Screening for Silence: HPV Oropharyngeal Cancer and You

Hi, everybody.

I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way. Welcome to today's show. I'm so excited to talk to you about this topic because I feel it's a topic that we don't talk often enough about, and it is related to oral cancer. And with me Today, I have Dr. Mohammad Kamal. He's a renowned pathologist, CEO and founder of Omni Pathology Labs. And you are in Pasadena, California, not too far from us. And you really have such an impressive track record, and you're an international educator, and you've shared your expertise with dentists, with medical doctors, but especially lately, you're reaching out to dentists to really collaborate on this important aspect of health, and especially oral health, which is throat cancer. Especially. So. Welcome to the show, Dr. Kamal.

Well, thank you so much, Dr. Moldovan, for having me on your show. I am really excited about speaking with you and your audience.

Yes. And I really want to tell everyone out there, a lot of people think, oh, going to the dentist is easy. You're just going to fill cavities, you're going for gum disease. But the truth of the matter is, especially in our practice, and hopefully all practices out there, they're doing an oral cancer screening. Very, very important to do this. We try to do it every time somebody comes for their oral hygiene, or at least annually. That's what we recommend in our practice. Is that a good thing to do? What do you recommend? Is it more than that? Are we doing the right thing?

Yeah. No, absolutely. First of all, I'm honored to be asked to give a recommendation to the dental community. Of course, as a pathologist. I'm a medical pathologist. I specialize in gastrointestinal pathology. I've always wondered during my training, why is the oral cavity not part of the GI pathology training? So there is a specialty or subspecialty of oral pathology, but I feel that the digestion starts with the mouth, and it would be really great to see programs where they incorporate oral pathology as part of the GI pathology.

I agree 100%. Yeah. I always say that the mouth is the opening of the GI tract.

Exactly. So when I think of myself as a pathologist, I don't really think that I'm in the business of cancer Diagnosis. I actually view myself as being in the business of cancer prevention. Most of the work that we do are biopsies performed in a screening process where you could catch a lesion, or hopefully you catch a pre malignant lesion. And by removing it, that patient would avoid developing cancer. So if you think about the mammograms in breast colonoscopies, and then what is happening in the dental practice when they come in and they get the palpation and the inspection and they do the thorough examination to find any potential premalignant lesion in the oral cavity. So by all means, I would advocate that.

Yes. Great. And, you know, a lot of people don't even know probably what you do as a pathologist. So tell us a little bit what a regular day is like. I see you have your microscope right there next to you.

Yes. So pathologists, they are. You have oral pathologists that go to dental school. They're dentists. And then they specialize in oral pathology. And then you have medical pathologists that go to medical school. They are physicians and they specialize in pathology. And in pathology have to sub specialties. You have anatomic pathology, which is looking at the tissue itself. So you take a biopsy, it gets processed in the lab, and then you have it on a slide, and then the slide is looked at under the microscope. So it'd be something like this that is examined microscopically. And then the clinical pathologist, they look at blood work and fluids, body fluids and things like that. So I, you know, as a pathology lab, we do get biopsies, but we also, because we service different specialties. One of them is the gyn. And with gyn, we started doing molecular testing because when, when a patient goes through pap smear, that pap smear sample is examined microscopically for cytological changes to see if there's any abnormalities. But that same fluid in the Pap smear is also tested for different microorganisms, such as hpv, human papillomavirus, and other sexually transmitted infections as well. So that makes us not just a pathology lab, but we are a molecular PCR testing laboratory as well.

Fascinating. No, I remember as a resident, I was looking at those little specimens as well. We have to actually take them and do a little work just as a resident. Resident. But I think right around 2010, I remember Michael Douglas got diagnosed with throat cancer. And I think really that's when things started that people started paying attention to this. And he actually says that it was oral sex that really caused that hpv. Infection in the throat and caused him to have oral cancer. Now you are looking at specimens for the throat as well in your lab.

