Prevention of HPV-Related Oral Cancer by Dentists: Assessing the Opinion of Dutch Dental Students

Dutch dental hygiene students' knowledge of HPV-related oropharyngeal squamous cell carcinoma and HPV vaccination

INTRODUCTION

The incidence of human papillomavirus (HPV)-related oropharyngeal cancer is rising, thus the understanding of HPV infection and vaccination among oral healthcare professionals is becoming increasingly important. This study aimed to investigate the knowledge of Dutch dental hygiene students on HPV infection and vaccination and assessed various aspects of HPV-related oropharyngeal cancer.

METHODS

This descriptive cross-sectional study invited the entire Dutch dental hygiene student population registered in September 2016 to complete an online questionnaire concerning the knowledge of HPV infection and vaccination, including the aspects of HPV-related Oro-Pharyngeal Squamous Cell Carcinoma (OPSCC). Data were analysed using t-tests, Mann-Whitney U tests and Chi-square tests.

RESULTS

Invited were all 1248 Dutch dental hygiene students and 232 (18.6%) students completed the questionnaire. More than 95% of the students indicated HPV infection as a risk factor for OPSCC and 48.7% was aware of the availability of HPV vaccination. Additionally, students considered it important to discuss HPV as a risk factor for oropharyngeal cancer with their patients. In general, the students scored highest on the questions about risk factors for OPSCC and poorest on the questions about general HPV knowledge and HPV vaccination. Although the mean overall knowledge score was significantly higher in senior compared with junior students, knowledge scores of senior students remained insufficient.

CONCLUSION

This study identified deficits in knowledge of HPV and HPV vaccination among Dutch dental hygiene students. Future research should focus on improving the content of dental hygiene curricula and development of ongoing educational tools for dental hygienists.

Investigating women's awareness and perceptions on human papillomavirus infection and oropharyngeal cancer in Italy

Introduction

This study explored knowledge, attitudes and behaviors toward human papillomavirus (HPV) infection and oropharyngeal cancer (OPC) among women attending primary care services.

Methods

The cross-sectional study was conducted from September to December 2022 in adult women attending three primary care services in Italy, who were invited to complete a self-administered questionnaire.

Results

Overall, 34.7% of participants know that OPC is HPV-associated; knowledge was higher among women who had personal, familiar or friends' experience of cancer, and who reported to often seek dental care, whereas it was lower in older women. The perception of risk of developing OPC was high for 26.4% of women and was higher in those who had experienced STD, who knew that early sexual debut is a risk factor for OPC, and who considered useful the role of dentists on the provision of information about OPC. Only 22.5% had received HPV vaccination, but 62% intended to receive it in the future. Moreover, 63.2% believe that HPV vaccination is very useful to prevent OPC and only 27% are concerned about health consequences of HPV vaccination.

Conclusion

These findings indicate that women's awareness of the role of HPV infection in the development of OPC is not satisfactory and underline the role that dentists might have in improving their patients' awareness on HPV related OPC.

Engaging new partners in human papillomavirus (HPV) vaccine promotion: Considerations for training private practice dental professionals in HPV vaccine promotion

OBJECTIVES

With rates of the human papillomavirus (HPV) vaccination remaining low and rates of oropharyngeal cancer rising, engaging new partners to promote vaccination is necessary. We aimed to identify dental hygienists' and dentists' knowledge about HPV, the HPV vaccine, and preferences for continuing education.

METHODS

This mixed-methods study recruited dental hygienists and dentists working in private practice in Iowa to participate in a mailed cross-sectional survey (dental hygienists) and qualitative telephone interviews (dental hygienists and dentists). Survey and interview topics included existing knowledge about HPV vaccination, HPV vaccination promotion efforts, barriers to HPV vaccine promotion, and preferences for continuing education (CE).

RESULTS

We received 470 surveys from dental hygienists (response rate = 22.6%) and interviewed 19 dental hygienists and 20 dentists. Vaccine efficacy and safety, along with communication strategies, were key topics of interest for CE. Dental hygienists' most commonly identified barriers were lack of knowledge (67%) and low comfort levels (42%).

CONCLUSIONS

Knowledge was identified as a key barrier to providing a strong recommendation for HPV vaccination and convenience was the most important factor to consider for any future CE. Our team is in the process of designing a CE course based on this information to help dental professionals effectively engage in HPV vaccine promotion in their practices.

