Available web-based teaching resources for health care professionals on screening for oral cancer

General dentists' knowledge, perceptions, and practices regarding oral potentially malignant disorders and oral cancer in Indonesia

INTRODUCTION

The most effective means for reducing oral cancer (OC) mortality is by preventing late-stage disease. Early diagnosis can be improved by increasing awareness among healthcare providers, specifically general dental practitioners (GDP). Therefore, our study aimed to assess GDPs' knowledge of OC risk factors and perceived competence in performing conventional oral examination (COE) in routine dental practice.

MATERIAL AND METHODS

This was a cross-sectional study conducted in five provinces of Indonesia, namely: Aceh, Banda Aceh (BA); Bandung, West Java (WJ); special district Jakarta (JKT), JKT; Pontianak, West Kalimantan (WK); and Sorong, West Papua (WP). The local Dental Association or Faculty of Dentistry invited the GDPs to attend an education program and complete the survey.

RESULTS

One hundred seventy-seven GDPs completed the survey (WJ, n = 63; BA, n = 44, JKT, n = 27; WP, n = 23; and WP, n = 20). A large proportion (164 out of 177, 92.66%) of GDPs felt they had received insufficient training to equip them to diagnose OC and as many as 22.6% (n = 40) did not refer to specialists when they found suspicious mucosal lesions. Notwithstanding the significant regional variations, the majority of Indonesian GDPs self-reported inadequate knowledge and awareness of OC and scarce confidence in performing COE.

CONCLUSION

GDP knowledge of OC risk factors and COE is key to improving early diagnosis of OC at a community level. Therefore, it is suggested that the lack of knowledge and confidence of GDPs reported here should be addressed through the national dental curriculum in Indonesia.

Quality and readability of the dental information obtained by patients on Internet: criteria for selecting medical consultation websites

Background

The main objective of this study is to examine the quality of the information available for patients online with regards to the apicoectomy surgical procedure, both on general and critically selected websites. The hypothesis is that general websites has less quality than other that have been pre-selected.

Material and Methods

A search for the English term "apicoectomy” was performed online. The first 100 websites that appeared in both Google and Yahoo were analysed. Seven validated instruments were used for these two dimensions: quality (DISCERN, JAMA and EQIP), and readability (FRES, Fog Scale, FKRGL and SMOG).

Results

A total of 21 websites (10.5%) were selected. The readability of the websites in both groups was difficult or very difficult. With regards to the quality of the websites, the DISCERN instrument indicated an average value of 2.28 [2.14-2.39] for all of the websites, therefore indicating very low quality with serious defects; however, in the selected websites, the average quality was 3.16 [2.84-3.48], indicating potential, but not serious defects (p<0.001). There were statistically significant differences for the FRES values (p = 0.030), with a greater readability in the selected group of websites.

Conclusions

We believe that it is very important for the population to become aware of and learn how to use certain exclusion criteria when selecting medical consultation websites, as in doing so, they will be able to obtain a higher quality of information from these websites.

Key words:Apicoectomy, readability, DISCERN.

Screening for oral cancer: Future prospects, research and policy development for Asia

Although the incidence of oral cavity cancer is high among low and middle income countries in Asia where the risk habits (tobacco smoking, tobacco chewing and betel quid use) are common, the benefits for introducing oral cancer screening for the whole population in these countries still remains controversial. It is disappointing, but not surprising that many of studies, without control arms, could not provide a clear answer as to whether screening is effective in reducing mortality or combating rising incidence trends. Only one Indian study that reported a randomized controlled trial (RCT) elucidated that mass screening for high risk groups could significantly reduce the cancer mortality or down-stage cancers detected by screening. Several professional organizations that considered any potential benefits of oral cancer screening remain unconvinced that the current knowledge on its natural history, available tests and interventions to treat potentially malignant disorders satisfy the desirable criteria to recommend organized screening for oral cancer. In this review we discuss advantages and disadvantages for oral cancer screening particularly with reference to high incidence countries in Asia. If screening is undertaken, we propose that it is targeted to high risk groups and to combine screening with education on risky life-styles so that overall incidence can be reduced in the future. Further research on increasing public awarenes and impact of professional education such as e-learning to reduce diagnostic delays, studies on the natural history of oral potentially malignant disorders and cancer, comprehensive tobacco and areca nut cessation programs, developing tools to identify high-risk individuals and high-risk lesions are proposed.

Medical practitioners' educational competence about oral and oropharyngeal carcinoma: a systematic review and meta-analysis