Yes. So first of all, Michael Douglas showed tremendous courage and did a tremendous service to this cause by being outspoken about it. It helped so many people to learn and be educated and seek knowledge in that area. So what happened is that we, as I mentioned, we were doing HPV testing on the cervical canal. We started doing that maybe around 2017. People started asking us about oral HPV. Do we have a test for HPV? Our cervical HPV test is FDA approved. We in omnipathology, as a high complexity laboratory, we are allowed to do what they call, we can run FDA approved tests, but we can also develop our own test, which is something called lab developed test. This is an approved process for us as a high complexity laboratory. So I'll give you an example. So we developed our COVID test and that is a lab developed test. We did get emergency use authorization from the fda, but that was a lab developed test that only a high complexity laboratory is allowed to develop. So, so what we did is that with people asking about this test, I kept it in the back of my head, is that we really need to have a test for oral or oropharyngeal hpv. And it took us time and it took us. You know, we started developing the test during the COVID era where we thought, okay, let's look at this. This is an oropharyngeal cancer. Oropharyngeal cancer, HPV related oropharyngeal cancer is on the rise.

I wonder why. Do you know why that would be?

Yeah, it's because there is no screening method for it. Nobody has come up. There are no guidelines to screen for that test. And the only way to screen is through examination. And you could also imagine that. And we're talking about. So oral cancer, oropharyngeal cancer are very close. They're both squamous cell carcinomas and they are both HPV related. The problem with the oropharyngeal cancer is that I didn't feel that if you do an oral rinse that you would adequately sample the oropharynx. I thought that this would probably require rinse and gargle.

Yes. Makes sense what you're saying because I actually did those rinses and it depends how people gargle. Some people it gets deeper in the throat, some people shallower.

Exactly. And the difference. So I thought, okay, let's do an oropharyngeal swab. And the oropharyngeal swab thought was made easier now that everybody was doing COVID testing. And people. Some. There are some tests that were available with oropharyngeal swab, some with nasopharyngeal, some with nasal. So I said, well, people are much more accepting to the idea of being swabbed. That's number one. Number two, the difference between an oral rinse or gargle and a swab is that the rinse and gargle is done by the patient. So you could have, you know, people do that differently. And you could imagine also that somebody who's older or younger or somebody who is, you know, people may not be able to do it the same way. However, an oropharyngeal swab is going to be performed by a healthcare professional. So I felt that this will give us a better yield. Then I noticed that I wasn't aware of any oropharyngeal swab to test for hpv. We said, okay, let's do this. We took our test, the exact assay that we have for this cervical HPV testing, which is FDA approved, and we basically validated it on oropharyngeal samples. Then we ended up with a very good clinical sensitivity is 95.2%. The specificity is 100%. The test performs very well. So that was the first phase of, yeah, okay, let's do it with a swab. Then the thought was, who has the best access to patients throats. Yeah, it's not the ent. People can live their entire life will never see an ENT once, right? Yes, but people go to dentists sometimes twice a year, sometimes more. And let's talk to our dental colleagues and see if they are going to really, you know, come on board with that test thinking that this is a service to the patient. It's a. It's a. It's an amazing screening tool. And we all, we want to take advantage of the patient being in the office because sometimes it's hard to get people to. To get it. But if with the right conversation and education and everything, you want to take advantage of the opportunity of having that patient in the office to be tested for that.

Yeah, I agree with you. I think, you know, in dental offices, we can screen for oral cancer, check for diabetes, you know, really do these preventative things so much better than a medical office which sees the patient maybe once in a while.

Right.

And what's nice is, like, even our hygienists, you know, they're qualified to be doing this oropharyngeal swab. To check for hpv. Now, there are different types of hpv, Correct? Is this testing for everything or do we need to test for everything?

So There are over 100 types of HPV that are divided into high risk and low risk. So high risk are of course, naturally, they're called high risk because they are the ones that are known to lead to the development of cancer. So we test for 14 high risk types in that test. So HPV 16 is responsible for up to 90% of the cases of oropharyngeal cancer. So our report gives you a result on HPV 16 separately, another result for HPV 18. And then the third result is called other, and it tests for the other, the remaining 12. These are exactly the ones that we test for in the cervical canal, which makes perfect sense because the infection is all regenital infection. So, so that's what we test. We test for 14 high risk HPV types.

