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ORIGINAL ARTICLE
Year : 2022  |  Volume : 21  |  Issue : 4  |  Page : 444-450  

Knowledge, awareness, and attitude among dental students regarding oral cancer in Saudi Arabia


Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia

Date of Submission04-Sep-2021
Date of Decision10-Nov-2021
Date of Acceptance25-Nov-2021
Date of Web Publication16-Nov-2022

Correspondence Address:
Bassel Tarakji
Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry Prince Sattam Bin Abdulaziz University, Al Kharj
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_185_21

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   Abstract 


Background: Oral cancer awareness among junior and seniors' dental undergraduate students may have an impact on the early detection and prevention of oral cancer. Aims and Objectives: To assess oral cancer awareness, knowledge and attitude among undergraduate dental students in government and private colleges in Saudi Arabia. Material and Methods: A cross-sectional survey was undertaken to assess oral cancer knowledge, awareness and attitude among undergraduate dental students in government and private colleges in Saudi Arabia. All junior and senior students enrolled during the 2020– 2021 academic year, were eligible to participate (n=189). Results: The study shows that dental Students at private and government colleges in Saudi Arabia are generally knowledgeable regarding Knowledge, awareness, attitude and management of oral cancer. There was no significant difference between knowledge, awareness, attitude, and management of oral cancer between students in either private and government colleges. Results shows that 99 (88.9%) of dental students in government colleges considered human papilloma virus as a risk factor, higher than dental students in private colleges 48 (73.3%). My results indicated that dental students considered (87%) tobacco, and alcohol (83.6%) as main risk to oral cancer, whereas, 100 (53%) identified limited consumption of fruit and vegetables and 124 (65.6%) considered old age as risk factor for oral cancer. Conclusion: The variation in correct answers indicate to need to reinforce the undergraduate dental curriculum with regards to oral cancer education; particularly in its prevention and early detection. Revision of knowledge senior students in oral cancer is highly recommended.

   Abstract in French 

Résumé
Contexte: La sensibilisation au cancer de la bouche chez les étudiants de premier cycle en médecine dentaire des cycles supérieurs peut avoir un impact sur la détection précoce et la prévention du cancer de la bouche. Objectifs: Évaluer la sensibilisation, les connaissances et l'attitude au cancer de la bouche chez les étudiants en médecine dentaire de premier cycle dans les collèges publics et privés d'Arabie saoudite. Matériel et méthodes: Une enquête transversale a été menée pour évaluer les connaissances, la sensibilisation et l'attitude face au cancer buccal parmi les étudiants en médecine dentaire de premier cycle dans les collèges publics et privés d'Arabie saoudite. Tous les étudiants juniors et seniors inscrits au cours de l'année universitaire 2020-2021 étaient éligibles pour participer (n=189). Résultats: L'étude montre que les étudiants en médecine dentaire des collèges privés et publics d'Arabie saoudite sont généralement bien informés sur les connaissances, la sensibilisation, l'attitude et la gestion du cancer de la bouche. Il n'y avait pas de différence significative entre les connaissances, la sensibilisation, l'attitude et la gestion du cancer de la bouche entre les étudiants des collèges privés et publics. Les résultats montrent que 99 (88,9%) des étudiants en médecine dentaire dans les collèges publics considéraient le virus du papillome humain comme un facteur de risque, plus élevé que les étudiants en médecine dentaire dans les collèges privés 48 (73,3%). Mes résultats ont indiqué que les étudiants en médecine dentaire considéraient (87 %) le tabac et l'alcool (83,6 %) comme le principal risque de cancer buccal, alors que 100 (53 %) ont identifié une consommation limitée de fruits et légumes et 124 (65,6 %) considéraient la vieillesse comme facteur de risque de cancer de la bouche. Conclusion: La variation des réponses correctes indique la nécessité de renforcer le programme d'études dentaires de premier cycle en ce qui concerne l'éducation sur le cancer buccal ; notamment dans sa prévention et sa détection précoce. La révision des connaissances des étudiants seniors en cancer buccal est fortement recommandée.

Mots-clés: Étudiants en médecine dentaire, connaissances, cancer de la bouche

Keywords: Dental students, knowledge, oral cancer


How to cite this article:
Tarakji B. Knowledge, awareness, and attitude among dental students regarding oral cancer in Saudi Arabia. Ann Afr Med 2022;21:444-50

How to cite this URL:
Tarakji B. Knowledge, awareness, and attitude among dental students regarding oral cancer in Saudi Arabia. Ann Afr Med [serial online] 2022 [cited 2022 Dec 9];21:444-50. Available from: https://www.annalsafrmed.org/text.asp?2022/21/4/444/361262




   Introduction Top


Oral cancer represents nearly 4% of all cancer worldwide.[1] Kazmi et al.[2] reported that 500,000 patients are estimated to have oral cancer globally, with approximately 389,000 new cases per year.

