Assessing oral cancer early detection: clarifying dentists' practices

Objective: This study explores new methods for assessing in greater detail what dentists do when they perform oral cancer early detection examinations. It clarifies practice behaviors and opens opportunities to identify factors that facilitate thorough early detection examinations by clinicians and to assess the relative effectiveness of different examination procedures. Methods: A 38‐item survey instrument was e‐mailed to dentists in a western US, multistate dental practice group. Questionnaires were received by 241 dentists, and 102 responded. An Oral Cancer Knowledge scale (0 to 14) was generated from correct responses on oral cancer general knowledge. An Oral Cancer Examination Thoroughness scale was calculated from the two dimensions of reported usage and frequency of procedures in oral cancer examinations. Results: Nearly all responding dentists were in general practice (90%), with a median year of graduation from dental school of 1994. The Oral Cancer Knowledge scores ranged from 5 to 14 with a mean of 10.4. The mean Thoroughness of Examination score was 11.34 (range 0 to 20). The two scales were not statistically correlated (r = ?0.015, P = 0.883). Statistically, recency of continuing education was significantly associated with knowledge (P = 0.0284) and appears to be marginally associated with thoroughness (P = 0.075). Conclusions: This study documents considerable variability in dentists' knowledge and thoroughness of examinations. The scales provide tools for future studies for improving understanding of early detection of oral cancer in clinical practice.     

Oral cancer knowledge and examination experiences among North Carolina adults

OBJECTIVE: This study assesses knowledge of oral cancer risk factors, clinical signs, and oral cancer examination experience among North Carolina adults. METHODS: A statewide random digit dial, computer-assisted telephone interview was conducted in 2002. Data from 1,096 respondents, with a response rate of 62 percent, were poststratified to 2000 census data by sex, race, and age group to produce population-based estimates. Knowledge of one sign of oral cancer, four or more risk factors for oral cancer, and having ever had an oral cancer examination were compared in logistic regression models using normalized weights. RESULTS: Fourteen (95% confidence interval [CI] +/-2) percent of adults had never heard of oral or mouth cancer. Risk factor knowledge was high for 56 percent (95% CI+/-3) and associated in a logistic regression model with younger age, feeling personal factors cause cancer, and nonuse of snuff. One sign of oral cancer (sore/lesion, red or white patch in mouth, and bleeding in the mouth) was correctly identified by 53 percent (95% CI+/-3) with significantly more correct responses from younger people, nonsmokers, and some college education. Only 29 percent (95% CI+/-3) reported ever having had an oral cancer examination when this procedure was described. Most respondents reported exams performed by dentists. In a weighted logistic regression model, older age, being dentate, nonsmokers, alcohol users, and those with some college education were significantly more likely to report having ever had an oral cancer examination. CONCLUSIONS: Although there is moderate knowledge of signs and risk factors for oral cancer among North Carolina adults, knowledge deficits remain. Oral cancer examinations need to be increased, particularly among tobacco smokers.     

Opinions about oral cancer prevention and early detection among dentists practising along the Texas-Mexico border

OBJECTIVES: The purpose of this study was to assess dentists' opinions about oral cancer (OC) prevention and early detection. METHODS: Data were collected by a self-administered mail questionnaire sent to all 398 registered dentists practising along the Texas-Mexico border. RESULTS: The effective response rate to the survey was 40%. While 90% of respondents agreed that oral cancer examinations (OCE) should be provided annually for patients 40 years of age and older, only 59% of respondents believed their OC knowledge was current. While 99% agreed that dentists were qualified to perform OCE, only 54 and 68% respectively, agreed that dental hygienists and physicians were similarly qualified. Dentists who rated their undergraduate OC training favorably (OR = 2.68, 1.23-5.81, P = 0.011), had attended their last oral cancer continuing education (OCCE) course within the past 5 years (OR = 2.46, 1.25-4.86, P = 0.009), and those who performed OCE on all patients 40 years and older (OR = 2.64, 1.32-5.26, P = 0.005), were more likely to agree their OC knowledge was current. CONCLUSIONS: Respondents expressed diverse opinions about OC prevention and early detection. Positive opinion on currency of OC knowledge was associated with performance of OCE. Results indicate a need for OCCE targeting the study population as well as increased emphasis on OC curriculum in dental schools.     

Diet and prevention of oral cancer: strategies for clinical practice

BackgroundOral health care professionals can play an important role in preventing oral cancer by performing oral mucosal examinations to detect pre-cancerous changes and by educating patients about oral cancer prevention strategies, including dietary approaches.ConclusionsCurrent evidence supports a diet high in fruits, vegetables and plant-based foods for prevention of oral cancer. Dietary supplements—including vitamins and minerals—have not been shown to be effective as substitutes for a diet high in fruits and vegetables.Clinical ImplicationsIn addition to discussing tobacco and alcohol use with patients (and, if relevant, betel nut and gutka consumption), as well as the risk of sexual transmission of human papillo-mavirus, clinicians should provide dietary advice for the prevention of oral cancer as part of routine patient education practices.     

