Oral HPV has been recognized in causing infection in the oral cavity andoropharynx. It is identified as a sexually transmitted disease with more than40 subtypes 4. As it has beenpreviously reported that high-risk HPV are etiological agents for ano-genitaltract 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 cervicalcancer 1.4% 8.
Therefore, the prophylacticHPV vaccines have the potential to bring down the incidence of OSCC as well asother cancers 9, 10. The growing prevalence of HPV-positiveoropharyngeal cancer 11mainly 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 UnitedStates is 15,738persons with oropharyngeal SCCs; compared to 11,771 females with cervicalcarcinomas 7. Although the incidence rate is lowest in theMiddle East particularly among Muslims and Jews in contrast to sub SaharanAfrica, central and South America.
14, A study in theunited states estimated an increase of 225% in the incidence ofHPV-related oropharyngeal cancer. Which highlight the magnitude of screeningand vaccination as cervical cancer is decreasing due to pap smear. 15,13, and several other countries implicating HPV as an underlyingcause. 16,17. Dentists are considered the mostvisited physicians, therefore their role in screening and preventing HPVrelated OPC is important to the health care system 18,19. By thatknowing the knowledge of our students about HPV will help us establish a betterapproach to patients. A study conducted among Florida dentists measuring the willingness todiscuss HPV vaccine with their patients. Surprisingly the majority fell in thepre-contemplation (not discussing and not intending) stage 52%, followed bycontemplation stage (not discussing but willing to) 40%, and only 18% inmaintenance stage (discussing with all patients) 18.
Adding to that, twostudies showed dentistslack the skills to address such HPV related issues owing to the young age as abarrier or feeling discomfort in discussing HPV topics and there was variation upon the roleof physician in discussing HPV knowledge and vaccine with patients 20,21. There isa lack in literature about the knowledge of HPV among dental students; fourstudies conducted in Florida, Malaysia, Texas, and Netherlandspointing a defectin the dental community regarding the knowledge of HPV and the need toimplicate educational material 9,22,23,24.Another, study inSaudi Arabia highlighted the magnitude of dental students still not knowing HPVis in the rise for OPC, the majority identified smoking 90% and alcohol 87.3%,while HPV 84% as risk factors 25. Extensive studieshave been conducted to examine the attitude, acceptability and knowledgeof human papillomavirus (HPV) and HPV vaccine among college students. In general, the majority exhibited low levels ofknowledge 26,27,28, particularly males29,30 withlower educational level 30. Nevertheless,student status showed higher acceptability(7-fold) in receiving the vaccination, but the strongest predictor with anincrease of 93-fold was the physician’s recommendation 31. In addition to that, a study conducted in Riyadh where a culturallyappropriated survey was administered to young women to determine the awarenessand attitude of HPV.
It showed a significantly low awareness of HPV infection34.5%, 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 SaudiArabia have shown lower HPV knowledge, screening, and vaccination awareness amongwomen attending routine examination 32.2% (101/314) as well as healthcareprofessionals.
Nevertheless, 89.9% (285/317) showed an interest in HPVvaccination 28. Acceptance of the HPVvaccine might be influenced by variable factors or barriers. Several studieshave consistently suggested that the cost of the HPV vaccines is a majorbarrier 33,34,35,36,37 the uncertainty over the side effects of thevaccine 38,39,40,41 and the engagementof daughters in riskier sexual behavior after receiving the vaccination 42,43,44,45,46 .Apart from that, barriers to HPVvaccination reported by al-Shaikh et al of 1400 students in Health Colleges include worrisome side effects of the vaccine 51.9%, andfear of injection 26.
5%, whereas only 6.5% were concerned about the safety andthe efficiency of the vaccine, and 8.5% of students reported family refusal 47.
Additionally, Wong et al reported that 41.5% ofthose who refused perceived themselves as not at risk of HPV infection and11.3% felt embarrassed about receiving an STI vaccine 48.Different studies measure thevaccine acceptability, where the intention to HPV vaccination was 66.2%, 64% in Saudi Arabia, while the twostudies in Malaysia were 48%, 80.3% 32,9,48,26.
The purpose of this study is to determineundergraduate dental students’ knowledge level toward HPV, HPV-relatedoropharyngeal cancer, and vaccination; in terms of their attitudes, acceptance,and knowledge. As dental students are considered the future health careproviders who can help in increasing the awareness of the public and to promote HPV vaccination among their patients.