A Comprehensive Guide to Oral HPV & Oral Cancer Screening
I am confident this is the most comprehensive guide you will find on the internet regarding Oral HPV and Oral Cancer Screening.
In this guide, I will share with you my knowledge of oral HPV and available treatments.
My name is Dr. Rana Shahi, DDS, MS, MSD, and owner of LA Periodontics & Implant Specialists --- which is one of the leading periodontal centers in Los Angeles and Brentwood, California.
So if you're searching to learn as much as you can about Oral HPV and oral cancer screening, I hope that you will find value in this guide.
DR. RANA G. SHAHI, DDS, MS, MSD
Diplomate, American Board of Periodontology
Contents
CHAPTER 1
Are You at Risk for HPV and Oral Cancer?
Human papillomavirus, or HPV, is the most common sexually transmitted infection in the U.S. An estimated 79 million Americans are living with HPV today. Fourteen million new cases were diagnosed in 2018.
At least 100 different types of the virus exist, 40 of which can affect the throat or genitals. Most types of HPV go undetected, never present symptoms and go away on their own. However, HPV can be a serious health concern.
For example, oral HPV, which is predominantly spread through oral sex, is the leading cause of oral, or oropharyngeal, cancers. Oral HPV causes 70 percent of these types of cancers that affect the tonsils, the back of the tongue and other areas of the mouth. High-risk types of HPV, such as HPV 16 or 18, increase the risk of oral HPV leading to oral cancer.
However, oral HPV is not as common as other types of HPV. Only seven percent of Americans age 14-69 have oral HPV. Still, it’s important to be aware of the risk factors to prevent oral HPV and the cancers it can cause.
Risk Factors for Oral HPV
Gender
Oral HPV, and oral cancers, are more common in men. About 11 million men have oral HPV in the U.S. compared to 3.2 million women. This could be due to increasing rates of oral sex.
Age
One study by the Center for Disease Control found higher rates of oral HPV in adults age 60-64. Researchers are still investigating the reason for this. Possible causes include weakened immune systems that are common in older adults or dormant cases of HPV that can flare up later in life.
Sexual Activity
Oral HPV is most commonly spread through oral sex, so participating in oral sex will heighten your chances of contracting oral HPV. In addition, having 20 or more sexual partners in your lifetime can increase your chances of contracting oral HPV by 20 percent.
Smoking
Smoke inhalation can cause cuts in the mouth, making it easier for HPV to infiltrate the oral cavity.
Alcohol Use
Studies have shown that drinking alcohol may increase the risk of oral HPV in men.
Kissing
More research is needed for this one, but some studies say open-mouth kissing can help spread oral HPV.
CHAPTER 2
What Are The Symptoms of Oral HPV and Oral Cancer?
Oral HPV typically doesn’t have symptoms and often the virus will take care of itself within two years. Even though you may not experience symptoms with oral HPV, you can still spread it to sexual partners. Because of this, if you participate in oral sex or think you could have oral HPV, it’s important to get tested. You can ask your dentist about an oral HPV infection test, but the reliability of these tests is questionable. For the most accurate testing, visit your doctor or dentist for a visual and tactile exam where they can ask further questions to determine whether or not you have oral HPV.
As we said above, oral HPV can lead to oral cancer, which does have signs and symptoms to which you should pay attention.
Symptoms of Oral Cancer Caused by HPV
a persistent sore throat
chronic ear aches
trouble swallowing
coughing up blood
unexplained weight loss
an ulcer or sore in the throat that isn't healing
enlarged lymph nodes
growths or lumps on the neck
a hoarse voice
numbness in your mouth
red or white patches on your tonsils
jaw pain or swelling
Source: Healthline
If you are or have experienced any of these symptoms, you should talk to your doctor to rule out the possibility of oral cancer caused by oral HPV.
CHAPTER 3
What Causes Oral HPV and Oral Cancer?
Human papillomavirus (HPV) is a sexually transmitted infection. All types of HPV are spread through skin-to-skin sexual contact, and oral HPV is spread through oral sex. If your partner has HPV, you can contract the virus through a cut or small tear in your mouth. Casual physical contact, such as kissing on the cheek or sharing food and drink does not cause oral HPV or other types of HPV.
How does oral HPV cause oral cancer?
Doctors have known about the link between HPV and cervical cancer for a few decades, but due to a recent rise in oral cancers of the throat and neck, doctors have only recently begun investigating what they now know is a strong link between oral HPV and oral cancer.
HPV is an infection that causes cellular changes. If your body is unable to fight the infection, you can develop tumors from the altered cells that cause cancer. If you have oral HPV, tumors will form in the throat, on the roof of the mouth or tongue. It is important to note that HPV can lie dormant in the body for several years before developing into cancer.
CHAPTER 4
How is Oral HPV Diagnosed?
Oral HPV can be detected using the testing protocol Polymerase Chain Reaction (PCR), which was originally used to detect HIV. However, using PCR to diagnose oral HPV is not highly encouraged. Since so few cases of oral HPV actually turn into oral cancer, the results of PCR testing do not lead to clear next steps because treatment is not necessary at this stage.
