Discussing oral cancer risks

March 1, 2013
Few people enjoy uncomfortable situations, but our profession creates daily opportunities to hone our skills in confronting unpleasant tasks

by Lory Laughter, RDH, BS

Few people enjoy uncomfortable situations, but our profession creates daily opportunities to hone our skills in confronting unpleasant tasks, be it patients, topics, or working situations. Developing a thick skin is not enough – you must be able to discuss, educate, and even walk away.

Halitosis is not viewed as an exciting conversation starter, especially when the offending mouth is seated in your treatment chair. Most dental professionals approach the subject with patients daily with a variety of techniques and tools. Guiding patients to Internet sources is one way to provide patient education. Colgate's page gives a good overview of halitosis in language everyone can understand.1 The site addresses the causes, symptoms, diagnosis, and treatment options, allowing readers to gain insight and participate in their own treatment.

Oral-B has a tab on their website labeled "dental health topics."2 Halitosis is one topic they tackle in depth in this section. I particularly like Oral-B's use of images to convey messages and entice the reader to learn more about the topic at hand.

You may think sexually transmitted diseases are beyond our scope of practice, yet nothing is further from the truth. ABC posted a report in 2012 addressing the rise in HPV-16 rates among adults.3 The experts in this piece estimate that nearly 7% of those from the ages of 14 to 69 are infected with HPV, and 2 million have HPV-16, the strain related to oral cancer.

The Oral Cancer Foundation website contains hours of reading information and videos for patients and professionals alike.4 There is a section devoted to the HPV connection that I highly recommend for all adults to read and share. This page includes articles and research on HPV and the relationship to oral cancer. While all are worth studying, one particularly interesting is titled "Risk Factor Profiles Related to HPV Status" by Dr. Gillison et al. (Journal of the National Cancer Institute, March 2008). While the general public may assume smoking and drinking are risk factors for all oral cancers, this study does a good job of describing the difference between HPV-16-positive and HPV-16-negative head and neck cancers. They also make the argument for considering these as two distinct cancers.

A story in the Los Angeles Times directly addresses the link between sex and HPV-associated oral cancers.5 According to the story, by 2020 HPV could cause more cases of oral cancer than cervical cancers, putting the topic within our scope of practice. We should be educating our patients on the prevalence, risks, prevention, and treatment of HPV and oral cancer. The task is much more difficult with teenage patients, but providing information is essential to patient health.

Not surprisingly, there are very few reliable and credible online sources for teens regarding HPV. There are some seeking to use fear to discourage risky behavior, some that gloss over the subject and merely promote the vaccine, and a few directed at parents, but almost nothing directed solely at teenagers and written in a format understandable or interesting to a young adult. LiveScience makes a good attempt at addressing the subject of teens and HPV risk.6 The article makes a bold statement: "Public health professionals should be aware of teens' attitudes toward oral sex, and educate and counsel them about the risks." How many readers just cringed at the thought?

Educating a child on health risks and sex is a parent's right and responsibility, but as health care providers we need to be comfortable with guiding teenagers to age-appropriate in formation when asked. I would like to see a pamphlet or information brochure aimed at children and promoting a discussion with parents on this delicate topic, though even when scouring sites for pediatricians, no such resource could be found. Perhaps it is time we stepped up and took action to protect the health of this vulnerable population.

The key to delivering education is communication: a skill that must be learned, refined, and refreshed over time. Dentalcare.com is a good source for advice on effective communication with patients. Under the "practice management" tab, you will find a section labeled "communication skills." Spending time reading the articles and continuing education offerings provides valuable tools for any dental professional.

Another excellent source for developing better communication skills is a series of books written by Toni S. Adams, RDH, MA. ToniAdams.com is full of information related to communication, including how to obtain her brief book series. I have read these books many times — mine are worn from use. The books have been left in the staffroom for others to learn and the books accompany me on every flight. Though they are small, the information inside these books holds huge value.

Get comfortable with the uncomfortable. Tackle the topics others do not want to address — it's all part of your chosen career to improve public health. RDH

Websites referred to in this column

1. What Causes My Bad Breath? 2005. Colgate Oral and Dental Health Resource Center. http://www.colgate.com/app/CP/US/EN/OC/Information/Popular-Topics/Bad-Breath/article/What-Causes-My-Bad-Breath.cvsp
2. Dental Health Topics – Bad Breath Information, 2013. Oral-B. http://www.oralb.com/topics/bad-breath.aspx
3. Experts Call for Safer Sex, More Vaccinations to Fight Oral HPV Rates, 2012. ABC News. http://abcnews.go.com/Health/oral-hpv-rates-story-changing-sex-practices-experts/story?id=15451177
4. Oral Cancer Foundation, 2013. www.oralcancerfoundation.org
5. HPV study finds 7% of U.S. teens, adults carry virus in mouths, 2012. Los Angeles Times. http://articles.latimes.com/2012/jan/27/health/la-he-oral-hpv-20120127
6. Teens View Oral Sex as Safer, But It Brings Cancer Risks, 2011. LiveScience. http://www.livescience.com/12933-teens-view-oral-sex-safer-brings-cancer-risks.html

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LORY LAUGHTER, RDH, BS, practices clinically in Napa, Calif. She is owner of Dental IQ, a business responsible for the Annual Napa Dental Experience. Lory combines her love for travel with speaking nationally on a variety of topics. She can be contacted at [email protected].

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