One Step Closer to Oral Health Care Provider-Administered HPV Vaccines

Dentists may be one step closer to administering HPV vaccines in pursuit of whole-person health. Earlier this year, the American Dental Association (ADA) Code Maintenance Committee approved new CDT codes for oral health care provider-administered HPV vaccinations. This is a crucial step in addressing HPV, the most common sexually transmitted infection and a leading cause of oropharyngeal cancer.

The human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. At first glance, it may seem harmless compared to other sexually transmitted infections and diseases. In many cases, people don’t even know when they have contracted HPV.

But HPV is responsible for 12 percent of cancers worldwide, including cervical cancer, penile cancer, and many oral cancers. In fact, according to the CDC, HPV is thought to be responsible for 70% of all oropharyngeal cancers. 70%!

The vaccine has been proven to prevent both HPV and associated cancers. Specifically, of the 36,500 annual cancer cases caused by HPV, it has been found that 33,700 could have been prevented through vaccination.

Why Oral Health Care Provider-Administered HPV Vaccines?

“HPV is the leading cause of oropharyngeal cancers (cancers in the throat, back of the mouth, base of the tongue, and tonsils) in the United States,” said NCOHC Director Dr. Zachary Brian, who serves on the Code Maintenance Committee as a representative for the American Association of Public Health Dentistry (AAPHD) . “It’s more than appropriate that oral health care providers not only educate about HPV-associated risks but also serve on the frontlines to administer this life-saving vaccine.”

Brian, along with Dr. Sharon Perlman, a dental provider and CCARE Lynch Syndrome co-founder, drafted the new HPV vaccine code. Perlman also served on the Code Maintenance Committee as an AAPHD representative.

“We are lucky to have a strong advocate in Dr. Perlman,” said Brian. “She was a critical component in the drafting and passage of this new code.”

With oropharyngeal cancers claiming one life every hour in the U.S., and just over 50 percent of adolescents not completing the HPV vaccine series, there is clear room for improved prevention through increased access and education.

In 2021, NCOHC spoke with Dr. Jennifer S. Smith, a vaccine epidemiologist who has worked to improve HPV vaccine acceptance to prevent cervical cancer. She said that while the HPV vaccine has proven to be a valuable preventive tool for many forms of cancer, acceptance continues to be an issue.

One of Smith’s colleagues, Dr. Noel Brewer, found that informed providers who understand potential outcomes need to be part of the vaccination process. For example, the pediatricians who often administer HPV vaccines may not be as familiar with the realities of cervical cancer compared to oncologists who take care of cervical cancer patients. The perspective of a health care professional familiar with the disease endpoint – in this example cervical cancer – is vital in answering questions and encouraging vaccine acceptance.

Similarly, dental professionals can play a valuable role in educating people about oropharyngeal cancers and the benefits of HPV vaccination.

The best time to vaccinate against HPV is between 11 and 14 years old. Parents will understandably have questions, not just about the vaccine itself but about the health outcomes it can help prevent.

“Dental professionals already play a vital role in early detection and oral cancer literacy,” said Brian. “This uniquely positions us to engage in direct prevention as well.”

What is the Code Maintenance Committee, and Why is an HPV Code Important?

The ADA’s Code Maintenance Committee evaluates and votes on changes to the CDT Code, or the Code on Dental Procedures and Nomenclature. The procedural codes are meant to ensure a level of consistency in dental treatment, and they are used to file insurance claims for oral health care services.

“The adoption of the code marks the first of many steps, and it opens several doors,” said Brian. “It signals broad agreement on oral health care provider-administered HPV vaccines to payers and policymakers, and it provides a framework to integrate HPV vaccination into the practice of dentistry.”

At NCOHC, we’re pleased to see the dental profession moving in this direction, and we believe these changes can make a profound difference in preventing HPV and, ultimately, oropharyngeal cancers.

What’s Next?

The adoption of the new CDT codes alone won’t allow oral health care providers in most states to begin HPV vaccination.

