NATURAL DENTAL IMPLANTS AT IDS 2017 COLOGNE

Company's Patent Portfolio Offers Unique Opportunity to Develop the Next Generation of Patient-Specific Tooth Replacement Solutions

 

               

             

Natural Dental Implants AG (NDI) announced the development of a 3D printed version of the REPLICATE Tooth at IDS 2017 held at Cologne Germany.  NDI began working on its first generation of customized tooth replacement products and filing patents in 2006, giving the Company a unique advantage in the market. The 3D printed REPLICATE Tooth, which the Company will have at the International Dental Show (IDS), features a titanium root portion and a zirconia abutment portion, like the commercially available version of the REPLICATE Tooth currently made by 5-axis CNC milling.
 

According to Ruedger Rubbert, CEO of Natural Dental Implants AG, "We started thinking about customized tooth replacement systems more than ten years ago. Our patent portfolio includes endossoeus and perio-integrative implementations, various surface enhancements, CAD/CAM systems, and manufacturing technologies, utilized in rapid prototyping methods and 3D printing. This enables industrialized and chair‑side fabrication of individually shaped dental implants." He added, "Using new technologies like 3D printing helps us reduce costs and provide even more value to our customers."

The Company has a working prototype and expects to begin extensive product testing this year.

About the REPLICATE Immediate Tooth Replacement System and Natural Dental Implants:

The REPLICATE System features the REPLICATE Tooth, an anatomically-shaped, 100% customized, titanium-zirconia tooth, and the REPLICATE Temporary Protective Crown, a customized cover shield designed to protect the REPLICATE Tooth during the healing process. This new approach to single-tooth replacement offers patients an immediate, minimally invasive alternative to traditional dental implants and three-unit bridges.

 
The REPLICATE Tooth is an anatomical copy of the patient's natural tooth that fits into the space occupied by the tooth being removed. It is one piece; a super-hydrophylic titanium root fused to a zirconia preparation with an emerging profile like that of a natural tooth. Each REPLICATE Tooth component is designed individually and can be modified to overcome anatomical limitations or to meet specific clinical requirements. The process starts with a DVT/CBCT scan and dental impression. The dentist submits the data prior to the tooth being extracted, NDI designs that patient's custom REPLICATE Tooth, manufactures it and delivers it sterile, ready to be placed at the extraction appointment. Immediately after the extraction, the REPLICATE Tooth is inserted into the tooth socket, without drilling, and covered with the REPLICATE Temporary Protective Crown until it osseointegrates. Once osseointegration is complete the REPLICATE Temporary Protective Crown is removed and a final crown is placed.

  Natural Dental Implants AG, headquartered in Berlin, Germany, and a U.S. subsidiary based in Dallas, Texas, was founded in 2006 to develop the intellectual property behind the REPLICATE Immediate Tooth Replacement System. The REPLICATE System is available in the European Union and will be offered in the United States pending FDA approval.

Courtesy:
PR NEWSWIRE 

3DS 

For more Related Information :
Replicate Tooth 

Patient Safety in Primary Care Dentistry: Where Ae We Now? A Study

Effective safety protocols require more investigation, according to the University of Manchester in the United Kingdom. Its researchers note that the concept of patient safety in dentistry is in its infancy, with little knowledge about the effectiveness of tools or interventions developed to improve it or minimize the occurrence of adverse events.

“There have not been many studies in this field due to the concept being poorly defined specifically in relation to dentistry: i.e, what is an ‘adverse event’ in dentistry?” said Edmund Bailey, locum consultant in oral surgery at the Eastman Dental Hospital, honorary lecturer in oral surgery at the university’s school of dentistry, and author of the study.

“All will accept that erroneous tooth extraction is an adverse event. But other issues, such as misdiagnosis of periodontal conditions or poor restorations, are a little harder to define. This also brings in the concept of quality to dentistry,” Bailey said.

The researchers initially identified 3,240 published studies potentially related to patient safety, defined by the World Health Organization as “The reduction of the risk of unnecessary harm associated with healthcare to an acceptable minimum.” Yet only 9 of them included different outcome measures and, therefore, different measures of success.

Four studies detailed the use of checklists to ensure safety. Three papers examined reporting systems for adverse reactions to dental materials. One described an intervention that alerted practitioners via electronic notes to Web-based guidelines regarding patients’ medical conditions. The last study detailed trigger tools, or easily detectable and focused items in a patient’s case notes that can help identify adverse events.

