Should dentists be concerned about exposure to human papillomavirus?

This question was submitted by a general dentist: Should dentists be concerned about exposure to human papillomavirus?

This information is adapted from the Centers for Disease Control and Prevention website and reviewed by Dr. Nita Mazurat, representing the Organization for Safety, Asepsis, and Prevention (OSAP)

Due to increased knowledge, increased publicity, and increased concern by the public, dentists need to be able to discuss human papillomavirus infections with their patients. The following is a short review of articles that can be found on the Organization for Safety, Asepsis, and Prevention (OSAP) on HPV. It is highly recommend to also use the Center for Disease Control (CDC) “Human papillomavirus (HPV) and Oroharyngeal Cancer – Fact Sheet. Many of the comments below have been drawn directly from this fact sheet.

HPV is the most common sexually transmitted infection (in the USA).

There are over 150 types of HPV, approximately 40 types that infect the mucosa: specifically the genital area and the head and neck. American studies have reported that 7% of the population has oral HPV. One percent (1%) of the population has HPV16, the type of HPV that is the causative agent for most oropharyngeal cancers. Men are 3 times more likely to carry this strain and to have oral cancer. Women with oropharyngeal cancer were more than 25 times more likely to also have cervical cancer. (1) Vaccines have been developed to prevent cervical and genital cancers and it is possible that these vaccines will help to reduce the risk of orophayngeal cancers.

The signs and symptoms of oropharyngeal cancer include: persistent sore throat, hoarseness or voice changes, pain or difficulty with swallowing, unexplained weight loss, a lump in the back of the throat or mouth, a lump in the neck. All of these could readily determined during a routine extraoral/intraoral examination by a dentist.

The risk of getting HPV from kissing or oral sex is unknown. There is research that suggests that HPV can be transmitted non-sexually. A recent study published online in the Journal of Antimicrobial Chemotherapy reported the results of the use of 11 common disinfectants to effect kill on lab grown samples of HPV16. The authors reported that “While HPV is susceptible to certain disinfectants, including hypochlorite and peracetic acid, it is resistant to alcohol-based disinfectants.” (2) The alcohol-based disinfectants “included ones made of ethanol and isopropanol” which causes concerns “because these are common ingredients in surface disinfectants and hand sanitizers”.

References

1. Biron et al. Otolaryng- Head and Neck Surgery, February 2011 from Dr Cleveland’s presentation at 2012 OSAP Symposium.
2. Jordan Meyers, Eric Ryndock, Michael J. Conway, Craig Meyers, and Richard Robison (2014). Susceptibility of high-risk human papillomavirus type 16 to clinical disinfectants. J. Antimicrob. Chemother. first published online February 4, 2014 doi:10.1093/jac/dku006.