The HPV Vaccine and Oral Health: How Are They Related?

The beneficial effects of the HPV vaccine could extend to oral health. We'll tell you about the relationship between this preventive measure and oral cancer.

Reviewed and approved by the dentist Vanesa Evangelina Buffa.

Written by Vanesa Evangelina Buffa

Last update: 20 April, 2023

The preventive action of the HPV (human papillomavirus) vaccine on genital and anal lesions is well known, but it may also have oral health benefits. Several researchers are currently studying this relationship.

HPV vaccines approved by the U.S. Food and Drug Administration (FDA) are used to prevent human papillomavirus (HPV) infection, as well as precancerous lesions and associated cancers.

And although HPV causes oral conditions, including oropharyngeal cancer, there’s little evidence of vaccine action at the oral level. In the United States, the incidence of HPV cancer has increased in recent decades.

More than half of the cases are related to a single high-risk HPV type, HPV 16, one of the strains covered by FDA-approved vaccines. Even so, these drugs have not been specifically licensed to prevent oral cancer. However, some studies associate this immunization with oral health benefits. We’ll tell you more about it in this article.

The HPV vaccine

HPV vaccines protect against human papillomavirus (HPV) infections. These germs are a group of more than 200 related viruses that cause various lesions throughout the body.

More than 40 types of HPV are transmitted by direct sexual contact. Among these, there are two strains that cause genital warts and about 12 types that cause cancers, such as anal, cervical, penile, vulvar, vaginal, and oropharyngeal cancer.

There are currently three FDA-licensed vaccines that protect against infection with some disease-causing HPV types:

• Gardasil ®
• Gardasil 9 ®
• Cervarix ®

All three prevent infection with HPV types 16 and 18, two of the high-risk strains that cause about 70% of cervical cancers and a higher percentage of other cancers.

The Gardasil ® vaccine also protects against infection with HPV types 6 and 11, which cause 90% of genital warts. Meanwhile, Gardasil 9 ®, approved in 2015, protects against the same four HPV types as its predecessor and five more types (31, 33, 45, 52, and 58), which cause uterine cancer.

In the United States, Gardasil 9 ® is the only HPV vaccine in use. The other two variants are still used in other countries.

In search of a link between the HPV vaccine and oral health

The International Agency for Research on Cancer (IARC) of the World Health Organization (WHO), in collaboration with researchers from Costa Rica and the National Cancer Institute (INC) of the United States, conducted studies that showed that the vaccine against human papillomavirus types 16 and 18 – used to prevent cervical cancer – also benefits oral health.

Specifically, it’s able to confer strong protection against HPV infections of the mouth, associated with cancer of the oropharynx and tonsils. To investigate the relationship between HPV vaccination and oral HPV infections, data from 2,627 young adults who participated in a health survey in the United States were analyzed.

The study found that the frequency of oral infection with four types of HPV, including the two high-risk cancer-causing types, was 88% lower in those who had received at least one dose of the HPV vaccine than in those who had not.

Some data from the U.S. study

NHANES data from 2011 to 2014 from men and women aged 18 to 33 years were included in the study because they belonged to the first group in the U.S. to receive the vaccine.

The researchers studied mouthwash samples containing oral cells from all study participants. They tested for the presence of 37 HPV types, including types 6, 11, 16, and 18, which are covered by the Gardasil® vaccine.

The frequency of oral infections with these four HPV types was 1.61% in unvaccinated young adults. In contrast, in the vaccinated population, it was only 0.11%.

The reduction in the frequency of the virus in the mouth associated with vaccination is 88%. Among men, the frequency of oral infection with the four HPV types was 2.1% in the unvaccinated and 0.0% in individuals who had received the vaccine.

Vaccination rates were low, with only 29.2% of women and 6.9% of men in the study having received at least one dose of HPV vaccine before the age of 26 years.

The researchers estimate that in an unvaccinated population, about 1 million young adults may have an oral infection with one of these vaccine HPV types. If all of them had been vaccinated, nearly 900,000 of these infections could have been prevented.

The Costa Rica HPV vaccine study

The Costa Rica study was initially conducted to evaluate the efficacy of the vaccine against cervical cancer. This was followed by an analysis of its efficacy in other anatomical sites, such as the oral cavity.

