17
Volume1 Issue6
|
N
ews and
E
vents
CDA:
Whathaschanged in the
epidemiologyofSTIs?
Changes in sexual behavioursover the last
fewdecades, suchas those related to theage
of first sexual encounters, numberof sexual
partnersororal-genital contact, are linked to
changes in theepidemiologyof STIs. Some
of theolderdiseasesaremakingacomeback.
For example, casesofgonorrheaand syphilis
aredramatically increasing inNorthAmerica.
TheseSTIshaveoralmanifestationsandare
potentially transmitted throughdirectoral
contact.
Have therebeenrelatedchanges in the
epidemiologyoforaldisease?
There’sbeenachange in theepidemiology
ofheadandneckcancer related toSTIs.
Human immunodeficiencyvirus (HIV) leading
tohost immunosuppressionmay result ina
numberof oralmanifestations, includingoral
squamouscell cancer and lymphoma.
Humanpapillomavirus (HPV) isalsoa sexually
transmittedvirus; in theheadandneck it is
responsible for causingmanycasesof oral-
pharyngeal cancers,whichare increasing in
number, andalsoaportionof theoral cancers.
Asa result, thepopulationwith thegreatest
risk for cancers in theheadandneckhas
changed. Traditionally, older individualswitha
historyof tobaccoor alcohol usewereat the
greatest risk, butnowHPV-inducedcancers
are seen inyounger adults, sometimes in the
absenceof traditional risk factors.
ForHPV-inducedcancers, the response to
current standard treatment ismuchbetter
than tobaccoandalcohol-induceddisease
and theprognosis isgreatly improved. But this
alsomeans that thereareoral complicationsof
cancer therapy that requiredental knowledge
andmanagement for the increasingnumbers
of long-term survivors.
Whatare the implications fordentistry?
Oralmanifestationsof STIs require that
dentistsplaya role indetection, diagnosis,
healtheducationandultimatelymanagement
of oral complications.Howdoyoupresent this
information topatients? It’s important toknow
aboutpotential transmissionof STIsand the
implications fororal care.
Is today’sdentistequippedwith the
knowledgeandskillsrequired todealwith
thischange inoralmanifestationsof sexual
behaviours?
Dentistsare in thebestposition to
identifyabnormalities in theoral cavity
andoropharynxandbroadly in thehead
andneck—andwhat theymay represent.
Recognizingdifferencesordeviations from
normal is thefirst step indiagnosis. But they
alsoneed tohaveabroader appreciationof
STIs that theymight identify. Thiswill facilitate
earlierdetectionanddiagnosisandpotentially
betteroutcomesofpatientmanagement.
What is thebestway toapproacha
conversationwithyourpatientaboutSTIs?
Thiscanbeachallengebecause thecurricula
indental schoolsdonotprepare thedental
provider fordiscussingnegativemedical
news. So if adentistdiagnosesacanceror a
potential cancer,weare limitedby teaching
andexperience inprovidingbadmedical
news topatients in thedental setting. We’re
reallynot taughthow to speakwithpatients
about seriousmedical conditions. Similarly,
howdoyou talk topatients in thedental
Changes in the epidemiology of sexually transmitted infections (STIs) have
influenced the oral complications of patients presenting for care indental clinics.
CDA spokewithDr. JoelEpsteinabout the role of dentists in recognizingand
managing oralmanifestations of STIs.
SEXUALLYTRANSMITTED INFECTIONS
ANDDENTISTRY
JoelB.Epstein
DMD,MSD,FRCD(C),
FDSRCSE
Dr. Epstein is consulting
staff in the division of
otolaryngology andhead
andneck surgery at theCity
ofHopeComprehensive
CancerCenter inDuarte,
California, andCedars-
SinaiMedicalCenter in
LosAngeles, andmaintains
an oralmedicine practice in
Vancouver, BritishColumbia
(Oralmedicinepacific.com).