“I would suggest that practitioners introduce correct site surgery policies and checklists into their clinics, especially when carrying out extractions,” said Bailey. “The review demonstrated that these could reduce errors in dentistry. It is important that all staff involved in this process are engaged. Otherwise, the checklist is just a piece of paper.”

Overall, the researchers said that the number of publications on patient safety is increasing, and it is an active area of research. Yet there is a lack of literature specifically showing patient safety interventions leading to improvements, as tools are identified but not verified from the literature searches. Interventions are suggested, but they are not trialed.

Also, the study found that there were no independently verified, well-validated tools in use that can lead to improvements in patient safety specific to dentistry. The researchers cited a lack of understanding of basic epidemiology of patient safety in dentistry as well, along with little understanding of the views of patients when it comes to safety.

As a result, the study recommends a collaborative approach as dental researchers work with other areas of primary care to develop concepts for improving patient safety using common methods and an agreed taxonomy. Priority areas for patient safety also should be identified, with clinical care guidelines produced as a result.

“National Health Services England has been interested in this work, as well as the dental faculty of the Royal College of Surgeons of England. The indemnity providers have also taken an interest, but were unable to provide much information to us due to their commercial interests and confidentiality,” said Bailey.

“Dr. Elisabeth Kalenderian at Harvard has a research interest in patient safety in dentistry. One of her studies was included in the review,” Bailey said. “Also, in Scotland, there is a Patient Safety Program that is looking at including dentistry in its remit.”

SOURCE:

The study, “Systematic Review of Patient Safety Interventions in Dentistry,” was written by Edmund Bailey, Martin Tickle, Stephen Campbell, and Lucy O’Malley and published by BMC Oral Health. Additional information on learning tools for practitioners is available in a previous study, “Patient Safety in Primary Care Dentistry: Where Are We Now?” published by the British Dental Journal. 


Dentistry Today

Oral Habits with Associated Oral Disorders.

Oral Habit

Oral Habit is an increased tendency of performance of a single or multiple acts repeatedly. Such acts are relatively fixed and easy to perform by an individual. Initially these acts are a result of conscious efforts by the individual. Later these acts become less conscious and more of an unconscious act. Thus the Act gets converted into a Habit. This kind of phenomenon is frequently seen in Children in their developmental stages of dentition. Hence these habits if persist have a definite effect on the Dental Occlusion and its supporting structures. They also cause abnormal facial growth in the children leading to aesthetics problems.

               

                   Various Oral Habits

• Thumb Sucking
• Finger Sucking
• Pacifier or Dummy Sucking
• Tongue Thrusting
• Mouth Breathing 
• Bruxism
• Lip Biting
• Nail Biting
• Cheek Biting
• Pencil Biting
• Pencil or foreign object sucking
• Lip Sucking
• Clenching
• Occupational habits

Classification of Habits

1. Useful and Harmful Habits  (James 1923)

   Useful habits are considered essential for normal function such as proper Respiration, Normal Degluttion, etc.
   
   
   Harmful habits have a deleterious effects on the normal dentition e.g., Thumb Sucking, Tongue Thrusting, etc.

2. Empty and Meaningful Habits   (Klein 1971)

   Empty habits are not associated with deep rooted psychological problems.
   
   
   Meaningful habits have a psychological bearing.
    

3. Pressure, Non pressure and Biting Habits (Morris and Bohanna 1969)

   Pressure Habits include sucking habits.
   Non Pressure habits do not apply a direct force on the teeth and their supporting structures. e.g., Mouth Breathing.
   Biting Habits includde nail biting, lip biting, pencil biting, etc.
    

4. Compulsive and Non Compulsive Habits (Finn 1987)

   Compulsive Habits are deep rooted and have acquired fixation in the child to the extent that the child retreats to the habit whenever his security is threatened by events which occur around him. The child tends to suffer increased anxiety when attempts are made to correct the habit.
   Non Compulsive Habits are easily learned and dropped easily as the child matures.

