HPV has a strong causal association with oropharyngeal squamous cell carcinomas (OPSCC). There are multiple subsets of HPV with HPV 16 being responsible for approximately 85% of all HPV positive OPSCC. Several viruses have been shown to have an association with the onset and progression of periodontal disease. In a recent cross-sectional study published in 2020 in the journal American Association of Public Dentistry, the authors examined differences in oral HPV prevalence among adults based on HPV vaccination status and periodontitis status.1
Previous studies indicate oral HPV infections increase with age. This could be due to latent infections or reduced immune function as we age. Additionally, oral HPV status is associated with low socio-economic status. Some very limited evidence suggests that oral health and periodontitis may be associated with an increased incidence of HPV infection. Periodontitis provides the perfect environment to facilitate an oral HPV infection. Individuals with periodontitis have microlesions where the virus can easily enter the epithelium as well as compromised immune response due to periodontal status. Therefore, the hypothesis is quite feasible that there could be a connection.
The authors used data from 2011-2012 and 2013-2014 National Health and Nutrition Examination Surveys (NHANES). Previous NHANES data (not used in this study) showed oral HPV risk was 3.5 times higher among women with severe periodontitis when compared to women without periodontitis. The results from this study showed that vaccinated individuals without periodontitis were at the least risk for oral HPV.
Multiple other studies have shown the presence of periodontitis to be associated with oral HPV. However, the authors of these previous studies caution that “the evidence of an HPV-periodontitis relationship is merely suggestive, and although biologically plausible, is currently inconclusive.”
Researchers in this area have called for better collaboration among medical and dental professionals, specifically because individuals visit the dentist more frequently and dentists and dental hygienists are the providers responsible for oral cancer screenings. The National HPV Vaccination Roundtable and the American Dental Association have voiced their support and encourage oral health providers to discuss the risks of HPV infection and the benefits of obtaining the HPV vaccine during dental appointments.
The authors cite multiple limitations in this study including causal inference not being permitted, age restrictions in the sample, and self-reporting regarding HPV vaccination.
The authors conclude by stating, “This study estimated oral HPV 16/18/6/11 prevalence in 24 demographic groups in the United States based on periodontitis status and HPV vaccination status. Using a nationally representative dataset (i.e., NHANES), a predictive model revealed that oral HPV prevalence was higher among individuals who had never had the HPV vaccine and who had periodontitis. Interventions that integrate primary care and dental care are needed. In particular, dental providers should consider discussing the need for HPV vaccinations with 10–13-year-olds and their legal guardians, provide an active medical referral to obtain the needed HPV vaccination, and provide active treatment of periodontitis as HPV cancer-related prevention measures.”
Do you discuss HPV-related cancer risks with patients? Do you discuss the benefits of HPV vaccination with guardians of your adolescent patients?
- McDaniel JT, Davis JM, McDermott RJ, Maxfield I, Kapatamoyo K. Predicted prevalence of oral human papillomavirus (HPV) by periodontitis status and HPV vaccination status. J Public Health Dent. 2020 Jun;80(2):132-139. doi: 10.1111/jphd.12357. Epub 2020 Jan 28. PMID: 31991496.
Spot on article on “what we know now”. Colorado has an initiative, Alliance for HPV Free Colorado, we are training dental providers on HPV, the importance of the HPV vaccine, how to make a strong provider recommendation for the vaccine, along with signs and symptoms and a thorough screening.