Human papillomavirus and oral and oropharyngeal carcinoma: the essentials

Aust Dent J. 2019 Mar;64(1):11-18. doi: 10.1111/adj.12652. Epub 2018 Oct 7.


There is a global increase in the prevalence of human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) in Australia and New Zealand. Risk factors for HPV-positive OPSCC are male gender, white race, age older than 40 but younger than 59 years old, having multiple lifetime sex partners, having oro-genital and oro-anal sex. High-risk HPV subtypes play a major role in the pathogenesis of OPSCC, however, they play a much lesser role in oral squamous cell carcinoma (OSCC). Among the laboratory tests used to detect oncogenic HPV infection, polymerase chain reaction is a sensitive method but does not reflect the role of HPV in oncogenesis. While widely used, p16 immunohistochemistry is both a sensitive and a specific surrogate marker for oncogenic HPV infection in OPSCC, but not in OSCC. However, it is a useful prognostic marker in OPSCC. The current gold standard to accurately detect oncogenic HPV infection is E6/E7 mRNAin situ hybridization. Because both HPV-positive and p16-positive OPSCC have better short-term prognoses there is current debate and trials on treatment de-escalation in HPV-positive OPSCC. Dental practitioners can play an important role in early diagnosis of HPV-positive OPSCC.

Keywords: Human papillomavirus; immunohistochemistry; oral cancer; oropharyngeal cancer; p16.

Publication types

  • Review

MeSH terms

  • Australia
  • Carcinoma, Squamous Cell / virology
  • Cyclin-Dependent Kinase Inhibitor p16
  • Female
  • Head and Neck Neoplasms / virology
  • Humans
  • Male
  • Middle Aged
  • Mouth Neoplasms* / virology
  • New Zealand
  • Oropharyngeal Neoplasms* / virology
  • Papillomaviridae
  • Papillomavirus Infections / complications*
  • Papillomavirus Infections / metabolism
  • Squamous Cell Carcinoma of Head and Neck / virology


  • Cyclin-Dependent Kinase Inhibitor p16