What the general dental practitioner needs to know about HPV-related oropharyngeal malignancy


The rates of oropharyngeal squamous cell carcinoma have continued to rise secondary to the increasing prevalence of the human papillomavirus (HPV). HPV-related disease is typically found in younger patients who do not have the traditional risk factors for malignancy. General dental practitioners (GDPs) often examine patients regularly and may therefore have an opportunity to identify oropharyngeal malignancies at an early stage. However, many GDPs are unfamiliar with oropharyngeal anatomy, pathology and clinical examination. This review summarises the key points in identifying patients with oropharyngeal malignancy who necessitate urgent referral.

Key points

  • Provides an overview of anatomy and an anatomical-based method of assessment for oropharyngeal malignancy.

  • Increases awareness of the increasing incidence of HPV-related oropharyngeal malignancy, occurring in younger patients without the traditional risk factors for oral cancer.

  • Recommends that all GDPs extend their routine clinical examination to include the oropharynx and neck in an attempt to improve early malignancy detection rates and reduce potential patient harm and medico-legal claims.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7


  1. 1.

    Field J C, Cowpe J G, Walmsley A D. The graduating European Dentist: a new undergraduate curriculum framework. Eur J Dent Educ 2017; 21 Suppl 1: 2-10.

  2. 2.

    Macluskey M, Durham J, Cowan G et al. UK national curriculum for undergraduate oral surgery subgroup for teaching of the Association of British Academic Oral and Maxillofacial Surgeons. Eur J Dent Educ 2008; 12: 48-58.

  3. 3.

    Gibson J. Oral cancer - CPD and the GDC. Br Dent J 2018; 225: 884-888.

  4. 4.

    American Dental Association. ADA expands policy on oral cancer detection to include oropharyngeal cancer. 2019. Available at https://www.ada.org/en/publications/ada-news/2019-archive/september/ada-expands-policy-on-oral-cancer-detection-to-include-oropharyngeal-cancer (accessed May 2020).

  5. 5.

    Conway D I, Purkayastha M, Chestnutt I G. The changing epidemiology of oral cancer: definitions, trends and risk factors. Br Dent J 2018; 225: 867-873.

  6. 6.

    Pan C, Issaeva N, Yarbrough W G. HPV-driven oropharyngeal cancer: current knowledge of molecular biology and mechanisms of carcinogenesis. Cancers Head Neck 2018; DOI: 10.1186/s41199-018-0039-3.

  7. 7.

    Syranen S, Syrjanen K. HPV in head and neck carcinomas: different HPV profiles in oropharyngeal carcinomas - why? Acta Cytol 2019; 63: 124-142.

  8. 8.

    Reid P, Marcu L G, Olver I, Moghaddasi L, Staudacher A H, Bezak E. Diversity of cancer stem cells in head and neck carcinomas: The role of HPV in cancer stem cell heterogeneity, plasticity and treatment response. Radiother Oncol 2019; 135: 1-12.

  9. 9.

    Speight P M, Farthing P M. The pathology of oral cancer. Br Dent J 2018; 225: 841-847.

  10. 10.

    Bzhalava D, Guan P, Franceschi S, Dillner J, Clifford G. A systematic review of the prevalence of mucosal and cutaneous human papillomavirus types. Virology 2013; 445(1-2): 224-231.

  11. 11.

    Antonsson A, Forslund O, Ekberg H, Sterner G, Hansson B G. The ubiquity and impressive genomic diversity of human skin papilloma viruses suggest a commensalic nature of these viruses. J Virol 2000; 74: 11636-11641.

  12. 12.

    Park I U, Introcaso C, Dunne E F. Human papillomavirus and genital warts: a review of the evidence for the 2015 centres for disease control and prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis 2015; DOI: 10.1093/cid/civ813.

  13. 13.

    Betz S J. HPV-related papillary lesions of the oral mucosa: a review. Head Neck Pathol 2019; 13: 80-90.

  14. 14.

    Tam S, Fu S, Xu L et al. The epidemiology of oral human papillomavirus infection in healthy populations: a systematic review and meta-analysis. Oral Oncol 2018; 82: 91-99.

  15. 15.

    Bharti A H, Chotaliya K, Marfatia Y S. An update on oral human papillomavirus infection. Indian J Sex Trasnsm Dis AIDS 2013; 34: 77-82.

  16. 16.

    Kim S M. Human papilloma virus in oral cancer. J Korean Assoc Oral Maxillofac Surg 2016; 42: 327-336.

  17. 17.

    Crosbie E J, Kitchener H C. Cervarixa bivalent L1 virus-like particle vaccine for prevention of human papillomavirus type 16and 18-associated cervical cancer. Expert Opin Biol Ther 2007; 7: 391-396.

  18. 18.

    Shi L, Sings H L, Bryan J T et al. GARDASIL: prophylactic human papillomavirus vaccine developmentfrom bench top to bed-side. Clin Pharmacol Ther 2007; 81: 259-264.

  19. 19.

    Huh W K, Joura E A, Giuliano A R et al. Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial. Lancet 2017; 390: 2143-2159.

  20. 20.

    NHS. HPV Vaccine overview. 2019. Available at https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/ (accessed April 2020).

  21. 21.

    Brisson M, Benard E, Drolet M et al. Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models. Lancet Public Health 2016; DOI: 10.1016/S2468-2667(16)30001-9.

  22. 22.

    Public Health England. HPV vaccination programme. 2019. Available online at https://www.gov.uk/government/collections/hpv-vaccination-programme (accessed August 2020).

  23. 23.

    Public Health England. Press release: HPV vaccine drives cancer causing infections down to very low levels. 2020. Available at https://www.gov.uk/government/news/hpv-vaccine-drives-cancer-causing-infections-down-to-very-low-levels (accessed August 2020).

  24. 24.

    de Oliveira C M, Fregnani J H T G, Villa L L. HPV vaccine: Updates and highlights. Acta Cytol 2019; 63: 159-168.

  25. 25.

    International Agency for Research on Cancer. WHO classification of Head and Neck tumours (World Health Organisation Classification of Tumours). 4th ed. Lyon: IARC, 2017.

  26. 26.

    American Joint Committee on Cancer. AJCC Cancer Staging Manual. 8th ed. Chicago, IL: Springer, 2017.

  27. 27.

    Dave B. Why do GDPs fail to recognise oral cancer? The argument for an oral cancer checklist. Br Dent J 2013; 214: 223-225.

  28. 28.

    McGurk M, Scott S E. The reality of identifying early oral cancer in the general dental practice. Br Dent J 2010; 208: 347-351.

Download references

Author information




Chivani Tailor and Karen A. Eley are recognised as joint first authors.

Corresponding author

Correspondence to Karen A. Eley.

Ethics declarations

The authors have no disclosures. No funding was received for this work.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tailor, C., Eley, K., Hussain, F. et al. What the general dental practitioner needs to know about HPV-related oropharyngeal malignancy. Br Dent J 229, 355–360 (2020). https://doi.org/10.1038/s41415-020-2113-6

Download citation