Sir, the title of the letter Oral cancer: Link with early coitus (BDJ 2016;220: 279–280) suggests a link which is misleading since it is oral sex that is associated with human papilloma virus (HPV), not early coitus.1

HPV is associated with between 12-63% of all oropharyngeal cancers and prognoses of HPV associated non-cervical cancers are better than HPV-negative noncervical cancers.2 Engaging in orogenital sex with multiple sex partners is associated with HPV-associated oropharyngeal cancer.3 Oral HPV is found three times more commonly in men than women; 8-40% of HPV-positive oropharyngeal squamous cell cancer patients report never having had oral sex4 and oral sex and open-mouthed kissing are a risk factor for HPV-associated oral cancer.5

Dentists should take a history of oral sex from all patients, particularly young patients who present with lymphadenopathy and sore throat, and educate them about HPV-associated oral cancers as early detection provides better prognosis. Dentists should discuss and educate patients about HPV vaccination and prevention of HPV transmission.