap smear, that I can only consistently achieve early detection of lesions with the help of such a technology. Because, while the incidence of oral cancer is not very common (one in 10,000 Americans diagnosed annually), the incidence of leukoplakic lesions, which comprise 85 percent of oral premalignant and malignant lesions, is very common (three in 100 patients) — and they are often very difficult to visualize in conventional lighting.
Using ViziLite Plus with TBlue630 results in a more thorough oral cancer screening procedure. As a result, I am confident that I have provided my patients with the best possible early detection program. It also shows my patients that I care about their overall health. It is another way in which our practice provides our patients with a distinctly higher level of service.
References
1. Wallboomers JM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol Sept. 1999; 189(1):1-3.
2. American Cancer Society — Detailed Guide: Cervical Cancer.
3. American Cancer Society, Cancer Facts and Figures, 2006. Atlanta: American Cancer Society; 2006.
Brandi Soldano, RDH, has practiced in the field of dentistry for 13 years, beginning her career as a dental assistant and serving for the past seven years as a dental hygienist in private practices in Florida and Arizona. She currently practices dental hygiene four days a week at Douglas Family Dentistry, a cosmetic dentistry practice in Scottsdale, Ariz., where she enjoys providing optimum oral health care to her patients. Brandi also serves as an adjunct professor of dental hygiene at Rio Salado College in Phoenix, where she is also a guest lecturer in the dental hygiene theory course on today's standard of care for oral cancer screening. Brandi is a member of the ADHA and the AZDHA and attends many dental meetings and symposiums annually to stay current on the latest advancements in dental technology and standards of care.
