It’s not only brushing and flossing that you should discuss with your dentist — you may also want to talk about your sexual health. Oral cancer affects tens of thousands of Americans every year, and understanding risk factors can make a real difference.
Each year about 40,000 Americans are diagnosed with oral cancer, and recent estimates put U.S. deaths around 7,890 annually. Historically, tobacco and alcohol were the primary risk factors for oral cancer, so dentists routinely recommended oral cancer exams for patients who drank or smoked. While tobacco and alcohol still raise risk substantially, the landscape has changed: human papillomavirus (HPV) has become the leading cause of oropharyngeal cancer.
Because HPV is now a major driver of oral cancer, it’s reasonable to discuss sexual history — including oral sex — with your dentist or primary care physician. That conversation could help identify risk and prompt timely screening.
When to Talk to Your Dentist About Oral Sex
There’s a dangerous misconception that oral sex is safer than intercourse when it comes to sexually transmitted infections. Oral sex can transmit STIs, including HPV, and that transmission can increase the risk of developing cancer in the back of the mouth and throat.
At a Glance: Facts About Oral Sex, HPV, and Oral Cancer
HPV is the leading cause of oropharyngeal cancer. This type of cancer affects the back of the mouth and throat, and multiple studies link HPV infection to oropharyngeal cancer.
HPV accounts for a large and growing share of oral cancers. Between 1970 and 2005, HPV accounted for a minority of oral cancers, but after 2005 its contribution rose substantially. The increase likely reflects changing sexual behaviors, including earlier sexual activity and a higher number of partners.
Risk increases with the number of oral sex partners. Studies show that having six or more oral sex partners raises the risk of developing oral cancers of the tongue, throat, or tonsils; much higher numbers of partners further increase that risk.
Men are at higher risk than women. Rates of HPV-related oral cancer have increased more sharply in men, which is one reason HPV vaccination is now recommended for both boys and girls.
HPV can be dormant for long periods. Absence of symptoms does not mean absence of infection; HPV can remain without clear signs for years.
Early detection matters. When oral cancer isn’t caught early, it can be fatal. Timely screening and evaluation improve the chances of successful treatment.
What to Ask for at the Dentist
At your next dental visit, ask whether you are a candidate for oral cancer screening and what steps the practice takes. A thorough routine exam should include visual inspection of the mouth and palpation of the neck. I recommend finding a dentist who examines the neck and performs an oral cancer screening during the twice-yearly checkup.
However, be aware that routine dental exams can miss early HPV-related lesions, especially in deeper or posterior areas such as the base of the tongue, the back of the throat, and the tonsils. An ear, nose, and throat (ENT) specialist can perform a more detailed assessment when warranted.
If you are sexually active — particularly if you’ve had many partners — consider consulting both your dentist and primary care physician. Ask for a referral to an ENT if you or your clinicians feel a more complete evaluation is necessary.
Also discuss HPV vaccination for children and adolescents. Although early HPV vaccination efforts focused on girls, vaccinating boys is important as well because males are at increased risk of HPV-related oral disease. Ask both your partner and your provider about vaccination history to help assess risk.
There are also newer screening options available. One test involves spitting into a tube to check for molecular markers associated with oral cancer. Ask your dentist if such tests are appropriate for you.
Open, nonjudgmental conversations with your healthcare providers about sexual activity can provide reassurance, guide preventive steps like vaccination, and lead to earlier detection when needed. Discussing oral sex with your dentist and medical providers can save lives.
Mark Burhenne DDS
Learn More:CRP and Oral Health: What Your Physician May Not Know