Literature Review: HPV/Vaccine, Oral Cancer, and Dental Professionals

This literature review examines the increasing incidence of head and neck cancers linked to human papillomavirus (HPV) infections, focusing on the role of HPV in oral cancers and the potential for dental professionals to educate patients about risk factors and vaccination. The review synthesizes findings from 80 scholarly articles published between 2010 and 2018, selected based on specific inclusion and exclusion criteria related to oral cancer prevalence, HPV, dental professionals' roles, risky sexual practices, HPV vaccines, barriers, and recommendations. It highlights the rise of HPV-related oropharyngeal cancers, particularly among white men with risky sexual behaviors, and discusses global variations in HPV prevalence and associated cancers. The review also addresses the importance of dental professionals in patient counseling and the obstacles they face, such as limited knowledge about HPV sensitivity, emphasizing the need for improved preventive measures and a deeper understanding of HPV's impact.

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Literature review on HPV/vaccine and recent recommendations
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Table of contents
Introduction................................................................................................................................2
Oral cancer prevalence...............................................................................................................2
US...........................................................................................................................................2
Global (worldwide)................................................................................................................3
Risk factors.................................................................................................................................5
Vaccination to prevent HPV infection...................................................................................5
The potential role of dental professionals in prevention....................................................5
Recommendations......................................................................................................................5
References..................................................................................................................................6

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Introduction
Dramatic increase in the head and neck cancer in US and worldwide have compelled
the scientists to put on thinking caps regarding the implementation of effective solutions.
Upon investigation, it has been found that human papilloma infections are the major drivers
of this cancer (Auluck et al., 2010). Literature review for the issue has been conducted
through the consideration of 110 scholarly articles, which were published in 2010-2018. For
these articles, inclusion and exclusion criteria were applied, which resulted in the selection of
80 papers relevant to the issue. In case of the inclusion criteria, the articles related to oral
cancer prevalence (epidemiology), HPV, dental professionals’ role, risky sexual practices,
HPV vaccine, barriers and recommendations were preferred. On the other hand, for exclusion
criteria, articles, which were in other languages and were partially available, were avoided.
This paper aims to assess the role of HPV oral cancers and dental professionals in
terms of resolving the queries of the patients regarding the potential risks involved in the
vaccinations.
Oral cancer prevalence
US
In 1970, spread of HPV 16 infection was considered as the main cause for the rise in
head and neck squamous cell carcinomas (HNSCC). This cancer usually occurred in lingual
and palatine tonsils in case of the younger men. According to the arguments of Chaturvedi et
al., (2013), one of the striking features is the absence of records regarding alcohol or tobacco
consumption. Scientists were of the view that chemotherapy and radiation were the effective
means for treating and curing this type of cancer. Data reveal that 80% of the oropharyngeal
cancers occur due to HPV spreads (Joseph & D'Souza, 2012). In this case, the most affected

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ones are the whites, who expose risky sexual behaviours. Presence of epidemiological,
clinical and molecular characteristics make HPV related HNSCC epidemic in its nature.
These characteristics differ from non-HPV cancers.
Marur et al., (2010) points out that in the last few years, one of the causes of HNSCC
is HPV
. In this case, the patients suffering from the attack of HPV are the most affected ones. This is
because of lack of proper treatment and monitoring, indicative of the recurring risks. Due to
the continuous and evolving nature of HPV associated HNSCC, refined measures are needed
in terms of gain a deeper understanding for the natural progress history and the linkage with
HPV related HNSCC (Conway, Purkayastha & Chestnutt, 2018).
Global (worldwide)
According to one of the studies in Canada, knowledge can be enhanced regarding the
incidence rates for OCC and pharyngeal cancer, affecting the population of South Asia and
China. According to the age adjusted incidences displayed radical decline in OCC. Along
with this, the data also reveal the rise in rates of oropharyngeal cancer in case of both men
and women. However, the case attains seriousness in case of men as compared to women. In
case of OCC, one of the striking features is ethnic differences related to the age adjusted
incidence rates. In this case, de Martel et al., (2017) shed light on the fact that the most
affected ones were South Asian men and Chinese women. These aspects also prove true for
the rates of oropharyngeal cancer in case of Chinese men and women. Here, one of the
important issues is the ethnic minorities, which aggravates the health complexities for the
population. Both the men and women are at risk, as they do not receive proper treatment for
the OCC and oropharyngeal cancer.

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As per the meta-analysis of the Chinese population, the rates for HPV16 were
tremendously high in case of HNSCC. Increase in the rates gave rise to tumorigenesis.
According to the reports published by one of the sections in China, prevalence of HPV 16
and 18 in HNSCC might result in the formation of HNSCC (Feller et al., 2010). This is in
addition to the potential risks related to tobacco and alcohol. Synergies in this direction
increased the levels of HNSCC.
Mention can be made of UK where variation was displayed in the anatomical sites.
This necessitated the need for managing the risks as an independent entity. The scientists are
concerned about the increase in the alarming rates of the disease in the countries of Northern
Ireland, Scotland, England and Wales. Upon investigation, the following have been
accounted as the main causes of the disease:
 Alcohol
 Tobacco
 Low SES
 Genetics
 Oral health
 HPV
On the other hand, in countries like Germany, smoking has been identified as one of the
prominent causes for increase in HNSCC (Gan et al., 2014). This increase has resulted in
dramatic prognosis effect on the health of the affected patients.
According to the revelations of the worldwide studies, HPV generally causes cervical
cancer, which bears the responsibility for anogenital and oropharyngeal cancers. According
to the data, 4.5% of the cancers are globally related to HPV. Within this, 8.6% of the women