Medical practitioners' (MP) role is pivotal in primary prevention, early diagnosis, prompt referral and effective management of oral and oropharyngeal carcinomas (OC/OPC), which raises the importance of their effective OC/OPC education at all levels of medical education. The purpose of this systematic review was to summarise the available scientific evidence about their educational competence in dealing with OC/OPC. We made a systematic search of papers in the English language in MEDLINE, Scopus, Cochrane Library CENTRAL and CINAHL databases from their inception until December 2018. Overall, 23 cross-sectional and three interventional studies have been selected for the systematic review and 18 of these were included in the meta-analyses. Excluding tobacco use (synthesised estimate of 95% of respondents identified tobacco as an OC/OPC risk factor, 95% CI of synthesised estimate 92% to 97%) and alcohol consumption (65%, 95%CI 52% to 77%), less than half of MP (approximately) were knowledgeable about important OC/OPC risk factors including human papilloma virus (42%, 95% CI 30% to 54%), poor diet (34%, 95% CI 17% to 54%), and advancing age (45%, 95% CI 21% to 70%). There was a low to moderate level of awareness among MP regarding common precancerous oral lesions involving leukoplakia (56%, 95% CI 32% to 79%), erythroplakia (30%, 95% CI 8% to 58%), and oral lichen planus (13%, 95% CI 0 to 41%). Moderate knowledge was also recorded about frequent sites of OC development involving the tongue (48%, 95% CI 33% to 64%) and floor of the mouth (37%, 95% CI 19% to 57%). Most MP enquired about tobacco use (86%, 95% CI 74% to 96%), and alcohol consumption (73%, 95% CI 47% to 94%) during history taking, and expressed willingness to be given supplementary OC/OPC education (78%, 95% CI 54% to 96%), as well. With regard to the incidence of intraoral screening, 27% of MP (95% CI 12% to 46%) make an intraoral examination as a routine. Interestingly, studies from each continent yielded significantly different outcomes to some research questions in the review. From the MP's perspective, clinical time restrictions and deficiencies in organised training were recognised as the main barriers towards their OC/OPC educational competence. The findings of this systematic review indicated the existence of deficiencies in knowledge and misconceptions, neglected preventive responsibilities, and associated barriers towards OC/OPC. A need for improved OC/OPC training at all levels of medical education is required to increase competence worldwide.

Patient-centered web-based information on oral lichen planus: Quality and readability

Background

To assess the readability and quality of web-based information available for patients about oral lichen planus (OLP).

Material and Methods

Three major search engines (Google, Bing and Yahoo!) were used to identify websites of particular interest to the study using the search term ‘oral lichen planus’. The first 100 sites of each search engine were considered for the study. The quality of the contents was evaluated using the DISCERN instrument. The Flesch-Kinkaid Reading Grade Level (FKRGL) and the Flesh Reading Ease Score (FRES) were used to assess readability. The presence of the Health on the Net (HON) seal was also evaluated.

Results

Following the application of the study’s exclusion criteria, only 28 websites were compiled for further analysis. The median of the DISCERN instrument was 3 [2-3] which means serious or potentially important shortcoming in the quality of the information. Readability indexes pointed to a high reading difficulty (FRES: 48.14±11.22; FKRGL:11.13±2.90).

Conclusions

The information provided by the Internet to the general public regarding OLP has major deficits in terms of quality, and at the same time is difficult for a comprehensive reading. Further studies are warranted to test well-produced patient-centered information on OLP.

Key words:Oral lichen planus, oral diseases, health literacy, health information.

Web-Based Information on the Treatment of Tobacco Dependence for Oral Health Professionals: Analysis of English-Written Websites

BACKGROUND

Studies have been conducted on the content and quality of Web-based information for patients who are interested in smoking cessation advice and for health care practitioners regarding the content of e-learning programs about tobacco cessation. However, to the best of our knowledge, there is no such information about the quality of Web-based learning resources regarding smoking cessation dedicated to oral health professionals.

OBJECTIVE

The aim of this study was to identify and evaluate the quality of the content of webpages providing information about smoking cessation for oral health care professionals.

METHODS

Websites were identified using Google and Health on Net (HON) search engines using the terms: smoking cessation OR quit smoking OR stop smoking OR 3As OR 5As OR tobacco counselling AND dentistry OR dental clinic OR dentist OR dental hygienist OR oral health professionals. The first 100 consecutive results of the 2 search engines were considered for the study. Quality assessment was rated using the DISCERN questionnaire, the Journal of the American Medical Association (JAMA) benchmarks, and the HON seal. In addition, smoking cessation content on each site was assessed using an abbreviated version of the Smoke Treatment Scale (STS-C) and the Smoking Treatment Scale-Rating (STS-R). To assess legibility of the selected websites, the Flesch Reading Ease (FRES) and the Flesch-Kinkaid Reading Grade Level (FKRGL) were used. Websites were also classified into multimedia and nonmultimedia and friendly and nonfriendly usability.

RESULTS

Of the first 200 sites selected (100 of Google and 100 of HON), only 11 met the inclusion criteria and mainly belonged to governmental institutions (n=8), with the others being prepared by Professional Associations (n=2) and nonprofit organizations (n=1). Only 3 were exclusively dedicated to smoking cessation. The average score obtained with the DISCERN was 3.0, and the average score in the FKRGL and FRES was 13.31 (standard deviation, SD 3.34) and 40.73 (SD 15.46), respectively. Of the 11 websites evaluated, none achieved all the four JAMA benchmarks. The mean score of STS-R among all the websites was 2.81 (SD 0.95) out of 5. A significant strong positive correlation was obtained between the DISCERN mean values and the STS-R (R=.89, P=.01).

CONCLUSIONS

The mean quality of webpages with information for oral health care professionals about smoking cessation is low and displayed a high heterogeneity. These webpages are also difficult to read and often lack multimedia resources, which further limits their usefulness.