Knowledge of Human Papilloma Virus among Female Dentists in Jakarta, Indonesia

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Journal of International Dental and Medical Research ISSN 1309-100X Knowledge of Human Papiloma Virus
http://www.ektodermaldisplazi.com/journal.htm Pudji H. et al.
Volume ∙ 10 ∙ Special Issue ∙ 2017
Page 663
Knowledge of Human Papilloma Virus among Female Dentists in Jakarta, Indonesia
Pudji Handayani1, Harum Sasanti Yudoyono2, Indriasti Indah Wardhany2,
Yuniardini Septorini Wimardhani2,3,4*
1. Oral Medicine Residency Program, Faculty of Dentistry, Universitas Indonesia.
2. Department of Oral Medicine, Faculty of Dentistry, Universitas Indonesia.
3. Cluster of Clinical and Epidemiology and Clinical Studies in Dentistry, Faculty of Dentistry, Universitas Indonesia.
4. Center of Ageing Studies Universitas Indonesia.
Abstract
Human papilloma virus (HPV), especially types 16 and 18, is thought to increase the risk of head
and neck cancer. Although sexual intercourse is still the main mode of transmission, direct contact
with body fluids has been reported as a mode of HPV transmission. Since HPV16 and 18 can be
found in saliva, knowledge among female dentists about the risk of HPV needs to be evaluated.
The aim of this study was to assess the general knowledge of HPV among female dentists in
Jakarta. A cross sectional study was conducted on 156 female dentists at the Faculty of Dentistry,
Universitas Indonesia using a 10-item questionnaire about HPV. 152 questionnaires (98%) were
completely filled out and analyzed. The median age of the respondents was 29 (min:25–max:44)
and the median score was 7 (min:3–max:10). In this study, 99.3% of respondents had heard about
HPV and 94.1% knew that HPV could cause cervical cancer. Only 46.7% knew that HPV can be
detected in saliva. Additional sources of HPV information need to be given to increase HPV
awareness among dentists.
Clinical article (J Int Dent Med Res 2017; 10(Special Issue): pp. 663-667)
Keywords: Human papillomavirus; knowledge; head and neck cancers, dentist.
Received date: 16 August 2017 Accept date: 18 September 2017
Introduction
High Risk Human Papillomavirus (HR-
HPV) is known to cause cervical cancer and is
also suggested to cause anogenital cancer
(cancers of the anus, vulva, vagina, and penis)
and head and neck cancers (commonly
oropharynx cancers).1,2 High Risk Human
Papillomavirus types 16 and 18 are responsible
for most HPV-associated oropharyngeal cancer.
They also increasing the severity of
oropharyngeal cancers triggered by cigarettes
and alcohol.3,4
Based on previous studies, HPV 16 and
18 were detected not only in the patients’ saliva
of the head and cancers but also in healthy
individuals.5–7 The HPV types 16 and 18 in saliva
were considered as an occupational hazard for
dentists due to frequent contact with patients’
saliva.8
Therefore, the implementation of hand
hygiene, self-protective equipment, such as
gloves, masks, and goggles, are commonly used
to avoid the transmission of infectious agents
from patients’ saliva to dentists.9
Since the self-protective equipment is
used daily in the dental practice, we conducted
this study to determine the level of dentists’
knowledge about the risks of HPV transmission
from patients saliva.
Methods
Respondents in this study were female
residents of the Faculty of Dentistry, Universitas
Indonesia (UI). The residents were
undergraduates from different dental schools
who were attending one of the seven specialist
departments in the Faculty of Dentistry, UI. The
respondents werealso been practicing at the
Dental Hospital Faculty of Dentistry, UI.
*Corresponding author:
Yuniardini Septorini Wimardhani
Department of Oral Medicine
Faculty of Dentistry, Universitas Indonesia
E-mail: yuniardini@ui.ac.id

Journal of International Dental and Medical Research ISSN 1309-100X Knowledge of Human Papiloma Virus
http://www.ektodermaldisplazi.com/journal.htm Pudji H. et al.
Volume ∙ 10 ∙ Special Issue ∙ 2017
Page 664
A cross sectional study was conducted
among all 156 respondents. The data were
collected using a self-administered questionnaire
consisting often statements about knowledge of
HPV. The face validity of the questionnaire was
rated by sixteen repondents and the
questionnaire were revised as a result of their
comments.
Statements in the questionnaire were
answered with “Yes” or “No”. Each correct
answer scored 1 and each wrong answer scored
0. All the statements in the questionnaire had to
be answered. The final score was determined by
adding all the scores for each questions.