5. Primary and Secondary Habits

   
   
   

   Thumb/Digit Sucking

                              

      Digit sucking is the placement of thumb or one or more fingers in varying depths  into the mouth. It is the most common type of Oral Habit. It is seen in very early age because sucking is the first co-ordinated muscular activity of infants and recent researches suggest its presence even in the IntraUterine Life. Till the age of 3-4 yr, this habit is considered normal, however, beyond this age, it can lead to the various malocclusions.
   
              SUBTELNY (1973) divided thumb sucking into different types on the basis of the portion of thumb or digit into the mouth:
   
   

   Type A (50%):

     Whole Digit  kept inside and the thumb pad  kept over palate, making contact with the Anterior Maxillary Teeth and the hand rests on the Mandibular Incisors.
   
   

   Type B (13-24%):

   The Thumb Pad does not touch the palate vault and only makes contact with the Anteriors.
   
   

   Type C (18%):

   The Thumb is kept just beyond first digit only and the contact is made only with maxillary Anteriors.
   
   

   Type D (6%): 

   Only the little portion of Thumb or just tip of Thumb remains inside mouth. 
   

    

   Phases of Development

   Phase I: (Normal and Sub-Clinically Significant)

   Seen during first 3yr of age and is considered normal because it usually terminates at the end of Phase I (3rd yr).
   

   Phase II: (Clinically Significant Sucking)

   This Phase extends between 3-6 yr of age. The presence of Habit during this period suggests some anxiety issues with the child and proper intervention should be made to solve the dental problems.
   

   Phase III: (Intractable Sucking)

   Any Sucking Habit persisting beyond 5th or 6th year relates to the underlying psychological aspects of the habit. A psychologist along with the Dentist is recommended for the consultation.
   
   

   Clinical Features

   • Maxillary Anterior Proclination and Retro-Mandibular Anterior Teeth.
                                   
   • Anterior Open Bite and Increase in the overjet. 
           
   • Narrow Maxillary Arch due to cheek muscle contraction leading to the Posterior Open Bite.
   • Development of Tongue Thrust Habit.
                            
   • Upper lip is hypotonic while lower lip is hyperactive.

   Management

   1. Psychological Approach:
   2. Mechanical Aids: 
    a) Removable habit breakers

                                  
           b) Fixed habit Breaker
                                  
  3. Chemical Approach:
           - Quinine
           - Pepper dissolved in volatile medium
           - Asafoetida

    Tongue Thrust Habit

The condition in which the tongue makes contact with any teeth anterior to the molars during swallowing.

Classification

 A) By James Barner and Holt

Type I  :  Non deforming Tongue thrust

Type II : Deforming Tongue Thrust

                Sub group 1: Anterior open bite

                Sub group 2: Anterior proclination

                Sub group 3: Posterior Crossbite

Type III: Deforming lateral tongue thrust

                Sub group 1: Posterior open bite

                Sub group 2: Posterior crossbite

                Sub group 3: deep overbite

Type IV: Deforming anterior and lateral tongue thrust
                Sub group 1: Anterior and posterior open bite

                Sub group 2: Anterior proclination

                Sub group 3: Posterior Crossbite

B)  Simple Classification

            a) Simple tongue thrust

            b) Comple tongue thrust

Clinical Features 

• Proclination of Anterior teeth
• Anterior open bite
• Bimaxillary protrusion
• Posterior open bite in case of lateral tongue thrust
• Posterior crossbite

Management

a) Habit interception
    Habit breaker appliances as used in thumb sucking.
    Teaching the correct method of swallowing
    Various muscle exercises

b) Treatment
     Correction of Malocclusion by removable and fixed orthodontic Appliances.

Bruxism

It is defined as the grinding of teeth for non-functional purposes.

Specifically Bruxism refers Nocturnal grinding while as Bruxomania is given for grinding during day time.

                       

 

Classification

1. Temporal pattern

     a) Sleep Bruxism

     b) Awake Bruxism 

2. Cause

    a) Primary Bruxism

    b) Secondary Bruxism

Clinical Features

• Occlusal wear facets on the teeth
• Fracture of teeth
• Mobilty of teeth
• Tenderness and hypeertrophy of masticatory muscles
• Muscle pain
• TMJ pain and discomfort
• Trismus 

Treatment

  a) Psychological Counselling
  b)Night Guards   
                        

Mouth Breathing 

Mouth breathing is a serious matter. In children of growing age, it may have devastating effects on general health and growth. Many seemingly unrelated conditions are related to mouth breathing.

