This cross-sectional study sought to assess the knowledge, practices, and attitudes toward oral cancer prevention and early detection among students and interns in the College of Dentistry at AAUP; and to investigate the factors that influence their practices of oral cancer screening or prevention.
There was an 68.8% response rate, which is higher compared to other analogous studies from Saudi Arabia (56.4%, 54.2%) [27, 32].
The current study revealed that the level of oral cancer knowledge among most of the surveyed participants is regarded as poor. This result is comparable to the results of previous studies conducted in Saudi Arabia [31, 32], Kuwait  and United Arab Emirates , but it is in contrast to those of other studies in Saudi Arabia [18, 28] and India  that revealed good to excellent knowledge of oral cancer and its associated risk factors among dental students and interns.
Regarding the level of the practice of oral cancer prevention and early detection, the present survey demonstrated a poor level of practice among the surveyed participants. This is in accordance with the results of a recent cross-sectional study in Saudi Arabia ; however, it is in contrary to the results of studies in India  and Brazil  that demonstrated good practices of oral cancer prevention and screening among undergraduate dental students. Might be the poor level of oral cancer knowledge in the current study justifies the poor level of practice among the responding participants.
In addition, the present study demonstrated that the attitude toward oral cancer prevention among the participants was favorable. This agrees with the results of other studies in Saudi Arabia , India  and Brazil , but contrasts with those of a recent cross-sectional study conducted in Saudi Arabia .
The current study concluded that the level of education positively affected the knowledge and attitude scores; since the interns in the College of Dentistry at AAUP had significantly better knowledge and attitude scores toward oral cancer prevention compared to the undergraduate dental students. This finding is in accordance with that demonstrated by Shubayr et al. , but it is in contrast to the results of a study in Turkey  that demonstrated no significant association between the year of study in the dental college and the level of knowledge of oral cancer risk factors.
Regarding the practice of oral cancer prevention and early detection, why fourth-year dental students had significantly better practice scores compared to fifth-year students and interns might be explained by their application of freshly educated topics since they start to take these topics at fourth-year level.
Concerning the perceived barriers to oral cancer prevention and screening among the undergraduate dental students and interns at AAUP, lack of training was the most prevalent, followed by lack of time, lack of confidence, and lack of effectiveness. These findings are in accordance with the results of a study  undertaken in Australia that reported that lack of training, confidence, time, and financial incentives were seen as barriers to performing oral mucosal screening to at least some degree by the responding participants. The lack of training could be managed by enhancing the dental undergraduate curricula and by making continuous educational programs and training on oral cancer prevention and early detection. In the United States, the CODA (Commission on Dental Accreditation) specifies that all USA dental students should be experienced in screening for head and neck cancer and in identification of its risk factors . It is worth noting that the studies published before the recent modifications of the CODA academic standard had revealed that American dental students and dentists considered themselves undertrained in oral cancer screening and detection [20, 21].
Undergraduate dental students in AAUP are sensitized to the subject of oral cancer starting from the third year of curriculum. During this year, the students in oral pathology course are exposed to risk factors and carcinogenesis of oral cancer and potentially malignant oral disorders. This course is given in the form of lectures, structured interactive sessions, and evaluation of histopathological slides. By the fourth and fifth years, the students in oral medicine courses get the theoretical basics of diagnosis and treatment of malignant and potentially malignant oral lesions in the form of lectures, structured interactive sessions, and seminars. These sessions are guided by oral medicine and oral surgery specialists. Clinically, the students in the fifth year have an oral medicine clinic where potentially malignant oral lesions and oral cancer cases are referred to and the students practice examining, diagnosing, and treating like these cases.
It appears that the present study is the first in Palestine to assess the knowledge, practice, and attitudes toward oral cancer prevention and early detection among future and current dentists.
This study gains its importance from being a cross-sectional, low-cost, and prompt method that provides useful information on the adequacy of the dental curriculum of oral cancer prevention in this dental school, and also gives insight into the need for continuous education programs to train students and practitioners in oral cancer prevention theoretically and practically.
However, caution should be taken when interpreting the results of the current study due to some methodological limitations. The study was a questionnaire-based survey and all data were self-reported and subjective; therefore, the responses may not appropriately reproduce the real levels of knowledge and attitudes. In addition, this study included only dental students and interns in the College of Dentistry at AAUP; this may limit the generalizability of the findings to all students and dentists practicing in Palestine. Finally, the relatively low response rate (68.8%) that could introduce a nonresponse bias should be taken into consideration. However, this study shed the light on the necessity of enhancing the educational undergraduate curricula and on conducting continuous training activities for dental students and dentists about oral cancer prevention and early detection both theoretically and practically. Numerous oral cancer screening cases should be part of dental students’ clinical requirements. Dental schools should be the leader in heading like these training programs for oral health providers; therefore, oral cancer cases will be early detected leading to an increase in oral cancer survival rates and a decrease of morbidity rates [36, 37].