Oral cancer [6]. Moreover, Oropharyngeal cancer is increasing

Oral HPV has been recognized in causing infection in the oral cavity and
oropharynx. It is identified as a sexually transmitted disease with more than
40 subtypes 4. As it has been
previously reported that high-risk HPV are etiological agents for ano-genital
tract cancers, and likely a subset of head and neck squamous cell carcinomas 5. HPV plays a causal role in some oropharyngeal squamous cell carcinomas
(OSCC) with 70% among other risk factors 6,7. In the US, HPV is detected in two-thirds of oropharyngeal cancer 6. Moreover, Oropharyngeal cancer is increasing in our country with 2.4% incidence compared with cervical
cancer 1.4% 8. Therefore, the prophylactic
HPV vaccines have the potential to bring down the incidence of OSCC as well as
other cancers 9, 10.  The growing prevalence of HPV-positive
oropharyngeal cancer 11
mainly HPV-related 16 and 18 that are linked with cervical cancer 12, is becoming a major concern of oral care. Where the incidence in the United
States is 15,738
persons with oropharyngeal SCCs; compared to 11,771 females with cervical
carcinomas 7. Although the incidence rate is lowest in the
Middle East particularly among Muslims and Jews in contrast to sub Saharan
Africa, central and South America. 14, A study in the
united states estimated an increase of 225% in the incidence of
HPV-related oropharyngeal cancer. Which highlight the magnitude of screening
and vaccination as cervical cancer is decreasing due to pap smear. 15,13, and several other countries implicating HPV as an underlying
cause. 16,17.


               Dentists are considered the most
visited physicians, therefore their role in screening and preventing HPV
related OPC is important to the health care system 18,19. By that
knowing the knowledge of our students about HPV will help us establish a better
approach to patients. A study conducted among Florida dentists measuring the willingness to
discuss HPV vaccine with their patients. Surprisingly the majority fell in the
pre-contemplation (not discussing and not intending) stage 52%, followed by
contemplation stage (not discussing but willing to) 40%, and only 18% in
maintenance stage (discussing with all patients) 18. Adding to that, two

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showed dentists
lack the skills to address such HPV related issues owing to the young age as a
barrier or feeling discomfort in discussing HPV topics and there was variation upon the role
of physician in discussing HPV knowledge and vaccine with patients 20,21. There is
a lack in literature about the knowledge of HPV among dental students; four
studies conducted in Florida, Malaysia, Texas, and Netherlands
pointing a defect
in the dental community regarding the knowledge of HPV and the need to
implicate educational material 9,22,23,24.
Another, study in
Saudi Arabia highlighted the magnitude of dental students still not knowing HPV
is in the rise for OPC, the majority identified smoking 90% and alcohol 87.3%,
while HPV 84% as risk factors 25. Extensive studies
have been conducted to examine the attitude, acceptability and knowledge
of human papillomavirus (HPV) and HPV vaccine among college students. In general, the majority exhibited low levels of
knowledge 26,27,28, particularly males
29,30 with
lower educational level 30. Nevertheless,
student status showed higher acceptability
(7-fold) in receiving the vaccination, but the strongest predictor with an
increase of 93-fold was the physician’s recommendation 31. In addition to that, a study conducted in Riyadh where a culturally
appropriated survey was administered to young women to determine the awareness
and attitude of HPV. It showed a significantly low awareness of HPV infection
34.5%, while 65.5% never heard of it, the majority were non-Saudis. Hence, 64 %
showed positive attitude toward vaccines acceptability 32. Another cross-sectional study conducted in three hospitals in Saudi
Arabia have shown lower HPV knowledge, screening, and vaccination awareness among
women attending routine examination 32.2% (101/314) as well as healthcare
professionals. Nevertheless, 89.9% (285/317) showed an interest in HPV
vaccination 28.


          Acceptance of the HPV
vaccine might be influenced by variable factors or barriers. Several studies
have consistently suggested that the cost of the HPV vaccines is a major
barrier 33,34,35,36,37 the uncertainty over the side effects of the
vaccine 38,39,40,41 and the engagement
of daughters in riskier sexual behavior after receiving the vaccination 42,43,44,45,46 .Apart from that, barriers to HPV
vaccination reported by al-Shaikh et al of 1400 students in Health Colleges include worrisome side effects of the vaccine 51.9%, and
fear of injection 26.5%, whereas only 6.5% were concerned about the safety and
the efficiency of the vaccine, and 8.5% of students reported family refusal 47. Additionally, Wong et al reported that 41.5% of
those who refused perceived themselves as not at risk of HPV infection and
11.3% felt embarrassed about receiving an STI vaccine 48.
Different studies measure the
vaccine acceptability, where the intention to HPV vaccination was 66.2%, 64% in Saudi Arabia, while the two
studies in Malaysia were 48%, 80.3% 32,9,48,26.
The purpose of this study is to determine
undergraduate dental students’ knowledge level toward HPV, HPV-related
oropharyngeal cancer, and vaccination; in terms of their attitudes, acceptance,
and knowledge. As dental students are considered the future health care
providers who can help in increasing the awareness of the public and to promote HPV vaccination among their patients.