The Massachusetts Dental Society puts out a semiannual publication called Word of Mouth. Copies are available in our reception area. The winter - spring 2012 issue headlines HPV and the changing face of Oral Cancer.
37,000 Americans are diagnosed with oral cancer each year. Previously smoking and drinking were considered the prime culprits. Today 80% of oral cancer is associated with a virus- humanpapillomavirus (HPV). There are more than 100 strains, including 2 sexually transmitted types known as HPV-16 and HPV-18 which are both aggressive high risk strains that lead to certain types of cervical and oral cancers. In the oral cavity HPV is associated with squamous cell carcinomas of the tonsils and the base of the tongue area.
The Advisory Committee on Immunization Practices, which advises the United States Centers for Disease Control (CDC), recently voted to recommend that boys ages 11 and 12 receive the the HPV vaccine, Gardasil, to battle HPV, and boys and men ages 13 to 21 receive a "catch-up" dose of the vaccine, if they were not yet vacinated. Note that previosly women ages 11 to 26 were recommended to get the vaccine since 70% of cervical cancers are associated with HPV.
Each patient has a head and neck oral cancer exam at least once a year. For those areas that are suspicious we will evaluate them again in 2 weeks. If the suspicious area was a result of trauma, it will heal in that time period. If it is still present at their reevaluation the individual is referred to an oral surgeon for a biopsy, and a definitive histological evaluation.
The problem with HPV cancers is their location- the base of the tongue and the tonsilar region. Our head and neck cancer exam can not evaluate those areas in the majority of patients. We do have a method of evaluating whether an individual is infected with HPV. Oraldna has developed a salivary test to monitor for the HPV virus. We can administer this test and inform the individual of their status. If the result comes back as positive we refer the individual to an ENT for further follow-up. Note that once infected the individual will need to be monitored on a routine basis for HPV oral cancers.
Ultrasonographic confirmation of carotid artery atheromas diagnosed via panoramic radiography Friedlander,Garrett,Baker JADA, vol 136, MAY 2005
Background. Studies have shown that panoramic radiographs can capture images of calcified atheromas in the internal carotid artery (ICA) in some neurologically asymptomatic patients receiving routine dental care. However, the prevalence of these hemodynamically significant lesions- that is , those causing greater than 50 percent vessel lumen occlusion with the heightened risk of stroke- has been evaluated rarely. The purpose of this study was to use Doppler ultrasonography (DUS) to determine the prevalence of large occlusive lesions detected initially via panoramic radiography. Aggresive medical and surgical interventions directed toward these large lesions have been shown to moderate the risk of stroke.
The radiographs of 4.2 percent of patients showed at least one internal carotid artery atheroma. These results demonstrated that 23 percent of those with an occult atheroma discovered on panoramic radiography had significant ( >50 percent) levels of ICA stenosis.