Syphilis and dentists: The data about knowledge and awareness of clinicians in Turkey

Background: Syphilis may give pathognomonic signs in oral cavity. In order to emerge an awareness about dentists' role in syphilis management, it was aimed to obtain the data from them about their knowledge.Methods: This survey-based, cross-sectional study was conducted with 709 dentists practicing in Turkey. Participants answered 16 statements about syphilis "Transmission Routes," "Extra-oral Clinical Features," "Oral Findings," and "Diagnosis & Treatment" with options yes/no/I do not know. Moreover, they responded to two 5-point Likert type questions about their comfort level and frequency of taking sexual anamnesis. The statistical significance was set at p ≤ .05.Results: The mean age (years) and female/male ratio of the participants were 35.7 ± 10.2 and 449/260, respectively. The average of the correct answers in the survey was 10.38 ± 3.3. "Transmission Routes" had the highest ratio (50.6%) in terms of all questions in a single category that were answered correctly among groups. Dentists practicing at faculties had the highest number of correct answers (p = .003). The total number of correct answers and the number of correct answers in each category were positively related to both the level of comfort and the frequency of taking patient's sexual anamnesis (Oral Findings p = .002; others p ≤ .001).Conclusions: The results of this study indicate that dentists practicing in Turkey lack a significant level of knowledge about syphilis. This highlights the need for further training and education programs for dentists in Turkey.

HPV Knowledge Retention and Concurrent Increase in Vaccination Rates 1.5 Years After a Novel HPV Workshop in Medical School

Comprehensive education regarding human papillomavirus (HPV) pathogenesis, vaccination, and patient counseling are not routinely included in the medical school curriculum; consequently, student and provider knowledge, especially concerning head and neck pathology, remains low. The objective of this study was to demonstrate long-term retention of HPV knowledge and positive attitudes towards HPV vaccination after attending our novel HPV workshop, with a focus on knowledge of oropharyngeal cancer. A follow-up survey was administered to medical students 1.5 years after the initial completion of the workshop. HPV vaccination records from the student-led clinic were collected from the immunization information system. Awareness that HPV causes oropharyngeal cancer was present in 33% of medical students pre-curriculum; immediate and long-term post-curricular awareness of this association remained at 90% or higher (p < 0.0001). Comfort with HPV counseling, having enough information to recommend the vaccine, and knowledge of HPV malignancies, symptoms, transmission, and vaccination schedule remained persistently elevated over pre-curriculum scores (p < 0.05). Long-term knowledge scores were also higher than a control group of medical students at the same stage of training who had never participated in the workshop (p < 0.05). HPV vaccination rates at the medical school's student-run clinic also increased after the curriculum, from an average of 1.89 HPV vaccines given per clinic to 3.55 (p = 0.001). This study demonstrates that knowledge and positive attitudes were maintained 1.5 years after participating in this HPV curriculum during students' preclinical years of medical school. Additionally, an increase in HPV vaccination rates occurred at a student-led clinic, indicating a positive clinical impact on the curriculum.

Knowledge, Practice, and Awareness of Oral Cancer and HPV Infection among Dental Students and Residents: A Cross-Sectional Study

Background and Objectives: Dentists play a very important part in the early identification of oral cancer lesions. This aspect of dental practice depends on the knowledge acquired during the faculty years. The aim of this study was to assess dental students' and residents' levels of awareness in terms of oral cancer. Materials and Methods: The cross-sectional study was conducted at the Faculty of Dental Medicine within the "Grigore T. Popa" University of Medicine and Pharmacy in Iasi, on a sample of 197 students in the fourth and the fifth years and first year residents in general dentistry. To assess their knowledge, a questionnaire was created containing 22 questions about the risk factors for oral cancer, with a focus on HPV infection. Results: Most participants correctly identified smoking, alcohol, and the HPV infection as risk factors and leukoplakia and erythroplasia as potentially malignant lesions. At the opposite site, aspects considered as unsatisfactory focused on the palpation of lymphatic nodules, a procedure largely carried out by 41.6% of the fourth year students, the counseling only of the patients at risk performed by 59.7% of residents, the lack of knowledge about the prevention of oral cancer through anti-HPV immunization found in 39.7% of the fifth year students. Other incorrect answers focused on other types of suspicious lesions, such as actinic cheilitis, as well as certain areas in the oral cavity subject to the frequent onset of oral cancer, such as buccal mucosa. Conclusions: Although the fifth year students and residents have better knowledge than the fourth year students, the gaps in terms of knowledge and practice encountered in all three categories of participants require a reevaluation of the academic curriculum and the focus on the building of the skills necessary for the correct screening of oral cancer.

Evaluation of head and neck cancer education at European dental schools

AIM

In Europe, approximately 150.000 patients are diagnosed with head and neck cancer annually. Dentists play an important role in prevention and detection at an early stage when survival rates are best. This study aims to evaluate content of head and neck cancer education curricula of European dental schools.

MATERIALS AND METHODS

A questionnaire, comprising 20 questions about content of curricula and teaching methods, was distributed to the deans of all 234 members of the Association for Dental Education in Europe.

RESULTS

The response rate was 24%. All dental schools included head and neck cancer screening practices in their curricula, two-thirds had their students perform this screening on all patients routinely and education was mostly divided over various courses (65%). A variation in content of education in screening practices and counselling patients about various risk factors was reported. Alcohol and tobacco use were included in most curricula as risk factors for head and neck cancer (98%), gastro-oesophageal reflux was less frequently included (41%). The human papillomavirus (HPV) as a risk factor for oropharyngeal cancer was included in 94% of curricula and 87% also contained education about strategies to discuss prevention of HPV-related cancer. No association was found between curricula containing strategies about discussing HPV-related cancer and inclusion of the HPV vaccine in national immunisation programmes.

