HJAR Mar/Apr 2023

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2023 51 oropharyngeal cancers are now the most common HPV-related cancer in the US. 5 The majority of sexually active people be- come infected with HPV at some point in their lives. 6 It is the most common sexually transmitted infection on the planet, mak- ing it not only a public health issue, but a global health issue. 7 There are over 200 re- lated types of HPV, and half of these infec- tions are high-risk types, including HPV16 and HPV18.5Almost all oropharyngeal can- cers are caused by HPV16. HPV is a small DNA virus with a biologic predilection for squamous epithelia. HPV infects mucosa, and HPV16 and HPV18 cause premalignant squamous neoplasms that can progress to malignancies. 8 Oral and oropharyngeal cancer signs and symptoms can range from a wide variety of manifestations. 9 These include: • A long-lasting sore throat. • Earache. • Hoarseness. • Swollen lymph nodes. • Pain or fullness when swallowing. • Unexplained weight loss. • A sore or ulcer on the lip or intraorally that doesn’t heal. • Persistent pain or burning sensation in the mouth or throat. • A lump or thickening in the lips, mouth, cheek, or jaw. • A white or red patch on the gum, tongue, tonsil, or lining of the mouth. • Asore throat or constant sensation that something is caught in the throat. • Difficulty chewing or swallowing. • Difficulty moving the jaw or tongue as normal. Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas weeks or longer to allow nutrition for the body, due to the incapability of the patient to eat and swallow. Feeding tube placement is a vital and necessary procedure, as it prevents malnutrition and dehydration of the patient. Difficulty in eating, chewing, and swallowing are often the issues that patients have before an oral diagnosis is made, which makes pa- tients weak and nutritionally deficient. 12 In some cases, feeding tube placement comes before the cancer treatment, when the pa- tient is too weak to undergo the required treatments to save their life. The positive news is that oral cancer treatments and awareness are improving. Historically, the death rate for oral cancer has remained particularly high, but this fact is not because it is hard to detect or diag- nose. It is because the cancer is discovered late and has progressed. 2 This adds to the many important reasons to regularly visit the dentist. There is an HPV prevention vaccination, which is estimated to prevent up to 90% of HPV-related cancers. 13 The current recom- mendations by the Centers for Disease Con- trol and Prevention include: • HPV vaccine is recommended for rou- tine vaccination at age 11 or 12 years. (Vaccination can be started at age 9.) • The CDC’s Advisory Committee on Im- munization Practices (ACIP) also rec- ommends vaccination for everyone through age 26 years if not adequately vaccinated when younger. HPV vac- cination is given as a series of either two or three doses, depending on age at initial vaccination. • Vaccination is not recommended for • Numbness of the tongue, lip, or other area of the mouth. • Swelling or pain in the jaw. • Dentures that become uncomfortable or start to fit differently. • Loosening of the teeth or pain around the teeth. • Voice changes. • A lump or mass in the neck or back of the throat. • Unexplained bleeding or bleeding when coughing. The dentist is often the first to notice an intraoral irregularity, even before there are symptoms. 10 Some patients have no symp- toms, and by the time they appear, the can- cer has already spread, making early detec- tion key. The role of dental providers is vital not only in early detection, but in educating and informing patients of an abnormality. Dentists are essential, as they increase sur- vival rates by detecting a cancerous lesion at an early state. 10 This early detection is criti- cal, since it prevents malignant progression, thus enabling the patient to have a better quality of life. Treatments for oral and oropharyngeal cancers include surgery, radiation, chemo- therapy, targeted drug therapy, and immu- notherapy. 11 These can be used in different combinations depending on the cancer stage, type, location, severity of the cancer, and the patient’s overall health and personal preferences. Of all the cancers, oral and oropharyngeal are the worst, as the majority of other can- cers allow eating and drinking. When these treatments occur orally, many times a feed- ing tube is placed into the GI tract for a few