If Zachary Brian, head of the North Carolina Oral Health Collaborative, has his way, your next visit to the dentist could also include a conversation about sex.

April is Oral Cancer Awareness month. One of the two most distinct routes through which people get cancer in the mouth, on the base of the tongue, tonsils, or side and back walls of the throat is from a human papillomavirus strain known as the HPV-16 virus that can be spread through oral sex.

Tobacco use, smokeless tobacco products, as well as heavy alcohol consumption also have been linked to oral cancer.

This month, during a most unprecedented time in health care, many dentists’ offices are closed because of the COVID-19 pandemic and the greater risk the dental and hygienist workforce has for contracting and transmitting the virus.

Brian says it’s still a good time to find out more about oral cancer and the increase in HPV-related cases. “It’s so important,” he said.

HPV-related cancers on the rise

There are more than 53,000 people diagnosed with oral cancers in the United States annually, according to the Oral Cancer Foundation, and could result in more than 10,860 deaths.

In North Carolina, the American Cancer Society estimates that there will be 1,880 cases of cancer in the oral cavity and pharynx this year, and an estimated 350 deaths.

The death rate associated with cancers of the throat and neck have remained consistently high, researchers say, largely because they’re often detected late.

Dentists across the state have long included in routine exams screening for signs and symptoms of oral cancer. Some have started using a new fluorescent light tool to aid that search for detection at earlier stages.

Concerns are that 71 percent of oral cancers nationally are found in stages III and IV, when they’re harder to treat and cure. That’s why Brian and the North Carolina Oral Health Collaborative is trying to shine a light on early detection and frank talk with people about HPV, which is primarily transmitted through sexual contact.

Dentists and hygienists can play a role in educating parents of pre-teens about the HPV vaccine, as well as telling others who might not have been vaccinated in their youth about the Gardasil 9 vaccine approved for women and men up to age 45, though typically recommended by age 26.

In general, men are twice as likely as women to get neck and head cancers, according to the Centers for Disease Control and Prevention. Though they are more likely to be diagnosed in people older than 50, HPV is the cause of the fastest growing oral cancer population — predominantly male, mostly people under 45.

HPV-related cancers are six to seven times more likely in men than women and those with six or more oral sex partners are 8.6 times more likely to contract the disease than those who have never had oral sex.

“What’s interesting is they tend to be in a high socio-economic risk factor and they’re younger,” Brian said,

Pandemic brings challenges

Though Oral Cancer Awareness month has arrived this year in the middle of a pandemic while many offices are closed and the state is under a stay-at-home order, the North Carolina Oral Health Collaborative has continued with its campaign to educate health care workers and the public.

Pamphlets with key data and information will be distributed across the state, and the collaborative is trying to pitch the topic as a curriculum that becomes routine in the education of health care workers.

Many in the oral health profession have been using time out of work to update their continued education, taking online courses and doing research. The collaborative hopes that their message on HPV awareness reaches many during this time.

NCHN Photo credit: Rose Hoban

“Our recommendation is to strengthen the oral and pharyngeal cancer screening networks in both traditional dental offices, but also by primary care providers,” Brian said. “It is important that all sectors of health give credence to oropharyngeal cancers, and as such, include the screening in their practice workflows.”

What to look for

Patients should be screened for oral cancer at least annually, Brian said.

“In addition, providers from both dentistry and medicine should be educating their patients about risk factors, abnormalities to look for at home, and when to contact a provider for further examination,” he added.

People also are encouraged to perform routine self-examinations, too, looking for symptoms such as:

  • White or red sores on the gums, tongue or lining of the mouth that don’t heal.
  • Jaw swelling.
  • A lump or thickening or unusual bleeding in the mouth.
  • Persistent trouble chewing or swallowing food.

Brian stressed that while many offices are closed for anything except emergency work, anyone concerned about a suspicious lesion should not hesitate to contact their dentist.

The provider may decide to perform a visual examination through teledentistry methods and determine whether a further exam or referral for consultation and biopsy is needed.

“It would be detrimental that folks do not get an assessment for a lesion that could turn out to be cancerous during Covid-19,” Brian said.

This story was previously published by North Carolina Health News, an independent news organization devoted to covering health care in the state.

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