Human Papillomavirus (HPV) and Oral Cancer- Part Two

iStock Oral cancer

As discussed in Part One of this blog, HPV is the leading cause of oropharyngeal (tonsils and base of the tongue) cancer. Oral cancer caused by HPV is very serious, and most patients aren’t even diagnosed until they present with symptoms because the symptoms are often painless and subtle. Physicians are enlisting the help of the dental profession in assisting with detection, diagnosis, and referral for treatment. In this blog, we’ll discuss the difficulty in diagnosis, symptoms, and treatments of HPV related oral cancer.

Difficult to Diagnose-

HPV is present in millions of males and females. In most cases, it clears on its own and treatment isn’t necessary. It rarely causes any symptoms making it very difficult to detect. There are many oral cancer detection kits on the market, but none are accurate in detecting HPV related cancers. Paying close attention to the patient’s medical history and any unusual lumps or lesions is imperative in helping with detection. It’s necessary to have a conversation regarding the seriousness of HPV related oral cancers and the availability of the HPV vaccine.

Symptoms-

Symptoms are rare, and if they do appear, it’s most likely that the cancer has been present for a while. While the symptoms listed aren’t necessarily linked to HPV oral cancer, it’s prudent to take detailed notes and have the patient return to your office if any of the following are present for two to three weeks or longer.

  • A painless lump present on the outside of the neck with a duration of at least two weeks
  • Numbness in the lips or mouth
  • A persistent cough or coughing up blood
  • A unilateral earache lasting for at least two weeks
  • A recurrent ulcer or sore that doesn’t heal after two weeks
  • A black, red, or white discolored patch on the soft tissue
  • Difficulty in swallowing or the feeling that something is stuck in the throat
  • Unilateral painless and inflamed tonsil. Both tonsils should be approximately the same size
  • An ongoing sore throat or hoarseness

Treatment-

If oral cancer is suspected, it’s crucial that the patient is referred to an oral surgeon, periodontist, or an ENT immediately. Upon examination by a specialist, a laryngoscope or pharyngoscope may be utilized to explore the base of the tongue and tonsillar areas. A biopsy of the suspect tissue will be taken. Depending on the results of the biopsy, a treatment plan will be created which may include surgery, radiation therapy, chemotherapy, or all three. Sometimes, surgery is sufficient. With any treatment, reconstructive surgery may be necessary.

HPV related oral cancers can be prevented with the vaccine and safe sex practices. Although this discussion may be awkward, it’s necessary to educate patients and parents about the devastation caused by this growing crisis.

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Human Papillomavirus (HPV) and Oral Cancer- Part One

iStock Oral cancer

Human Papillomavirus (HPV) is a group of nearly two hundred different strains of viruses with most being harmless and not cancer causing. It’s the most common sexually transmitted disease (STD), and it can be present for many years before transitioning into cancer. More difficult to detect than tobacco and alcohol-related oral cancers which usually occur in older patients, HPV related cancers affect young adults. Oral cancer caused by HPV is very serious, and most patients aren’t even diagnosed until they present with symptoms because the symptoms are often painless and subtle. Therefore, physicians are requesting the assistance of the dental profession with detecting and diagnosing HPV related oral cancer.

HPV is the leading cause of oropharyngeal (tonsils and base of the tongue) cancer. The location of these cancers makes the dental team invaluable, and their role is two-fold. First, it’s important to perform an oral cancer screening at each recall appointment. Second, it’s crucial to talk with the patient (if over 18 years of age) or parent to inquire if the three-dose HPV vaccination series has been administered. The vaccination series is recommended for patients ages nine to twenty-six, and The Food and Drug Administration (FDA) recommends that males and females receive the first injection of the series between the ages of eleven and twelve. This timing coincides with tetanus and meningitis vaccinations.

A less awkward way to begin the discussion of HPV related oral cancers is to ask the patient or parent if they see their doctor for regular exams and if they’re current on their vaccinations. Furthermore, ask if their vaccination series includes the HPV prevention injections. The conversation can be approached while performing an oral cancer exam. Explain that the exam is to look and feel for any lumps or lesions because HPV is the leading cause of oral cancer.

While there is a lot of information concerning HPV and the vaccine, some of it’s negative concerning the side effects, and this puts the likelihood of getting vaccinated in jeopardy. Direct the patient to legitimate websites such as the Centers for Disease Control (CDC). There are also reputable pamphlets that can be handed out to patients.