CAUSES:

Chronic allergies, tonsil hypertrophy, nasal polyps, deviated nasal septum, constricted upper airways, a backward positioned lower jaw caused by thumb sucking, excessive dummy use or insufficient suckling as an infant.

Signs in Mouth Breathers

• Long, narrow face
• Difficulty breathing through nose
• Retarded physical growth
• Dry lips
• Dark circles under eyes
• Excessive creases between lower lip and chin
• Allergies
• Smaller jaws with crowded teeth
• Swollen tonsils

                              

Consequences of Mouth Breathing

• Jaw deformity
  The jaws and subsequently the whole facial structures grow in an altered fashion, resulting in long faces, constricted arches, tooth crowding, a narrowed nasal airway passage, and an altered head posture. The lower jaw remains too far behind in its growth, producing a small chin, dental malocclusion, a large overjet, and an unfavourable profile. If the mouth breathing is addressed, these children can often be treated for their malocclusions and skeletal growth discrepancies by a dentist or orthodontist who follows a functional - orthopaedic approach.
• Compromised airway
  Caused by: 1. the lower jaw being positioned too far back, along with the tongue, thereby constricting the upper airway. 2. Enlarged tonsils and adenoids due to chronic allergies may be the primary cause for mouth breathing; however mouth breathing in itself will also cause a further increase in tonsil size, thus constricting the airway to such an extent, that normal nasal breathing becomes an impossibility.
• Altered head, neck and body posture
  The unnatural and unphysiological process of breathing through the mouth, which in many children looks like they are "gasping" for air, produces a reflex forward head posture. This puts a large load on the upper back and neck muscles, which if sustained, will cause permanent posture changes, such as abnormal curvatures in the cervical and thoracic vertebrae, and an altered shoulder posture. Ultimately, we see a domino effect affecting hips, knees and feet. In adults, Jaw joint dysfunction (TMJ problems).
• Bad breath and gum disease
  Caused by the shift in the bacterial flora in the mouth.
• Lowered immune system and poor health
  Nasal breathing produces a tissue hormone that regulates normal blood circulation. It also filters, warms and moisturizes the air. The lack of oxygen in mouth breathers, who usually snore at night and struggle for air, weakens the immune system, disrupts deep sleep cycles, and interferes with growth hormone production.
• Obstructive sleep apnoea (OSA)
  In newborns, this is thought by many researchers to be related to SIDS, or Sudden Infant Death Syndrome. In children, this is manifested as snoring, bed-wetting, poor quality of sleep, obesity, and ultimately behavioural symptoms resembling ADHD.
  In adults, OSA is a silent killer. Snoring is a manifestation of a blocked airway, which in essence is a milder version of sleep apnoea. Most snorers, however, may not be aware that they may be suffering from OSA. On average, snorers are more likely to suffer from cardiovascular disease and stroke, and carry an increased risk for obesity, high blood pressure, stroke, severe obstructive sleep apnea, and diabetes.
• Poor performance
  The same lack of oxygen and other hormonal factors make these children tend to be overweight, tired, and not perform well at school. Physically they are not athletic.

Mouth breathing in children should be addressed as soon as possible by consulting a physician, a dentist, a myofunctional therapist or an ENT specialist, who are experienced in treating this condition.

Management in Mouth Breathers

Allergy elimination

Screening and elimination of allergens: Pollen, Fungi, Animal dander, chemicals. Evaluate heavy metal burden.

Nutritional guidelines

Cow’s milk and dairy products should be eliminated from the diet. Avoid foods with preservatives, dyes, artificial sweeteners, refined sugars and other additives. Screen for yeast intolerance or gluten allergy. Beware of soy milk.

Physical therapy and exercise

Craniosacral, osteopathic and massage therapy encourage circulation of blood, lymph, and cerebrospinal fluid, as well as unblocking energy channels. Daily exercise done breathing through the nose. Exercise produces adrenaline, is a natural antidote to histamine.

Nose breathing exercises

The aim is to encourage a lip seal to achieve:

• Air flow through the nasal cavity, which will automatically enlarge the airway passages through the nose and will improve the quality of air. It will also stimulate nitric oxide tissue hormone production for improved blood circulation and immune function.
• Increased muscle tone of the muscles around the mouth, which are weakened due to the chronic mouth open posture.
• Stimulation of a correct craniofacial and jaw growth pattern.