Like, I'm trying to think of a patient that we diagnosed and we had actually people and who would we screen? Right. Where do we start? We started as early as, you know, teenagers. And, you know, we have actually patients that had a positive HPV that were in their 60s.

Yes.

So. So yeah, it's possible at any age. So would you recommend screening for pretty much everyone? And how would you decide? Like, what are the risk factors?

So let's start with the risk factors. Okay. This conversation is just exclusive for HPV related oropharyngeal cancer. Right. I know that there is a link to oral cancer, but just let's focus on that since we're talking about an oropharyngeal swab.

Yeah.

Oropharyngeal cancer used to be predominantly caused by smoking until about, maybe about 30 years ago, we started to see a trend where then the 8. So non HPV related oropharyngeal cancer was the dominant part. The majority of cases were non HPV related. And then recently we started to see a rise in HPV related cancers. So the top risk factor, of course, is HPV infection.

Okay, yes.

With that, you have other conditions that can make a patient more likely to develop hpv. One of them is smoking. So smoking actually reduces the immunity and there is a chemical local effect that makes the patient more susceptible to HPV infection. And there are papers on that topic. Anyone with reduced immunity, this could be somebody who has diabetes, somebody who is on chemotherapy, somebody who has acquired immune deficiency. Any type of reduced immunity can cause that. But what is really interesting is that HPV infection is common in people that have multiple sexual partners. So when we thought about the cervical canal and the oropharyngeal canal or oropharyngeal space, we found that HPV resolves on its own. But hpv, persistent HPV is linked to the development of cancer. So I'm saying that because when somebody is positive for oropharyngeal hpv, that doesn't mean that this person has cancer, but that should identify that person as somebody who needs to be retested to see if he or she has persistent HPV infection. And if they do, then we shouldn't really worry about this sector. So I took the risk factor into multiple levels to get you to the point that it is the persistent HPV infection that worries us.

What is the increased risk of cancer? I think it's exponential, I believe, with HPV 16, isn't it?

Yes. Yeah. So it's about 90% of the cases are HPV 16 related. And in our experience since we started doing that test, every case with the exception of One that was HPV 18, every case that positive case was. Every positive case was HPV 60.

Wow. Now, you mentioned smoking. Does it include like marijuana smoking? Because now everybody, you know, especially in California, is legalized. So actually, no. Yeah.

I, I was in conversation with an oral pathologist and she was telling me that this is also possible. Now, a trend that's been seen that smoking could, that could be that. And then, and then I think. What is it called? Smokeless tobacco. Of course, that's another thing. And so I don't know that there are a lot of data on it, but I can't see that of course, to be a risk factor as well.

Yeah. So let's say somebody comes into our office, we do a swab. How quickly do we get results?

So we get the sample, we can run it in the same day. But it's basically what we offer is 24 hours. You get a 24 hour turnaround time. Because also we recognize people. People can be anxious about this.

Yes. Yeah, that's pretty fast, actually. 24 hours, I don't see that. And then let's say somebody is positive, then what do we do? Because we. I think that's one of the big unknowns. If a lot of dental offices will start to do this. We really don't know what to do.

Yeah. So that's what I say when I lecture on this test. What I do is I tell people is we do have established guidelines for screening cervical cancer, screening breast cancer. The fact that this cancer doesn't have established guideline should not mean that the healthcare community should just sit and wait for those guidelines to descend upon us. I think as healthcare providers, we have an obligation to do our best to offer the patients the best way to screen to the best of our knowledge. Right. So going back to the idea that majority of HPV infection resolves on its own, that's the case in the cervical canal and in the oropharynx. So because of that, somebody who tests positive, we recommend that they get tested in six to 12 months.

Okay.

If they clear it, then maybe we can test them one more time. But it usually resolves within 18 months. But if somebody can show that they have positive HPV tests in the oropharynx for a period that expands over 18 months, that person could be a good candidate or would be a good candidate to be referred to an ENT doctor.

Okay. And they probably would use a camera.