CONCLUSION

Head and neck cancer teaching programmes show a considerable variation across European dental schools. Development of a unified teaching programme suitable for all European dental schools seems warranted.

Influence of Human Papillomavirus on Alveolar Bone and Orthodontic Treatment: Systematic Review and Case Report

BACKGROUND

As the human papillomavirus (HPV) infections are detected in healthy oral mucosa as well as in oral lesions, dental practitioners have an important role in detecting any possible lesions that might be caused by this virus. Therefore, the aim of this study was to investigate the outcomes of orthodontic treatments and HPV infections and to report a rare case of ongoing orthodontic treatment superposed on an HPV infection.

METHODS

An electronic English literature research of the articles published between the years 2011-2021 was conducted between December 2021-February 2022, accessing PubMed, Web of Science, Embase, Scopus, and Google Scholar. The terms "HPV", "orthodontics", "orthodontic treatment", "tooth movement", "tooth mobility", and "malocclusion" were searched. The following inclusion criteria were pursued: articles published in English language; studies reporting HPV infection in subjects with past or ongoing orthodontic treatment; and case reports of subjects with HPV and orthodontic treatment. Exclusion criteria were: articles in languages other than English, studies related to malignancies other than HPV and orthodontic treatment; and studies reporting patients with HPV and no orthodontic treatment.

RESULTS

Following the systematic review, which includes six papers, a case of orthodontic treatment superposed on a HPV infection is presented.

CONCLUSION

Incumbent, postponed HPV infection on an ongoing orthodontic treatment might affect treatment outcome and patient compliance.

Cross-cultural adaptation of a Spanish version of a previously validated HPV survey that evaluates dental students' knowledge, perception and clinical practices in Latin America

BACKGROUND

The global incidence of oropharyngeal cancer (OPC) is increasing. Dental professionals play a key role in the detection of oral lesions that could lead to cancer. However, scientific-based HPV-OPC visual inspection guidelines are underdeveloped and HPV knowledge and awareness has been reported to be low among dental students and professionals. The present study adapted and performed pretesting of a multi-scale survey evaluating knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC for Latin American Spanish-speaking populations.

METHODS

A previously developed questionnaire for English-speaking dental students was translated to Spanish. The questionnaire was administered to first year dental students at two Latin American universities with dental programs. Internal consistencies were measured using Cronbach Alpha. Analyses were conducted in SAS Version 9.4.

RESULTS

Data from a total of 114 students, a majority of the which were female (61%), and Hispanic/Latino(a)/Spanish (91%). The HPV, HPV-OPC, and HPV vaccine knowledge subscales demonstrated good internal consistency, the Cronbach's alpha was 0.83, 0.75, and 0.86 respectively. The Barriers subscale had a Cronbach's alpha of 0.93, showing excellent internal consistency. The Clinical Procedures subscale, focused on factors surrounding dental students' hypothetical clinical practice procedures, had a Cronbach's alpha of 0.86. The Scope of Practice scale had a Cronbach's alpha of 0.93.

CONCLUSIONS

Ultimately, this survey demonstrated reliability and applicability for the assessment of dental students' knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC in Latin America.

Human Papilloma Virus Vaccination and Oropharyngeal Cancer: Knowledge, Perception and Attitude among Italian Pediatric Dentists

Background: Pediatric dentists could play a key role in the prevention of human papilloma virus (HPV)-related oropharyngeal cancer (OP-cancer). The aim of this study was to assess knowledge, perception, and attitude on HPV-related OP-cancer, HPV infection, and HPV vaccination among Italian pediatric dentists. Methods: A cross-sectional study was conducted. Pediatric dentists received, by email, a link to participate in the questionnaire online. The questionnaire comprised four parts: (i) demographic information, (ii) knowledge on HPV-related OP-cancer, HPV infection, and HPV vaccine, (iii–iiii) perceptions and attitude on HPV-related OP-cancer, HPV infection, and HPV vaccine. Data were statistically analyzed with Kruskal–Wallis and Mann–Whitney test and Pearson’s chi-square test. Results: A total of 271 pediatric dentists completed the questionnaire. Results showed a good overall knowledge; a positive perception of their role in HPV disease prevention; a good attitude in discussing sensitive topics; a need for acquiring more information about HPV’s connection to cancer, HPV infection, and HPV vaccine. Conclusions: Improving educational training programs, as well as informing about prevention of HPV-related OP-cancer, will place pediatric dentists in the front line of HPV diseases primary prevention.