A good way of doing this is to get the child to hold a thin piece of stick between the lips twice a day. Start with five minute increments each time, and increase the interval by one minute every day. Keep a written log of this schedule and make sure it is not interrupted. Follow this schedule until you achieve 30 minutes twice a day. After this add a third time into the daily schedule. Try to coincide these sessions with homework or TV watching, so the effort in keeping the lips together is on a subconscious level, and is more tolerable.

Pacifiers Sucking The consequences of extensive use of a pacifier are similar to that of finger and thumb sucking but not as pronounced.  The pacifier habit tends to end earlier than digital habits because they are easier to lose intentionally or non-intentionally.  90% are ended before 5 years of age and 100% by age 8.  The earlier the pacifier is removed the greater the chance of the dentofacial changes self correcting.

Lip Habits Lip licking is the most common lip habit.  The most common clinical effects are inflamed chap lips exhibiting an erythematous wide border encircling the lips with normal skin area just around the vermillion border.  Severe lip licking, with the lower lip tucked behind the maxillary incisors, places excessive lingually directed forces on the mandibular teeth and facial forces on the maxillary teeth, resulting in retro-inclination of the mandibular incisors, proclination of the maxillary incisors and increased overjet.  There is little that can be done to stop the habit, however, the irritated areas can be controlled with the application of steroids, antibacterial and antifungal ointments.

 Nail Biting

Onychophagia (also onychophagy) or nail biting, is an oral compulsive habit  and is sometimes described as a parafunctional activity.

                                    

Nail biting is also related to oral problems, such as gingival injury, and malocclusion of the anterior teeth. It can also transfer pinworms or bacteria buried under the surface of the nail from the anus region to the mouth. When the bitten-off nails are swallowed, stomach problems can develop^.
Nail-biting is also associated to guilt and shame feelings in the nail biter, a reduced quality of life, and increased stigmatization in the inner family circles or at a more societal level.

Treatment

The most common treatment, which is cheap and widely available, is to apply a clear, bitter-tasting nail polish to the nails. Normally denatonium benzoate is used, the most bitter chemical compound known. The bitter flavor discourages the nail-biting habit.
Behavioral therapy is beneficial when simpler measures are not effective. Habit Reversal Training (HRT), which seeks to unlearn the habit of nail biting and possibly replace it with a more constructive habit, has shown its effectiveness versus placebo in children and adults.

Emerging trends in dentistry: odontogenesis

Advancements in the dental field have surpassed many expectations and include CAD/CAM, dental implants, all porcelain crowns, and many more and have allowed patients to have more options during the treatment planning phase. Some of these procedures are time-saving and decrease the amount of invasive treatment such as an implant to the adjacent tooth structure. The next big advancements deal with the potential to regrow a tooth using mesenchymal cells. If this technique proves successful with predictable outcomes, then it has the potential to revolutionize the face of dentistry.

There is a natural production of stem cells in teeth at the periodontal ligaments. The ability to implant them into the oral cavity and expect growth may seem like a Sci-Fi movie but it’s today’s reality. With the latest uses of stem cells in modern medicine it may not be as shocking. Most of these artificial organs are made outside of the body and transplanted into or on the desired area which can generate complications and risk (source). Thus question is posed: can we grow replacement parts within the body? This research is currently being done at Harvard University. Don Ingber, MD, PhD and founding director of the Wyss Institute for Biologically Inspired Engineering at Harvard posed this question that drove his team to find an artificial gel-like material. This material must have the potential to mimic the actions of embryonic mechanisms to shape organs and allow of the reconstruction of new teeth but also other important tissues and organs (source). There is still little knowledge on the actual mechanism of how mesenchymal condensation is controlled and how cell condense cause cell fate switching but this mechanism is important in embryonic tissues which use this physical process for many bodily organs (source).

