Oral health care professionals recommending and administering the HPV vaccine: Understanding the strengths and assessing the barriers

Abstract

Introduction: Head and neck cancer is a deadly cancer that ranks among the six most common cancers worldwide. The HPV vaccine has been used to prevent head and neck cancer of the oropharynx, and changes in health policies and state law are impacting the role of dental professionals in HPV vaccination. However, relatively little is known about dental professionals' attitudes regarding the vaccine.

Objectives: Our study assesses dental professionals' willingness to administer the HPV vaccine, their confidence discussing HPV with patients, beliefs about the vaccine's efficacy, perceived barriers to administering it, and sites of referral.

Methods: We surveyed 623 dental professionals, including dentists, hygienists, dental students, and hygiene students across Michigan. Attitudes toward the vaccine and predictive characteristics were evaluated by logistic regression, ANOVAs, and t-tests.

Results: The majority of the respondents (51% of dentists, 63% of hygienists, 82% of dental students, and 71% of hygiene students) were willing to administer the HPV vaccine if allowed by law. The role of dental and dental hygiene students would be one of advocacy, educating and recommending the vaccine, and the dental students administering it once licensed. Dental professionals were variably confident discussing HPV with patients and generally believed it enhanced patients' health. Stronger confidence and beliefs were associated with greater willingness to administer the vaccine. Barriers among professionals opposing the HPV vaccine included lack of knowledge on the subject, liability concerns, and personal beliefs.

Conclusion: Dental professionals can become leaders in preventing HPV-related cancers. Training and continuing education courses could enhance their confidence and willingness to recommend and administer the HPV vaccine.

Policy implications: Legislation that permits dental professionals to administer the vaccine could increase the vaccine's accessibility to patients, improve vaccination rates, and population health.

Fig 1. Most dental professionals are willing to administer the HPV vaccine.

(A) Willingness of dental professionals across Michigan to administer the HPV vaccine if allowed by law (n = 623). Rates vary by professional role, as shown by a Chi-squared test of independence (**P<0.01). (B) Willingness among dentists, compared by gender, years in the profession (±25), and having taken a class on HPV infection (n = 140 registered dentists’ responses; graduate students excluded). (C) Similarly, as in (B), for registered dental hygienists. All values are percentages. N-values for each analysis are shown. P-values for Chi-squared tests or Fisher’s tests, as appropriate, are given. Note that participation in previous educational classes about HPV correlates with the oral health care professional’s willingness to administer the vaccine.

Fig 2. Dental professionals are variably confident in discussing HPV infection with their patients.

(A) Confidence of dental professionals to discuss HPV infection with their patients. For this analysis, a Likert scale of confidence, ranging from completely uncertain to completely confident, was converted to a 1–5 scale. Means ± standard deviations are shown and were compared by one-way ANOVA (n = 619 respondents; P = 0.30). (B) Confidence among each professional role, analyzed by having taken a previous class on HPV infection or not (n = 140, 89, 241, and 148, respectively). (C) Confidence of licensed professionals, analyzed by years in practice (n = 112 and 84, respectively; graduate students excluded). For (B) and (C), means ± standard deviations are shown and were compared within each professional role by Welch’s two-sample t-tests, pairwise. Note that participation in previous educational classes is significantly associated with higher confidence of most oral health care professionals to talk about HPV with patients.

Fig 3. Dental professionals believe that the HPV vaccine enhances the health of patients.

(A) Agreement that the HPV vaccine improves the health of patients. These analyses used a Likert scale level of agreement, from completely agree to completely disagree, converted to a 1–5 scale. Means ± standard deviations are shown and were compared by one-way ANOVA (n = 623 professionals surveyed; **P<0.01). Significant Tukey’s post-hoc comparisons are shown; non-significant comparisons are excluded. (B) Agreement among each professional role, analyzed by having taken a previous class on HPV infection or not (n = 140, 89, 241, and 148, respectively). (C) Agreement of dental professionals, analyzed by years in practice (n = 112 and 86, respectively; graduate students excluded). For (B) and (C), means ± standard deviations are shown and were compared within each professional role by Welch’s two-sample t-tests, pairwise.

Fig 4. Barriers to administering the HPV vaccine for dental professionals and sites of referral.

Ninety-four professionals were unwilling to administer the HPV vaccine and 95 were uncertain. (A) Among them, counts and percentages for reasons that these professionals were unwilling or uncertain. *These reasons were written in by participants in the "Other" field. (B) Percentages of all survey respondents who were willing to refer their patients to the indicated HPV vaccination site. Percentages were determined using the total number of respondents (n = 623).

Fig 5. Additional attitudes of dental professionals about the HPV vaccine.

(A) Likelihood of considering administration of the HPV vaccine if given adequate insurance reimbursement (n = 620). Note that dental professionals generally agree that they’re likelier to administer the vaccine if reimbursed by insurance. (B) Likelihood of enrolling in a future class on HPV infection (n = 619). For (A) and (B), respondents indicated likelihood along a Likert scale ranging from very unlikely to very likely, which was converted to a 1–5 scale. Means ± standard deviations are shown and were compared by one-way ANOVA (**P<0.01 for A and B). Significant Tukey’s post-hoc comparisons are shown; non-significant comparisons are excluded. (C) Awareness of dental professionals that some states allow dentists to administer vaccines. All values are percentages.