To look inside, they can scope, and they can do more advanced testing. Now, the other thing that's also interesting in this approach is we believe, and I had that, I heard that from dental colleagues, that they say, no, if a patient is positive, I want that patient referred because I don't want to worry about the liability of having, you know, sitting on a positive test that could lead to cancer. I think that this is legitimate, especially that we don't have established guidelines. I think that this is a reasonable approach. And I had also people that spoke to patients that are nervous about it. They get apprehensive about the positive test, or they would have a friend or a loved one who died or got diagnosed with oropharyngeal cancer. A patient with high anxiety like this is also reasonable to be referred to an ENT doctor. So I really think that there is a lot of flexibility, and that doesn't really necessarily mean that we're going to send everybody or we're going to have one thing fits everyone. I don't think that this is reasonable at this stage. I think there is a lot of flexibility. But this approach that we have proposed gives us that we want to retest to make sure the patient has persistent HPV infection. And we want to refer those who have that. Then if somebody wants to deviate from this because of any other reason, they're allowed to do it.

Yeah. And I know, you know, some. Some people might not even feel the need that this test is necessary because of this issue that you brought up that, you know, goes away by itself. Yes, but how many times do you know, what is the statistics on that? How often does it go away by itself? Like most of the time.

Okay, this is. This is great. This is a great question. Yes, most HPV infection resolves on its own. That's not unique to the oropharynx. It's the same thing in the cervix. But you don't hear anyone making any arguments that we should eliminate HPV testing on the cervical canal. In fact. In fact, the gym community is moving towards not having to do the Pap smear. They just focus on the HPV testing because it's a more accurate way, because the cytology has some subjectivity. So what I'm saying is that it's not a unique thing. It's not a unique disease. It's a squamous cell carcinoma caused by HPV infection. So the argument that it's going to resolve by its own is I don't think it's a valid thing because otherwise people would have done the same thing in the cervix. And then also the other question about raising anxiety, I mean, we have women going through this every day in America or in the world when they do their Pap smear and they get the HPV result. So it is not. And then we're not talking about a cancer that is not prevalent or not. We're talking about cancer that is rising. I can't imagine if we are talking about a cancer that's HPV related and we know that persistent HPV infection is linked to cancer development. How are we going to identify these patients without testing for hpv? It just. There is really. This is the most logical approach I can see. People didn't test because there was no available oropharyngeal swab for hbv. But now that it's available, I think it's a reasonable approach. It's scientifically sound and reasonable.

Absolutely. So really we should focus people because we know smoking can be a problem. Like if you're a smoker, really recommend this test or those people who smoke. Very important.

Sure. And somebody whose partner tested positive for hpv.

Yes, absolutely. That's a great idea.

Somebody who reports multiple. I mean, it's probably very difficult to report that in a dental practice, but somebody who has multiple sexual partners should be educated to do that.

Yeah, you brought up a good point. You know, I think most dental offices use a medical intake form. That's pretty archaic and I think really changing that history to also ask, well, being questions. And one of them could be, has your partner been diagnosed with hpv? Cervical hpv.

Brilliant. Brilliant. Yeah.

So if anybody marks yes, we can offer them oropharyngeal swab.

Yeah. The other thing is when. When the. The dentist or the dental hygienist are doing the examination and they're palpating the neck. They're palpating the neck because what? Because the most common presentation of oropharyngeal cancer is a metastasis to a neck lymph node. That's really too late. So if we are doing this and educating patients that we are doing this because one of the things we look for is positive lymph nodes, which could be caused by cancer that is HPV related. This is why we want to screen for hpv.

Ah, great. So. So anytime. Also, we have any kind of swollen tonsils that we diagnose that may be recurrent. It's something to test.

Right. And.

And.

And again, I mean, if you think about the. The. The value of having a camera going in and identifying a lesion. So one of the things that really fascinated me when I started looking at this test is that almost all of the literature says that there are no known precursor lesions to oropharyngeal cancer. There are no known precursor lesions. That doesn't mean that there are no precursor lesions. I mean, this is a cancer like any other squamous cell carcinoma. There will be a dysplastic, which is the stage before the development of cancer. There will be dysplastic. But the problem is that no one is looking, right?

