With the revelation of Michael Douglas’ oral cancer, there’s a lot of information in the consumer press regarding the disease in general, and the relationship between oral HPV and oral cancer in particular.
To get more insight on the current state of research on the oral HPV/ oral cancer connection and what dental professionals need to know, we spoke to Ron McGlennen, MD, Chief Medical Officer of OralDNA Labs Inc., a leading provider of salivary diagnostic tests to the dental profession, and a subsidiary of Quest Diagnostics Inc.
Dr. McGlennen is board certified in Anatomic and Clinical Pathology, and also board certified by the American Board of Medical Genetics, with a specialty in Clinical Molecular Genetics. He is internationally recognized as an expert in Molecular Biology and Genetics.
Dentalcompare: With a heightened awareness among patients, what should dentists and hygienists be doing to prepare for patient questions and concerns?
Dr. McGlennen: The most recent spike in consumer awareness not only puts the spotlight on oral cancer, it is challenging the preconceptions of clinicians and patients alike as to what are the most common causes of this underdiagnosed disease.
Alcohol and tobacco have been the likely suspects for causing oral cancer for generations, but this has changed in less than a generation. Today, of the 34,000 cases of oropharyngeal cancer diagnosed annually, the oral human papillomavirus virus or Oral HPV, is found in up to 50 percent of those cases. Dental professionals should be taking the time to learn as much as they can about Oral HPV and its link to oral cancer. A lot has been written lately and is available through trusted resources such as the online medical reference library PubMed, the American Dental Association website and New England Journal of Medicine.
DC: What are some of the screening tools available to the dental team?
McG: There are several screening tools currently available that utilize tissue fluorescence as an adjunct to visual inspection to help detect suspicious lesions in the oral mucosa that are not readily visible with the naked eye.
In the case of Oral HPV-related oropharyngeal cancer, salivary diagnostic testing can screen for oral HPV infection and monitor its persistence long before it develops into a benign or cancerous lesion or tumor. Earlier this year, OralDNA® Labs introduced the OraRisk HPV Test specifically for this purpose.
DC: Tell me about the OraRisk HPV test?
McG: The OraRisk HPV test is a non-invasive, easy-to-use screening tool for identifying the type(s) and level of oral HPV. This test provides the dental clinician with the ability to establish risk for HPV-related cancers of the oral, head and neck regions and determine appropriate referral and monitoring conditions. Using the test is a very simple process: The patient is instructed to swish a saline solution around the entire mouth, gargle deeply and expectorate into a specimen collection tube.
The collection tube, is then placed into its own plastic specimen transport bag and shipped from the dental office via pre-paid FedEX envelopes to OralDNA Lab™, in Brentwood, Tennessee for DNA analysis.
An OraRisk HPV lab report is then sent back to the ordering dentist via the secure website within 7-9 business days so that he/she can share the information with the patient and develop a personalized treatment plan based on their test results.
DC: Why is the dental visit an optimal environment for testing?
McG: The dental professional is on the front lines of oral cancer screening. What’s more, with most patients scheduled every six months or once a year, early detection is much more likely if a thorough exam is performed using the most advanced screening and diagnostic technology available.
With the availability of these diagnostic tools and more research confirming that oral health is linked to systemic health, dentistry is rapidly evolving into oral medicine. In the very near future, dentists will be able to administer a variety of salivary diagnostic tests to detect diabetes and other systemic diseases.
The oral cavity is the gateway to one’s overall health and dental professionals are the gatekeepers. Soon, dentists will routinely be referring patients to physicians for treatment long before physical and/or visible symptoms appear. Patient co-management will be the key to better patient outcomes for a multitude of diseases.
DC: Should all patients be tested for Oral HPV or is there a profile?
McG: There is a profile. Dental patients having the following characteristics are strong candidates for the OraRisksm HPV test:
- Males and females over 12 years of age
- Sexually active individuals
- Anyone who has had three or more sex partners
- Individuals with a family history of oral cancer
This new profile presents a challenge to the average dental professional who is used to asking questions no more personal than “Are you brushing or flossing?” Fortunately, OralDNA provides scripts to help broach these very personal discussions.
You’ll notice that the patient profile is skewing a lot younger than in the past. This is because people are having sex with multiple partners at an earlier age and also because there is the widespread misperception among young people that oral sex is safe sex.
DC: This is probably uncharted territory for most dental patients? What are some of the effective talking points that the dental team can use to explain the need for testing?
McG: Dental professionals do not have to speak specifically about sex since the HPV virus can also be transmitted by skin-to-skin contact and kissing. If explained in the context of kissing, the patient can fill in the blanks without anyone feeling awkward. Here an example of a “why you should be tested” conversation that a dentist can have with a patient: “There’s a new screening test for oral HPV, or human papilloma virus, that I would like to talk to you about. HPV is one of the most common sexually transmitted virus groups, and affects nearly everyone at some point in their lives. Research has shown that anyone can be exposed to the virus simply by kissing.”
DC: What’s if the test comes back positive? What’s the typical protocol?
McG: If the test comes back positive, but there are no visible lesions. The dentist should recommend that the test be re-administered in a follow-up appointment scheduled within the next six months, or based on practice’s existing protocol for oral cancer exams.
It should be noted that very often the oral HPV infection will be eliminated naturally by the patient’s immune system. However, if a follow-up test indicates a persistent HPV infection, referral to an ENT or oral surgeon is recommended.
If the test comes back positive and there is visible oral lesion, the patient should be referred to an oral surgeon or ENT. By the way, OralDNA provides complete referral protocol workflow charts for all possible test result scenarios.
DC: Is there a recommended fee for the OraRisk test? What about insurance coverage?
McG: The OraRisk test is covered by most insurance plans. The OraRisk testing supplies cost $199.00 for a box of 12 salivary diagnostic tests. The doctor’s lab fee is $70. Dentists in turn generally charge their patients between $120 and $150.
DC: In light of the blurring lines between the dental and medical professions in terms of screening, diagnosis, and even treatment, what’s the take-away from this interview to the dental team about the OraRisk HPV test?
McG: Dentistry is evolving from a “disease-oriented” model to “wellness oriented model” which provides dental professionals with an excellent opportunity to detect disease earlier, determine who is more at risk, and ensure better patient outcomes.
What’s more, with more than 150,000 practicing general dentists in the US seeing their patients on an average of every six months to one a year, no other healthcare provider group can screen as many patients and have as great an impact on the wellness of the general population.
Dental and medical specialists alike will benefit from referrals from GPs on the front lines. Not only from a practice-building standpoint, but because they will be seeing patients earlier, when their treatment of diagnosed disease in a greater number of successful outcomes.
Overall, the general dentist’s stature as a clinician will be elevated as an important part of a patient’s’ diagnostic and wellness management team.