Survival from the head-and-neck malignancy is dependent upon the stage of disease and extent of spread at presentation and diagnosis. A dental practitioner's attitude and knowledge of oral cancer were the factors that contributed to delays in diagnosis, according to some papers.[3],[4] Dentists felt it was not within their specialty to offer cancer prevention advice, as well as a general lack of knowledge were considered principal barriers toward the prevention and early detection of oral cancer, respectively.[5] General dental practitioners showed the lack of clinical skills relating to the diagnosis, treatment, and counseling of patients with oral cancer.[6],[7] The delay in the detection of oral cancer is distributed between patients and doctors.[7] The unawareness of oral cancer among the public and professionals and partly due to barriers in the health-care system that may prevent patients from seeking dental and medical care.[8]

Researchers over the world agreed that the early detection of oral cancer will increase the probability of cure and survival rate.[9],[10] It is clear that dental practitioners who have good knowledge of the signs and symptoms of malignant and premalignant lesions for the early and effective diagnosis will improve the efficacy of screening and management of these lesions.[10],[11]

Several studies in Australia, Jordan, Kuwait, Sudan, and Brazil[12],[13],[14],[15],[16] have investigated of the dental students or dentist's awareness of oral cancer and premalignant lesions. These studies showed the necessary need to improve the knowledge on preventing and detecting oral cancer. To date, there has been few published data regarding oral cancer knowledge and practices among dental students in Saudi Arabia. The aim of this study was to assess oral cancer awareness, knowledge among undergraduate dental students in government and private colleges in Saudi Arabia. A questionnaire will evaluate oral cancer awareness and knowledge and attitude among undergraduate students at second-third-fourth and fifth, 6th year and internship students at private and government colleges of dentistry. Knowledge and awareness of oral cancer, dentistry student's attitude toward oral cancers, management practice regarding oral cancer, and oral cancer information sources will be assessed using multiple questions.


   Materials and Methods Top


A cross-sectional, questionnaire-based survey of undergraduate dental students including junior and senior students at government and private colleges in Saudi Arabia was undertaken. All dental students in their 2nd to 5th year (junior students), 6 years and internship (senior students) enrolled during the 2020–2021 academic year, were eligible to participate (n = 189). The study was approved by Prince Sattam University Ethical Review Board (REC-HSD-49-2021). A prevalidated questionnaire, developed from a previous study,[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17] was given to all students during routine lectures or was sent to individual students through E-mail, WhatsApp, and other social media platforms, which also contained consent form and explanation about the study. The questionnaire was designed in the first section to assess the following included demographic variables of the responding students such as age, gender, year of study, type of dental school, and source of information on oral cancer. The second section of this study focused on knowledge and awareness of participating dental students about oral cancer. The third section focused in the assessment of dental student regarding attitude and management of oral cancer. The fourth section focused in association between survey items in oral cancer and study level (junior and senior students). The fifth section focused in association between survey items in oral cancer and type of university, either government or private colleges. Participation was voluntary, and participants were informed that could withdraw at any time and that their responses would be anonymous and treated confidentially. Before distributing the questionnaire, a pilot study was performed on a random sample of students (n = 30), and the questionnaire was modified according to the feedback obtained.

Data analysis

The SPSS statistical package was used for the data analysis (IBM SPSS Statistics for Windows, Version 20.0, Released 2011, IBM Corp, Armonk, New York, USA). Descriptive statistics presented the characteristics of participating dental students, and frequency tables were generated to illustrate the response of dental students to survey questions. The Chi-square statistics were used to assess any possible association between questionnaire items and study level and type of colleges. P < 0.05 was considered statistically significant.


   Results Top


A total of 500 dental undergraduate students were contacted and 189 questionnaires were completed (38% response rate). Incomplete questionnaires were excluded from this study.