Yeah.

If people didn't do colonoscopy, it wouldn't have been any reason. It wouldn't be reasonable for anyone to say colon cancer does not have precursor lesions. We know that polyps are the precursor lesions. But if we didn't look, we wouldn't have known that. Right. We didn't do colonoscopies. We wouldn't have known that. So that argument is going to help us convince more and more people to come on board and to convert and to understand that this is not. It's a perfect screening test because it's inexpensive and it is not invasive. I mean, I mean, as invasive as just swabbing the back of the mouth, the back of the throat?

Yeah. That's as easy as it gets, for sure. So speaking of price, how much is a test like this?

So this is something that we thought. This is a PCR test. We priced it the same as the COVID test. Now, we have applied for. We just got accepted for something in the medical coding called the plaque, which is something with the American Medical association called proprietary laboratory analysis. So the PLA code is designated for that test by our lab, we got approved for that. We're going to see the pricing next year. We're in the process of applying for a dental code, but at this point, we are in the range of the COVID testing price. So we think that this is something compared to the expense of treating oropharyngeal cancer, which in some publications up to $140,000 a year. And it could also get up to not counting the lost wages for the patient and the caregivers and things like that. So it is in the grand scheme of things, it's an inexpensive, and it's a perfect tool for screening.

Inexpensive, it's quick, it's painless. So there's many, many reasons why prevention is so key when it comes to oropharyngeal cancer.

Exactly. Yes. And I think one way we're going to get to a point where what I call the tipping point for the test would be when more and more healthcare providers and patients are educated about the test. Where you're going to see people. We had a great call two weeks ago. A dental practice in the Midwest called and they said that a patient heard about the test because I think I was a guest on another podcast or something like that. And she went and talked to her dentist. The dentist listened to the boss, said, I'm on board, let's start. And it was kind of really good to see that what we're doing and educating people is working.

And that's the goal, even with today's show, is to really help people to understand why is it important? Because unfortunately, you don't find out about it until you're actually faced with a lesion or with a positive diagnosis. So prevention is big for us. I think it's an easy way to incorporate it. But what do you think needs to be done in like, patient education there or even healthcare provider education besides podcasting?

I presented at the California Dental association last Decade May in Anaheim, and I, I had a dentist coming by and talking to me after my lecture. And he, he said that his best friend was passed away with HPV related oropharyngeal cancer. And he was really moved by, by this whole, you know, idea of the test. And, and he was really, you know, he said this is a great thing and he wants to do it. So to, you know, I'm doing a lot of lecturing and presentations. I am also talking to other people that are giving workshops to dentists and dental hygienists. So we're including that test also in these, in these courses. I am in the process of coming out with a white paper to publish and allow people to access that. I have a few YouTube videos on my YouTube channel and on our website omnipathology.com we have a few things about that. But yes, and speaking to experts like yourself and thought leaders like you is going to help us spread the word because this is really, it's a great test. I truly believe that one day people would look at HPV related oropharyngeal cancer and will say this cancer was rising and started to get down when people started screening for oropharyngeal hpv.

Yeah. And I know probably some of you listening today are thinking, oh, you know, I'm going to go look in the mirror and say, oh my God, is my throat red? Are my tonsils enlarged? You know, and I always recommend go ahead and do a self exam. Let's say you haven't been to the dentist or until you make it to the dentist, always check, you know, check the back of your throat. How are your tonsils looking? Are your tonsils enlarged? Are your tonsils enlarged? Pretty much all the time. That might be a good indication that a test like this would reveal why that occur.

And there are a couple of thoughts that I that came to me when you were mentioning that, number one, a patient who's positive does not have cancer. So we really need to emphasize that this is just a tool for us to stratify patients, identify patients and identify those who need further follow up. That's number one. Number two, when you examine locally, you wouldn't be able to tell an HPV positive from HPV negative, meaning that you have to really swab because HPV positive is not recognizable just by looking. So that's another thing. And the third point is that one of the early signs of oropharyngeal cancer would be this feeling of a foreign body in your throat. A lot of people tend to ignore this. And this is like the clock is ticking. Anytime you feel something that's not right, difficulty swallowing or something like, but the sense of foreign body, something stuck in my throat, that is something that you should immediately seek help with and go find and go to your primary care doctor, get a referral to an ENT doctor or if you're at your dentist, mention that and they may be able to look and offer you other solutions. But I think that this is, these are things that kind of really need to, people need to be educated on because men are also notorious for ignoring things.

