Article Accessed July 15th 2014
Article published by the American Dental Association on August 23, 2013

Dental patients may ask about a new University of Texas-Houston study 1 that is reportedly the first to identify poor oral health as an independent risk factor for oral human papillomavirus (HPV) infection, which is associated with a variety of oral lesions and a subset of oral and oropharyngeal cancers. The study, published online in the journal Cancer Prevention Research, was widely publicized by the New York Times, Time Magazine and other news agencies.

The study looked at data from over 3,400 adults who participated in the 2009-2010 National Health and Nutrition Examination Survey (NHANES), and who also had data available on oral health measures and oral HPV infection. The large number of subjects in this study provides strong statistical power to detect differences between variables.

Using this NHANES dataset, the researchers found a higher prevalence of oral HPV infection among individuals with poor oral health, including a significantly elevated risk of oral HPV in adults with self-reports of poor-to-fair oral health or possible gum disease. From the study sample, 7.5 percent of the NHANES participants also tested positive for oral HPV infection.

After multivariable analysis of the NHANES data, the research team determined that self-rated poor oral health was an independent risk factor for oral HPV infection regardless of the study participants’ smoking or oral sex practices, two known risk factors for head and neck cancer. As reported in previous studies, the UT-Houston researchers also found that men, users of alcohol or marijuana, and individuals with more oral sex partners over time had a higher prevalence of oral HPV infection.

Exposure to HPV occurs commonly through sexual contact, and papillomaviruses can induce a wide range of cutaneous or mucosal epithelial lesions, mostly benign hyperplasias such as papillomas (warts). Over 100 HPV subtypes are known to infect mucosal surfaces in various sites of the body, including the skin, anogenital tract and oral cavity.

The study authors assert that individuals with poor oral health could have ulcerations, chronic inflammation or other disruptions of the oral mucosa, which “may increase susceptibility to and infectiousness of HPV.” Given HPV’s proclivity to infect epithelial basal cells in the oral cavity and other mucosal surfaces, it is indeed suggestive that individuals with poor oral health could have a higher susceptibility to oral infection with HPV, which could gain access to the oral cavity through epithelial wounds or other oral lesions.

The University of Texas-Houston researchers cite several limitations of their study, including the use of self-reported oral health data from NHANES, which could not be used to evaluate temporal aspects regarding the occurrence of HPV infection or the frequency of oral hygiene care (e.g., brushing, flossing). Study participants with poor oral hygiene habits may also have had poor general health habits that contributed to oral HPV infection.

In addition, the study findings only show an association, and do not prove cause and effect. Individuals under age 30 and a large proportion of unmarried individuals were also excluded from the study due to data availability. Although this study is suggestive, considerable research still needs to be done to elucidate the association between oral health, oral hygiene habits and HPV infection in the oral cavity.

The incidence of HPV-associated oropharyngeal cancer is increasing, particularly among men, who accounted for over 10,000 HPV-positive head and neck cancers in 2009. HPV-associated oropharyngeal cancers typically develop near the base of the tongue and in the tonsils, and are often difficult to detect in their earliest stages.

Oral health professionals should remain aware of the increasing incidence of HPV-associated oropharyngeal cancer, and promote optimal oral health and hygiene to minimize the risk of oral disease or infection. The ADA strongly supports optimal oral health for all individuals, and will continue to monitor emerging research on HPV-associated oropharyngeal cancer to reduce its incidence.

Footnotes
1. Bui TC, Markham CM, Ross MW, Dolan Mullen P. Examining the association between oral health and oral HPV infection. Cancer Prev Res. Published online first August 21, 2013; doi:10.1158/1940-6207.

Article Accessed July 10th 2014
Article published by the American Dental Association on May 14, 2014

In recent months, various news agencies,1 social media sites and blogs have reported about the practice of "oil pulling" (swishing oil in the mouth) and its potential benefits on oral and general health. Websites that support natural therapies are also fanning hope—and strong emotions—about oil pulling procedures, with proponents claiming it enhances oral health, whitens teeth, and improves overall health and well-being. This Science in the News provides a brief overview on the practice, health claims associated with oil pulling, and information on the lack of science to support use of this technique for any oral or general health benefit.