The problem lies with the lack of an ideal study model under controlled conditions but the research team was able to use mouse embryos (source). They discovered that condensation occurs when the mesenchyme cells tissue layers locates near the layer of epithelial cells and release cytokines to trigger the process of producing a tooth. This leads to the induction of mesenchymal to condense at desired location where tooth will be generated. Dr. Igber’s group made the discovery that the physical compression causes the mesenchymal cells to activate that transcription of certain genes to start odontogenesis. The potential difficulty lies with how to artificially induce the physical compression without damaging the mesenchymal cells. The research team was set on founding a material that would encapsulate the mesenchymal cells and shrink plus compress at body temperatures similar to embryonic cells. They developed a sponge-like material from a gel-formed polymer that has been used to deliver drugs to the body. They implanted the gel with success into a mouse kidney capsule due to the amount of blood supply which started to” lay down mineralized tissue of a natural tooth.” Dr. Ingber added that the mesenchymal cells require the presence of epithelial tissue and can’t perform this process alone.

Although this research is very promising it is still in the early stage of pre-clinical trials. They still have yet to begin Phase I clinical trials which is carried out to prove no harm will be done to patients. In addition the team must file an Investigational New Drug (IND) application form with the FDA and have the Harvard University institutional review board approve the transition to clinical trials. Thus traditional dentistry has a while before it will be impacted by the findings of Dr. Ingber and questions always arise about the cost to patients of new discoveries. This is an intriguing article, and the potential future of the dental field is increasing the ability to treat patients in the most non-invasive, cost effective manner.

source: American Students Dental Association

RESEARCH SHOWS Cavities Are Contagious

Dental caries, commonly known as tooth decay, is the single most common chronic childhood disease. In fact, it is an infectious disease, new research demonstrates. Mothers with cavities can transmit caries-producing oral bacteria to their babies when they clean pacifiers by sticking them in their own mouths or by sharing spoons.
 Despite your mother’s finger-wagging, sugar-laden candy bars aren’t the only cause of cavities. Tooth decay actually results when bacteria in your mouth feed on food debris (starchy, sticky foods are a primary culprit) and produce acid as a byproduct. This mix of food, acid, saliva, and germs clings to your teeth as a filmy substance called plaque, which can erode teeth enamel and cause cavities to form.
No matter what you eat, cavities won't form without the help of such bacteria. These germs can spread from mouth to mouth via shared food and utensils, sneezing, kissing, and more, so making cavities contagious.
Parents should make their own oral health care a priority in order to help their children stay healthy.

               According to Liliana Rozo, D.D.S., assistant profesor, University of Louisville School of Dentistry, tooth decay can have a detrimental effect on a child's quality of life, performance in school and success in life. The disease can cause pain, inability to chew food well, embarrassment about discolored or damaged teeth, and distraction from play and learning.
The American Academy of Pediatric Dentistry (AAPD) encourages parents to find a dental home for their baby as soon as the child's first tooth erupts. Regular visits to a pediatric dentist will help parents become familiar with their child's dental and oral health milestones. They'll inform parents about teething, proper oral hygiene habits, normal tooth development, and trauma prevention. Nutritional counseling also will be a part of the discussion.
Often, Rozo said, parents do not make the connection between oral health and overall health, but they are related. The mouth is an open door for many microbial infections to enter the bloodstream. Poor oral health may be a risk factor for systemic disease. Oral health manifestations, such as bleeding or dry mouth can indicate the presence of a systemic disease or exacerbate the effects of an existing disease such as diabetes and heart disease.

Thus Turns out, you can spread cavity-causing bacteria — especially to young kids.

So does this mean you should avoid smooching with someone who has a horrible track record at the dentist? Not for dental health reasons, at least: As an adult, you're far less susceptible to bacteria spread than children because they haven’t built up immunity yet.

Here are some of the Tips for preventing the Caries and Cavity in your Family:

1• Go to the dentist. 

2• Use a heavy-duty mouth rinse.

3• Chew sugar-free gums

4• Don’t overshare the Food Utensils

5• Cover your mouth

6• Be a good dental patient.

Story Source:

The above story is based on research material provided by University of Louisville.  The original article was written by Julie Heflin.

