Since the incidence of HPV + OP-cancer is increasing, dentists, in collaboration with other healthcare professionals, could play a key role in HPV prevention by recommending HPV vaccination to patients and discussing HPV infection and links to OP-cancer [20, 29]. Dental students, as future healthcare professionals, must have an adequate level of knowledge, along with a positive attitude toward vaccination and effective communication skills, to address this need.
Knowledge
Among the 3 subitems analyzed, the highest percentage of correct answers concerned knowledge of the vaccine (74.3%), followed by the HPV + OP-cancer and infection items, with values of 67.0% and 66.9%, respectively. This finding indicates increased interest among students in vaccination and highlights the intertwined relationship between awareness of HPV infection and understanding of HPV + OP-cancer. Furthermore, enhancing this knowledge is essential for improving dental care providers’ role in HPV prevention and helping them discuss these topics with patients [24].
Almost all interviewed students were aware of the possibility that HPV caused OP and cervical cancer, but only approximately 50–60% knew that HPV caused anogenital cancer. This was certainly due to the higher prevalence of HPV + cervical and OP-cancer [8] and to the greater attention given to these cancers during the course of the studies. Therefore, awareness about the possibility of infection determining cancer in other anatomical sites should be implemented [30], strengthening knowledge in dental curricula. Statistically significant differences for all three subitems analyzed among students with different degrees were found, with higher percentages of correct responses from students enrolled in the last years of university agreeing with the published literature [31–34].
Additionally, statistically significant differences were found between the knowledge of the 1st and 2nd years and that of the 5th and 6th years. This is probably due to the information acquired by students during their 3rd and 4th years while attending various courses. Specifically, the infectious disease course equipped students with knowledge about HPV biology, the replication cycle, routes of infection, and HPV-associated diseases. In the dermatology course, both cutaneous and mucosal HPV-related benign lesions were identified. Furthermore, the oral pathology and head and neck pathology courses covered information on HPV + oropharyngeal cancer and vaccination.
Perception
Overall, the students showed good perceptions of their future role in combating HPV infection. In fact, 82.5% and 91.1% of participants agreed and strongly agreed, respectively, about the role of dentists in preventing infection and in educating patients on the link between HPV and OP-cancer. Additionally, 87.9% of respondents generally promoted vaccination in line with the published literature [31], which indicated that students were ready to debate it with their patients.
Although our sample demonstrated satisfactory knowledge of the 3 subitems, most of the students acquired more information on HPV + diseases during the attendance of the degree course, in agreement with Spanish, Dutch, Jordan and American students [31, 35–37]. These data demonstrated the students' perception of wanting to learn as much as possible on this topic to correctly implement primary prevention against this infection in their future profession [38]. Moreover, 2 out of the 3 students surveyed thought that patients’ parents were interested in prevention and would accept vaccination to prevent STIs and to avoid potentially carcinogenic infections, and when vaccination declined, they thought this was due to a lack of adequate knowledge of STIs. Parents’ knowledge and opinions about vaccines are among the main factors that influence the decision to vaccinate [39]. Consequently, health professionals must develop and reinforce communication strategies for addressing parental concerns about vaccines to help them in their decision-making [40–42]. In support of this, a study showed that 1 out of 5 parents agreed to vaccinate their sons against HPV after receiving a vaccine information sheet[43].
Furthermore, approximately 80% and 88% of the students agreed that the dentist has an important role in preventing HPV infection and should promote vaccination. Our results, coupled with those reported by Naavaal et al. in the American population [24], suggest that both future dentists and the general population are inclined to accept and integrate HPV prevention discussion into dental clinical practice.
Attitude
According to Wright’s results, more than 2 out of the 3 sampled students felt comfortable talking about HPV + cancers, infection and vaccination with patients and parents [36]. Only approximately 50% of participants were inclined to recommend the vaccine regardless of sex, with a statistically significant difference in favor of women. This showed that students still need to raise awareness of the role of the vaccine in men, which is important for increasing immunization coverage and reducing HPV + diseases [44]. For HPV + cancer, most students agreed that they would routinely carry out oral cancer screening on their patients, in accordance with a Spanish survey [35]. This result was promising if we considered that a positive attitude in discussions about patient and early diagnosis strategies by dental professionals, who have a good knowledge background, could have a direct helpful impact on OP-cancer patient survival [45].
Almost 90% of the students interviewed were inclined to periodically update their knowledge on HPV + diseases by attending education programs and reading scientific papers, according to Lingam et al. [46]. Therefore, educational training programs are necessary to achieve a better understanding of infection and its association with OP-cancer [37].
Statistically significant differences were found for perception and attitude in relation to both gender and graduation year attendance. Specifically, female students and students in their last years in a degree course demonstrated more positive attitudes and perceptions. For graduation year attendance, these results were expected considering that older students participated in internships and were more aware of the effects of HPV + diseases on patients' lives and that their perceptions and attitudes were supplemented by these internships.
Limitations
This study had limitations that should be considered. First, there is a potential risk of bias in the survey responses, as participants may have been inclined to respond according to the researcher's expectations, particularly in the Attitude section. Second, the nonmandatory nature of participation might have led to self-selection bias, with only the most knowledgeable students about HPV opting to participate. However, online surveys offer advantages over paper-based surveys, such as ensuring complete responses from participants, thus minimizing the risk of incomplete or inaccurate data that may arise from skipped questions.