Knowledge and Attitudes of Primary Health Care Dentists Regarding Oral Cancer in Brazil

Bridging the knowledge-Practice gap: Insights from a survey of Belgian dental professionals on diagnosis and supportive oral cancer treatment in comparison with international guidelines

OBJECTIVE

Early detection significantly improves the prognosis of oral cancer patients, contingent upon the knowledge of dental professionals. This study aimed to assess and compare the knowledge, practices and perceptions regarding oral cancer among dental professionals in Belgium.

MATERIALS AND METHODS

A cross-sectional survey was distributed via Qualtrics to general dentists, dental specialists, dental hygienists, and oral and maxillofacial surgeons. The self-administered questionnaire comprised three sections: demographics (4 questions), knowledge (9 questions) and clinical practices (19 questions) related to oral cancer detection and treatment. Descriptive statistics were employed for data analysis, with Chi-square tests assessing responses by specialization, gender, years of experience and number of oral cancer patients treated.

RESULTS

A total of 262 questionnaires were completed, with the majority of respondents being general dentists (61%) followed by dental specialists (25%), oral hygienists (8%) and oral and maxillofacial surgeons (6%). 70% of the respondents reported treating fewer than four oral cancer patients throughout their careers. 5 out of the 9 knowledge questions achieved over 50% correct responses, with an average correct answer rate of 54%. Oral and maxillofacial surgeons and dental professionals who have treated more than four oral cancer patients, demonstrated significantly higher scores on multiple knowledge questions. Responses to clinically oriented questions showed less diversity across professions, and generally aligning with guidelines from professional oncological societies.

CONCLUSION

This survey highlights the need for enhanced education on oral cancer among Belgian dental professionals. Knowledge levels were notably higher among more experienced respondents. The development and implementation of comprehensive guidelines tailored to dentists and oral hygienists for oral cancer prevention and patient care are warranted to optimize clinical practice standards.

How Much Do We Know about Oral Cancer?-An Online Survey

INTRODUCTION

Oral cancer (OC) is a disease with a high mortality rate due to its late recognition. Since the oral cavity is easily accessible for visual inspection, enabling early diagnosis, the education of healthcare workers about preventive oral examinations is critical. This research aimed to assess the level of participants' OC knowledge, as well as to raise awareness about this diagnosis.

MATERIALS AND METHODS

The research was conducted as an online survey among students of dental medicine, students of medicine, doctors of dental medicine and doctors of medicine. The questionnaire was designed solely for the purpose of this study and consisted of 29 questions. The first part of the questionnaire consisted of general questions about the participants, whereas the questions in the second part addressed their knowledge and attitudes towards OC.

RESULTS

The surveyed population comprised of 140 dental students, 105 medical students, 159 doctors of dental medicine and 100 medical doctors. The level of knowledge about OC among the participants is not yet satisfactory. The group of dental medicine students scored highest, while medical doctors showed the weakest knowledge.

CONCLUSION

Additional education about OC for doctors of dental medicine and medical doctors is needed. This step will improve prevention and increase chances for early detection.

Knowledge, Opinions, and Practices of Oral Cancer Prevention among Palestinian Practicing Dentists: An Online Cross-Sectional Questionnaire

Oral-health professionals play a critical role in the early recognition and prevention of oral cancer; however, most patients are diagnosed in the advanced stages that demonstrate poor prognosis. Therefore, this study aimed to investigate the knowledge, opinions, and clinical practices of practicing dentists related to oral cancer prevention and oral mucosal screening in Palestine. This research used an online cross-sectional questionnaire design. Practicing dentists in Palestine completed the 44-item questionnaire encompassing the following four sections: (a) personal data (6 items); (b) oral cancer knowledge (21 items); (c) opinions and beliefs related to oral cancer (10 items); and (d) clinical practices related to oral cancer (7 items). The questionnaire was sent to all eligible participants (N = 650) between July and September of 2022. The response rate was 39.1% (N = 254). About 70.1% of the respondents had poor knowledge of oral cancer and its risk factors, and almost 84.3% had positive opinions related to oral cancer prevention and oral mucosal screening. Concerning the clinical practices, only 29.9% routinely examined their patients every time their patients visited. More experienced dentists showed significantly more positive opinions and better clinical practices related to oral cancer prevention and screening; however, they had significantly lower knowledge scores compared with the younger dentists (p < 0.05). Inadequate training was the most reported perceived boundary against routine oral cancer screening. Palestinian dentists appeared to have positive opinions related to oral cancer prevention and oral mucosal screening. However, the assessment of the knowledge and clinical practices revealed deficiencies in this regard.