Oral HPV that has turned cancerous requires treatment and can be diagnosed by a dentist or doctor. Most often, a simple examination of the mouth is all that is required. Using small mirrors, a physician will look around your mouth for any lesions or areas that look abnormal. Since the throat or larynx are more difficult to see with a mirror, a doctor might use a scoping device such as a laryngoscope or pharyngoscope to examine the area.
If anything looks suspicious, the physician will take a biopsy by collecting cells from the area using a needle or small instrument and sending the sample cells to a lab for testing. Once at the lab, the cells are examined under a microscope to detect cancer and assess whether or not HPV DNA is present in the cancerous cells. Typically, it is easier to treat the cancer if it does contain HPV DNA.
The Oral Cancer Foundation maintains that asking questions is one of the best ways to screen for HPV-related oral cancer. By asking a series of questions about your past and current health, a doctor can learn more about underlying factors that might contribute to possible oral cancer.
If you are exhibiting any of the symptoms listed above, it is important to inform your dentist or doctor so they can do a screening as soon as possible. As is the case with all cancer, the earlier it is caught, the easier it is to treat, and the higher the likelihood that you will recover.
CHAPTER 5
How is Oral HPV and Oral Cancer Treated?
Most cases of oral HPV do not require treatment. The body will take care of the virus on its own. However, if you develop warts in your mouth due to oral HPV, your doctor or dentist will probably recommend that you have them surgically removed. While some topical treatments exist for oral warts, surgery is a more reliable method.
If oral HPV has developed into oral cancer, it will be treated like other types of oral cancer. Cancer caused by HPV tends to respond better to treatment than other types of cancer. Because of this, researchers are looking at lighter chemotherapy options for HPV-related cancers. However, more research is needed in this area.
To treat oral cancer, a doctor will typically recommend three stages of treatment: surgery, radiation, and chemotherapy. You may need all three or just one or two. It is up to your oncologist to determine the best treatment plan for your specific type of oral cancer.
Surgery
A few different types of surgery can be performed on the area of your body affected by cancer. Preventative surgery is used to remove tissue in your body that could become cancerous but is not yet malignant. Staging surgery is used to determine the scope of the cancer. This type of surgery is exploratory rather than curative. Curative surgery, on the other hand, removes the cancerous tumor. The goal is to get rid of all of the cancer by removing the tumor, but radiation and chemotherapy may still be needed in addition to this surgery.
Radiation
Radiation therapy uses ionizing radiation to target and destroy cancerous cells. In doing so, radiation also destroys non-cancerous cells; however, these cells are healthy enough to grow back. Patients with head, neck, or oral cancer use a mesh mask during treatment to ensure that radiation only goes to the affected area.
Chemotherapy
Chemotherapy is the use of chemicals against cancer cells. Unlike surgery and radiation, chemotherapy can be used against cancer cells throughout the body rather than one specific area. Chemotherapy can fight cancer in a few different ways, depending on which type of chemotherapy you receive. The goal for all chemotherapy treatments is to stop the replication of cancer cells by damaging the cancerous cells’ DNA.
CHAPTER 6
How Can You Prevent Oral HPV?
You can prevent contraction of oral HPV by taking the same precaution you would to avoid other sexually transmitted infections (STI): by practicing safe sex. You can do this by using a condom any time you have sexual intercourse or oral sex. You can also use dental dams during oral sex. Talk to a new partner about their sexual history before having sex, and avoid having oral sex with a partner you do not know well. You should also avoid oral sex if you have any cuts in your mouth.
Visit your doctor regularly to get tested for STI. Which tests to get and when depends on your age, sexual activity, and other factors, so talk to your doctor about the best course of testing for you. Women can be tested for HPV during their regular women’s exam and pap smear, which they should have at least once every three years.
One of the best ways to prevent oral HPV is through the HPV vaccination. It is standard today for boys and girls ages 9 to 14 to receive the HPV vaccination through two shots of the vaccine over a 12-month period. HPV vaccines were once only available to children and young adults up to age 26. However, new guidelines allow for adults age 27 to 45 to receive the HPV vaccine, Gardasil 9.
The HPV vaccine has proven effective in preventing oral HPV. A study done in 2017 found that oral HPV was 88% lower in men who had received an HPV vaccine than those who had not. Similar results were found in a study on women in 2013.
You can also prevent, or at least catch, oral HPV by asking your dentist to check for any abnormalities in your mouth during your six-month check-up. Check your mouth and tongue at home once a month for any changes or sores, and alert your dentist or doctor if you find anything.
CHAPTER 7
HPV and Oral HPV
HPV v. Oral HPV
While HPV and oral HPV are technically the same sexually transmitted infection, there are major differences in the way they show up in the body and affect your health. If you have read the sections above, you already know a good bit about oral HPV, but let’s recap:
Oral HPV
- Oral HPV is a sexually transmitted infection most often spread through oral sex.
- Most cases of oral HPV go away on their own without the need for treatment.