Assessment of Knowledge Level and Awareness About Human Papillomavirus Among Dental Students

Epidemiological studies have shown that the worldwide trend of human papillomavirus (HPV)-induced oral cancer has increased. Dentistry students need comprehensive information about HPV to provide accurate advice to their patients. The aim of this study is to evaluate 3rd, 4th, and 5th grade students' knowledge and awareness about HPV. A questionnaire consisting of 16 questions was applied to 318 students (100 3rd grade, 119 4th grade, and 99 5th grades), who were studying at XXX. In this survey, students' knowledge level and awareness were examined. In our study, 99 (31.0%) of the participants were male and 219 (68.9%) were female. There was a statistically significant difference between the classes in terms of participation rates in the statement "Some types of HPV cause oral cancer (p, 0.000; p < 0.05). The rate of participation of third grade (72%) students in this proposition was significantly lower than 4th grade (89.9%) and 5th grade (84.8%) students (p1, 0.000; p2, 0.000; p < 0.05). There was no statistically significant difference between 4th and 5th grade students (p > 0.05). Overall, advanced students showed better knowledge, attitudes, and perceptions regarding human papillomavirus-related oral cancer. Comprehensive training and motivation for improving dentistry students' awareness against HPV-induced oral cancer will also improve knowledge and attitudes of the dental students.

Lack of knowledge regarding HPV and its relation to oropharyngeal cancer among medical students

Background

Oropharyngeal cancer (OPC) is an important cause of cancer‐related mortality. Early detection of OPC results in a favorable prognosis and higher survival rates. Infection by high‐risk types of human papillomavirus (HPV) is a risk factor for OPC with an upward trend globally. Medical students' knowledge and awareness of HPV‐related OPC can be crucial in the preventive efforts.

Aim

To assess HPV knowledge among medical students at the University of Jordan, with particular focus on its relation to different cancers.

Methods

This paper‐based survey study was conducted in November 2019. The survey items were based on previously validated surveys used to evaluate HPV‐related OPC knowledge among dental students and professionals. To assess HPV knowledge and students' confidence in personal history taking and physical examination, we developed a knowledge and confidence scores that showed acceptable reliability.

Results

The total number of participants was 1198 students, with a median age of 21 and female predominance (n = 697, 58.2%). Among the participants, 93.3% heard of HPV prior to this survey (n = 1118). Higher levels of knowledge regarding cervical cancer, OPC and HPV vaccination was seen among clinical students compared to their preclinical counterparts, but their overall HPV knowledge was low. Only 18.4% and 21.0% of the clinical students correctly identified the association of HPV with penile and oropharyngeal cancers, respectively. Additionally, 34.5% of the clinical students were not aware of the availability of HPV vaccines. The majority of students (92.0%) reported that the university courses were their major source of knowledge about HPV.

Conclusion

A profound lack of knowledge regarding HPV role in OPC was found among medical students. This insufficiency included several aspects of the virus and its associated diseases. Such gaps in knowledge could have negative consequences in early detection and prevention of OPC and should be addressed by evaluation of the current curriculum.

A Mixed-Methods Examination of Factors Related to HPV Vaccination Promotion in Private Dental Settings, Iowa, 2019

INTRODUCTION

Human papillomavirus (HPV)-associated oropharyngeal cancer rates are rising, particularly in males, although rates of other HPV-related cancers are decreasing. Although the HPV vaccine is safe and effective, vaccination rates remain below the Healthy People 2030 goal of 80% coverage. Engaging dental providers, who have experience with patient education and oropharyngeal cancer, may prove useful in efforts to increase vaccination rates. Our research explores dental providers' (dentists, dental hygienists) willingness to participate in continuing education about HPV, educate parents of adolescents, recommend the vaccine for adolescents, and refer parents to medical providers.

METHODS

We used a mixed-methods approach and conducted a survey with dental hygienists and semistructured interviews with dental providers. We produced frequencies and descriptive statistics for all variables and used regression modeling to explore factors related to willingness to promote the HPV vaccine. We used a deductive approach to code interview transcripts.

RESULTS

Regression models using survey data (n = 470) showed that after controlling for demographic and practice-level characteristics, higher levels of willingness were associated with thinking that parents would act on a recommendation and thinking that engaging in HPV promotion is within the scope of practice. Interview data reflected willingness of dental providers to work on HPV vaccination, but revealed barriers (eg, time, knowledge) that need to be addressed.

DISCUSSION

Overall, dental providers expressed a willingness to participate in HPV vaccine promotion, and future efforts should focus on addressing barriers to doing so. Engaging dental providers in HPV vaccine recommendation and referral can help prevent future HPV-related cancers.

Elevating dental training to prioritize prevention efforts for reducing HPV-related oropharyngeal cancer incidence

Human papillomavirus (HPV) infections are commonly recognized in the United States with associations to cancers of the vulva, vagina, penis, anus, and oropharynx; the incidence of HPV-related oropharyngeal cancer (OPC) in the United States is on the rise.¹ The aims of this scoping review were to examine the curricula of pre-doctoral dental students with respect to dental students: (1) awareness of the connection between OPC and HPV; (2) readiness to screen for OPC; and (3) ability to deliver patient education about OPC and its relation to HPV. We also codified published educational materials related to OPC and HPV for pre-doctoral dental students. Literature searches were performed in PubMed, Scopus, the Educational Resources Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (EBSCO), and Dissertation Abstracts-ProQuest. After screening titles and abstracts, we selected 36 articles for full text review. Only articles reporting pre-doctoral dental training in HPV and OPC were included in the review, which resulted in 15 articles being excluded from the study. Only two studies in this review specifically discussed a curriculum that would involve educating dental students on HPV-related OPC. This scoping review also found that the majority of existing training opportunities for OPC and HPV are through post-graduate continuing education. To address these deficiencies, competencies regarding the HPV-OPC connection should be included within pre-doctoral dental training programs. As such, we identified four key strategies for advancing HPV-OPC content within pre-doctoral dental training curricula.

