The human papillomavirus (HPV) is one of the group of viruses that affect the skin and the moist membranes lining your body, for example, the cervix, anus, mouth and throat, and it can be transferred during oral sex. It’s becoming an increasing concern among dental professionals as a significant number of patients are presenting with symptoms at advanced stages. Unfortunately, once HPV-induced malignancy has reached an advanced stage there’s only an average survival rate of five years. When you consider the deaths associated with HPV in 2007 were 1,852, and rose to 1,985 in 2010, you can get an idea of how important it is that symptoms are detected earlier.
It’s important to look for the symptoms of HPV as part of your regular oral screenings and refer the patient immediately if any potentially malignant legions present. These can be both oral and oropharyngeal, so it’s always worth having a look down the throat. Things to look out for are white patches that won’t resolve with pressure, red patches and infection of the oral mucosa, which can also be caused by the chewing of Paan. Seventy per cent of HPV presents in areas where saliva pools in the mouth, with only 30% presenting in the surface area of the mouth, and there is a rising number of cases in younger age groups, so never rule a lesion out thinking the patient is too young.
HPV is also related to oropharyngeal cancers found on the tonsils and the base of the tongue, but patients often avoid having symptoms checked out until it’s too late. That’s tragic when you consider HPV has a favourable prognosis if caught early enough (87.5% survival rate with chemotherapy).
Dental professionals are in an ideal place to spot the symptoms as part of their regular patient consultations, and it’s clear that this is a responsibility not to be taken lightly.
According to the most recent health service statistics, around 8.5 million people in the UK still smoke and 75% of them say they would like to give up. The majority of people you see will have their own reasons for attending the dentist, whether that be better oral health, aesthetics, fear of future pain etc. But smoking cessation advice must surely be considered as important as oral hygiene instruction?
We all know that smokers are more likely to present with periodontitis than non-smokers, and that smokers who quit present with higher mean pocket reduction than those still smoking. Smokers also have a poorer response to non-surgical therapy and surgical treatment, but how do we get these messages to the patient in an effective way? We could refer them to a stop smoking support service, which I would wholly recommend, but why not offer one in your practice? That way, not only will your current patients be better off, but you will have people walking in off the street, especially if you highlight your cessation services on your website.
The key is to use the patient’s reason for attending the practice as a motivation to quit – better aesthetics, better breath, better chance of successful treatment outcomes – the list is endless. Shock tactics are best avoided as these images can make a patient leave feeling stressed and all the more likely to reach for the cigarettes. It’s also not advisable to tell people to cut down on their smoking as, when they do smoke, they take longer drags on their cigarette. It’s far better to work with your patients to come up with an appropriate ‘quit day’ and using all the cessation aids and support from you, they will be far more likely to quit for good.
Encouraging patients to quit smoking is anything but simple. It’s a complex issue with both physical and psychological aspects to tackle. Holding samples of the different forms for cessation aid in practice, so that smokers can see them and ask questions, can be a valuable service and patients are far more likely to respond positively if they feel well informed. Some payment plan specialists also offer tailor-made training days specific to your practices needs and can incorporate modules focused on smoking cessation. This training can not only give you the confidence to offer guidance and support to your patients, but the means to build mutually beneficial relationships to last into the future.
Rock ‘n’ roll
As far as I’m aware, at the time of writing this article, rock ‘n’ roll is still relatively harmless, at least from a medical perspective. This is just as well considering the challenges that HPV and smoking alone are bringing to the fore.
The key to effective education is effective communication. Many dental care professionals are afraid to give patients potentially upsetting or scary advice, as they don’t want to lose them as a patient. However, by working with the patient collaboratively and developing a partnership with them, you can see them through some potentially touchy times – securing their trust and loyalty for life. Surely this is a better option than the alternative?
As usual, it’s up to you how much time, effort and resource you put into these areas, but not only is there an increasing need from your patients, but there are some real business benefits to take advantage of to increase your practice profitability and ongoing success – so it’s win win.
Roger Matthews MA BDS DGDP (UK) FDSRCS (Edin) joined Denplan in 1995 having spent 20 years working in general dental practice and as a dento-legal adviser for the Medical Defence Union. He oversees dental advice to the company and its links with professional bodies, and is responsible for Denplan’s professional services.