Results of a recent study published in August 21, 2013 online edition of Cancer Prevention Research, a journal of the American Association for Cancer Research, shows that poor oral health, including gum disease and dental problems, was found to be associated with oral human papillomavirus (HPV) infection.[1]

Commenting on the published results, Thanh Cong Bui, DrPH., postdoctoral research fellow in the School of Public Health at the University of Texas Health Sciences Center in Houston, noted: ?Poor oral health is a new independent risk factor for oral HPV infection and, to our knowledge, this is the first study to examine this association. The good news is, this risk factor is modifiable ? by maintaining good oral hygiene and good oral health, one can prevent HPV infection and subsequent HPV-related cancers.?

Public health interventions aiming to promote oral hygiene and oral health as an additional measure to prevent HPV-related oral cancers may be beneficial.

Impact of poor oral health
Oropharyngeal cancer is rare, but in the last 10 years, rates have been increasing rapidly, especially among men.[2] The researchers found that among the study participants, those who reported poor oral health had a 56% higher prevalence of oral HPV infection, and those who had gum disease and dental problems had a 51% percent and 28% higher prevalence of oral HPV infection, respectively. In addition, the researchers were able to associate oral HPV infections with number of teeth lost.

Similar to genital HPV infection, there are two kinds of oral HPV infection. The first kind includes infection with low-risk HPV types that do not cause cancer. These infections can, however, cause a variety of benign tumors or warts in the oral cavity. The second kind of infection includes high-risk HPV types that can cause oropharyngeal cancers.

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Thanh Bui (photo 1), Christine Markham (photo 2), Ph.D., and colleagues used data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC). This survey consisted of a nationally representative sample of about 5,000 people recruited each year, located in counties across the United States.

Risk profile
The researchers identified 3,439 participants aged 30 to 69 years from NHANES, for whom data on oral health and the presence or absence of 19 low-risk HPV types and 18 high-risk HPV types in the oral cavity were available. Oral health data included four measures of oral health, including: self-rating of overall oral health as poor-to-fair [prevalence ratio (PR) = 1.56; 95% confidence interval (CI), 1.25?1.95], presence of gum disease (PR = 1.51; 95% CI, 1.13?2.01), use of mouthwash to treat a variety of dental problems within past seven days of the survey (PR = 1.28; 95% CI, 1.07?1.52), and number of teeth lost (Ptrend = 0.035). The researchers examined data on age, gender, marital status, marijuana use, cigarette smoking, and oral sex habits, among others, which influence HPV infection. They found that, in their multivariable logistic regression model, oral HPV infection had a statistically significant association with self-rated overall oral health (OR = 1.55; 95% CI, 1.15?2.09), independent of smoking and oral sex.

Men have higher risk
The researchers found that being male, smoking cigarettes, using marijuana, and oral sex habits increased the likelihood of oral HPV infection. They also found that self-rated overall oral health was an independent risk factor for oral HPV infection, because this association did not change regardless of whether or not the participants smoked or had multiple oral sex partners.

Entry for HPV
“Because HPV needs wounds in the mouth to enter and infect the oral cavity, poor oral health, which may include ulcers, mucosal disruption, or chronic inflammation, may create an entry portal for HPV,” Bui explained. “There is, however, currently not enough evidence to support this, and further research is needed to understand this relationship,” he noted.

Maintaining good oral health
?Although more research is needed to confirm the causal relationship between oral health and oral HPV infection, people may want to maintain good oral health for a variety of health benefits,? said Bui. ?Oral hygiene is fundamental for oral health, so good oral hygiene practices should become a personal habit.?

The researchers conclude that public health interventions aiming to promote oral hygiene and oral health as an additional measure to prevent HPV-related oral cancers may be beneficial.

For more information:
[1] Bui TC, Markham CM, Ross MW, Mullen PD. Examining the Association between Oral Health and Oral HPV Infection. Cancer Prev Res (Phila). 2013 Aug 21. [Epub ahead of print][Article][PubMed]
[2] Kreimer AR, Pierce Campbell CM, Lin HY, Fulp W, Papenfuss MR, Abrahamsen M, et al. Incidence and clearance of oral human papillomavirus infection in men: the HIM cohort study. Lancet. 2013 Jul 2. pii: S0140-6736(13)60809-0. doi: 10.1016/S0140-6736(13)60809-0. [Epub ahead of print][Article][PubMed]

Photo:Thanh Cong Bui, andChristine M. Markham. Photo Courtesy:The University of Texas Health Science Center

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