How to talk to patients about HPV vaccine

Dentists can play vital role in addressing vaccine hesitancy, increasing uptake

Dentists can play a vital role in educating their patients about the HPV vaccine, addressing vaccine hesitancy and increasing its uptake.

“Dental professionals have a unique opportunity to decrease vaccine hesitancy by offering supportive and trusting relationships with their patients,” said Rosie Wagner, D.D.S., a general dentist with a private practice in Massachusetts and the founder of the National Organization for Dental Immunizers, a community of dental, medical and public health professionals that supports vaccinations in the dental setting. “People tend to see their dentist and hygienist more frequently than their physicians and may go to two or more preventive care visits, along with procedural visits, throughout the year, offering several opportunities to have discussions.”

The American Dental Association 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. Dentists are authorized to administer vaccines in certain states.

The Centers for Disease Control and Prevention estimates 60%-70% of oropharyngeal cancers in the U.S. are caused by HPV, with more than 15,000 new cases of oropharyngeal cancer likely caused by HPV reported each year. In June 2020, the Food and Drug Administration added prevention of oropharyngeal and other head and neck cancers to the list of indications for the HPV vaccine.

Current versions of the HPV vaccine protect against the nine major strains known to cause cancer in people, according to the CDC, which recommends vaccination for both girls and boys starting at 11-12 years old and adults through age 26.

Despite its benefits, there is still significant hesitancy about getting the vaccine, Dr. Wagner said.

“It is more effective to have a supportive, casual and friendly conversation recommending a vaccine than to discuss reasons for hesitancy,” she said. “Patients want to know that they have autonomy over their own health care and that any concerns are heard and validated. When they make an informed decision, they want to know that it will be a safe and effective one for their health. A recommendation from a provider that they already know and trust goes a long way.”

Dr. Wagner offers the following recommendations to help dentists talk about the HPV vaccine with their patients:

• Start with a question on vaccines as a routine part of obtaining patients’ medical histories. The question on the form could be something like: "Are you up to date on all of your vaccines, including HPV?" This can create the opportunity for a discussion. When going through medical histories verbally, the dentist or hygienist may ask, "Do you know if you are current on all of your vaccines,” "Have you had your HPV vaccine to prevent throat cancer,” or "I noticed that your child has not started their cancer prevention HPV vaccination series. Should we give them their first dose today (if applicable in your state), or can I refer them back to their pediatrician?" 

• When the conversation is opened, it is not necessary to discuss HPV transmission, particularly since the only way to prevent infection is through vaccination. The virus is transmitted despite the use of safer sex practices, which means people who use condoms and who do not have intercourse can still transmit HPV.

• Keep it brief with no more than a few sentences: "HPV is a virus that almost everyone has at some point. Some of the strains can cause cancers in several parts of the body, and there's a vaccine that prevents these cancers and works really well. I can refer you to your doctor or pharmacist to get the vaccine, or we can offer it here (if applicable)” or "Getting a vaccine against this virus will prevent cancer for your child when they are older."

• Educate yourself and your team on HPV-related cancers: HPV causes oropharyngeal cancer, rather than oral cancer, and most of the lesions are not visible during a clinical examination. The cancer tends to be found in the pharynx, tonsillar area, base of the tongue and larynx.

• Educate patients on the symptoms of oropharyngeal cancers. Ask patients if they’ve had any difficulty swallowing, a sore throat on one side that doesn't go away, or a feeling of fullness in their throat or tongue. These questions can be asked while you are already leaning the chair back to perform an examination and oral cancer screening and don't require a lot of extra time for the appointment.

• Have literature posted in the waiting room or treatment areas that can educate both patients and providers. There are resources available on the ADA’s Oral Health Topics webpage on head and neck cancer.

• If you feel comfortable, you can share that you and your children have received the HPV vaccine. This personal recommendation can go a long way in reassuring a patient about the vaccine’s safety and efficacy and is often more meaningful than presenting data or literature.

For additional information and resources, visit the Oral Health Topics page at ADA.org. Dr. Wagner also explains how to safely and effectively administer vaccines in the dental office in the ADA online course Injecting Impact: The Emerging Role of Dental Professionals in Vaccine Delivery, available at ADAStore.org.