- Although it is rare, oral HPV can lead to oral cancer.
- Oral HPV is the leading cause of oral cancer.
- Signs and symptoms of oral cancer include a persistent sore throat, ulcers or sores in the mouth that are not healing, and growths or lumps on the neck, among other symptoms.
- Risk factors for contracting oral HPV include gender (more men than women contract oral HPV), sexual activity (the more partners you have, the more likely you are to get oral HPV), and lifestyle choices such as smoking and drinking alcohol.
HPV
Non-oral types of HPV, simply known as HPV, are found in the genital area, including the vulva, vagina, cervix, penis, or anus. This type of HPV is spread through skin-to-skin sexual contact. Like most cases of oral HPV, most genital HPV will go away on their own without the need for treatment. However, some kinds of HPV can lead to more serious symptoms, and even cancer.
HPV types 6 and 11 cause genital warts, which are not particularly harmful, as they do not lead to cancer and can be easily removed by a doctor. Other types of HPV, such as 16 and 18 can cause cervical cancer and other types of cancer in the genital area. These types of HPV do not cause obvious symptoms like warts. For this reason, it is important to get regularly tested for HPV. Women can get tested for abnormal cells in their cervix during their regular pap test. Men should look for any changes in their genital area and talk to their doctor if they notice anything.
You can prevent spreading or getting HPV in the same way you prevent oral HPV—by practicing safe sex. Use condoms and dental dams, ask your partner about his or her sexual history, and get tested regularly. If you are age 45 or under, you can also get the HPV vaccine.
Squamous cell carcinoma of the oral cavity
This is the most common type of oral cancer, making up to 90% of all oral cancer cases. Squamous cells are the cells that line the throat, mouth and other organs of the body. Carcinoma means cancer, so squamous cell carcinoma refers to the squamous cells in the mouth that have mutated and turned into cancer.
Oral verrucous carcinoma
Only 5% of oral cancer cases are verrucous carcinoma. This type of cancer is also made up of squamous cells, but it is slow-growing and typically does not metastasize, meaning it does not spread to other places in the body.
Minor salivary gland carcinoma
This type of cancer forms in the salivary glands, which are located throughout the lining of the mouth and throat. A few different types of cancer can form in the salivary glands, including adenoid cystic carcinoma, polymorphous low-grade adenocarcinoma, and mucoepidermoid carcinoma. These types of cancer are very rare; less than 1% of oral cancer cases are salivary gland carcinoma.
Lymphoma
Lymphoma is the cancer found in the lymph tissue of the mouth, which is located in the tonsils and the base of the tongue.
You can also contract skin cancers like basal cell carcinoma or melanoma on the lips, or on the head, neck or inside the nasal cavity. The types of cancer listed above comprise what is found in the cells inside the oral cavity.
Check out “What Are the Symptoms of Oral HPV and Oral Cancer?” above to see what signs and symptoms to look for that might indicate oral cancer. Talk to your dentist or doctor if you are experiencing any of these symptoms.
CHAPTER 9
The OraRisk® HPV Test
If you are showing any signs of oral HPV, such as lesions in the mouth, your doctor, dentist or periodontist will biopsy the area to determine if you have HPV. If you do have HPV, your doctor might use a salivary diagnostic test such as the OraRisk® HPV test to determine which strand of HPV you have. Identifying the specific strand of HPV will determine whether or not your oral HPV is high risk, meaning it has the potential to turn into oral cancer.
The OraRisk® test simply requires you to swish and gargle with a saline solution. Your doctor will then collect your saliva sample into a secured tube and send it to a lab for testing. Your results will typically come back within three to five days.
Are you at risk?
Test, Don't Guess!
The oral HPV virus is primarily found in the oropharyngeal complex (throat). Specific types of oral HPV are now considered to be separate and serious risk factors for developing oral cancers. Early detection and identification of the presence or absence of oral HPV is very important!
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Oral DNA, the manufacturer of OraRisk® HPV testing, actually makes two different tests. The OraRisk® HPV Complete Genotyping test will test for 51 different types of HPV. The OraRisk® HPV 16/18/HR test will only test for HPV types 16 and 18—the types that most commonly cause cancer—along with 12 other high-risk types of HPV. Your periodontist, dentist or doctor will decide which test is best for you.
It’s important to note that a salivary diagnostic test like OraRisk® is only necessary if you have already tested positive for oral HPV. If your OraRisk® test comes back showing you have high-risk strands of HPV, your doctor will determine your best route of care. That might simply include monitoring your condition more closely and continuing with routine head and neck-cancer screenings, or your doctor may suggest developing a relationship with an ear, nose and throat doctor (an ENT) or an oral surgeon in case your HPV develops into something more serious.
CHAPTER 10
FAQ - HPV / Oral Cancer Facts
OraRisk® HPV is a screening test that identifies the type(s) of oral Human papillomavirus (HPV), a viral infection that could potentially lead to oral cancer. At LA Periodontics & Implant Specialists we will use this information to establish increased risk for oral cancer and determine appropriate referral and monitoring conditions.