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Council on Scientific Affairs issues two statements

One looks at HPV link to oropharyngeal cancer, the other at lasers

Growing evidence linking oral infection with human papillomavirus as a risk factor for oropharyngeal cancer prompted the ADA Council on Scientific Affairs to approve a new statement on the topic at its April meeting.

The statement aims to promote awareness of the rising incidence of HPV-associated cancers, particularly in the region of the oropharynx (the middle region of the throat, including the tonsils and base of the tongue).

Although the primary risk factors for oral cavity cancer remain tobacco use and excessive alcohol consumption, HPV infection is now associated with more than 7,300 cases of oropharyngeal cancer diagnosed annually in the United States. Surveillance data has shown a steady increase in HPV-related oropharyngeal cancers over the past three decades, particularly in white men between 40 to 59 years of age.

"Oral HPV infection is now commonly accepted as an important risk factor for head and neck squamous cell carcinoma," said Dr. Mark Lingen, an oral pathologist and council member. "Over the last two decades, the paradigm of the traditional oral cancer patient has been redefined, and dentists should be aware of this new etiology when providing routine oral soft tissue examinations to patients."

The council statement emphasizes that oral HPV infection has emerged as a significant risk factor for oropharyngeal cancers for both men and women, even in the absence of smoking and alcohol consumption. New evidence indicates that the association with oropharyngeal cancer is three times higher for men than women, and a higher lifetime number of sex partners (vaginal and oral) is also associated with increased risk.

Also at its April meeting, the CSA adopted a statement on lasers in dentistry to provide science-based perspectives on several increasingly popular uses for dental lasers.

The CSA statement presents a brief overview of the Food and Drug Administration's premarket notification 510(k) process and educational options for dental laser systems. The council recommends that dentists understand the specific indications for use for each device, and consult with the FDA or the manufacturer for specific information about cleared indications for use.

The statement addresses a range of soft and hard tissue laser applications related to topics such as periodontics, restorative dentistry, surgery and endodontics.

Like other products or devices, practitioners may periodically determine that off-label use of dental lasers may be appropriate to meet an individual patient's needs. In these cases, dentists should consider such usage in light of possible benefits and risks and the scientific evidence available to support the off-label application.

According to CSA Chair Michael Rethman, "The council supports the introduction of new, innovative products and procedures that will improve patient outcomes, and/or offer patient benefits comparable to current practices at lower cost. Whether it's dental lasers or any other product, the council encourages dental companies and the research community to find ways to fund, conduct and report research findings beyond what may be necessary to obtain regulatory clearance to market. Well-designed effectiveness studies need to become more commonplace in today's environment of evidence-based care.

"Dentistry's movement toward practice-based research is a great step in this direction," Dr. Rethman continued. "The profession needs to expand its ability to test and critically evaluate products and procedures in order to meet the needs of the profession and the patients we serve."

To see all CSA statements on ADA.org, visit www.ada.org.