Getting Personal About HPV and Oral Cancer

Dr. Samantha Rawdin gets personal about HPV and Oral Cancer:

April is Oral Cancer Awareness Month, and as a member of the medical community dealing directly with the oropharynx (including the mouth and throat), this is something that we feel our patients and readers should be aware of. Although it doesn’t always get the attention that other types of cancer receive, oral cancer is still a prevalent issue in the U.S. Almost 50,000 people will be diagnosed with oral cancer this year and one person every hour of every day will die from it.

Tobacco use and alcohol consumption still remain the greatest risk factors for developing oropharyngeal cancer, but the fastest growing population of people being diagnosed are young, healthy, non-smoking individuals with Human Papilloma Virus (HPV). Now, this is where things get a little weird. HPV is a sexually transmitted disease that can occasionally manifest in the oral cavity. Since your dentist is usually the only one examining your mouth on a regular basis, finding one of these lesions can lead to conversations you wouldn’t otherwise expect to have with your oral health care specialist.

According to an article this week in the New York Times, more than forty-two percent of Americans bewteen the ages of 18-59 are infected with HPV. In adults aged 18-69, 7% have an oral HPV infection and 4% have the high-risk strains that can cause cancer in the mouth and throat.

The good news? Over 90% of HPV infections are gone from the body within 2 years.  But, just to be on the safe side, make sure your dental professional is doing a thorough oral cancer screening. And don’t feel bad about asking– it’s something that should be a routine part of their examination anyway. If you see or feel something that’s not quite right in your mouth or throat that sticks around for longer than two weeks, such as discoloration, swelling or irritation, make an appointment to see your dentist or doctor. If you are visiting them on a regular basis, changes will be easier to spot and may be easier to manage.

Is flossing overrated? Maybe- but you still need to remove the plaque!

Recent reports removing the recommendation to floss, have led to rejoicing among many people and shock and despair for dental hygienists. http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavities.html?_r=0 But what was actually said and what does it mean?

The Departments of Agriculture and Health and Human Services are required by law to have strong scientific research for every recommendation. The reality is that many of our health recommendations don’t have great scientific research. That is why we are constantly given updated recommendations, as new and better information becomes available. When it comes to home practices like flossing, getting well done, double blind studies on large numbers of people is very expensive and time consuming.

It is important to note that the survey did not claim that there was evidence that flossing is ineffective but rather that there is not strong evidence that flossing is effective in reducing cavities and gum disease. Big difference!

So what do we know? Well we know that plaque, (the bacterial film that colonizes teeth), causes cavities and gum inflammation. We know that inflammation is strongly correlated to gum disease. We know that flossing is one of several effective methods for reducing plaque between teeth. There are other aids to remove plaque and we often suggest them to patients who have trouble flossing or don’t like to floss.

There is no reward for flossing- there is a health benefit to removing plaque.

See the alternative uses for floss our Gallery57Dental hygienist have suggested, on our Gallery57Dental Facebook page: https://www.facebook.com/Gallery57Dental/videos/1105217906202967/

The New York Times Questions Dental X-RAYS

A New York Times article on dental X-rays, http://www.nytimes.com/2016/07/26/upshot/you-probably-dont-need-dental-x-rays-every-year.html, generated many questions from our patients. Read an exchange between a Gallery57Dental patient and Dr. Andrew Koenigsberg, which addresses that question.

Patient RK-

What do you think of this article, “You probably don’t need dental x-rays every year?” I’ve wondered about it before. Thanks! RK

Dr. K

Hi RK. I had seen this article and find it interesting for several reasons.

The way the conversation starts, the hygienist asks the patient if they would like to take x-rays since it is a free service. This question is what is wrong with a lot of our health coverage where need, benefit, cost, risk are decoupled.

In our office, every patient has an individual schedule of X-ray frequency for bitewings, Panorex and other x-rays. That schedule is based on each patient’s individual risk/benefit profile.  We do not decide to take X-rays based on insurance coverage.

Bitewing X-rays are taken primarily to identify decay between the back teeth. This may be new decay or decay under existing restorations. Decay rarely causes pain, (until it is so extensive that the nerve is infected and root canal treatment is necessary). Our goal is to find decay early when it can be treated with a simple filling or crown. This is the same reason we take a stress test to check for clogged heart arteries before there are symptoms. Often, by the time there are symptoms, the disease is more serious and harder to treat.

You have restorations on almost every back tooth, which puts you at higher risk for decay, hence the once a year bitewings. We don’t take X-rays of the front teeth to check for decay because the teeth are thinner and can be checked visually.

I hope this makes sense.

Regards,

Andy