Knowledge of Human Papillomavirus (HPV) and Oropharyngeal Cancer and Acceptability of the HPV Vaccine among Dental Students

Objectives:

To assess knowledge about human papillomavirus (HPV), vaccination, and HPV-related oropharyngeal cancer (OPC) and to evaluate HPV vaccine acceptability among a sample of undergraduate dental students.

Methods:

All third- and fourth-year dental students enrolled in any of the dental schools in Jeddah, Saudi Arabia, were invited to participate in this cross-sectional study. In total, 500 students completed a self-administered questionnaire on HPV, HPV vaccines, and HPV-related OPC knowledge. HPV, HPV vaccine and HPV-related OPC knowledge scores were calculated. Associations of participants characteristics with the knowledge scores and with willingness to take the HPV vaccine were assessed.

Results:

Of the participants, 62% had heard of HPV infections, and 57% of HPV vaccines. Average knowledge scores were low: HPV knowledge score 3.8±4.5 out of 16, HPV vaccination knowledge score 0.9±1.6 out of 7, OPC knowledge score 0.9±1.2 out of 5. Clinical-year students had better knowledge and were more willing to take the HPV vaccine than were preclinical-year students, as were those vaccinated for hepatitis B versus those not vaccinated for hepatitis B. Students with higher HPV knowledge scores were more willing to take the HPV vaccine (66%) than were those with lower scores (43%) (p=0.018). Only 4% of males and 12% of females reported taking the HPV vaccine. Of those who refused it, 51% cited lack of knowledge as the primary reason.

Conclusions:

Knowledge about HPV, its vaccine, and HPV-related OPC is low among this sample of Saudi undergraduate dental students. Improving knowledge among them may increase their awareness, which could affect the care provided to patients.

A Multi-state Evaluation of Oral Health Students' Knowledge of Human Papillomavirus-Related Oropharyngeal Cancer and HPV Vaccination

Human papillomavirus-related oropharyngeal cancers (HPV-OPCs) are on the rise, yet HPV knowledge among dental professionals remains low. The purpose of this multi-state study was to examine sociodemographic factors associated with final year dental hygiene (DH), third year dental (DS3), and fourth year dental (DS4) students' knowledge regarding HPV, HPV-OPC, and HPV vaccination. Twenty dental programs in the USA were approached in the implementation phase to complete an online, 153-item, self-administered questionnaire that was developed and tested in a previous study. Descriptive statistics and chi-square analyses were conducted in SAS version 9.4 to examine the relationship between sociodemographic variables with HPV, HPV-OPC, and HPV vaccination knowledge levels. This study included the participation of students from 15 dental programs (n = 380) with an overall response rate of 28%. Although the results cannot be generalized to the entire population of dental students in the USA, most students had inadequate overall HPV knowledge (65%), HPV-OPC knowledge (80%), and HPV vaccination knowledge (55%). While all student groups displayed adequate general HPV knowledge levels (≥ 70% correct responses), gender, racial, religious, age, and regional differences were observed. Future dental professionals need to have adequate levels of HPV knowledge to aid in reducing the HPV-OPC burden. This study identified sociodemographic factors related to lower knowledge of HPV, HPV-OPC, and HPV vaccination, and highlights groups of students with greater needs for HPV education. This study provides a foundation for future research and interventions to be developed. Dental institutions can use findings to strengthen curricula development.

HPV Knowledge and Attitudes Among Medical and Professional Students at a Nevada University: A Focus on Oropharyngeal Cancer and Mandating the Vaccine

Medical professionals and students often feel as if they do not have enough understanding of the human papillomavirus (HPV) vaccine in order to recommend or obtain vaccination themselves. A 25-question online survey regarding knowledge and attitudes about the HPV vaccine was distributed among professional students, including all classes of medical students, at a Nevada university. First- and second-year medical students were administered the same survey 1 week after a new vaccine workshop. One third of respondents were aware of the link between HPV and oropharyngeal cancer, and 63% believed that the HPV vaccine should be mandatory. Reported full vaccination status (OR = 2.63 compared with no vaccination, 95% CI = 1.53, 4.53), awareness of the link to oropharyngeal cancer (OR = 1.85, 95% CI = 1.04, 3.29), and female sex (OR = 1.64, 95% CI = 1.00, 2.70) positively predicted whether a student believed the HPV vaccine should be mandatory. After an interactive workshop, first- and second-year medical students improved on HPV knowledge questions, comfort in HPV vaccine counseling, and having enough information to counsel on the HPV vaccine. Post-test knowledge scores surpassed those of current third- and fourth-year medical students, who never underwent such curriculum. Medical, physician assistant, graduate, and undergraduate students lack HPV knowledge, with a low percentage aware of oropharyngeal cancer as a result of HPV infection. An interactive curriculum implemented for first- and second-year medical students improved knowledge and comfort in counseling on HPV vaccination.

