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    What you need to know about HPV, oral cancer and your dental patients

    A comprehensive review of a patient's health history can be critical in exposing symptoms of HPV-related cancer.

    Vibrant, energetic and fitness-conscious, Sandy Wexler, a pediatric nurse who appeared to be in perfect health, was shocked to learn during her routine dental check up that she had a large suspicious lump on the right side of her neck.

    Sandy had not noticed anything different about her neck until that moment and thought it must be simply a swollen lymph node due to a subclinical infection of some kind. She assumed a course of antibiotics would easily remedy the situation.

    However, her dentist, Dr. Dorothy Paul, was concerned enough about the soft, movable, non-tender growth to pursue further investigation. Dr. Paul, always vigilant about performing a thorough extra- and intra-oral head and neck examination for every patient at every appointment, was aware that suspicious areas are often assumed to be innocuous. When a dental professional makes the choice to “watch and wait” to see if the growth, lesion, or discoloration goes away, they risk missing an early diagnosis of cancer. Late stage diagnosis of head and neck cancer results in poor prognosis.

    Related reading: The importance of oral cancer screening in the dental practice

    Dr. Paul was not willing to let a potentially dangerous growth go unchecked, so she referred Sandy to her internist, who referred her immediately to an otolaryngologist (ENT) for further assessment. 

    A fine needle aspiration was inconclusive, but after a computerized tomography radiograph (CT scan) followed by a biopsy, she was diagnosed with metastatic Squamous Cell Carcinoma.  The subsequent PET scan did not reveal a primary source.  Sandy was immediately referred to MD Anderson Cancer Center in Houston.  Surgery at MD Anderson revealed the primary source in the oral pharyngeal area and a biopsy illuminated that the Human Papilloma Virus (HPV) caused the tumor.

    According to the Oral Cancer Foundation, there are nearly 200 different strains of HPV, most of which are harmless. Out of all of these, nine are known to cause cancers and six others are suspected to cause cancers. In oral and oropharyngeal cancer, HPV 16 is the version most responsible.

    In the oral and oropharyngeal environment, HPV manifests itself primarily in the posterior regions, such as the base of the tongue, the back of the throat, the tonsils, the tonsillar crypts and the tonsillar pillars. It is extremely difficult to visualize these areas of the mouth and throat during a routine head and neck cancer screening. Vigilance in the use of fluorescence technology and in pursuit of further evaluation of suspicious growths is critical in order to improve survival rates of those diagnosed with oral cancer.

    Trending article: Study finds link between periodontal disease and increased risk of breast cancer

    Sandy underwent six weeks of proton therapy, a form of radiation, and seven weeks of chemotherapy. The treatment for throat cancer is severe and the side effects are extremely painful. The proton therapy caused the skin on Sandy’s neck to break down, resulting in painful sores and peeling. She also had tremendous difficulty swallowing, leaving her extremely dehydrated. Sandy lost 25 pounds from her already slim frame and needed frequent hydration treatment. 

    Continue to page two for more...

     

    Kathryn Gilliam, RDH, BA
    Founder of PerioLinks, LLC, and dental team coach, speaker and author, Kathryn Gilliam, RDH, BA, delivers practical protocols to ...

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