Results
From a total of 156 residents, 155
respondents returned the questionnaire
(response rate 97.4%). One respondent from the
Oral and Maxillofacial Surgery could not join this
research due to semester break. The history of
HPV vaccination was done by 82 respondents
(52.9%)
Table 1. Distribution of Specialties of the
Respondents.
Departments
Total Potential
Respondents
Total Actual
Respondents
N(%)
n(%)
156(100)
155(100)
Conservation Dentistry
30(19.2)
30(19.3)
Oral and Maxillofacial
Surgery
16(10.2)
15(9.6)
Oral Medicine
13(8.3)
13(8.3)
Orthodontics
30(19.2)
30(19.3)
Paediatric Dentistry
32(20.5)
32(20.6)
Periodontics
11(7.1)
11(7.1)
Prosthodontics
24(15.4)
24(15.5)
Of the 155 respondents, only 152 (98.0%)
fully completed the questionnaire. Their
responses were analyzed statistically using
Microsoft Excel 2003 and SPSS version 23.0
softwares. The descriptive data of respondents’
ages were analyzed for normality using the
Kolmogorov – Smirnovtest. The youngest
respondent was 25 years old, the oldest was 44
yearsold, and the median age was 29 years (min:
25– max: 44).
Table 2. Socio demographic profile of the
Respondents (n=152)*
Variable
Total
%
Median
(Min–Max)
Age (Years)
21–30
89
58.6
31–40
60
39.5
29 (25–44)
41–50
3
2.0
Marital Status
Single
59
38.8
Married
90
59.2
Divorced/Widowed
3
1.9
Dental Undergraduate Institution
Universitas Airlangga
12
7.9
Universitas Gadjah Mada
5
3.3
Universitas Hang Tuah
1
0.6
Universitas Hasanuddin
1
0.6
Universitas Indonesia
89
56.6
Universitas Jember
2
1.3
Universitas Prof. Dr. Moestopo
5
3.3
Universitas Padjadjaran
16
10.5
Universitas Sumatera Utara
4
2.6
Universitas Trisakti
18
11.8
Answer not available
2
1.3
*From 155 questionnaire, 152 questionnaire were
completely filled. This descriptive data were taken from 152
respondents who filled the questionnaire completely.
Table 3. HPV Knowledge of the Respondents.
Respondents
%
Heard about HPV
information
151
99.3
Sources of HPV
information:
Lectures
77
50.6
Health articles
76
50.0
HPV transmission via
sexual intercourse
138
90.8
HPV vaccination to
prevent transmission
136
89.5
HR-HPV as the cause of
cervical cancer
102
67.1
From the results of the questionnaire, we
obtained10 as the highest score and 3 as the
lowest score, with a median of 7 (min: 3–max:
10).

Journal of International Dental and Medical Research ISSN 1309-100X Knowledge of Human Papiloma Virus
http://www.ektodermaldisplazi.com/journal.htm Pudji H. et al.
Volume ∙ 10 ∙ Special Issue ∙ 2017
Page 665
Table 4.HPV Opinions of the Respondents
No.
Statements
Expected
answer
Correct answer
Total
%
1
HPV can cause cervical cancer.
Yes
143
94.1
2
HPV can cause oral cancer.
Yes
78
51.3
3
HPV can exist in the saliva.
Yes
71
46.7
4
Vaccination is best injected before the first sexual
intercourse.
Yes
142
93.4
5
HPV vaccination should be done after marriage.
No
116
76.3
6
Vaccination is best administered after being infected by
HPV.
No
142
93.4
7
Vaccination is best administered when having sex with
multiple partners.
Yes
104
68.4
8
Women are recommended with HPV vaccination.
Yes
151
99.3
9
Men are recommended with HPV vaccination.
Yes
68
44.7
10
Providing information about head and neck cancer to
patients.
Yes
25
16.4
Discussion
Variations in residents’ specializations
may play an important role regarding the HPV
knowledge result. Only 17.9% of the residents
(those from the Oral Surgery and Oral Medicine
departments) had a thorough theoretical
grounding in HPV-induced oral cancers. A
previous study shows that people with previous
self-experience, familiy or friends’ history of HPV
infection seek information on HPV.10 In our study,
the residents of the Oral Surgery and Oral
Medicine departments appeared to have seen
manifestations of HPV lesions in basic daily
practice. For this reason, this groups of residents
learn HPV infection thoroughly. The others were
therefore not interested in seeking more
information about HPV, and this probably
accounts for the similar results in both studies.