In some states such as Illinois and Oregon, where dentists are already authorized to administer various vaccines, there likely won’t be much delay in adjusting their regulatory frameworks to allow for HPV vaccination. However, in most states, including North Carolina, state law will need to change for oral health care providers to be authorized to administer the vaccine. \

“We will need to modify state law to incorporate HPV vaccination into the scope of practice for oral health care providers,” said Brian. “For that to happen, it will be critical that we work closely with our partners across the state, including our medical counterparts and other advocacy groups.”

Insurers will also be important partners in this effort. While the necessary legal changes are being made, payers will also need to engage to encourage and support oral health care providers’ administration of the HPV vaccine.

“Once the policy has been updated and the reimbursement framework is in place, the dental profession will have a significant opportunity to improve population health,” said Brian. “The dental community could rapidly increase the availability of the HPV vaccine and add a much-needed perspective to cancer prevention efforts.”

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.


Update: What We Know About the Oral-COVID Connection in 2022

COVID-19 has impacted virtually every aspect of human life for the past two years. From retaining steady employment and income to maintaining preventive medical care, healthy habits, and more, things got a bit more difficult for most everyone, and a whole lot harder for many.

COVID-Oral Health Connection

Earlier in the pandemic, we published an initial overview of the ways that the virus has impacted oral health. As we enter 2022, with a hopeful light at the end of the tunnel, we are taking another look at the connection between COVID-19 and oral health to break down the many ways the pandemic impacts our mouths.

Here’s a brief review of what we know so far.

Loss of Taste and Smell

From the beginning of the pandemic, loss of taste and smell have been prominent symptoms of COVID-19. As the first recognized oral manifestation of the virus, loss of taste was an early indicator of infection, even as testing and other precautionary measures were still ramping up.

Loss of taste and smell, which are typically grouped together in part due to the similar nature of the two senses, continue to be significant issues for many diagnosed with COVID-19. They are also often among the longer-lasting impacts of the disease. Like many COVID-19 symptoms, however, people who have contracted the virus have a wide range of experiences with the loss of these senses.

In some cases, loss of taste and smell lasts a short period of time before returning to normal, and many who contract COVID-19 don’t lose these senses at all. But in others, sensory loss lasts months, and there are even some cases where the loss of taste and smell seems to be permanent.

Treatment for COVID-related Loss of Taste and Smell

“There are frustratingly few interventions” to treat taste and smell loss, according to a Journal of the American Medical Association (JAMA) commentary. One of the only successful options is olfactory (smell) training. This treatment basically involves regularly smelling a variety of scents. While the mechanisms that make this remedy work are still largely unknown, it has demonstrated a significant level of success.

Physicians and researchers at Thomas Jefferson University Hospital are currently developing another potential treatment: topical platelet-rich plasma (PRP). PRP, which is commonly used for injuries like tennis elbow and muscle pulls, has shown promising results in early trials for treatment of loss of taste and smell.

Dry Mouth and Oral Lesions

While loss of taste and smell were among the first widely known symptoms of the virus, dry mouth has become the most common oral manifestation of COVID-19, present in 43 percent of cases.

Dry mouth has the potential to lead to or intensify existing oral disease. Saliva is an oral health powerhouse — it helps defend against decay-causing acids and bacteria. With less saliva, people who contract COVID-19 and experience dry mouth are at greater risk of tooth decay and gum disease.

Researchers have also found a significant correlation between COVID-19 infection and oral lesions. Again, the exact mechanisms connecting the virus and the oral manifestation are not clear, and there is a wide variety of types of lesions that have been documented. Ranging from canker sores to herpes-like sores, oral thrush, and more, these lesions were found in 20.5 percent of patients in a study surveying 2,491 cases of COVID-19.

