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Clearing up confusion about HPV

Angie Gribble Hedlund DMDBy Angie Gribble Hedlund, DMD @AngieHedlund

I went to a great OSHA training seminar today.  That sounds like a funny thing to say about an OSHA seminar, but the presenter was more like a stand-up comedian than a lecturer and made the material really interesting and entertaining.  During the discussion of infectious pathogens, she devoted several minutes to Human Papillomavirus.  This is a considerable area of interest for me as we have been using the OraRiskHPV diagnostic test to detect oral HPV in our patients for over a year.

Some of the statistics that our presenter highlighted were:

  1. 30-60% of all oral cancer is caused by HPV.  (Actually her figures may be slightly outdated- it’s 50-65%-
  2. The 5 year mortality rate for oral pharyngeal cancer that is discovered in late stage is 50%.
  3. Tragically, the fastest growing population for oral cancer is young adults ages 18-40.
  4. By age fifty- 80% of people will have been infected with some strain of HPV.
  5. On the positive side, 90-95% of HPV clears within one year.

These are alarming figures; and when you combine them with the following numbers that we know from other research, I think you will agree that this is an area of disease that needs our attention.  

Additional facts to consider

    • 41,000 people are diagnosed yearly in the U.S
    • 66% of people will be diagnosed at late stage three or four
    • Resulting approximately 12,000 deaths per year- More than one person dies every hour of every day of oral cancer!
    • HPV infected individuals have up to 32x greater risk of developing oral cancer
      (Compared with traditional risk factors like: smokers- 3x greater risk and excessive alcohol 2.5x greater risk.)

The good news is that early discovery will decrease the mortality rate, and for the first time in history, dentists have at their disposal a reliable, accurate test to detect the presence of oral HPV- OraRisk HPV from OralDNA labs.  This simple chair side rinse and expectorate assessment tests for the presence of Human Papillomavirus and more specifically, classifies the strain/strains of HPV that are present.

Criticisms of  the OraRiskHPV diagnostic test

Two complaints that my OSHA presenter had about this test were:

  1. All of the studies that have been done on it are funded by the company, and she would like to see independent research.
  2. She expressed concern about reports of false positive results.

Regarding the first concern, I agree.  I would love to see more independent studies performed, but this will take time and an increased use and awareness of the test and does not invalidate the results of the screening.

Regarding the second concern, this is simply misinformation.  During extensive validation testing, there were no known false positives.  All DNA PCR (Polymerase Chain Reaction) processes are highly specific.  There cannot be a false positive test because if HPV is detected, it is actively shedding virus.

Providing Oral HPV testing to patients

Let me be clear that I personally have no relationship with OralDNA labs financially or otherwise, nor does The Dawson Academy.  Furthermore, this is not designed to be another “profit center” for my practice. Although some clinicians charge more, I charge just enough for the test to cover my costs because I do not want the cost to be a deterrent for the patient.  If our desire is truly to be physicians of the masticatory system rather than tooth doctors, I believe we should be on the front lines of screening for oral HPV infections.  This is part of being advocates for our patients and at least offering them the opportunity to be tested in our dental offices.  The test is quick, non-invasive, affordable and accurate, and more importantly- early detection can save lives.

There is should be no stigma to having the presence of oral HPV.  It is not merely sexually transmitted; it can be transferred by skin-to-skin contact.  This includes hand-to-hand or hand-to-mouth contact.  This is a key point for clinicians and patients to understand, because when we offer to screen our patients for oral HPV, it does not infer that they are non-monogamous, promiscuous, or even sexually active.  This is an early detection device that should be offered regularly and repeated annually in patients who are positive for HPV-16 which is implicated in most oral pharyngeal cancers.  If it does not clear in one year like most oral HPV will, then they have a chronic, resistant infection and should be examined meticulously in our dental offices for any signs of precancerous lesions and, in my opinion, be seen for regular annual exams by an ENT with endoscopy if needed.

Our opportunity as Dawson Dentists

Currently this test is only available to dentists, but if we do not incorporate this into our practices, it will end up being offered to physicians.  It seems so logical that dentists should be at the forefront of fighting oral cancer; we see our patients more frequently, and examine their oral cavity at every visit.  Lack of public awareness about the link of HPV to oral cancer is very serious, and my hope is that Dawson dentists can help raise awareness about this HPV assessment in the dental community as well as among our patients.

Dr. Angela Gribble Hedlund completed her undergraduate training at Baylor University in Waco, Texas, where she received her Bachelor of Science Degree. She received her DMD from the Medical College of Georgia School of Dentistry in Augusta Georgia, and has completed an ADA-accredited program in Advanced General Dentistry at Baylor College of Dentistry in Dallas, Texas. Dr. Hedlund practiced with Goldstein, Garber, & Salama for 16 years, and have recently opened a private practice in North Atlanta. She has practiced dentistry in Atlanta since 1994. Dr. Hedlund has also received extensive training in esthetic dentistry. She has received her certificate in the Postgraduate Program in Esthetic Dentistry from Baylor, as well as completing the Comprehensive Esthetic Restorative Continuum at the same institution. During her postgraduate studies at the Medical College of Georgia, she was awarded the Goldstein Esthetic Dentistry Award, presented yearly to a senior student who has shown exceptional interest and talent in the area of esthetic dentistry. She is an active member in the Georgia Academy of Cosmetic Dentistry and the American Academy of Cosmetic Dentistry where she is currently an accreditation candidate. Dr. Hedlund is an active contributor to organized dentistry. This began when she served as the first female president of an MCG dental class, and a representative to the American Student Dental Association executive council. She is currently a member of the American Academy of Cosmetic Dentistry, American Dental Association, Georgia Dental Association, the Hinman Dental Society, and the Academy of General Dentistry, where she has completed over 1,500 hours of continuing education in dental studies. She has received her Fellowship in the Academy of General Dentistry; this is an honor held by fewer than 2% of dentists in the country. In July 2006 she became one of the youngest women ever to receive Mastership in this Academy. Dr. Gribble also is on the dental advisory council for the Christian Medical Dental Assocation. Dr. Gribble has published articles in the Journal of Esthetic Dentistry and the Journal of the American Dental Association. She has served as a contributing editor to the Dental Study Club Journal, which contains reviews from leading clinicians on articles from over seventy-five international dental journals. She also lectures on the subjects of restorative and esthetic dentistry. Dr. Gribble paid for a large portion of her education and received lots of “smile practice” in the Miss America Scholarship programs. She was 2nd runner-up in Miss Augusta in 1991, and 2nd runner-up in Tennessee’s America Junior Miss Pageant in 1985. Dr. Angie Gribble Hedlund enjoys singing, scrapbooking, and is a master scuba diver. She is an active member of the Atlanta Women’s Medical Alliance and Bible Study Fellowship where she serves as the Substitute Teaching Leader for the Norcross Women’s class. She and her husband Richard are members of Roswell United Methodist Church. They volunteer regularly with the children’s program there with their 2 daughters Tori and Lexi.