Between 2004 and 2005, a total of 7466 healthy women aged 18-25 years received either the HPV 16/18 vaccine or the hepatitis A vaccine as a control. Mouth swabs were obtained from 5,840 participants, which were used to evaluate the efficacy of the vaccine against oral HPV infections.

The researchers established that the vaccine is able to reduce oral HPV 16 and 18 infections in more than 90% of the participants up to four years after vaccination.

An increasingly frequent type of cancer

The estimated number of new cases of cancer of the oropharynx, which includes the tonsils and base of the tongue, is approximately 85,000 per year in both sexes worldwide. Men are four times more likely to suffer from the disease than women.

Traditionally, malignant lesions of the mouth and throat were associated with tobacco and alcohol use. Today, 30% of cancers in this area arelinked to HPV, associated with sexual practices such as oral sex.

In fact, in the last 20 years, the detection rate of HPV in tumor samples from the oropharynx increased from 16% to 70%. Researchers postulate that – in the coming decades –  there could be more cases of HPV associated oropharyngeal cancer than cervical cancer in the United States.

Thus, HPV is a risk factor contributing to the development of oropharyngeal cancers. If not treated in a timely manner, oral cancer can be fatal.

How is oral cancer detected?

Regular visits to the dentist are essential to detect any signs in the mouth associated with oral cancer. Here are some of the symptoms your dentist will look for when performing a routine oral exam:

• Pain in the mouth that doesn’t go away
• Ulcerations or sores that don’t heal
• Spots on the oral mucosa
• Numbness of the tongue or other areas of the mouth
• A lump in the neck
• Difficulty swallowing or speaking

If you present any of these problems in your mouth, do not hesitate to consult your dentist as soon as possible, especially if they persist for more than one or two weeks.

If the professional detects any suspicious signs, she or he will perform several tests and complementary examinations to arrive at an accurate diagnosis. In the case of a malignant lesion, the sooner it’s treated, the better the prognosis.

You should also know that HPV infections in the mouth don’t just generate oral cancer. The presence of the virus in the oral mucosa also causes sores, lumps, or whitish, raised, and sometimes hairy or cauliflower-like growths. It’s important that the dentist examines and assesses these lesions for the possibility of malignant transformation.

Taking care of your oral health with the HPV vaccine

The HPV vaccine is applied to prevent lesions derived from sexually transmitted infections. In addition, it appears to provide protection at the oral level by combating the virus strains that cause most oropharyngeal cancers.

And while more evidence is needed on this relationship, it’s postulated as an important tool for reducing oral HPV infections, which, as you have seen, are a risk factor for malignant lesions in the mouth.

Human papillomavirus can cause a variety of problems throughout the body. However, having an effective vaccine is a simple way to reduce the risks. Therefore, it’s advisable to complete the HPV vaccination schedule.

Who should get the HPV vaccine?

The American Dental Association (ADA) supports the HPV vaccine as an effective and safe way to reduce the risk of oral HPV infections and the cancers they can cause.

The ADA has approved the HPV vaccine for people of both sexes between the ages of 9 and 45. Therefore, it’s not only a preventive measure for children and young adults.

Depending on the country and the type of vaccine, the schedules for its administration vary. The following is recommended by the Centers for Disease Control and Prevention (CDC):

• Ideally, it’s given at 11-12 years of age: Two doses of the HPV vaccine are needed, 6-12 months apart. It’s given to both girls and boys. If the vaccines are given less than five months apart, a third dose will be needed.
• If starting the series after age 15: Three doses of the HPV vaccine are needed within six months.

As with any vaccine, soreness or redness in the injected area of the arm may occur after administration. In general, the patient is observed for 15 minutes to rule out any adverse effects. Afterward, the patient can continue with his/her daily routine as normal.

HPV vaccine to take care of your oral health

Vaccines aren’t just to prevent rubella, measles, and the flu. Completing the HPV vaccination schedule provides multiple health benefits.

It helps prevent dangerous genital lesions, but it’s also a tool to take care of oral health. Reducing your risk of oral infections with the human papillomavirus reduces the chances of suffering serious diseases, such as cancer.

Therefore, don’t hesitate to get advice to have your vaccinations up to date and thus take care of all your health, including the health of your mouth.