Based on the lack of currently available evidence, oil pulling is not recommended as a supplementary oral hygiene practice, and certainly not as a replacement for standard, time-tested oral health behaviors and modalities. The ADA recommends that patients follow a standard oral hygiene regimen that includes twice-daily tooth brushing with fluoride toothpaste and cleaning between teeth once a day with floss or another interdental cleaner, using ADA-Accepted products.  Brushing with fluoride toothpaste and cleaning between teeth help prevent cavities and keep gums healthy. 

If individuals need more help to reduce gingivitis, they can add an ADA-Accepted mouthrinse shown to reduce plaque and gingivitis to their oral hygiene regimen.  Several Listerine antiseptic mouthrinses carry the ADA Seal of Acceptance because they have been shown, through laboratory and clinical studies, to help reduce plaque and gingivitis.  Listerine contains four essential oils (thymol, eucalyptol, methyl salicylate and menthol) as its antiplaque and antigingivitis active ingredient combination.  Unlike the oils used in oil puling, these essential oils are present in small amounts in an aqueous solution that is intended to be swished for 30 seconds, twice a day.  The ADA Seal on over-the-counter oral care products is your assurance that those products have been evaluated by an independent group of experts, the ADA Council on Scientific Affairs, and that the product does what it claims to do.

As background, oil pulling is an ancient, traditional folk remedy that has been practiced for centuries in India and southern Asia as a holistic Ayurvedic technique. 2 The practice of oil pulling involves placing a tablespoon of an edible oil (e.g., sesame, olive, sunflower, coconut) inside the mouth, and swishing or “pulling” the oil through the teeth and oral cavity for anywhere from 1-5 minutes to up to 20 minutes or longer.

Overall, as is true for many folk remedies, oil pulling therapy has insufficient peer-reviewed scientific studies to support its use for oral conditions. One study 3 that compared oil pulling to the use of a chlorhexidine rinse found chlorhexidine to be much more effective in reducing S. mutans levels in plaque and saliva. However, the same study did not look at whether the S. mutans reduction provided the clinical benefit of reducing cavities.

Current reports on the potential health benefits of oil pulling have clear limitations.  Existing studies are unreliable for a number of reasons, including the misinterpretation of results due to small sample size, confounders, absence of negative controls, lack of demographic information , and lack of blinding. To date, scientific studies have not provided the necessary clinical evidence to demonstrate that oil pulling reduces the incidence of dental caries, whitens teeth or improves oral health and well-being.

Recent articles in the media recommending oil pulling procedures generally have not described potential adverse health effects, but case reports of lipoid pneumonia 4 associated with oil pulling or mineral oil aspiration 5 have appeared in the literature.  In addition, cases of diarrhea or upset stomach have been reported.

Various over-the-counter products and oral health practices may promise therapeutic effects when used, but only through rigorous scientific analysis can the dental profession be assured of a product or therapy’s effectiveness and safety.  As emphasized in the ADA policy statement on unconventional dentistry, [t]he provision of dental care should be based on sound scientific principles and demonstrated clinical safety and effectiveness.

Footnotes

1. Haupt A.  Should you try oil pulling?  USA Today April 23, 2012.  Available at: http://health.usnews.com/health-news/health-wellness/articles/2014/04/23/should-you-try-oil-pulling. Accessed April 24, 2014.
2. Singh A, Purohit B.  Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health.  J Ayurveda Integr Med. 2011 Apr-Jun; 2(2): 64–68.  Available at: “http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131773/; Accessed April 23, 2014.
3. Asokan S, Rathan J, Muthu MS, et al.  Effect of oil pulling on Streptococcus mutans count in plaque and saliva using Dentocult SM Strip mutans test: a randomized, controlled, triple-blind study.  J Indian Soc Pedod Prev Dent. 2008 Mar;26(1):12-7.
4. Kim JY, Jung JW, Choi JC, et al.  Recurrent lipoid pneumonia associated with oil pulling.  Int J Tuberc Lung Dis. 2014 Feb;18(2):251-2
5. Bandla HP, Davis SH, Hopkins NE.  Lipoid pneumonia: a silent complication of mineral oil aspiration.; Pediatrics 103:2 1999 Feb pg. E1.  Available at: “http://pediatrics.aappublications.org/content/103/2/e19.abstract”.  Accessed April 24, 2014.