Questionnaires that have more than two unanswered questions considered incomplete; thus, they were not included in the statistical analysis. The study population comprised Saudi and nonSaudi dental undergraduate students of both genders and different ages. One hundred and twelve (59%) students from second to 5 years and 77 (41%) students from 6 years and internship participated in this study [Table 1]. The response rates were higher among male students (65%) as compared to female (35%). Age, gender, nationality, and study level is presented in [Table 1]. One hundred and thirty-five (72%) dental students from private colleges and 54 (28%) from government colleges. The source of information on oral cancer is presented in [Table 1].
Table 1: Characteristics of participating student (n=189)

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To evaluate knowledge and awareness of participating dental students about oral cancer, participating dentistry students were asked about risk factors, the most common location of oral cancer, the most likely lesions to show malignant transformation, the most common form of oral cancer, the biopsy should be done if you suspect, the most common age for oral cancer and the distribution of those who answered each of the different items is presented in [Table 2]. One hundred and sixty-five (87%) dental students out of 189 are considered that tobacco is a risk factor of oral cancer. One hundred (53%) dental students out of 189 are considered that the limited consumption of fruit and vegetables as risk factor. One hundred and thirty-seven (72.5%) out of 189 dental students are considered that ultraviolet exposure as risk factor. One hundred and forty-seven (77.8%) dental students are considered human papilloma virus as risk factor. One hundred and fifty-eight (83.6%) dental students out of 189 are considered that alcohol use as a risk factor. One hundred and sixty-one (85.2%) dental students out of 189 are reported that premalignant lesions as risk factor. One hundred and twenty-foir (65.6%) dental students out of 189 are indicated that old age as risk factor. Respondents were also asked about the most common location of oral cancer. One hundred and seventeen (61.9%) answered correct that posterior lateral margins of the tongue 81 (42.9%), where the others selected all sites equally 54 (28.6%), cheeks/lips/gingiva 5 (2.6%), floor of the mouth and ventral aspect of the tongue 34 (18%), hard and soft palate 15 (7.9%). The participant responses regarding the most likely lesions to show malignant transformation, erythroplakia 37 (19.6%), mild dysplastic leukoplakia 30 (15.9%), moderate or severe dysplastic oral leukoplakia 117 (61.9%), and oral lichen planus 5 (2.6%). Students were asked to give their opinions regarding the most form of oral cancer. One hundred and forty-one (74.6%) out of 189 answered correctly that squamous cell carcinoma is the most common form of oral cancer [Table 2]. Sixteen (8.5%) students answered spindle cell carcinoma, 15 (7.9%) answered verrucous carcinoma, nine (4.8%) students answered adenosquamous cell carcinoma, and three (1.6%) answered basaloid squamous carcinoma. One hundred and fifty-one (79.9%) out of 189 answered correctly and stated that the biopsy should be done if you suspect any oral abnormal lesion presents it more than 3 weeks. Thirty-eight (20%) students preferred to do biopsy for white or red oral lesion presents it for less 1 week. The vast majority of students 139 (73.5%) reported that the most common age for oral cancer was range 40–60-year-old [Table 2], 41 (21.7%) students selected age 30–40 for oral cancer, 8 (4.2%) students considered age 15–30 for oral cancer, 1 (0.5%) student considered age 10–15 for oral cancer.
Table 2: Knowledge and awareness of participating dental students about oral cancer (n=189)

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With the references of assessment of dental student regarding attitude and management of oral cancer. The majority of dental students 99 (52.4%) out of 189 strongly agree that recommend your patients with suspect oral cancer, whereas 67 (35.4%) agree, 1 (0.5%) disagree, and 22 (11.6%) uncertain. Eighty-eight (46.6%) of dental students strongly agree to inform their patients with risk factor of oral cancer, 84 (44.4%) agree, 6 (3.2%), and 11 (5.8%) uncertain.

Seventy-seven (40.7%) of participated dental students strongly agree that have good training to perform an oral cancer examination, 70 (37%) agree, 11 (5.8%) disagree, and 31 (16.4%) uncertain.

Ninety-eight (51.9%) of dental students strongly agree to perform patient's lymph nodes palpation, 61 (32.3%) agree, 9 (4.8%) disagree, and 21 (11.1%) uncertain [Table 3].
Table 3: Assessment of dental student regarding attitude and management of oral cancer (n=189)