Knowledge Gaps among Patients and Providers in HPV-Related Oropharyngeal Cancer: A Systematic Review

Objective

To describe the level of knowledge of human papillomavirus (HPV) and HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) among the general population and health care providers.

Data Sources

Systematic search was performed on December 20, 2018, using MEDLINE (1966 to December 2018), EMBASE (1975 to December 2018), Web of Science (1900 to December 2018), and CENTRAL (1996 to December 2018) databases. English-language literature involving human subjects was used, and studies were limited to case series, case-control, cohort, and randomized controlled trial designs.

Review Methods

Studies were included if they assessed knowledge of HPV and HPV-associated OPSCC. The primary outcome measure was the knowledge of HPV-associated OPSCC among the general population and with health care providers. Meta-analysis of proportions was attempted using random-effects model. The PRISMA guidelines were used for accuracy of reporting.

Results

Thirty-two studies were included with 17,288 participants. There was a high degree of heterogeneity preventing completion of a meta-analysis. Knowledge of HPV and HPV-associated OPSCC varied between the general population and health care providers. The proportion of the general population and health care providers with knowledge of HPV ranged from 16% to 75% and 21% to 84%, respectively. Knowledge of HPV-associated OPSCC was greater in health care providers and ranged from 22% to 100% compared with the general population, which ranged from 7% to 57%.

Conclusion

There is a knowledge gap of HPV-associated OPSCC for both the general population and health care providers. Additional education may not only increase awareness but may also result in prevention and earlier detection.

Exploring lay public and dental professional knowledge around HPV transmission via oral sex and oral cancer development

Background

Human papillomavirus (HPV) has been associated with certain types of oropharyngeal cancers and yet, the level of knowledge that dental professionals and the lay public have in terms of HPV transmission, oral sexual activities, and oral cancer development needs exploration. The aim of this study was to assess the knowledge held by practicing dental professionals as well as the lay public regarding Human Papillomavirus (HPV) transmission through oral sex and subsequent oropharyngeal cancer development.

Methods

Textual data were collected from a public forum with dental professionals in.

Vancouver, who discussed the HPV-oral sex-oral cancer triad, and from survey data gathered from 212 lay public participants (also in Vancouver) who answered a 13-item questionnaire on the perceived risks of oral sex in terms of HPV infection and oropharyngeal cancer development. The data were analyzed statistically by age group, gender, and sexual orientation using descriptive statistics, while an ANOVA test was used to compare variation in the responses to the survey (p-value = 0.05).

Results

The forum engaged 46 health care professionals, many of whom were aware of the potential risks for head and neck cancer development due to HPV infection, while also questioning “how to effectively talk about HPV with patients.” The survey revealed that 34.5% of the participants believed that oral sex is an activity with no or low risk for the transmission of HPV, while 84% of participants believed the same sexual practices were of low or no-risk for HIV (Human Immunodeficiency Virus) transmission. Most participants (82%) never discussed oral sexual activities with their physicians or dentists/dental hygienists.

Conclusions

The general public remains mostly unaware of the potential links between HPV infection and oropharyngeal cancer. Physicians and dental providers should discuss oral sexual practice with their patients to raise awareness.

Evaluating the Effectiveness of Human Papillomavirus Educational Intervention among Oral Health Professionals

This study aims to evaluate the effectiveness of an educational intervention that was designed to increase human papillomavirus (HPV) awareness and knowledge among oral health providers (OHPs). HPV educational lectures and a dental information toolkit on HPV were offered to OHPs in New England in 2016-2017. OHPs included dentists and dental hygienists. Post intervention surveys were distributed 1 month later. A total of 230 participants attended the educational lectures and received the toolkit. Descriptive statistics were used to compare the difference in knowledge and preparedness about HPV before and after the intervention. Eighty-nine OHPs completed the surveys. The response rate was 38.7%; however, for each question, the number of responses varied. Fifty-four (54%) (n = 26) of survey respondents were between 55 and 75 years of age with 73.5% (n = 36) being female and 55% (n = 45) working in private practice. Post intervention, 67.5% (n = 27) of the respondents felt more prepared, 82.6% (n = 38) reported clarity of their roles in educating their patients about HPV, and 91.6% (n = 44) reported an increase in knowledge about HPV. The HPV educational intervention was well received and successful at improving self-reported knowledge, comfort level, and preparedness of OHPs in discussing HPV with their patients. OHPs have the great opportunity to educate their patients about HPV and HPV vaccination. Further continuing education efforts may improve OHPs' participation in HPV prevention.

