Oral health and prevention and screening for HPV

Oral health is critical to overall good health and it also serves as a surrogate marker in critical disease. We commend Kelsall and O’Keefe1 for highlighting the need to eliminate barriers to dental care for some of our most vulnerable patients.

Oropharyngeal cancers are among the most commonly occurring malignancies in Canada. Human papillomavirus (HPV) is the causative factor in 80% oropharyngeal cancers, and it is estimated that, in the United States, these cancers will overtake uterine HPV cancers in the next 15 years;2 noncervical cancers are dramatically on the rise in Canada as well.3

The development of HPV vaccine has changed the face of gynecologic oncology, but an important emerging area is the role of immunization in HPV-related oral malignancies, and research is underway.

It is a common misconception that HPV vaccine is only effective in those who have not yet been exposed to the disease, however there is evidence that patients treated for HPV malignancy benefit from recurrence from other HPV strains with immunization.4

Understanding of HPV malignancies is growing. In one study, patients with oropharyngeal squamous-cell carcinoma had a 25-fold increased risk of cervical cancer.5 Referral and screening across the spectrum is critical.

Patients with HPV disease and malignancy provide an opportunity for interdisciplinary collaboration for those working in primary and secondary prevention, including immunization, oncology, oral health and gynecology.

Research is required to explore the role of immunization against HPV-related diseases, particularly in the senior population. We must collaborate with our dental health colleagues to promote awareness and prevention.