Florida adults' oral cancer knowledge and examination experiences

OBJECTIVE: This study assessed awareness of oral cancer, knowledge of its major risk factors and clinical signs, and oral cancer examination experiences among Florida adults aged 40 years and older. METHODS: A statewide random digit dial, computer assisted telephone survey was conducted in 2002. Data from 1,773 respondents were weighted to permit statewide estimates. Bivariate analyses were used to examine awareness and knowledge of oral cancer. Multiple logistic regression analysis was used to model past-year oral cancer examination experiences of Florida's adults. RESULTS: In Florida, 15.5% of adults aged 40 years and older had never heard of oral cancer and another 40.3% reportedly knew little or nothing about it. About one-half of adults did not think oral white or red patches or bleeding could indicate oral cancer and 27.6% correctly identified three of oral cancer's major risk factors. After hearing an oral cancer exam described, just 19.5% of adults reported receiving one within the preceding 12 months. Blacks and Hispanics were significantly less likely than non-Hispanic whites to have received a recent oral cancer examination. Persons with low levels of education, those who lacked a regular dentist or source of preventive medical care, and adults who knew few or none of the clinical signs of oral cancer also were less likely to have received a recent oral cancer exam. CONCLUSIONS: There is widespread lack of awareness and knowledge in Florida regarding oral cancer and low levels of reported examination, particularly among groups experiencing disproportionately high incidence and late stage diagnosis. Increasing awareness of this disease and promoting primary and secondary prevention may help lessen the disease burden in Florida and reduce racial disparities in its outcomes.     

Screening and early detection of oral cancer: current controversies

Some evidence suggests that the early detection of oral cancer (OC) during surveillance might improve survival rates. In addition to this, interventions aimed at enhancing public awareness and knowledge of signs, symptoms and risk factors of OC are thought to decrease the burden of disease. Nevertheless, there is much controversy with regard to the cost-effectiveness of population-based strategies for OC screening. Here, we present and briefly discuss timely findings that have put under scrutiny the applicability of approaches targeted at the early identification of patients with OC.     

Oral cancer prevention and diagnosis

Globally, oral cancer is one of the leading cancer sites. The profile problems are similar, that is, late diagnosis, advanced tumors and poor survival and cure rates.     

Oral cancer screening: Practices, knowledge, and opinions of dentists working in Ohio nursing homes

The state of oral health of nursing homes residents is less than satisfactory. The oral health care in nursing homes is also deficient, therefore it is likely that oral cancer (OC) screening of residents will be inadequate. The purpose of this cross-sectional study was to determine OC screening practices, knowledge, and opinions of dentists working in nursing homes throughout Ohio. A 28-item pretested questionnaire was mailed to 75 dentists who were serving 606 nursing homes.
The response rate was 49%. The main outcome measures of interest included: OC screening practices of the Ohio dentists, their knowledge of OC detection, and their opinions regarding OC screening competency. Age was found to be a significant factor, with younger dentists being more likely to have higher knowledge scores after adjusting for all other covariates.     

Opinions and attitudes of the UK's GDPs and specialists in oral surgery, oral medicine and surgical dentistry on oral cancer screening

OBJECTIVE: To survey two broad areas of oral cancer awareness and management of patients at risk of oral cancer by specialists in oral surgery, oral medicine, surgical dentistry and general dental practitioners (GDPs) in the UK. The first of these included knowledge and awareness of aetiological factors, changing patterns of disease, and screening/detection programmes including their effectiveness. The second included oral cancer detection methods, advice on avoidance of high-risk activity and self-examination, and referral pattern of GDPs. DESIGN AND METHOD: A pretested, 44-item questionnaire, a covering letter, a brief outline of the research protocol and return, stamped envelope were mailed in March 2003. A sample of 200 GDPs whose names were obtained from the General Dental Council's main list and 305 dental specialist names obtained from specialist's list in surgical dentistry, oral medicine and oral surgery were selected randomly. Information on oral cancer awareness and practice, screening practice and education was obtained. RESULTS: The response rate was 66.9%. The knowledge of the dental specialists was consistent with that in reports of current aetiological studies on oral cancer. However there were gaps in the GDP's knowledge and ascertainment of oral cancer risk factors. Over 70% of the dental specialists provided counselling advice on the risks of tobacco and alcohol habits compared with 41.2% of GDPs. More GDPs (52.4%) than specialists (35.4%) believed that oral cancer screening on a national basis would be effective in decreasing the mortality of oral cancer. Over 95% of all respondents used a visual examination for oral cancer screening and 89.9% of all respondents strongly believed that visual screening is effective in the early detection of oral cancer. CONCLUSION: The results showed that GDPs had knowledge gaps in their awareness of oral cancer risk factors and the application of preventive measures. Most dental health providers in the UK perform visual screening of the oral mucosa for their patients. Opinion was equivocal as to whether a nationally based screening programme similar to cervical cancer would be effective in improving the mortality and morbidity of oral cancer.     

