Knowledge and attitudes of oral health students and professionals related to HPV-related oropharyngeal cancer and selected oral mucosal lesions

Infection with a high-risk type of the human papillomavirus (HPV) is associated with an increasing percentage of oropharyngeal squamous cell carcinoma (OPSCC). Therefore, sufficient knowledge of HPV among oral healthcare professionals is becoming increasingly important. In chapter 2, 3 and 4 we identified specific deficits in HPV-related knowledge. This is concerning as HPV-related OPSCC are generally present in younger patients and classical risk factors are lacking. Therefore, OPSCC may be less well recognized in these patients. Oral healthcare professionals considered counseling patients about HPV as a risk factor for OPSCC as important but were more reluctant about discussing HPV vaccination with patients. They reported barriers such as a lack of knowledge and the sensitive aspect of sexual transmission of the virus. Furthermore, it was reported that it is not the responsibility of the oral healthcare professionals to inform patients about this topic. Results of chapters 2, 3 and 4 showed that oral health professionals did not feel confident about their head and neck cancer examination skills. Dentists reported a relatively low level of confidence in performing a visual inspection and palpation of the head and neck region. Levels of confidence reported by oral health students were comparable, however, dental students reported to be slightly more confident than dental hygiene students. Although visual examination of the oropharyngeal region is not possible, oral health professionals could be aware of symptoms of OPSCC during examination of the head and neck region. Sufficient knowledge of head and neck cancer among oral health providers is relevant for diagnosing potentially malignant diseases and oral cancer at an early stage. Lack of confidence in head and neck cancer examination and deficits in knowledge among oral healthcare professionals might contribute to a delay in diagnosis. The content of head and neck cancer education of dental curricula might not be sufficient to fully prepare dentists for early detection and prevention of head and neck cancer. Therefore, the objective of chapter 5 was to evaluate the content of head and neck cancer education in curricula of European dental schools. We found a wide variation in the content of these curricula. Regarding clinical examination, one-third of dental schools did not educate their students to examine the skin of the head and neck region for suspicious lesions and two-third did not include palpation of the neck region. Regarding theoretical content, sexual behaviour was identified as a risk factor by 69%, but only one third of curricula addressed counseling patients on this topic. This results in differences of specific knowledge and competences of graduating European dentists. In chapter 6, we aimed to explore dentists’ knowledge about selected oral mucosal lesions (OMLs). Results showed that dentists did not have sufficient knowledge to accurately diagnose some OMLs and to determine a correct management. This may result in over-referral of benign OMLs and under-referral for (potentially) malignant OMLs. Clinical guidelines, that include standardized criteria for referral, postgraduate education and adaptation of dental curricula may improve dentists’ ability to correctly diagnose and accurately manage OMLs.