Yes, that's so true. It's like, oh, it's going to go away on its own.

Yeah, yeah. So. So that's something that we need to educate people about.

Yeah. I actually remember this one time, one of my patients, he's in his 70s, and he came to me with that symptom. He's like, you know what? I feel like I have something in my throat. And this was a couple of years ago. And he's like, it hasn't been going away and it's been a month. You know, can you look at it? And sure enough, when I looked at it, it was actually I lesion that's about a centimeter in diameter that was completely desquamated. So it was. It looks squamous cell in the end, it was towards the back of the throat. I don't know if it was HPV caused because we didn't test. But, you know, I have seen it and it's very, very important, even for the dentist and hygienists listening right now. Make sure you look in the back of the throat behind the tongue when you're doing your exams, actually take the tongue out and move it to the side to make sure to catch these lesions early enough.

Right.

You know, and the patient in question, of course, actually ended up doing a brush biopsy. At that point, when we're actually seeing some kind of ulceration or a lesion, I have to actually do. And I've sent it to a pathology lab and I'm sure enough became a positive for squamous cell. But then we send them to ENT Oncology. Yeah.

The idea also is part of patient education is to let them know that it's not like a switch that you flip and cancer shows up. So there is a continuum where things can. There's something called dysplasia, which is the cells are going to start to look abnormal, but they're still not neoplasia, it's not malignant. And that dysplasia could be low grade, which would be in that context would be limited to the lower third of the thickness of the lining. And then high grade could be like full thickness of the lining, but they're still at high grade. It's not invasive cancer because it hasn't gone through the basement membrane, it has not invaded yet. So that high grade dysplasia is carcinoma and site still there. And then you have invasive cancer. So we do have. What we're doing basically, is that we want to come in the game early. And we know because it's caused by hpv. So let's find the patients that are positive for HPV after then let's find the patients that have persistent HPV and then refer to any doctor that they do a scope and look with a camera and find things, and they maybe they do other testing. And I'm telling you, in the future, there will be more advanced testing that hopefully can identify cancer at an earlier stage and identify these dysplastic lesions. The other thing that we haven't talked about is that pretty much every cancer today has some kind of genetic abnormality. And I wouldn't be surprised if in the future we identify certain genetic abnormalities. Patients that have these are most susceptible to the development of cancer, and those are the patients that have persistent HPV infection that can be tested for those more advanced esoteric genetic testing. And then maybe we can do something about it. Maybe if the majority of those cancers are on the tonsils, we can take these patients and do tonsillectomy.

Absolutely. Yeah.

So this is not the end of the game. HPV testing is just the beginning. And then I think the future will bring so many other tools, but eventually this cancer will be, maybe not in my lifetime, but eventually this cancer will decline and hopefully disappear.

Yeah, that's really the goal. And with hpv, I think you mentioned to come back in, like, six months for retesting. But if somebody would want to come back sooner, let's say they're going to do some, like, ozone sprays and things to help with the viral infection. Can they come back sooner for retesting, like in three months?

Yeah, they can, but I also think that they can with the understanding that if it goes away in three months, it doesn't mean that it's gone for good. Right. And again, the absence of established guidelines allow us, you know, flexibility. But again, the last thing we want to do is to give people an impression that we're just going to be testing people every day or every two weeks and just, you know, where, where the. The test becomes a cash machine. That's not what we're thinking about. We are approaching it from a purely scientific way where we think that, you know, I. I believe that it's three months, maybe too soon. And I worry about testing in three months because maybe people will get a false impression that has gone for good. So that's why we say six to 12 months, and then we want to test again. And even if the patient is negative in 12 months, it doesn't hurt to test in 18. It doesn't hurt to turn this into an annual test. Just like what happens in the cervical canal.