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   Discussion Top


The reduction of rates of morbidity and mortality in oral cancer depending the early diagnosis and detection of oral cancer.[4],[10] Hence, this study was conducted to assess awareness, knowledge, attitude, and management of oral cancer among undergraduate dental students (junior and senior students) in government and private colleges in Saudi Arabia. The results of this study show that dental students at private and government colleges in Saudi Arabia are generally knowledgeable regarding knowledge, awareness, attitude, and management of oral cancer. However, similar to previous studies,[6],[9],[10],[18],[19] but there is variability in their knowledge, and awareness. Although the majority of dental students identified tobacco, the Ultraviolet exposure, human papilloma virus, alcohol, premalignant lesions, old age as the risk factors, and similar to previous studies in other countries.[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] A considerable rate of students was not aware that, limited consumption of fruit and vegetables 70 (37%), tobacco, 23 (12%) and other factors are also potential risk factors. In this study, no significant associations (P > 0.05) were found between junior (2–5 years) and senior students (6 and internship) regarding the knowledge of oral cancer risk factors especially for tobacco, alcohol, ultraviolet exposure, limited consumption of fruit and vegetables, premalignant lesions, and human papilloma virus as risk factor. These findings are consistent with other studies.[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] Boroumand et al.[18] found that knowledge of oral cancer was low among juniors when compared with other grads. Camêlo et al.[22] conducted a cross-sectional study to assess knowledge and attitude of undergraduate dental students about oral cancer. One hundred and thirty-three undergraduate dental students between the 2nd and 5th years participated. The risk factors for oral cancer mainly described by the students were smoking (92.48%) and drinking (84.21%). Our results indicated that dental students considered (87%) tobacco and alcohol (83.6%) as main risk to oral cancer, 100 (53%) identified limited consumption of fruit and vegetables and 124 (65.6%) considered old age as risk factor for oral cancer. In another study from United Arab Emirates,[23] 83% of students identified tobacco as a risk factor for oral cancer, 74.4% of participants indicated that alcohol as a risk factor for oral cancer, whereas 52% identified old age and 45.6% low consumption of fruits and vegetables as a risk factor for oral cancer.

Camêlo et al.[22] conducted a study in Brazil to evaluate the knowledge and attitude of undergraduate dental students about oral cancer. Squamous cell carcinoma was described as the most common type of oral cancer by 48.12% of the students. In our study, 141 (74.6%) dental students considered that squamous cell carcinoma as the most common type of oral cancer. Our students 81 (42.9%) identified that posterior lateral margins of the tongue as the most common location of oral cancer, whereas Camêlo et al.[22] indicated that students identified lip cancer (66.17%) as the most common location of oral cancer. Our results show significant difference (P < 0.05) between junior and senior students regarding the most common location of oral cancer, 57 (50.9%) junior students, senior students 24 (31.2%), respectively, identified that posterior lateral margins of the tongue as the most common location of oral cancer. Our students 117 (61.9%) indicated that moderate or severe dysplastic oral leukoplakia as the most likely lesions to show malignant transformation more than others. This similar to Maria study,[24] that reported that large number of students considered that oral leukoplakia most likely to show malignant transformation.

Our dental student shows a good background regarding attitude and management of oral cancer. Our students answered correctly that squamous cell carcinoma 141 (74.6%) was the most form of oral cancer [Table 2]. Al Maweri et al.[17] showed that (92.6%) of dental students knew that squamous carcinoma is the most common form of oral cancer. Keser and Pekiner[4] indicated that squamous cell carcinoma was described as the most common type of oral cancer by 48.12% of the students. There was no significant difference between senior and junior students (P > 0.05) regarding the most common type of oral cancer.

Our students 151 (79.9%) indicated that any oral abnormal lesion presents it more than 3 weeks, the biopsy be done. Keser and Pekiner[4] reported that only one third of the students mentioned that they would decide to take biopsy for all suspicious oral lesions.

Our study showed that there was no significant difference between senior and junior students (P > 0.05) regarding the indication to take biopsy in suspicious oral lesions.

Our students demonstrated better knowledge regarding attitude and management of oral cancer [Table 3]. Eighty-eight percent of our dental students agree or strongly agree to inform their patients with suspect oral lesions. Eighty-eight percent of our dental students agree or strongly agree to inform their patients with risk factor of oral cancer. Seventy-eight percent of our dental students reported that have good training to perform an oral cancer examination. Eighty-four percent of our dental students perform patient's lymph nodes palpation during clinical examination. Our study shows that no significant difference between senior and junior students (P > 0.05) regarding attitude and management of oral cancer. These results are similar to Keser and Pekiner.[4]

I think that the teaching of oral diagnosis clinical course for dental students in early academic years increased their clinical hand skills and pay attention of intra-examination and extraoral examination especially for cervical lymph nodes to detect or suspect oral cancer and this reflects a good diagnostic skill for junior and senior dental students in the early detection of oral cancer. Our results show that there was significant difference (P < 0.05) between junior and senior students regarding the source information in oral cancer [Table 4]. Thirty-four (30.4%) of junior students depending on educational courses more than senior students 16 (20.8%). It is similar to Keser and Pekiner[4] who reported that students in third grade depending on educational courses more than fifth grade.
Table 4: Association between survey items in oral cancer and study level (junior and senior students)