US oral health students' willingness to train and administer the HPV vaccine in dental practices

HPV oropharyngeal cancers have now surpassed cervical cancer rates in the US. Dental providers' engagement in HPV education and vaccination efforts may help reduce the burden of HPV oropharyngeal cancers. We examined factors associated with oral health students' willingness to train and administer the human papillomavirus (HPV) vaccine in dental settings. US students in 15 oral health programs participated in an online survey in 2016. Unadjusted and adjusted multivariable logistic regression were conducted and odds ratios (OR) and 95% confidence intervals (CI) were reported. Analyses were conducted in SAS Version 9.4. Data from a total of N = 306 students were analyzed to examine sociodemographic, educational, practice, and attitudinal factors associated with willingness to train and administer the HPV vaccine. Majority of the participants were female (70.3%), non-Hispanic/Latino (90.8%), and White (62.1%). Perceiving that HPV vaccination recommendation (OR = 1.95, 95% CI = 1.14-3.35) and administration (OR = 3.79, 95% CI = 1.63-8.81) was in the dental professional's scope was positively associated with outcome measures when other factors were held constant. Students with greater patient contact time (OR = 4.47, 95% CI = 1.14-17.58) and lower role conflict (agreed that HPV vaccine administration was in the dental professional's scope) had higher odds of willingness to administer the HPV vaccine when other factors were held constant (OR = 5.9, 95% CI = 2.27-15.3). The major barrier to engaging oral health students in HPV vaccination efforts was role conflict. Professional organizations and oral health programs should strongly support the role of oral health professionals in HPV oropharyngeal prevention.

US oral health students' willingness to train and administer the HPV vaccine in dental practices

HPV oropharyngeal cancers have now surpassed cervical cancer rates in the US. Dental providers' engagement in HPV education and vaccination efforts may help reduce the burden of HPV oropharyngeal cancers. We examined factors associated with oral health students' willingness to train and administer the human papillomavirus (HPV) vaccine in dental settings. US students in 15 oral health programs participated in an online survey in 2016. Unadjusted and adjusted multivariable logistic regression were conducted and odds ratios (OR) and 95% confidence intervals (CI) were reported. Analyses were conducted in SAS Version 9.4. Data from a total of N = 306 students were analyzed to examine sociodemographic, educational, practice, and attitudinal factors associated with willingness to train and administer the HPV vaccine. Majority of the participants were female (70.3%), non-Hispanic/Latino (90.8%), and White (62.1%). Perceiving that HPV vaccination recommendation (OR = 1.95, 95% CI = 1.14-3.35) and administration (OR = 3.79, 95% CI = 1.63-8.81) was in the dental professional's scope was positively associated with outcome measures when other factors were held constant. Students with greater patient contact time (OR = 4.47, 95% CI = 1.14-17.58) and lower role conflict (agreed that HPV vaccine administration was in the dental professional's scope) had higher odds of willingness to administer the HPV vaccine when other factors were held constant (OR = 5.9, 95% CI = 2.27-15.3). The major barrier to engaging oral health students in HPV vaccination efforts was role conflict. Professional organizations and oral health programs should strongly support the role of oral health professionals in HPV oropharyngeal prevention.

Human Papillomavirus-Related Oral Cancer: Knowledge and Awareness Among Spanish Dental Students

Human papillomavirus (HPV) infections are responsible for a significant part of the global burden of cancer. Epidemiologic studies have shown increasing trends of HPV-related oral cancers worldwide. Dental professionals need comprehensive up-to-date HPV-related information to be able to provide correct advice to their patients. The aim of this paper is to describe knowledge and awareness levels of dental students from Spain on HPV infection, HPV vaccination, oral cancer prevention, and HPV-related oropharyngeal cancer. A survey was distributed to 240 dental students, of which 158 returned it. Most students reported not been vaccinated against HPV (n = 81, 51.3%) and believed that HPV infection was linked to oropharyngeal cancer (75%). Overall, advanced students showed better knowledge, attitudes, and perceptions regarding this issue while novice students showed relevant shortcomings. However, their attitudes in relation to the diagnosis of oral cancer were adequate. These results suggest that there are important HPV-related knowledge deficits among Spanish dental students, which hinders their interventions in oropharyngeal primary prevention efforts. Findings of this study suggest the inclusion and standardization of HPV-related educational information to the dental curriculum.

Dental students' awareness and attitudes toward HPV-related oral cancer: a cross sectional study at the University of Jordan

BACKGROUND

The incidence of human papilloma virus (HPV)-related oral cancer has recently increased worldwide. The role of dentists is of prime importance in the early detection of oral cancer which would result in a favourable outcome for the patients. The aim of the current study was to assess the knowledge, awareness and attitudes of dental students, interns and postgraduate maxillofacial residents at the University of Jordan (UJ) to different aspects of oral cancer, particularly those related to HPV.