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are affected. The rate is 0.8% for the men (Tinhofer et al. 2015). The fractional rates in
women are:
 3% in Australia/New Zealand and USA
 20% in India and sub Saharan Africa
In case of the HPV related HNSCC cancers, the developed countries account for 21000
cases out of 38000 cases related to oropharyngeal cancers. Mention can be made of the
relative contributions of HPV 16 and 18, which accounts for 73%. In case of the HPV strains,
the contribution is 90%, which is alarming (Gillison et al., 2015). Other studies reveal that the
significant increase in the HNSCC cases in US, Australia, Canada, Japan and Slovakia. In
these countries, both the men and women were affected equally. Zhu et al., (2015) states that
in men, decrease in the rates of lung cancer aggravated the complexities of HPV. The case
was exactly the opposite in case of women. Increase in lung cancer took the condition of
HPV to an alarming level. Mention can be made of the younger men in Slovakia, Denmark
and United Kingdom (Maxwell et al., 2016).
Risk factors
Vaccination to prevent HPV infection
The potential role of dental professionals in prevention
Adopting new communication channels have helped AAP to address the queries of
the patients regarding HPV vaccine. Typical evidence of this lies in brochure guides, survey
questionnaires, educational lectures and seminars among others. Gooi, Chan and Fakhry,
(2016) opines that direct communication with the dental professionals is assistance towards
catering to the health needs of the patients. Within this process, some of the potential
obstacles are lack of proper skills and knowledge regarding the sensitivity of HPV. This

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situation creates communication gaps, delaying the adoption of preventive measures (Pytynia,
Dahlstrom & Sturgis, 2014).
Recommendations
The process of acquiring the preventive measures needs to be improved. For this,
sound knowledge of the intensity of HPV is needed.

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References
Auluck, A., Hislop, G., Bajdik, C., Poh, C., Zhang, L., & Rosin, M. (2010). Trends in
oropharyngeal and oral cavity cancer incidence of human papillomavirus (HPV)-
related and HPV-unrelated sites in a multicultural population: the British Columbia
experience. Cancer, 116(11), 2635-2644
Chaturvedi, A. K., Anderson, W. F., Lortet-Tieulent, J., Curado, M. P., Ferlay, J., Franceschi,
S., . . . Gillison, M. L. (2013). Worldwide trends in incidence rates for oral cavity and
oropharyngeal cancers. J Clin Oncol, 31(36), 4550-4559.
Conway, D. I., Purkayastha, M., & Chestnutt, I. G. (2018). The changing epidemiology of
oral cancer: definitions, trends, and risk factors. Br Dent J, 225(9), 867-873
de Martel, C., Plummer, M., Vignat, J., & Franceschi, S. (2017). Worldwide burden of cancer
attributable to HPV by site, country and HPV type. Int J Cancer, 141(4), 664-670.
Feller, L., Wood, N. H., Khammissa, R. A., & Lemmer, J. (2010). Human papillomavirus-
mediated carcinogenesis and HPV-associated oral and oropharyngeal squamous cell
carcinoma. Part 2: Human papillomavirus associated oral and oropharyngeal
squamous cell carcinoma. Head Face Med, 6, 15.
Gan, L. L., Zhang, H., Guo, J. H., & Fan, M. W. (2014). Prevalence of human papillomavirus
infection in oral squamous cell carcinoma: a case-control study in Wuhan, China.
Asian Pac J Cancer Prev, 15(14), 5861-5865.
Gillison, M. L., Chaturvedi, A. K., Anderson, W. F., & Fakhry, C. (2015). Epidemiology of
Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma. J Clin
Oncol, 33(29), 3235-3242.

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Gooi, Z., Chan, J. Y., & Fakhry, C. (2016). The epidemiology of the human papillomavirus
related to oropharyngeal head and neck cancer. Laryngoscope, 126(4), 894-900.
Joseph, A. W., & D'Souza, G. (2012). Epidemiology of human papillomavirus-related head
and neck cancer. Otolaryngol Clin North Am, 45(4), 739-764.
doi:10.1016/j.otc.2012.04.003
Marur, S., D'Souza, G., Westra, W. H., & Forastiere, A. A. (2010). HPV-associated head and
neck cancer: a virus-related cancer epidemic. Lancet Oncol, 11(8), 781-789.
doi:10.1016/s1470-2045(10)70017-6
Maxwell, J. H., Grandis, J. R., & Ferris, R. L. (2016). HPV-Associated Head and Neck
Cancer: Unique Features of Epidemiology and Clinical Management. Annu Rev Med,
67, 91-101. doi:10.1146/annurev-med-051914-021907
Pytynia, K. B., Dahlstrom, K. R., & Sturgis, E. M. (2014). Epidemiology of HPV-associated
oropharyngeal cancer. Oral Oncol, 50(5), 380-386.
doi:10.1016/j.oraloncology.2013.12.019
Tinhofer, I., Johrens, K., Keilholz, U., Kaufmann, A., Lehmann, A., Weichert, W., . . .
Raguse, J. D. (2015). Contribution of human papilloma virus to the incidence of
squamous cell carcinoma of the head and neck in a European population with high
smoking prevalence. Eur J Cancer, 51(4), 514-521. doi:10.1016/j.ejca.2014.12.018
Zhu, C., Ling, Y., Dong, C., Zhou, X., & Wang, F. (2012). The relationship between oral
squamous cell carcinoma and human papillomavirus: a meta-analysis of a Chinese
population (1994-2011). PLoS One, 7(5), e36294. doi:10.1371/journal.pone.0036294

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