January JADA examines barriers to HPV-related discussions in dental settings

Guidelines, policies could help encourage conversations


A study published in the January issue of The Journal of the American Dental Association found conversations about human papillomavirus vaccination are infrequent in oral health care settings, although they could potentially contribute to the prevention of HPV-related oropharyngeal cancers.

The cover story — "Could Oral Health Care Professionals Help Increase Human Papillomavirus Vaccination Rates by Engaging Patients in Discussions?" — looked at 24 studies to evaluate oral health care providers’ knowledge related to HPV and their discussions with patients about HPV infection, associated risks and vaccination. The study also looked at barriers and facilitators of providers' knowledge and discussions.

"The value of an effective health care provider recommendation in vaccination uptake, including HPV vaccination, is well established, yet there is less research on oral health care professionals as advocates for HPV vaccination," the authors said in the study. "Although dental organizations such as the American Dental Association and the American Academy of Pediatric Dentistry support vaccination against HPV, oral health care professionals are generally not involved in the vaccination process because of legislative constraints, and, as a result, may not receive adequate support and training to engage patients in conversations about HPV vaccination."

The researchers found knowledge among oral health care professionals and students about the prevalence of HPV infection,modes of transmission, oral screening procedures, and the association between HPV infection and oropharyngeal cancer varied across studies. The studies also highlighted a general lack of knowledge about the HPV vaccine, as well as misinformation about risks and adverse effects associated with it.

HPV-related discussions between oral health care professionals and patients during routine dental appointments were often brief because of time constraints, and providers reported they were hesitant to initiate conversations about patients’ sexual behaviors, although they were more comfortable in patient-led HPV discussions. Conversations about the link between oropharyngeal cancer and HPV were most likely to occur during oral cancer screenings.

Some providers said they speak about and encourage HPV vaccination with their patients as it relates to prevention, but this varied across studies.

"Insufficient knowledge as well as a lack of skills and training specifically related to discussion and communication of HPV-associated prevention, risks, and outcomes was a common barrier," the authors said. "Discomfort in initiating a sensitive conversation about HPV was frequently mentioned as a primary barrier as well as uncertainty across specific oral health care provider roles. Moreover, a demand for cancer screening guidelines, standardized best practices, and policies from dental associations were requested to help overcome some of these challenges."

The ADA adopted a policy in 2018 that urges dentists to support the use and administration of the HPV vaccine, recognizing it as a way to help prevent infection of the types of HPV associated with oropharyngeal cancer. The policy was the result of a proposal that included input from the ADA's Council on Advocacy for Access and Prevention, Council on Dental Practice and Council on Scientific Affairs. An HPV workgroup led by ADA volunteers developed an evidence-based background report to help write the policy.

The Centers for Disease Control and Prevention estimates 70% of oropharyngeal cancers in the U.S. may be linked to HPV. In June 2020, the U.S. Food and Drug Administration added prevention of oropharyngeal and other head and neck cancers to the list of indications for the HPV vaccine.

Other articles in the January issue of JADA discuss improvements in digital image quality , digital versus conventional complete dentures and the risk of prosthetic joint infections .

Every month, JADA articles are published online at in advance of the print publication.

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