Experts: Yes it’s awkward, but more dentists should talk to patients about oral cancers and sex

Published January 29 2018
Updated January 29 2018

Dentists may soon be prying deeper in their patientsí sex lives.

The human papillomavirus, or HPV, is now the most common sexually transmitted disease, and one local researcher is urging dentists to get on board to warn patients about it.

But talking about HPV ó and how it can be spread through oral sex ó can be awkward.

"This is an emerging topic for dentists and not really one they ever expected to have to talk about," said Ellen Daley, the lead investigator of a recent study on this topic published in the Journal of the American Dental Association this month. "Itís controversial and uncomfortable. No one wants to talk about these sensitive topics."

HPV is the cause of 72 percent of oropharyngeal cancers, which can impact the base of the tongue, tonsils and walls of the pharynx, said Daley, who is also a professor studying womenís health at the University of South Florida.

Younger patients, usually pre-teens and teens, are the most at risk for HPV. But the virus can also be dormant for years, which could impact older patients who wonít necessarily experience symptoms for many years.

Itís transmitted during vaginal, anal or oral sex with someone who has the virus.

Nearly 80 million people ó or about one in four ó are currently infected with HPV in the U.S., according to the Centers for Disease Control and Prevention. About 14 million people become infected each year, and 30,700 of those cases cause cancer in men and women.

The HPV vaccine can prevent most of those cancers, or 28,000 of them. An estimated 50,000 cases of oral type cancers will be diagnosed this year, according to the American Cancer Society.

The Florida Legislature is currently considering companion bills in the House and Senate that could add the HPV vaccine to the child immunization requirements for school.

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HPV prevention methods are typically addressed by pediatricians, family medicine practitioners, obstetricians and gynecologists. But dentists and dental hygienists see nearly 85 percent of children and their parents in the U.S., making them an important group of health care providers who could address HPV prevention and detection, Daley said.

"Dentists are already seeing patients who are concerned about oral cancers or may be displaying symptoms. Itís time for dentists to be prepared to start talking about prevention methods," she said.

The study says that dentists donít talk to their patients about HPV prevention because they donít know enough about it or the proper prevention methods. Other dentists ó Daley and her team interviewed many for the study ó said they never anticipated that theyíd have to talk about sexually transmitted diseases in their profession, which can be a sensitive subject when age is a factor.

Most donít want to embarrass older patients or have a tough conversation with the parents of a younger one.

"I know as a professional, you really should be able to talk like that. But for me, sometimes with patients the same age as my grandpa, I find it very uncomfortable to talk with him about anything related to HPV and their sexual activity," wrote one participating dentist in the study. "I guess Iím a little weirded out by that."

Dr. Scott Tomar, a dentist and professor at the University of Floridaís College of Dentistry, sees routine teeth cleanings and examinations as the "opportune time" to broach this subject with regular patients.

"We live in a time where there is a vaccine for HPV, and dentists have a chance to reach adolescents at a young enough age where they can get the vaccine that could help prevent these kinds of cancers," he said. "This is an ideal setting."

As for it being uncomfortable, Tomar says dentists need to focus less on that and more on the educational importance of it.

"We can frame the conversation as education, and talk to them about STDs and what kind of potential side effects those can have on their oral health," Tomar said. "This is a tremendous role for dentists to play not just in oral health, but overall health."

The American Dental Association has partnered with University of Texas MD Anderson Cancer Center to increase HPV vaccination rates and raises awareness, said Dr. Marcelo Araujo, the vice president of the ADA Science Institute. HPV prevention will be the topic of the organizationís annual meeting this year for the second year in a row. So far, the institute has received positive feedback from its members, Araujo said.

The vaccine has also become a politically charged topic in recent years because of its link to reproductive cancers and because itís recommended to be administered before adulthood.

"I think thereís a stigma because the public is not informed yet," Araujo said. "This conversation needs to be taking place in the dental office, not just the medical office. We know that mothers are the decision makers for their children, and we have the chance to help them understand how this vaccination is saving lives, not just for girls, but boys too. And not just related to reproductive type cancers."

Daley said she and her team are trying to help break through that awkward small talk barrier to better help dentists lead these conversations. She plans to initiate a "health literacy" project to provide dentists and hygienists with the information and talking points they need to chat with patients about HPV.

"The really good thing is that all the dentists we talked to said they understand that they have a role in this," Daley said. "HPV isnít something thatís going away. The spread of it is increasing. So the next step is to apply for funding to come up with difference communication approaches. We want to develop bullet-point materials so patients can ask their dentists about prevention."


Who should get the HPV vaccine?

The HPV vaccine protects against cancers caused by human papillomavirus (HPV) infection. Most people with HPV never develop symptoms or health problems. Most HPV infections go away by themselves within two years. But some HPV infections last longer and can lead to cancers in the cervix, vagina and vulva in women, or the penis in men, and the anus, back of the throat, the tongue and tonsils in women and men.

ē Children ages 11 or 12 can get two shots of the HPV vaccine six to 12 months apart. If 14 years or older, three shots will need to be given over six months.

ē The HPV vaccine is recommended for women up to age 26, men to age 21 and young adults who are transgender through age 26.

Source: Centers for Disease Control and Prevention

Contact Justine Griffin at [email protected] or (727) 893-8467. Follow @SunBizGriffin.