Association between sociodemographic characteristics and level of knowledge about oral cancer among Mexican dental health professionals: a cross-sectional online survey

BACKGROUND

A good level of knowledge in dentists is crucial for an early diagnosis of oral cancer (OC). In Latin America there are a few studies of OC knowledge among dentist, those has been performed in Brazil, Colombia, and Chile, and their results showed low level of OC knowledge. On the other hand, there is no publication in which the level of knowledge of dentists in Mexico has been addressed. Therefore, this study aimed to assess knowledge of OC and to determine the association of the level of knowledge with sociodemographic characteristics among dentists in Mexico.

METHODS

A cross-sectional online survey was designed to obtain information via questionnaire. The questionnaire was developed in the Spanish language, and the content validity was determined. The study was conducted among Mexican dentists with a 23-item questionnaire that was designed to be anonymous. The sample size was calculated using the finite population formula. Based on the responses, the level of knowledge of OC was categorized as very low, low, regular, good, or excellent. Additionally, the association between sociodemographic characteristics and the level of knowledge about OC was evaluated.

RESULTS

This research was conducted on a sample of 387 dentists. Most of the respondents were general dentists and worked in urban zones. The majority of dentists lacked a specialty (76.7%). Additionally, most of the respondents were students (44.2%). The level of knowledge of the participants was between regular and good (77.8%). On the other hand, concerning self-evaluation, most of the participants considered their knowledge of OC to be regular (50.6%). In addition, there was no association between sociodemographic characteristics and knowledge about OC.

CONCLUSIONS

This research identified some weaknesses in most Mexican dentists' knowledge of OC.

Oral Medicine Experience and Attitudes Toward Oral Cancer: An Evaluation of Dentists Working in Primary Health Care

This analytical, cross-sectional, observational study aimed to evaluate the perception of dentists working at the public system of the state of Rio Grande do Sul, southern Brazil, regarding academic training to treat oral lesions, adoption of preventive measures for oral cancer, and attitude toward the need to perform oral biopsies. The sample consisted of questionnaires filled out by 192 dentists (153 women and 39 men) working in primary health care who participated in training activities on oral cancer diagnosis in July 2016. To enroll in the training activities, the professionals completed an online questionnaire to evaluate their perceptions regarding oral cancer issues. With respect to preventive measures, 96.88% of dentists reported performing full mouth examination, 87.50% reported providing tobacco cessation counseling, and 51.04% reported giving advice on excessive alcohol consumption. In addition, 72.40% and 44.79% of dentists considered, respectively, clinical training and theory instruction in oral medicine to be insufficient during undergraduate school. Only 8.33% reported performing biopsies in daily clinical routine, and almost 90% reported referring the patient to a specialist from the public system or universities. Lack of experience was the main reason not to perform a biopsy. The dentists in our sample recognize the importance of preventive measures for oral cancer, but few of them perform biopsies regularly. Therefore, there is a need for continuing education actions including practical training.

Câncer bucal: o que sabem os cirurgiões-dentistas da Baixada Litorânea-RJ?

Resumo Introdução Apesar das estratégias para prevenção e diagnóstico precoce, o câncer bucal está entre os mais incidentes no Brasil. Objetivo Avaliar o conhecimento de cirurgiões-dentistas da Atenção Primária à Saúde sobre o câncer bucal. Material e método Pesquisa censitária, exploratória e quantitativa, realizada em 2021. Cirurgiões-dentistas vinculados à rede pública dos 9 municípios da Baixada Litorânea/RJ preencheram um questionário com 41 questões, divididas em 5 blocos: 1. Perfil sociodemográfico, 2. Conhecimento sobre câncer bucal, 3. Fatores de risco para câncer bucal, 4. Segurança para diagnóstico do câncer bucal e 5. Experiência na identificação de lesões suspeitas. Resultado Dos 128 cirurgiões-dentistas habilitados, 89,1% (n=114) participaram e caracterizavam-se por terem menos de 40 anos (50%), serem do sexo feminino (64,9%) e formados há mais de 16 anos (57,9%). Quanto ao conhecimento sobre o câncer bucal e fatores de risco, 84,2% consideraram seu nível de conhecimento regular ou bom e 65,8% consideraram baixo o seu nível de segurança para realização de procedimentos de diagnóstico do câncer bucal. Quanto à identificação de lesões suspeitas de câncer bucal, 86,8% realizavam exame da cavidade bucal, 7,9% não realizam porque o tempo da consulta é insuficiente e 5,3% porque não sabem fazer. Além disso, 50,9% identificaram alguma lesão suspeita nos últimos 12 meses. Notou-se também que 65,8% dos CDs não tinham conhecimento do fluxograma do município para diagnóstico e tratamento do câncer bucal. Conclusão Os achados evidenciaram lacunas com relação ao conhecimento e procedimentos para diagnóstico precoce do câncer bucal.

