Sir, during a recent consultation, a patient asked me when it was suitable for him to engage in sexual activity after his tooth extraction. Initially, this question took me aback, as it is not something I had ever been asked before. I gave the usual advice of no vigorous exercise in the first 24-48 hours after an extraction due to risk of bleeding. However, this scenario made me think, is there a deeper conversation to be had?
Patients are more open to discussions surrounding their health and ways in which they can prevent disease. As dentists, we are aware of the head and neck cancers associated with human papillomavirus (HPV), a type of sexually transmitted disease (STD). It has been estimated that over 80% of the population will acquire HPV before they reach the age of 45.1HPV-related cancers have been on the rise for a number of years. Certain types of oropharyngeal cancers are associated with HPV, particularly HPV 16 and 18.2 There have been great efforts to immunise adolescents against HPV, aiming to administer the vaccine at an age before they are sexually active. Originally, this vaccine was only offered to girls; however, from 1 September 2019, boys were also offered this vaccine from 12 years of age.3
As dentists, we undertake oral cancer screens at every routine check-up. We also give smoking cessation and alcohol cessation advice where appropriate, both of which are risk factors for oral cancer. HPV and other STDs can present in the oral cavity. Perhaps as clinicians we have a wider role to play in sexual education and prevention. This could be in the form of patient information leaflets and posters raising awareness of HPV-related head and neck cancers, emphasising the importance of safe sexual practice and early vaccination. These could be placed in waiting rooms and in surgeries, giving patients the opportunity to start the conversation if they wish to do so.
References
Chesson H W, Dunne E F, Hariri S, Markowitz L E. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis 2014; 41: 660-664.
Lechner M, Liu J, Masterson L, Fenton T R. HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol 2022; 19: 306-327.
Public Health England. HPV vaccination programme. 2019. Available at: https://www.gov.uk/government/collections/hpv-vaccination-programme (accessed October 2022).
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Doughty, F. Sex conscious clinicians. Br Dent J 233, 586 (2022). https://doi.org/10.1038/s41415-022-5150-5
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DOI: https://doi.org/10.1038/s41415-022-5150-5
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