In our study, 99.3% of respondents had
previously heard about HPV. This result is
similiar to the study of Onowhakpor et al., in
which more than half of the respondents had
previously heard about HPV.11 This similarity
may be due to the fact that the respondents in
both studies had medical backgrounds (medical
and dental students participated in the previous
study). The respondents in both studies received
information about HPV from medical lectures
(50.6% in the present study and 78.7% in the
study of Onowhakpor et al.).
Our study is contrary to the study of Khan
et al., in which 57% of respondents had
previously heard about HPV.12
This is because their study surveyed
non-medical students who had not received HPV
lectures as part of their curriculum of study.
Sexual intercourse as the main mode of
HPV transmission was known by 90.8% of
respondents. This result differs from the study of
Mehta et al., in which only 38% of respondents
knew about sexual intercourse as the main mode
HPV transmission.13 This discrepancy might be
due to differentation of the HPV vaccine
awareness level. From Mehta et al. study, it was
suggested that the respondents think that HPV
infection usually without any symptoms and the
infection healed by itself without treatment.13
In our study, 41.3% of respondents had
received HPV vaccination as a premarital
preparation. This is why 76.3% disagreed with
the statement“ HPV vaccination should be done
after marriage”. This supports the claim that the
respondents inour study knew that sexual
intercourseis the main cause of HPV
transmission. That is also the reason why 93.4%
of respondents in this study agreed that
vaccination should be carried out before first
sexual intercourse. It is known that Indonesian
culture does not allow sexual intercourse before
marriage.
From the explanation above, it appears
that our respondents knew about vaccination to
prevent HPV (89.5%), although only 67.1% knew
HR-HPV as causative of cervical cancer. The
statement “HPV can cause cervical cancer” was

Journal of International Dental and Medical Research ISSN 1309-100X Knowledge of Human Papiloma Virus
http://www.ektodermaldisplazi.com/journal.htm Pudji H. et al.
Volume ∙ 10 ∙ Special Issue ∙ 2017
Page 666
answer correctly by 94.1% of respondents. This
is due to the HPV lecture in the medical
curriculum.In the study of Mehta et al., the
percentage was even higher (96%).13
Only 51.3% of respondents knew that
HPV can cause oral cancer. This is because
some respondents had limited access to the
latest information about HPV. We know that
research into HPV started just a few decades
ago. Our study contradicts the study of Osazuwa
and Tutlam, which found that 63% of
respondents knew about the relationship
between HPV and oral cancer. That study
involved non-medical students, but the
respondents’ sexual behaviour induced them to
seek information about the relationship between
sexual behaviour and oral cancer. Their sexual
behaviour can be seen from their descriptive
data: 86% of respondents had previously had
sexual contact, but only 13% were already
married.14
Low awareness about HPV-associated
oral cancer was seen in the statement “HPV can
exist in the saliva”, answered correctly by 46.7%
of respondents. It is possible that the
respondents obtained this information from
reading the informed consent sheets provided to
the respondents before joinning this study. It
seems that HPV vaccination was known only for
women. In our study, 99.3% of respondents
agreed that HPV vaccination was
recommendedfor women, but only 44.7% of
respondents agreed that HPV vaccination was
recommended for men.
The indications of HPV vaccination is
also for the bisexual people.15,16 The statements
of Vaccination is best administered when having
sexual intercourse with multiple partners is
answered correctly by 68.4% of respondents.
Since HPV infection was transmitted via sexual
intercourse, it was suggested that the HPV
vaccination was done before the infection itself.
The statement about HPV vaccination is best
administered after being infected by HPV was
disagree by 93.4% of respondents.
Poor oral cancer awareness can also be
seen from the statement “Providing information
about head and neck cancer to patients (Yes)”,
which was answered correctly by only 16.4% of
respondents. This result shows that information
about oral cancer has not been delivered
properly by dentists in accordance with their
professional obligation. This is evident from the
statement “HPV can cause oral cancer (Yes)”,
which was answered correctly by only 51.3% of
respondents.
Conclusion
It is important to have a good knowledge
of HPV in order to be aware about its possibility
transmission via patients’ saliva, to educate
patients about the role of HPV in several types of
oral lesions and in HPV-associated head and
neck cancers. Knowledge of HPV could be
gathered from the dental curriculum or from
regular seminars held by the Dental Hospital for
increasing HPV awareness.
Acknowledgment
This research was funded by Direktorat
Riset dan Pengabdian Masyaratkat (DRPM),
Universitas Indonesia, Contract Number:
1959/UN2.R12/HKP.05.00/2016. We would like
to acknowledge the Managers of the Dental
Hospital, Faculty of Dentistry, Universitas
Indonesia for providing the location for the
research.
The publication of this manuscript is
supported by Universitas Indonesia.
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