Human Papilloma Virus (HPV) / Oral Cancer Important Facts To Know

HPV oral and oropharyngeal cancers are harder to discover than tobacco related
cancers because the symptoms are not always obvious to the individual who is developing the disease, or to professionals that are
looking for it. They can be very subtle
and painless. A dentist or doctor
should evaluate any symptoms that
you are concerned with, and certainly
anything that has persisted for two or
more weeks. Although there are many
adjunctive oral cancer screening
devices and tests, not all of them can
find HPV positive oral and
oropharyngeal cancers. The best way
to screen for HPV related oral and
oropharyngeal cancer today is through
a visual and tactile exam given by a
medical or dental professional, who will
also do an oral history taking to ask
about signs and symptoms that cover
things that are not visible or palpable.
Like other cancer screenings you
engage in, such as cervical, skin,
prostate, colon and breast
examinations, opportunistic oral cancer
screenings are an effective means of
finding cancer at its early, highly
curable stages. However like many
other cancer screening techniques, this
process is not 100% effective, and any
screening technique or technology can
miss things. This is why it is so
important that persistent problems,
those which do not resolve in a short
period of time like 2-3 weeks, are
pursued until a definitive diagnosis of
what it is is established. Most of the
time these will be issues that are not
cancer, but persistent problems need to
be addressed, cancer or not.

HPV FACTS:

• HPV is the most common sexually
transmitted virus and infection in
the US.

• There are nearly 200 different
strains of HPV, most of which are
harmless and not cancer causing.

• Out of all these 9 are known to
cause cancers, and another 6 are
suspected of causing cancers. In
oral cancers we are primarily
concerned with number 16 which
is also associated with cervical,
anal, and penile cancers.

• You can have HPV without ever
knowing it because the virus often
has no signs or symptoms that you
will notice, and the immune
response to clear it is not a
process that you will be aware of.

• Every day in the US, about 12,000
people ages 15 to 24 are infected
with HPV. The vast majority of
them will clear the virus naturally
and never know that they were
exposed or had it.

• If you test positive for HPV, there is
no sure way to know when you
were infected with HPV, or who
gave it to you. A person can have
HPV for many years, even
decades, before it is detected or it
develops into something serious
like a cancer. In the vast majority
of infected people, even with a
high risk version of HPV known to
cause cancers, they will not
develop cancer.

• Testing positive for an HPV
infection does not mean that you
or your partner is having sex
outside of your relationship. It is
believed to have long periods of
inactivity or dormancy that may
even cover decades; these are
periods of time that you will test
negative for it.

• Sexual partners who have been
together for a while tend to share
HPV. This means that the partner
of someone who tests positive for
HPV likely has HPV already, even
though they may have no signs or
symptoms. Like most Americans,
their immune system will clear it in
under 2 years.

• Condoms may lower your chances
of contracting or passing the virus
to your sexual partners, if used all
the time and the right way.

However, HPV can infect areas that
are not covered by a condom- so
condoms may not fully protect
against HPV.

HPV AND ORAL CANCER:

• HPV is the leading cause of
oropharyngeal cancers (the very
back of the mouth and part of what
in lay terms might be called a part
of the throat), and a very small
number of front of the mouth, oral
cavity cancers. HPV16 is the
version most responsible, and
affects both males and females.

• In public messages for simplicity,
OCF frequently speaks about oral
cancers in general. Scientifically,
this is really anatomically divided
up into the oral cavity and the
oropharynx. Each anatomical site
has different statistics, etiologies
which dominate that location, and
outcomes from treatment. The
fastest growing segment of the oral
and oropharyngeal cancer
population are otherwise healthy,
non-smokers in the 25-50 age
range. When you consider both
anatomical sites, HPV is driving
the growth in numbers of oral
cancers.

• White, non-smoking males age 35
to 55 are most at risk, 4 to 1 over
females.

• In the oral/oropharyngeal
environment, HPV16 manifests
itself primarily in the posterior
regions such as the base of the
tongue, the back of the throat, the
tonsils, the tonsillar crypts, and
tonsillar pillars.

RISK FACTORS:

• Number of sexual partners- The
greater your number of sexual
partners, the more likely you are to
contract a genital HPV infection;
and when engaging in oral sex, this
also holds true for oral infections.
Having sex with a partner who has
had multiple sex partners also
increases your risk.

• Weakened Immune Systems-
People who have weakened
immune systems are at greater risk
of HPV infections. Immune
systems can be weakened by HIV/
AIDS or by immune system-
suppressing drugs used after
organ transplants.

ORAL CANCER SIGNS AND SYMPTOMS:

• This list considers both oral cancers
from HPV and those from tobacco and
alcohol.

• An ulcer or sore that does not heal
within 2-3 weeks

• Difficult or painful swallowing

• Pain when chewing

• A persistent sore throat or hoarse
voice

• A swelling or lump in the mouth

• A painless lump felt on the outside
of the neck, which has been there
for at least two weeks.