Treatment for Dry Mouth and Oral Lesions Due to COVID-19

According to the Mayo Clinic, dry mouth treatment options include:

  • Stay hydrated
  • Reduce caffeine intake
  • Don’t use alcohol-based mouthwashes
  • Stop using tobacco
  • Use a humidifier at night
  • Use an over-the-counter dry mouth mouthwash

Oral lesion symptoms associated with COVID-19 vary widely. Minor canker sores generally clear up on their own with no treatment, and there are a variety of mouth rinses and topical products available for more persistent sores. For other symptoms like oral thrush, antifungal medicines may be necessary. Because of the wide variation in lesions, the best approach if you are experiencing these symptoms is to consult your dentist.

Understanding COVID-19 and Its Oral Manifestations

To say the least, COVID-19 is an incredibly confusing virus. The list of potential effects is seemingly endless and disconnected, ranging from flu-like symptoms like fever, cough, and sore throat to:

  • Shortness of breath, and difficulty breathing
  • Headaches
  • Loss of taste and/or smell
  • Oral lesions
  • Brain fog
  • Pink eye, light sensitivity, and sore or itchy eyes
  • Rashes
  • Swollen or discolored extremities
  • And more

Some of the most prominent symptoms are very similar to the flu, suggesting that COVID-19 is a respiratory disease. But researchers are continuing to find evidence indicating that COVID-19 might be a vascular virus – a disease of the blood vessels.

Looking at COVID-19 as a blood disease can help demystify the variety of seemingly disconnected symptoms. In the dental community, we are familiar with the important role of blood vessels in the mouth-body connection. With COVID-19, blood vessels could be the link between stroke-like brain impacts, respiratory problems, and oral manifestations.

COVID-19 and Oral Health Equity

Beyond direct connections between COVID-19 and the mouth and the nearly endless list of symptoms associated with the virus, there is another long list of impacts that make their way back to our mouths. Nearly every social determinant of health has been exacerbated during the COVID-19 pandemic, and they all have oral health repercussions.

Prior to the pandemic, the U.S. poverty rate was at its lowest point since 1959. Despite supplemental programs to offset income loss early in the pandemic, poverty rates for adults and children alike have increased. Many people struggled (and continue to struggle) to get enough food, retain steady employment, and maintain stable housing — all of which have known links to oral health and overall health.

The bottom line: Outside of the dental office, it has been much harder for millions of people to maintain good oral health habits during the pandemic.

Inside the dental office, things also became harder when the pandemic hit.

  • There is a plethora of anecdotal evidence from dentists across the country who have seen more patients with stress-induced cracked teeth.
  • Fear of seeking care due to possible COVID-19 exposure continues today, putting people at risk of more extensive treatment needs down the road.
  • The widening income gap and shaky employment situations have left many without the insurance necessary to maintain regular preventive appointments.
  • Dental staffing shortages, a problem before COVID-19, have become more severe during the pandemic, especially among hygienists and assistants.

Oral Health & COVID-19: Where Do We Go from Here?

The list of connections between COVID-19 and oral health could go on and on. For example, dental researcher Faleh Tamimi is leading a study of similarities between COVID-19 and periodontal disease co-morbidities, finding that people with COVID-19 and gum disease are 3.5 times as likely to be admitted to an ICU and 4.5 times as likely to be put on a ventilator. In the months and years ahead, we’ll continue to keep a close eye on this and other research exploring the link between COVID-19 and oral health.

At the end of the day, however, one thing is clear: the many ways COVID-19 impacts oral health continue to be significant.

The pandemic could, and should, be an opportunity as well. With so many in need, and with so much focus on health care, we have an incredible opportunity to look at structural changes to dramatically increase access to care.

NCOHC and our incredible coalition of partner organizations and advocates are taking strides to map out the future of oral health care – a. future that includes everyone, everywhere. Learn more about current initiatives and ways you can get involved today at

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.


How To Become a Dental Hygienist in North Carolina

It is time to celebrate! National Dental Hygienist Week is the second week of April each year (April 4-10). During this week, NCOHC wants to celebrate the students excited about becoming future registered dental hygienists. This is the time of year potential dental hygiene students are preparing and submitting applications and anxiously awaiting acceptance letters. Let’s explore the process prospective dental hygiene students must go through to prepare and apply to a dental hygiene program and the road they travel to become dental hygienists.

