As a clinical Restorative Dental Hygienist for many years, I have performed countless oral cancer screening exams and have had to have difficult conversations with many clients regarding sexually transmitted diseases. When I first graduated, oral cancer was traditionally found in the middle aged population with a history of smoking and alcohol abuse. Unfortunately today the risk factors and demographics have changed. The human papilloma virus (HPV) is now considered the epidemic of oral cancers especially among men. The virus is now found in 70% of cancers and much more difficult to detect. There is no cure for HPV related cancers.
HPV is the most common STD virus and infection. It is the leading cause of oropharyngeal cancers primarily at the base of the tongue, tonsils, crypts and throat. There are nearly 200 strains of the virus but we are most concerned about HPV16 in oral, cervical, anal and penile cancers. Most sexually active individuals have been exposed to HPV and we could be carrying the virus without knowing for many years or decades before our body does one of two things: fosters the infection OR our immune system clears the virus. Most of us with a strong immune system will usually clear the virus within two years.
Risk factors for becoming infected are the number of sexual partners you have had or the number your partner has had, and a weakened immune system. It is transmitted from skin to skin genital contact (intercourse and oral sex). Condoms reduce the incidence of contraction as well as HPV vaccinations. Gardasil and Cervarix vaccines protect against HPV16 and millions of females starting at the age of nine have been safely vaccinated at no cost to them through our school boards. The vaccination needs to be administered at the PRE sexual age as it will not work if you have already been exposed to the virus. What about the male population?? Males are four times more likely to contract HPV and Ontario does NOT currently have a no-cost school based HPV vaccination for nontrans males. It is likely to change in the future but currently most males are NOT protected unless they seek vaccination through a private clinic at cost of approximately $540.00 for the three necessary doses. Some private insurances will cover the cost and I encourage all parents of young boys/men to invest in the vaccination. It could save their life.
DETECTION - Dentistry has a huge role to play in detection and education of these HPV related cancers. Dental exams when done thoroughly and properly saves lives! Ensure your dental professional is performing oral cancer screenings for you, your kids and grandkids. I am a huge proponent in education and not only should the screenings be done at every dental visit but young males who are around the age to becoming sexually active, should be informed of the higher risks associated to them due to lack of the vaccination and protection available to lower the incidence of this deadly disease.
WHAT CAN YOU DO? - It is important that you also perform your own oral cancer screening and there is a widely publicized “Seven Step DIY Oral Cancer Screening” that you can do that could save your life. Any sore/lesion, discoloration, irritation, hoarseness, induration or prominent tissue which does not resolve in two weeks should be checked by an oral health professional.
THE SEVEN STEP DIY ORAL CANCER SCREENING: Compete while facing a mirror with adequate lighting.
Step 1: Tongue – Stick your tongue out and hold the end with a cloth to give you some grip. Move your tongue to the right and left and look for any red and white patches. Do the same for the top and bottom of the tongue. Use your index finger to feel for any unusual lumps on the sides, top and bottom of the tongue
Step 2: Lip and cheek – Look around the edge of your lips for any lesions or sores. Using the thumb and index finger of both hands, pull back your upper and lower lips and look for red or white lesions/sores. Using these same fingers, feel for any lumps or bumps. Next, use your thumb and index finger to pull back the right side of your cheek looking for any red or white patches. Rub your cheek to feel for any lumps or bumps. Repeat on the left side.
Step 3: Floor of Mouth – Raise tongue to the roof of your mouth and look under where it rests on the bottom of your mouth for any white or red patches. Using one finger inside the floor of the mouth and another on the opposing surface from the outside (under your chin) feel for any lumps/bumps between your fingers.
Step 4: Roof of Mouth – Look at the roof of your mouth for any unusual sores or red and white patches. Rub the roof of your mouth and feel for new or unusual swelling.
Step 5: Head and Neck – Using all four fingers to rub in a circular motion, feel your neck for unusual lumps/bumps or tender areas. Repeat this on the back of your neck along your hairline and behind, under and in front of your ears.
Step 6: Say “ahhhh….” Press down on your tongue with a tongue depressor or teaspoon , say “ahhhh..” and examine the back of your throat looking for red/white patches or unusual bumps.
Step 7: Tell someone – Call your oral health professional and have any unusual findings checked – early detection is key!!
We can all be proponents for change for our at-risk youth. Let’s get talking about HPV … to one another, our kids, our insurance carriers and government officials for changes to Ontario’s policy to vaccinate our young men and save lives!
Cathy Byrnes is the recently retired as the restorative dental hygienist at the Sharbot Lake Dental Clinic.