• A numb feeling in the mouth or lips

• Constant coughing

• An ear ache on one side
(unilateral) which persists for more
than a few days.

How do people get HPV?

• HPV is passed on through genital
contact, most often during vaginal,
anal and oral sex.

• You are more likely to get HPV if
you have many sex partners or a
sex partner who has had many
partners.

• Many people don’t have symptoms
and are unaware that they have
HPV.

• The virus may be inactive for
weeks, months and for some
people possibly even years after
infection.

What does that mean for my health?

Partners usually share HPV. If you have
been with your partner for a long time,
you probably have HPV already.
Although HPV is the most commonly
transferred sexual infection, in most
people it is cleared by the immune
system in under 2 years. Individuals
with persistent infections are at risk for
several types of cancers depending on
the location of the infection. When
considering the entire US population of
over 300 million people, the incidence
rate of oral cancers from it are still
relatively rare mathematically.

How common is HPV?

HPV is the most commonly sexually
transmitted infection. The CDC
estimates that there are 6.2 million new
infections each year in the United
States. The vast majority of Americans
will have some form of HPV early in
their sexual experiences. Since it is so
common, there is nothing to be
ashamed about. If you are diagnosed
with HPV, talk to your health care
provider about it. HPV's are divided
into 9 high risk types and more than
150 others that either cause benign
warts, or do nothing at all that we know
of at all.

How do I know if i have HPV?

The only way to know if you have an
HPV infection is if your health care
provider tests you for the virus. For
females, in relationship to cervical
discovery, this may be done directly
from the Pap test cervical exam or by
using an additional swab at the time of
the Pap test. The CDC now
recommends an HPV test for women
along with the pap test as a matter of
routine. Oral HPV testing in both men
and women is problematic. While there
have been some commercial tests
available in the dental community, the
value of this testing is not clear, and
testing positive on any given day for an
oral HPV does not prove persistence of
the infection, which is what we are
really concerned about. There are no
visible oral signs of an HPV infection.
There are also no established genital
tests for men. There are anal brush
cytology tests for those that engage in
anal sexual practices. Those tests can
be early predictors of HPV caused anal
cancers.

Is there a cure for HPV?

There is no cure for the virus. Most of
the time, HPV goes away by itself
within two years and does not cause
health problems. It is only when HPV
stays in the body for many years that it
might cause these oral cancers. Even
then, it is a very small number of
people that will have an HPV infection
cascade all the way into an oral
malignancy, though that number is
increasing every year by about 10%. It
is not known why HPV goes away in
most, but not all cases. For unknown
reasons there is a small percentage of
the population whose immune system
does not recognize this as a threat and
it is allowed to prosper. Although HPV
can increase the risk of developing
some types of cancer, most people who
have HPV do NOT develop cancer.

HPV VACCINES

Two vaccines known as Gardasil and
Cervarix protect against the strains of
HPV that cause cervical cancers
(HPV16 and 18), Garadsil also protects
against two versions that cause genital
warts (HPV6 and 11). Millions of young
girls in the US and in developed
countries around the world have been
safely vaccinated with an HPV vaccine.
Because the original clinical trials were
done on cervical cancers, the FDA
restricts the manufacturers from talking
about other positive implications of
these vaccines. Since they block people
from ever getting HPV16, it is not much
of a scientific leap to extrapolate that
to "if you can't get the virus, you can't
get things the virus might cause". Using
this logic, many in the science
community recommend vaccinating to
protect people from the various
different cancers associated with the
virus such as oropharyngeal. The
foundation also believes this to be
worth doing, and has advocated at the
CDC for vaccination of boys, not only to
help reach the point of "herd immunity"
in our country protecting our next
generation from HPV caused cervical
cancers, but also other HPV cancers as
well including oropharyngeal.
The National Advisory Committee on
Immunization Practices recommends
routine HPV vaccination for girls ages
11 and 12, as well as girls and women
ages 13 to 26 if they haven’t received
the vaccine already. The Gardasil
vaccine has also been approved for
use in boys and men, 9 through 26
years old. These vaccines are most
effective if given to children before they
become sexually active. If you have
already been exposed to HPV, the
vaccines will not for work you. So
vaccination at pre-sexual ages brings
the most protection.

Courtesy: ORAL CANCER FOUNDATION