Yeah. And that's probably identifying where is this infection coming from, because obviously if your partner has cervical HPV and they keep reinfecting you, you're always going to be positive. So really I think it's also looking okay. I always like to look at the root cause coming from. Yes.

And a lot of times also people go through like we now it's established that sometimes the psychological stress can cause one to, you know, can weaken the immunity. So a lot of times it can be dormant and it would just get activated with an event that results in. In reduced immunity. Something that can happen that make people, all of a sudden they just have HPV and then it goes away. But the original exposure, of course, is what you're describing. So I truly believe that the main thing here is patient and healthcare provider education. We have to basically actively work on educating the population and explaining to them what the positive tests mean, what a negative test mean, and what why we're doing this. And it is. I can't imagine somebody turning down an opportunity to test and then how are they going to deal with it When a patient comes back with cancer, oropharyngeal.

Cancer, you know, this brings me to this one patient I was treating for capitations. These area on the back of the jaw, she had a necrotic bone where an area of extraction was essentially. And we send it for microbiological testing. And one of the microbes was HPV in the jawbone. I don't see it often, I don't think. But I'm wondering now, I want to go back to that patient and say, hey, maybe we should do oropharyngeal because we really don't know how this HPV ended up in the necrotic bone of the jaw.

Yeah, no, I completely agree. That is an amazing finding.

Yes. I oftentimes microbiology.

Hats off to the pathologist and the lab that made that diagnosis. And for you, of course, to. To be able to pursue it like this, it's amazing.

I think it's so important, you know, and I'm one of the few dentists that does so much microbiological testing and I like genetic testing as well for inflammatory purposes. But really we test saliva for like the microbiome of the gingiva. We test also candida HPV now. So it's just so important because it's really us with the microbes. So we have to find a balanced way to live together.

Yes. Yeah, absolutely. Absolutely. And I always say that this is one of the lessons learned from the COVID pandemic. Is that the value, first of all, the value of medical technology. And people had to mobilize and develop PCR testing with high throughput capabilities and all of that. But I truly believe that one of the things that I do a lot is try to talk to young people about science and art and things like that. And I can tell you that there has been an increased interest in medical technology and medicine and science because of the young generation saw with the COVID pandemic.

Yeah, absolutely. So where can somebody listening find more information on this test? Or maybe who are the providers? I know we're going to be offering this at Beverly Hills Dental Health and Wellness for sure.

Fantastic. That's great to know. So our website is omnipathology.com we have a page for throat HPV for patients and another page for health care providers. So the patients can go in and click and they can call and get an appointment to, to come into our office and get tested. But they can also print a requisition and go to their healthcare provider, a dentist or a medical doctor, and they can say, all right, I want to have that test. I heard about this. This is what we do. Can you, can you order that test for me? I don't want people to think that they can order the kit and then have their young sister swab there. But that's not what we're doing.

Yeah, because it has to be done correctly.

Yeah, exactly. So they come here, we're going to be testing them and then what we. So that's the way to do the test. The other way, of course, is to talk to your healthcare provider about it. And then when you go on our website, you will find educational page that has all of my lectures and all my interviews and things like that. And this podcast will be on it once it's available. So that's what we're trying to do, is spread the word this way. And I have a YouTube channel also Omnipathology. You look it up and you'll find all the videos that we have about the test and other pathology related topics.

Well, Dr. Kamal, this has been such an enlightening conversation and much needed for everyone to hear. So thank you very much for your contribution.

Well, thank you for giving us the opportunity to talk about the test. And every time I talk to someone, especially healthcare provider, and then I see that they see the logic of testing, I feel a special reward because that's really what we want to do is we're going to convert the community one by one and thanks for all of this. I think that inviting me is a way to support our cause, and I want to thank you for that.

It's my pleasure. You're here to save lives, so thank you.

Same as you. I appreciate it.

Yes, absolutely.

All right. Thank you so much.

Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram. Doctorsanda, this is Dr. Sanda. And remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.