METHODS

A paper-based survey was conducted at UJ among all pre-clinical dental students (pre-clinical group), clinical dental students, interns and postgraduate maxillofacial residents (clinical group). The survey included five sections comprising 29 items. The sections included questions investigating oral cancer knowledge, oral cancer screening, HPV knowledge and the ability to discuss personal topics with patients.

RESULTS

A total of 376 respondents out of 1052 potential participants completed at least one item of the survey (study coverage of 35.7%). Among the study participants, the pre-clinical group represented 41.2% (n = 155) and the clinical group represented 58.8% (n = 221). The majority of participants in the clinical group showed better knowledge on oral cancer potential anatomic sites, clinical presentation and possible risk factors compared to the pre-clinical group. Most participants in the clinical group (n = 195, 88.2%) correctly identified HPV as a risk factor for oral cancer development. The majority of participants in the clinical group displayed suitable attitude towards oral cancer screening despite their desire for a reliable screening device and additional training in oral cancer screening. A number of limitations in basic knowledge about HPV was noticed among participants in the clinical group particularly related to unawareness of the vaccine availability. The majority of participants in the clinical group displayed hesitancy in discussing personal topics with the patients, including the history of previous sexually transmitted infections and sexual abuse.

CONCLUSIONS

Gaps in knowledge regarding HPV-related oral cancer has been detected which necessitate intervention measures including curricular changes, training workshops and awareness campaigns.

Knowledge and Practice of Oral Cancer Screening in Teaching Faculty-Comparison of Specialty and Year of Clinical Experience

The purpose of this study was to assess the knowledge, practice, confidence, and perceived barriers to oral cancer screening among teaching faculty in Japan. Results were compared by specialist as well as years of clinical experience. A 25-question survey was used to assess the oral cancer screening practices of faculty dentists at Iwate Medical University, School of Dental Medicine, the only dental school located in the northeast (Tohoku) region of Japan. The study was approved by the Institutional Review Board of Iwate Medical University. The response rate was 83% (n = 110, 71.8% were male). This survey revealed that only 43.6% of the dentists performed oral cancer screening frequently (always or usually) at the initial appointment, and there was no significant differences between specialists and clinical experience. Visual inspection of the oral cavity was the primary screening method, but the frequency and content of the examination (TMJ and tonsil) was significantly different between specialties. A history of cancer and tobacco use motivated providers to perform an examination and was significantly different between various specialists and clinically experienced providers. In contrast, HPV and alcohol consumption were a weak motivator. The confidence level of providers on their examination knowledge/skills was poor, especially among junior faculty. More than 80% of junior faculty indicated a lack of knowledge/skills as a major barrier.

The prevalence and genotyping of human papillomavirus in patients with oral tumors in health centers and clinics of Mazandaran in Iran

Oral cancer is one of the most prevalent cancers in the world which contains many kinds of malignant neoplasms in the oral cavity. Due to the carcinogenicity of human papillomavirus (HPV) and its prevalence in cancer, including the oral cancer, this study was aimed at investigate the prevalence of HPV and its genotypes in patients suffering from oral tumors using PCR method. In this study, 83 samples of oral lesions were collected in the form of paraffin-embedded tissue. After extracting the DNA using DNA extraction kits, high-risk HPV positive samples were examined using special kits for genotyping, and low-risk types were sequenced after nested PCR. The results showed that 13.2% of samples was HPV positive. The result of PCR using genotyping kit indicated that high-risk types of 18, 31, 16, and 33 appeared in samples with prevalence rate of 27.2, 18.1, 9.09 and 9.09%, respectively. In this manner, the result of sequence indicated that the prevalence of HPV-6 genotype was 36.3% in the samples. The results of this study indicated that both low-risk and high-risk types of HPV are associated with the risk of oral tumors, so that Types 6 and 18 were reported as the most prevalent types in the samples.

Are dental providers the next line of HPV-related prevention? Providers' perceived role and needs

The rise in HPV-related oropharyngeal cancer incidence necessitates novel prevention efforts including multiple provider types. Although dental providers screen for HPV-related oropharyngeal cancers, little is known about their needs to advance “primordial prevention,” or interventions at the earliest possible stage, to prevent HPV-related cancers. This study assessed dentists' and dental hygienists’ perceived roles and needs regarding HPV-related primordial prevention.

We conducted a mixed-method study with data from focus groups with dentists (n= 33) and dental hygienists (n= 48) and surveys from both provider types (n= 203) among providers from a diverse set of practice settings and geographic communities. Data were analyzed using qualitative thematic analysis and chi square tests.

Participants affirmed dental professionals’ roles in preventing HPV-related cancers and identified needs to overcome barriers to fulfilling prevention objectives. Barriers included: (1) practice environment and patient characteristics, and (2) the sensitive topic of HPV. Further, participants identified needs to improve HPV-related cancer prevention.

Findings from this study suggest that dental providers may become the next line of prevention for HPV-related cancers. Dental providers’ professional associations have provided guidance on HPV and oropharyngeal cancers, but our study reveals dental providers’ needs for following professional organizations’ guidance to advance prevention efforts and reduce HPV-related cancer incidence.