Dentists and oral cancer prevention in the UK: opinions, attitudes and practices to screening for mucosal lesions and to counselling patients on tobacco and alcohol use: baseline data from 1991

OBJECTIVE: To investigate the opinions, attitudes and practices towards oral cancer prevention among UK dentists as a baseline from which to measure the need for continuing education efforts in this area. DESIGN AND METHOD: Postal questionnaire survey carried out in August 1991. A questionnaire with 13 test items was piloted at continuing education courses then distributed to all subscribers of the British Dental Journal with a postage paid return envelope. The aspects inquired into were recent attempts by dentists at updating their knowledge on oral cancer, their practical approaches to screening for oral mucosal diseases and follow-up actions after oral screening, their questions to patients regarding the major risk factors for oral cancer, their efforts towards behavioural counselling for patients and any constraints felt or experienced in this regard. RESULTS: The questionnaire was circulated to 15,836 dentists. The response rate of 16% was poor but due to the many dentists circulated, 2519 responses were available for analysis. This large sample, though presumptively biased towards those interested in professional matters, showed an encouraging 84% claiming to perform screening of the oral mucosa routinely. Among these, 74% reported referral of screen detected cases to a hospital for further attention and only 4% would adopt a wait and see policy. Disturbingly, half of the respondents did not enquire about risk habits related to oral cancer and, among the other half who claimed to make such enquiries, only 30% routinely provided brief health education advice concerning these. Seventy-one percent agreed that giving advice against tobacco use is desirable but major constraints were identified, notably a lack of training, and frustration regarding patient compliance. There was even greater reluctance on the part of the respondents to enquire into the alcohol use of their patients and to provide advice on alcohol moderation. CONCLUSIONS: Most of this large but unrepresentative sample of UK dentists were carrying out screening of the oral mucosa as a part of their prevention activities in 1991. However, the survey indicated a considerable need for improvement in the manner and extent of provision of health advice in respect of the major risk factors for oral cancer: such a substantial need amongst the presumptively better motivated implies that the need amongst the practitioner population at large is even greater.     

Practices of Maryland dentists: oral cancer prevention and early detection--baseline data from 1995

OBJECTIVES: To investigate practices and opinions of general dentists in Maryland, USA, related to oral and pharyngeal cancer prevention and early detection. DESIGN AND METHODS: A pre-tested, 34-item questionnaire, cover letter and addressed, stamped envelope were mailed in the summer, 1995, to a simple random sample of 800 members and non-members of the American Dental Association practicing in Maryland. A reminder postcard was sent 3 weeks after initial mailing; a second complete mailing to all non-respondents 6 weeks after first mailing. RESULTS: Over 90% of dentists asked about patient's current use of tobacco but only 77% assessed patient's history of tobacco use and types and amounts used. Fewer (66%) asked about present use of alcohol. Ninety percent reported providing an oral cancer examination at the initial appointment for patients 40 years of age or older; only 6% provided the examination for edentulous patients and only 40% reported palpating lymph nodes of patients 80% or more of the time. CONCLUSIONS: Dentists' reporting on providing oral cancer examinations and taking appropriate health histories are disappointing. These results call for comprehensive educational interventions in terms of changes in dental curricula and as continuing education courses especially since most dentists were interested in continuing education courses on oral cancer prevention and early detection.     

Knowledge of oral cancer and screening practices of primary care providers at Federally Qualified Health Centers

OBJECTIVES: Primary care providers (PCPs) who worked in Federally-Qualified Health Centers (FQHC) in Michigan were surveyed to assess their knowledge level and practices related to screening and preventing oral cancer. METHODS: A questionnaire was developed with the assistance of dental and medical experts, and revised through focus groups. The questionnaire included one case scenario describing a suspicious oral lesion in a 55-year old female patient, followed by questions assessing PCPs' knowledge level, attitude, opinion, and screening practices for oral cancer. This mail survey was conducted in 2003. RESULTS: Survey response rate was 56.4%. Over 70% of the respondents reported that they screen patients for oral cancer during a routine physical examination. Forty-four percent of PCPs had high knowledge level, based on the scenario questions. Those who had high knowledge level were more likely to be physicians, males, and more likely to perform screening for oral cancer than those with low knowledge level. There was no difference in age and race/ethnicity between high and low knowledge groups. Perceived barriers included (1) lack of education; (2) lack of specialists to refer patients; and (3) lack of reimbursement. CONCLUSIONS: The majority of PCPs in this survey had positive attitudes about performing screening for oral cancer. To involve PCPs in screening for oral cancer, oral health programs should focus on providing up-to-date education, setting up a referral system, and providing proper reimbursement.