Análise da cobertura de saúde bucal e práticas das equipes de saúde bucal na atenção primária em municípios sul-mato-grossenses

Resumo Introdução Considerando a estimativa para o Brasil de 15.190 novos casos de câncer de boca e orofaringe para o triênio de 2020 a 2022, justifica-se a importância de o odontólogo na atenção primária estar capacitado para o diagnóstico precoce de câncer de boca e orofaringe, à biópsia e à regulação ao Centro de Especialidades Odontológicas. Objetivo Analisar a cobertura de saúde bucal e práticas das equipes de saúde bucal da atenção primária à saúde quanto ao cuidado ao câncer de boca e orofaringe em municípios de Mato Grosso do Sul. Material e método Estudo descritivo, transversal, quantitativo, em bases de dados secundários oficiais e públicos, referentes aos municípios do estado de Mato Grosso do Sul em que foram determinadas prevalência de câncer de boca e orofaringe, CID-10 C00 - C10, cobertura de saúde bucal e análise de dados de cuidado em saúde bucal do PMAQ-AB, 3º Ciclo. Resultado Houve divergência nas respostas entre as equipes de saúde bucal de alguns municípios no direcionamento do fluxo de referenciamento para biópsia e tratamento do câncer de boca e orofaringe, evidenciando desconhecimento das ofertas de serviços especializados. Conclusão Há fragilidades no processo de trabalho que podem influenciar no estadiamento do diagnóstico, tratamento, qualidade de vida e sobrevida do paciente com neoplasia maligna de boca e orofaringe. São importantes a capacitação e valorização das equipes de saúde bucal por meio de uma educação continuada e permanente, voltada ao diagnóstico precoce e à orientação dos fluxos assistenciais aos serviços especializados de referência, fortalecendo a coordenação do cuidado e ordenação na rede de atenção à saúde.

Brazilian Oral health teams in primary care and oral cancer: Results of a national evaluation

Oral cancer is one of the most prevalent cancers in Brazil. An understanding of how public policies are implemented to address this problem can contribute to the construction of solutions. The "Programa de Melhoria do Acesso e da Qualidade" (PMAQ-AB and PMAQ-CEO) at the level of primary and secondary care are evaluations that also collect data on prevention and monitoring strategies for oral cancer. This study aimed to analyze the results of the incorporation of oral health teams to evaluate the strategies adopted by Brazil regarding the impact on the diagnosis of oral cancer. Of the 17,202 family health teams evaluated, 72.10% had oral health teams (OHT). Considering the strategies for prevention, screening, campaign, and follow-up of suspected cases, 72.27% of the campaign teams and 59.09% of the teams who accompanied suspected cases had OHT. In secondary care, more than 65% of the teams in the Southeast and South regions registered cases of oral cancer, and the referral network was more represented. The inclusion of OHT had a positive impact on campaign actions, follow-up, referral to specialists, and registration of suspected cases throughout Brazil.

The readiness of dentists to use the autofluorescence method

Background. Head and neck squamous cell carcinoma are the sixth most common cancer in prevalence rate. Early diagnosis significantly reduces morbidity and mortality. Autofluorescence facilitates diagnosis the disease at the early stages, but it depends on the doctor’s skill in interpreting images. The aim of the study: to analyze the results of reading autofluorescence images of the oral mucosa by dentists.Materials and methods. The results of reading 10 autofluorescence images of potentially malignant diseases of the oral mucosa and 10 images of benign lesions and conditions were evaluated. The study involved 308 dentists. The assessment of the ability to recognize autofluorescence images was carried out with respect to gender, age, length of service, qualification category, academic degree, position of the head of the department.Results. On the average, dentists correctly differentiated the results of visualization of potentially malignant diseases of the oral mucosa in 3.85 ± 2.47 cases, benign lesions together with other benign conditions – in 4.56 ± 2.47 cases. Images of benign lesions and conditions were identified by dentists better than images of potentially malignant diseases of the oral mucosa (t = –17.0; p < 0.001). There is a direct correlation between the correct differentiation of visualization of potentially malignant diseases of the oral mucosa with the correct interpretation of benign lesions and conditions (r = 0.956; p < 0.001). The interpretation of potentially malignant diseases of the oral mucosa is not related to gender (t = –1.62; p = 0.306), work experience (r = –0.002; p = 0.977), department head (t = –0.11; p = 0.910), qualification category (t = –0.50; p = 0.574), academic degree (t = –0.34; p = 0.731).Conclusion. Dentists cannot recognize diseases of the oral mucosa well in autofluorescence images. The recognition skill is not related to general professional development.