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Our study shows that senior students 24 (31.2%) have less knowledge in selection posterior lateral margins of the tongue as the most common location for oral cancer than junior 57 (50.9%). This result shows significant difference between senior and junior students (P < 0.05) regarding the selection of posterior lateral margins of the tongue as of the most common location of oral cancer. This selection of senior students reflects poor knowledge in the clinical features of oral cancer and might be due to their concentration in other fields in dentistry more than oral medicine and oral pathology courses and that highlighted the importance to increase continuous education in the field of oral cancer.

Our results show [Table 4] that there was significant difference between senior and junior students regarding the most common age of oral cancer. Eighty-seven (77.7%) of junior students select age 40–60 years as the most common age of oral cancer, but 52 (67.5%) of senior student prefer 40–60 years as the most common age of oral cancer [Table 4]. The demographic variables such as age are very important to determine the age group that has risk to develop oral cancer.

I believe that junior students attend courses in oral pathology in second or third academic year; therefore, their information in oral cancer is still up to date more than senior students that already finished the oral pathology or medicine in previous academic years.

In general, our results show that 139 (73.5%) of dental students considered the most common age of oral cancer is 40–60 years and were higher that reported in Sadeq et al.,[17] who indicated that only 60% of students considered older age as a potential risk factor for the development of oral malignancy. This result is similar to Kujan et al.,[7] Saleh et al.,[11] and Joseph et al.[9]

Our study highlighted the association between survey items in oral cancer and type of colleges either government or private [Table 5]. There was no previous study to compare the assessment of knowledge in oral cancer in private and government collages. There were minor variations between knowledge, awareness, attitude, and management of oral cancer for dental students in private and government colleges. Our results show that 99 (88.9%) of dental students in government colleges considered human papilloma virus as a risk factor, higher than dental students in private colleges 48 (73.3%), P < 0.05. There was no significant difference between knowledge, awareness, attitude, and management of oral cancer between students in either private and government colleges (P > 0.05).
Table 5: Association between survey items in oral cancer and type of university

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Miller et al.[25] reported that patients have been found to be receptive to dentists' advice to etiological factors such as tobacco and alcohol that cause oral cancer. Dental students have an important role in the prevention of oral malignancies by educating their patients at each contact.

My study is similar to Poudel et al.[26] who exhibited the apparent lack of awareness of dental students in some aspects of oral cancer and highlights the need of enhancing the undergraduate dental syllabus. Daily oral screening of all patients in dental clinic can reduce mortality in oral cancer through early detection and this point must be very clear in curriculums of dentistry in either private or government colleges and should generalized for all junior and senior dental students during study dentistry and their practice after graduation. Although there is no significant knowledge or awareness in oral cancer for junior and senior students, our results highlight the urgent need to revise the current curriculum with emphasis on oral cancer risk factors.

The limitations of my study indicate that sample size is relatively small. I have targeted dental students in their laboratory and clinical years specifically to gauge the efficacy of teaching modalities concerning oral cancer in junior and senior dental students in private and government colleges. As expected, some variations have been detected between junior and senior students especially of source information in oral cancer, the most common location of oral cancer and most common age for oral cancer.

It is surprising that junior students have better knowledge than senior students in selection either the most common location of oral cancer and most common age of oral cancer. Junior students are still attending courses in oral pathology or medicine in beginning academic years; therefore, I think their knowledge is up to date. Whereas senior students are more exposed to clinical common cases in dentistry more than oral cancer cases which is not common in dental clinic. Therefore, revision of knowledge senior students is very important.

In the time of the current COVID-19 epidemic, I think that the students' failure to attend all practical or theoretical sessions due to this epidemic has caused some shortage of knowledge related to oral cancer, which calls for the need to increase the learning hours in courses related to oral cancer after the end of the COVID-19 epidemic.


   Conclusion Top


Dentists play a major role in the prevention and early detection of oral cancer. This study showed gaps in the awareness, knowledge, and clinical skills of dental students including junior and senior students in relation to oral cancer. There is a need to reinforce the current undergraduate dental curriculum in regard to oral cancer education, particularly in the prevention and early detection.

Acknowledgments

The author would like to thank the Deanship of Scientific Research at Prince Sattam Bin Abdulaziz University for their support in the publication of this research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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