Dental Hygiene Programs

North Carolina has thirteen Commission on Dental Accreditation (CODA) approved dental hygiene programs. These include 12 Associate of Applied Science degree programs at community colleges throughout the state and one baccalaureate program at the University of North Carolina Adams School of Dentistry.

For dental hygienists to practice in North Carolina, they must graduate from a CODA-approved dental hygiene program. CODA is the sole agency that accredits dental and dental-related education programs and is nationally recognized by the United States Department of Education (USDE).

Dental hygiene programs must go through accreditation — a rigorous self- and peer-reviewed process — every seven years to ensure they provide a quality education and comply with CODA’s Accreditation Standards and Commission Policies.

Prerequisite Admission Requirements

The education process for a dental hygienist is quite extensive. Before being accepted into a CODA-approved dental hygiene program, it is strongly recommended that students complete required general education/dental hygiene prerequisite courses due to the rigorous nature of the dental hygiene curriculum.

Prerequisite courses for dental hygiene programs include but are not limited to:

  • anatomy and physiology (one or two courses)
  • microbiology
  • chemistry (class and lab)
  • communications
  • English (two courses)
  • math
  • psychology
  • sociology
  • a humanities/fine arts elective (i.e., critical thinking)

These courses can take a student a year or two to complete prior to being accepted into a hygiene program.

Dental Hygiene Program Admission Process

Admission into dental hygiene programs is very competitive due to the limited number of students each program accepts. For example, 80-100 students may apply to a dental hygiene program that only has 20-30 seats available.

The selection process is usually based on a point system. Points are awarded for specific requirements, including but not limited to:

Applicants with the highest number of points are admitted into the program.

Dental Hygiene Curriculum and Program Requirements

After being accepted into a dental hygiene program, students begin an intensive two-year program that requires them to complete traditional classroom and hands-on clinical coursework with a grade of “B” or better.

The dental hygiene curriculum includes:

  • orofacial anatomy
  • infection/hazard control
  • medical emergencies
  • preclinic lecture and lab
  • dental radiography
  • general and oral pathology
  • periodontology
  • nutrition/dental health
  • dental pharmacology
  • community dental health
  • dental materials and procedures
  • professional development
  • dental hygiene theory courses
  • clinical courses throughout the program

In clinical courses, students are required to treat patients in dental hygiene clinics located on their school’s campus. They learn to manage and treat patients’ needs and provide preventive oral health care.

When I was the program director for Catawba Valley Community College’s dental hygiene program, dentists and even one pharmacist were constantly surprised to learn about the rigorous nature of hygiene programs. One dentist told me that she wasn’t aware of the extensive knowledge hygienists gain in school, and teaching our students gave her even more respect for dental hygienists.

Examinations and Licensure

During the last semester of dental hygiene school, students apply for and complete national and regional exams and begin the licensure requirements. The National Board of Dental Hygiene Examination (NBDHE) is an eight-hour comprehensive exam administered by the Joint Commission on National Dental Examinations (JCNDE).

Exam Requirements for Dental Hygienists in North Carolina

There are state-specific exam requirements for dental hygiene students, as well. In North Carolina, dental hygiene students take the American Board of Dental Examiners (ADEX) exam administered by the Council of Interstate Testing Agencies (CITA), a regional testing agency. The ADEX exam consists of two components – the Patient Treatment Clinical Exam (PTCE) or the Manikin Treatment Clinical Exam (MTCE) and the Computer Simulated Clinical Examination (CSCE).


After students complete the national and regional examinations, they must complete a North Carolina State Board of Dental Examiners (NCSBDE) licensure application. The application process requires completing an extensive application, a background check, a nominal licensure fee, a passing score on the NBDHE and CITA exams, and successful completion of the Infection Control/Sterilization and Jurisprudence examinations.

Finally…a Registered Dental Hygienist

The NCSBDE issues a candidate a dental hygiene license once their application is completed and approved. At last, the dental hygiene student has earned the status of a Registered Dental Hygienist!

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.