Salivary melatonin in oral squamous cell carcinoma patients

Melatonin’s role in circadian rhythm is well documented, as are its’ anti-oxidant, oncostatic and anti-inflammatory properties. Poor sleep quality has been associated as a potential risk factor for several malignancies, including head and neck cancers. The purpose of this study is to determine salivary melatonin (MLT) levels in oral squamous cell carcinoma (OSCC) patients, compare the salivary MLT levels with those in healthy individuals and compare the salivary and serum levels in OSCC patients. Furthermore, the aim is to investigate the potential relationship between sleep quality and salivary MLT levels in OSCC patients. Unstimulated (UWS) and stimulated (SWS) whole saliva was sampled from patients with T1N0M0 and T2N0M0 OSCC (N = 34) and 33 sex and age matched healthy subjects. Serum samples were taken from 11 OSCC patients. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) questionnaire. Melatonin levels in UWS and SWS were significantly higher in the OSCC group. Sleep quality was significantly lower in patients with OSCC (P = 0.0001). ROC analysis was found to be significant (P < 0.001) in evaluating MLT concentration limit in diagnosing OSCC. The expected relationship between sleep quality and salivary MLT levels in OSCC patients was not observed. Our results suggest salivary MLT as a potential biomarker that might facilitate non-invasive detection of early stage OSCC.

Current Knowledge, Attitudes, and Practice among Health Care Providers in OSCC Awareness: Systematic Review and Meta-Analysis

OSCC remain a global health problem. Lack of awareness leads to inadequate watchfulness regarding early signs/symptoms despite the ease of visual oral inspection. What clinicians know and feel, and how they behave on OSCC is crucial to understand the feasibility and effectiveness of screening programs. The aim of this systematic review was to assess knowledge, attitudes, and practice (KAP) regarding OSCC among health care providers (HCPs). Therefore, a systematic review was conducted with SPIDER and PICO as major tools. A meta-analysis was structured through common items in two comparison groups of medical and dental practitioners. Descriptive statistics and a Mantel–Haenszel test were used to validate data. Sixty-six studies were selected for systematic review, eight of which are useful for meta-analysis. A statistically significant difference was recorded between dentists and medical practitioners for questions regarding: Alcohol (p < 0.001); Elderly (p < 0.012); Sun exposure (p < 0.0001); Erythroplakia (p < 0.019); Red patch (p < 0.010); White patch (p < 0.020); Tobacco consultation (p < 0.0001); Intraoral examination (p < 0.0001) and Up-to-date knowledge (p < 0.002). Overall, the incidence of OSCC screening is low. Most HCPs feel the need to increase KAP. Data confirmed gaps in KAP, highlighting the need for a more efficient pre- and post-graduation training, necessary to increase competence worldwide.

May VelScope Be Deemed an Opportunistic Oral Cancer Screening by General Dentists? A Pilot Study

Early diagnosis of oral cancer through visual inspection followed by histopathological confirmation is a pivotal step for reducing rates of morbidity and mortality. There are several auxiliary devices used to improve oral examination. The purpose of this cross-sectional pilot study is to evaluate the sensitivity and specificity of the Visually Enhance Lesion Scope (VelScope) system when it is used by the general dentist after a yearly oral medicine training. Thirty-five patients with oral lesions were evaluated with clinical and VelScope examination by two general dentists, one of which trained with a specific course. A comparison of the histopathological results, clinical examination, and VelScope made by both dentists was performed through statistical analysis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting oral potentially malignant disorders (OPMDs) are 53.3%, 65%, 53.3%, 76.5% for unskilled dentist, 73.3%, 65%, 61.1%, 76.5% for skilled clinician. When both examiners use VelScope the values are 53.3%, 70%, 57.1%, 66.7% for unskilled general dentist (u-GD), 86.7%, 90%, 86.7%, 90% for skilled general dentist (s-GD). Improvement of a skilled general dentist for detecting malignancies is higher than inexperienced examiner when using VelScope. VelScope alone is unable to improve the general dentist’s ability to detect malignancies, but it could be a useful adjunctive device for clinicians when a focused training program is performed.