“Open wide,” your dental hygienist says when you lie back for your 6-month cleaning and exam. We hope he or she starts by feeling your neck and pulling your tongue out from side to side. For decades, the risk for oral cancer centered on smoking tobacco, and lesions were often found on the sides of the tongue or the floor of the mouth.
But times have changed, and most mouth and throat cancers (also called oropharyngeal cancer) are missed with this exam and are undetectable. They hide in the back of the mouth, behind the tonsils, at the base of the tongue, or in the throat.
This type of oral cancer is caused by a virus called human papillomavirus (HPV). Although most cancers have gone down in the past 7 years, the number of oral cancers has increased considerably. In fact, every 20 minutes every day, 1 person gets cancer caused by HPV.
Sex, HPV Infection, and Oral Cancer
According to the Centers for Disease Control and Prevention (CDC), HPV is the most common sexually transmitted disease in the United States, and oral cancer is increasing by about 30% each year in white American men, probably because of the growing cases of HPV infections.
Oral cancers have become an epidemic in the United States. HPV is a common cause of cervical cancer, which is transmitted by sexual contact, but these days, oropharyngeal cancers linked to HPV are more common than cervical cancer caused by HPV.
According to a recent study, HPV infection affects men 3.5 times more than women.1 Overall, 25 HPV types have been linked to oral cancer, and these are most often contracted through oral sex with an infected partner. HPV is a virus that for most people can be cleared in time; if the virus remains in the cells, it can develop into cancer. HPV infection does not always have symptoms.
Whether HPV infection is cleared or remains in the body depends on the person’s overall health and the immune system, which is also related to our lifestyle. The foods we eat and the quantity and quality of our sleep play a role in our health. Our cells need nutrients and sleep time to protect and repair our body.
Risk factors for HPV infection include tobacco use, drinking acidic beverages, acid reflux disease, and continued exposure to HPV.
The Symptoms of Oral Cancer
Oral cancer linked to HPV is usually not detected early. Therefore, don’t ignore any symptoms in your body, especially in your mouth or throat. Possible symptoms of oral cancer include:
- A lump in your throat
- Difficulty swallowing
- Loss of appetite
- Rapid weight loss
- Swelling in the neck
- Speech difficulties
- Weakness and excessive fatigue.
To find out if you have oral HPV and are at risk for oral cancer, try to find a dentist who offers HPV testing from saliva. By using a “swish saline and spit” test, we can look for the most threatening virus strain(s), although this does not yet detect cancer.
If you have an HPV infection, you should be tested again in 1 year to see if the infection is still there. If you have a persistent HPV infection, pay attention to early warning signs, and establish a relationship with an ear, nose, and throat doctor for earlier detection. Remember, early detection of cancer is the key to survival.
Vaccinate Your Kids and Yourself
We currently have 2 vaccines against HPV—Gardasil 9 and Cervarix—which can prevent HPV infection, but these are not as widely used as is needed to stem the HPV epidemic. According to the CDC, in 2016, only 37.5% of boys and 49.5% of girls in the United States were up to date with their HPV vaccinations.
Meanwhile, the CDC estimates that 50% of all new HPV infections occur in young adults between ages 15 and 24. This trend will only go down when most of our young people are vaccinated against HPV.
Considering that the 9 HPV types that are covered by Gardasil 9 are the most common causes of oral cancers, by 2020 we may have more middle-aged men with oral cancer caused by HPV than women with cervical cancer caused by HPV infection.
So have your kids vaccinated, and consider getting vaccinated as well. Although private and public health insurance cover the vaccine for young men until age 21 and for young women until age 26, the vaccine is now approved for adults up to age 45. As an adult, the vaccine may cost you a few hundred dollars per dose (you’ll need 3 doses) at your local pharmacy, but it may be the best $1,000 (total) you ever spend.
You could also help to spread the word that oral sex is not “safe sex.” In our culture, oral sex is often considered as a casual way to experience sex. The fact that it’s killing many young men (and women) is rarely mentioned.
Keep in mind that having a cervical, vaginal, anal, or a penile HPV infection does not mean you also have an oral infection. These body areas are infected separately. Oral HPV infection causes oral cancer that is undetectable in its early stages, so pay close attention to early signs of the disease.
Ask your dentist about the saliva test for HPV infection. If you test positive for one of the cancer-causing strains, ask your doctor how to clear the virus from your system.
Treat your body like a temple by getting plenty of quality sleep, following whole and healthy foods, and decreasing exposure to toxins such as tobacco, recreational drugs, processed foods, and soda and sports drinks.
Don’t put off your dental exams. HPV infection is one of the many ways your mouth can tell you secrets about the rest of your body. Dental professionals are continually learning how systemic diseases, such as HPV infection, show up in the mouth, and how oral diseases wreak havoc in the body.
Keep learning along with us, your dental professionals, and ask us challenging questions. We are all in this together.
1. Sonawane K, Suk R, Chiao EY, et al. Oral human papillomavirus infections differences in prevalence between sexes and concordance with genital human papillomavirus infection. Annals of Internal Medicine. 2017;167:714-724.
- Don’t ignore symptoms such as a lump in your throat, difficulty swallowing, or speech difficulties
- Vaccinate your children and yourself against HPV infection
- Have regular dental exams, and get tested for HPV infection
Centers for Disease Control and Prevention
National Cancer Institute