they can become exposed to the HPV virus. Additionally, it is helpful for parents to understand that exposure to HPV is not limited to sexual intercourse. It is also unlikely that the immunization will compel anyone to begin engaging in sexual intercourse (Conley & Kasting, 2022). While the decision to immunize a child against HPV is a parent’s choice, healthcare professionals can present evidence-based information and resources to parents to aid their decision- making process. The Resources section of this course contains information on a variety of patient-education materials. ● In your lifetime, how many vaginal sex partners have you had? ○ Response options, if provided, can include 0 to 5, 6 to 25, and more than 25. ● At what age did you become sexually active? ○ Response options, if provided, can include 17 years or younger, 18 to 25 years, and 25 years or older. ● Have you ever been diagnosed with a genital or anal HPV infection? ● Have you ever been diagnosed with an oral HPV infection? ● Have you received the HPV vaccine? How many injections did you complete? Every clinician has his or her own technique and individual approach to performing an oral examination. However, a key component of the examination process, one that is often overlooked, is communication. The clinician should tell the patient what he or she is doing and what he or she is looking for; many patients never know they have been examined. It may be awkward for a dental clinician to speak about the oral manifestations of disease that is transmitted by sexual means. Reframing the conversation that HPV is an infection that could cause benign oral lesions that could be infectious towards others and that could even lead to oropharyngeal cancer may prompt the patient make a further inquiry about HPV related diseases (Rehan, 2017). The availability of brochures or literature about HPV can be provided to patients in the privacy of a dental operatory and may provide an incentive for a patient to discuss their concerns about HPV-related diseases. Dental clinicians must always maintain a nonjudgmental and compassionate overtone in their conversations with their patients about HPV-related diseases. Where appropriate, a referral to the patient’s physician or an infectious disease specialist may be necessary. It is helpful for the clinician to avoid jumping in before the patient responds by counting to 7 slowly. Usually, the patient will respond before the clinician gets to 7. While performing the oral examination, an initial question might be “Have you heard of the association between oral cancer and HPV?” If the patient responds affirmatively, the clinician can ask the patient what he or she has heard. If the response is negative, the clinician can proceed by explaining the association and risk factors. After explaining the association and risk factors, the clinician might find it helpful to ask the patient if he or she has any of the risk factors for HPV or to review the patient’s HPV information form if one is used. Table 12 provides a list of common patient questions and response content.
Parents are also concerned and often confused about why they need to vaccinate their 10- or 11-year-old child to protect him or her from an STI, especially when their child is not having sex, at least to their knowledge. Parents also hope that their children will remain sexually inactive until “at least” high school, and fear that administration of the vaccine implicitly gives their children permission to have sex earlier than they might have without the vaccine (Centers for Disease Control and Prevention, 2019e). Most often, parents do not initially understand that the vaccine offers the most protection for their children when administered before Patient communication and education Media information associating HPV infection and oral cancer will likely cause dental patients to have questions regarding their risk of infection and risk of developing HPV-related oral cancer (Kline, et al., 2018). Deep (French) kissing is a potential risk factor for the transmission of (HPV) to the oral cavity and the oropharynx (Cleveland Clinic, 2022). is one of many articles focusing on the relationship between oral cancer and oral HPV, and not the only one with a provocative headline. Stories such as these attract the attention of young and old alike, underscoring the need for inclusion of accurate HPV information in patient-provider discussions of oral cancer risks. Talking to adult patients about HPV All dental providers have an obligation to inquire about a patient’s behavioral risk factors and to examine the oral cavity for signs of cancer (Kline, et al., 2018). Initiating an open conversation with your adult patients about HPV and HPV-related conditions is an important part of a patient’s examination, although one that can at first be challenging for the provider (Henry, n.d.). Whereas in the past dental providers were happy to leave sexually-related health topics to the family practitioner or gynecologist, the association between HPV and oral cancer makes sidestepping discussions related to sexual behaviors no longer possible (Rehan, 2017). Although initiating these conversations may be uncomfortable at first, continued efforts hone communication skills and confidence. Practicing with the dental team serves the dual purpose of increasing comfort when discussing the subject and educating the team. Many adult patients wish to receive information on HPV transmission (including high-risk versus low-risk virus types), HPV prevention, detection, treatment, progression, and risk of cancer (Kline, et al., 2018). All of these topics can be introduced as the oral examination is performed. Screening can begin with a patient history form designed to collect information on alcohol and tobacco use, previous diagnosis of genital HPV (women) and oral HPV infection (men and women), and high-risk sexual behaviors. This information can be reviewed prior to performing the oral examination, which includes inspection and palpation of the neck, face, eyes, nose, ears, oral cavity, lips, buccal mucosa, tongue (including the base), floor of the mouth, hard and soft palate, oropharynx, tonsils, posterior pharyngeal wall, neck, hypopharynx, and larynx (Wagner and Villa, 2017). Specific HPV-related questions can also be included on the patient history form. These questions can include: ● In your lifetime, how many oral sex partners have you had? ○ Response options such as none, 1 to 5, or more than 5 can also be provided.
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