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Self-Study Course #1 Course the Ohio State University College of Dentistry Is a Recognized Provider for ADA CERP Credit

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2017 self-study course #1 course The Ohio State University College of Dentistry is a recognized provider for ADA CERP credit. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at www.ada.org/cerp. The Ohio State University College of Dentistry is approved by the Ohio State Dental Board as a permanent sponsor of continuing dental education. This continuing education activity has been planned and implemented in accordance with contact us: the standards of the ADA Continuing Education ABOUT this Recognition Program (ADA CERP) through joint efforts between The Ohio State University COURSE… College of Dentistry Office of Continuing Dental phone Education and the Sterilization Monitoring 614-292-6737 Service (SMS). READ the MATERIALS. Read and review the course materials. FREQUENTLY asked toll free . COMPLETE the TEST. Answer the QUESTIONS… eight question test. A total of 6/8 1-888-476-7678 questions must be answered correctly Q: Who can earn FREE CE credits? for credit. SUBMIT the ANSWER FORM A: EVERYONE - All dental fax ONLINE. You MUST submit your professionals in your office may answers ONLINE at: earn free CE credits. Each person 614-292-8752 must read the course materials and http://dentistry.osu.edu/sms-continuing-education submit an online answer form . CHECK YOUR EMAIL for your CE independently. e-mail certification of completion. Q: Where can I find my SMS [email protected] number? A: Your SMS number can be found in your the upper right hand corner of your web ABOUT FREE CE… monthly reports, or, imprinted on the dentistry.osu.edu/sms back of your test envelopes. The . TWO CREDIT HOURS are issued for SMS number is the account number successful completion of this self-study for your office only, and is the same course for the OSDB 2016-2017 for everyone in the office. biennium totals. Q: How often are these courses . CERTIFICATE of COMPLETION is available? used to document your CE credit and is A: FOUR TIMES PER YEAR (8 CE emailed to each course participant credits). ALLOW 2 WEEKS for processing of The Ohio State University your certificate. The Ohio State University College of College of Dentistry Dentistry is an American Dental 305 W. 12th Avenue Association (ADA) Continuing Education Recognized Provider Columbus, OH 43210 (CERP). 2017 HPV-related Oropharyngeal course Carcinoma #1 Learning Objectives: 1. Learn key points about HPV-related OPSCC 2. Describe OPSCC prevalence and routes of acquisition 3. List and describe subtypes of HPV-related OPSCC 4. Identify the warning signs and methods of diagnosis, as well as disease treatment 5. Test knowledge by reviewing the True/False questions This is an OSDB Category B – Supervised self- instruction course written by Vimi Mutalik, BDS, MDS INTRODUCTION edited by Sydney Fisher, BS The purpose of this CE self-study is to review the acquisition, Nick Kotlar, BS prevalence, diagnosis and treatment of HPV-related oropharyngeal carcinomas, as well as disease subtypes and warning signs/symptoms. This CE self-study will also address prevention methods and the relationship between HPV and release date OSCC. February 27, 2017 (8:30am EST) last day to take the course at no charge March 31, 2017 4:00pm EST Page 1 What is HPV-related OPSCC? The head and neck squamous cell carcinomas (HNSCC) are a heterogeneous group of neoplasm originating from various anatomic regions namely the oral cavity, oropharynx, hypopharynx, larynx and nasopharynx. Increased incidence of Human Papilloma Virus (HPV) as a cause of cancer in the head and neck region has made it important to analyze different subsites intraorally with caution. Although we refer to oral cancers in general, anatomically they are divided into oral cavity and the oropharynx. The cancers originating from the two anatomic sites, oral cavity and oropharyngeal region causes oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC) respectively. Table 1: Features differentiating oral (OSCC) and oropharyngeal cancers (OPSCC) Parameters Oral cancer Oropharyngeal cancer Site Anterior oral mucosa Base of tongue, tonsils, posterior oral mucosa Etiology Smoking, alcohol Increased sexual partners, HPV Primary Clinical White plaque, ulcer Enlarged lymph node in neck, features dysphagia Incidence Decreasing Increasing Nodal Present and may be the only involvement Present sign of the disease Sex Males common (3:1) Males (5:1) predilection Social history Smoking (80-90%) Smoking (50-65%) Synergistic Alcohol Alcohol not a significant factor effect Prognosis 40% survival rate 80% survival rate Page 2 The cancers originating from these two anatomic sites (OSCC and OPSCC) vary considerably in terms of their statistics, etiologies, clinical signs and symptoms and response