In part two of this blog, we’ll discuss the difficulty in diagnosis, symptoms, and treatments of HPV related oral cancer.

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Habitually Late Patient? No Thank You!

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Patients may be running a little late from time to time and that can be overlooked. Repeat offenders, however, can make office life pretty unbearable. You know the patients of which I’m referring. They are the ones that when you see their name on the schedule, you begin taking bets on just how late they’ll be or if they show up at all.

Running on time is paramount in any office, but in dental offices, the entire world revolves around the schedule, and one misstep can cause a snowball effect of disaster and you can’t recover. So, what can be done to finally get these patients on the same page and stop causing you to run behind, thus having to feel the wrath of each subsequent patient?

First of all, you should incorporate a form which each patient must sign. This document will be committed to a late or no-show policy for your office. It will describe policies regarding showing up on time or not arriving for the appointment and the consequences of each. The form should include that the practice respects the patient’s time and the patient should return this respect.

The document should clearly outline the consequences of a no-show such as a fee if they don’t indeed arrive but also a fee in they cancel within 24 hours of their appointment. If the patient does actually arrive late, more than 10-15 minutes, explain that they may not be seen at all or that treatment may be extremely limited.

If you do provide treatment when the patient is more than 15 minutes late, the treatment should not include a prophy. The appointment should be records (Xrays, Charting, and Doctor’s exam) only. If you perform a prophylaxis, the patient is likely not to return for the records portion of the appointment.

Once this policy is written and signed, it must be strictly adhered to. There’s no saying, “it’s OK this one time”. Although it may be uncomfortable at first, it’s imperative to get the policy written, signed, and Implemented to save time and missed appointment time.

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Put That Cellphone Away!

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The beloved cell phone has become a part of our lives, and some would agree that they’re a blessing and a curse. While mobile devices are awesome, having rules regarding their use in your practice is wise.

Develop a written policy devoted to what will and won’t be tolerated in the reception area and operatory, and have the patient read and sign the document. Having clear guidelines prevents having to address an offender. Also, posting signs stating “No Cell Phone Use” is helpful.

While waiting for their appointment, patients can create quite a scene while using their cell phone. A noisy app or conversation can become a real problem for others in the reception room. If the patient uses the device in the treatment room, a myriad of problems may arise. I’ve had patients try to conduct conference calls, take phone calls, and ask me to move out of their line of sight while attempting to text.  

Of course, phones may be utilized in the office, but be clear about the rules you’ve set. You may prefer that patients have their phones on silent mode while in the office and not permit taking phone calls or texts while receiving treatment. There are some exceptions where I’ve allowed patients to keep their phone with them and answer it if necessary during the appointment. Examples include a loved one in the hospital, moms of school-aged children, and any other unusual circumstance.

You must also remember that the rules apply to you and the team. Everyone’s phone should be out of sight and earshot.

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Room Turnover - Properly and Efficiently

2e1ax default entry Infection Control Dental Offices

Turning your room over to prepare for the next patient can feel somewhat like a pit crew experience. However, this procedure is crucial for the safety of everyone entering the operatory. After dismissing the patient, returning to the operatory must be seen as a field of numerous pathogens waiting to infect anyone in their path. Cleaning and disinfecting should be considered as important as sterilizing instruments and wearing Personal Protective Equipment (PPE).

Most offices use disposable barriers for surfaces such as light handles, air/water syringes, suction apparatus, headrest/chair, and computer mouse/keyboard. These barriers are simple to remove and replace, but what about all the other contaminated surfaces? When it comes to a surface disinfectant, look for these characteristics.

  • Tuberculocidal- not only will this level of disinfectant kill TB, but it will also be effective against a wide range of pathogens such as HIV and HBV.
  • Cleaner and Disinfectant- The same product should serve as a cleaner and disinfectant. A surface must be cleaned first, or it can’t be disinfected properly
  • Must possess rapid contact (kill) time
  • Excellent surface compatibility- must be compatible with multiple surfaces while not discoloring, staining, corroding, or producing other damage
  • Must feature low-toxicity and be fragrance-free, and not be likely to cause allergies
  • Must not require rinsing or leave a residue. Easy storage and satisfactory shelf-life is also essential

It’s very important to follow the manufacturers directions because failing to do so can cause the active ingredients in the disinfectant to become deactivated. If in doubt, your dental representative can offer suggestions and answer questions.

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