to treatment. HPV is now thought to be a risk factor in causation OPSCC (referring to posterior regions of the mouth) and not OSCC (common in anterior regions of the mouth). The discussion in this course is focused mostly on HPV-positive OPSCC which includes cancers from the base of tongue, tonsillar and pharyngeal wall. The OPSCC that are HPV-positive have risk factors related to sexual behavior, whereas HPV-negative cancers are strongly associated with tobacco and alcohol use. What are the key facts about HPV infection? Human papilloma virus (HPV) is the most common cause of sexually transmitted disease in the United States. HPV infection is very well-known in the causation of cervical cancers. However, it has been linked to various other cancers as well. In United States, new cases of cervical cancer have declined over the past 30 years because of increased use of Pap test, cervical smears or Pap smears. These tests enable professionals to identify early alterations in mucosa and are more curable than the invasive cancers. Although the rate of cervical cancer has been decreasing in women, the cancer on the back and sides of the throat, tonsils and base of tongue have increased significantly in men over the past few years. HPV has been thought to infect 90% of the U.S. population. About 12,000 Americans between ages of 15 to 24 are infected with HPV daily and about 26 million Americans have oral HPV infection on a given day. This definitely does not mean that all these patients develop OPSCC. In a vast majority of patients, the infection is cleared away within two years with their immune response and may not cause any health issues. There are nearly 200 strains of HPV; however, most of them do not cause cancers. Hence they are categorized into high-risk and low-risk subtypes. The low- risk strains are associated most commonly with the causation of benign, non- cancerous, genital and nongenital warts and the high-risk strains cause precancerous lesions which subsequently progress to cancer. The high-risk strains like HPV 16 and 18 are most commonly associated with occurrence of oropharyngeal cancers. Among them, HPV 16 is greater than 90% of times associated with oropharyngeal cancer. Page 3 HPV facts continued… The Human Papilloma Virus (HPV) is a double stranded DNA virus that infects the epithelial cells of the skin and mucosa. These viruses have special affinity towards epithelium and are called epidermo-tropic. The mucosal surfaces that are moist like the throat, tongue, tonsils, vagina, cervix, vulva, penis and anus are more susceptible for development of diseases from this virus. Hence these viruses have also a major role in development of cervical, anal and penile cancers. When the virus contacts the epithelial surface it causes changes (koilocytic or viral induced changes) in the infected cells. The unique nature of transitional mucosa and the invaginations in the mucosal surface in the tonsils enables virus capture and makes it a preferential site for HPV. Moreover, the genetic features of HPV 16 facilitate an ideal environment for survival of these oncogenic (cancer-causing) organisms. Although HPV-positive and HPV- negative subtypes OPSCC exists, HPV is detectable in majority of the patients with oropharyngeal cancers. Therefore, in the oropharyngeal region the HPV-positive cases of OPSCC definitely outnumber the HPV-negative OPSCCs. Table 2: HPV facts sheet HPV is highly associated with oropharyngeal squamous cell carcinoma (OPSCC), but not oral squamous cell carcinoma (OSCC) Oropharyngeal squamous cell carcinoma (OPSCC) can be HPV-positive or HPV- negative. But the prognosis for the HPV-positive cases is better. Not all patients who have high-risk HPV in saliva develop oropharyngeal carcinoma. If you get HPV infection, you may or may not develop a precancerous or cancerous lesion. HPV, a primary cause for oral cancer (OSCC), lacks enough scientific evidence. HPV vaccines are safe and effective. Page 4 What is unique about HPV infection and OPSCC? The HPV-induced OPSCC have On the other hand, in a vast many unique features that distinguishes majority of patients, the infection is them from the conventional OSCC. cleared away within two years with Some studies indicate that the timing their immune response and does not between the first exposure to HPV and cause any health issues. Some the development of oropharyngeal studies report that the infection with cancer approximately exceeds 19 years. high-risk HPV usually last for 12-18 months and is eventually cleared by Oropharyngeal cancers (HPV- the immune system. induced) present with very subtle clinical signs/symptoms and at most times the Persistent high-risk cases are patient is unaware of it. Even the the ones that eventually lead to clinicians may find it hard to discover development of malignancies or because the symptoms can be very cancers.
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