Skip to main content
Download PDF

Comparison of knowledge, awareness, and behaviors toward oral cancer among dental students and dentists: an online cross-sectional questionnaire in Türkiye

BMC Oral Health volume 24, Article number: 502 (2024) Cite this article

Abstract

Objective

This cross-sectional online questionnaire-based study evaluated the knowledge, awareness, and behaviors of dentists and senior dental students regarding oral cancer (OC).

Materials and methods

This study included 168 dentists and senior dental students who had completed all theoretical educations and clinical practices. An online survey was administered to all participants to assess their awareness of the risk factors for OC, clinical knowledge, and behaviors. The participants’ demographic characteristics and knowledge of OC were analyzed.

Results

Of the participants, 48.8% were female and 51.2% were male. Their mean age was 27.04 ± 5.56 years (range: 21–51). In addition, 59.5% were dentists, and 40.5% were senior dental students. The dentists’ mean time since graduation was 6.38 ± 5.64 years (range: 1–27). Routine oral mucosa examination for OC was significantly more frequent among the dentists than the senior dental students (p < 0.05). Among all participants, 33% of dentists and 51.5% of senior dental students had poor knowledge of OC-related or possibly predisposing factors. Routine evaluation of OC-related and predisposing risk factors, including human papillomavirus infection, smoking, alcohol use, trauma-related non-healing oral lesions caused by long-term incompatible prostheses, and poor oral hygiene, was significantly more frequent among the dentists than the senior dental students (p < 0.05).

Conclusion

Educating dental students about a more comprehensive oral examination and early diagnosis of OC would help overcome the current lack of adequate knowledge and attitudes in OC prevention and early detection. A core curriculum compatible with the global standards on OC should be provided to dental students.

Peer Review reports

Introduction

Oral cancer (OC) is a malignancy affecting the lips, palate, floor of the mouth, gingiva, alveolar mucosa, buccal mucosa, or oropharynx [1]. It is the sixth most common cancer worldwide and the ninth leading cause of cancer-related mortality [2]. Oral cavity cancers are the second most common type of head and neck malignancy after skin and thyroid cancer in Türkiye [3]. Among cancer-related deaths, OC ranks twentieth in men and sixteenth in women worldwide [4]. Almost half of patients with OC and non-survivors are aged ≥ 65 years [1].

OC has a multifactorial etiology; excessive alcohol consumption, heavy smoking, and betel nut chewing are among its main risk factors [5]. The risk of OC is 13-fold higher in individuals with simultaneous exposure to alcohol and smoking [6]. In addition, human papillomavirus (HPV)-16 and HPV-18 infections are the primary risk factors for oropharyngeal cancer, while exposure to ultraviolet radiation is the leading risk factor for lower lip cancer [7]. Other risk factors include immunodeficiency, malnutrition, and low socioeconomic status [8]. Despite recent advancements in diagnosing and treating OC, nearly half of patients die within the first five years after diagnosis; however, the survival rate can increase to 70–90% with early diagnosis and effective treatment [9].

In its early stages, OC may be asymptomatic or resemble benign lesions. It is diagnosed mainly based on the clinician’s examination findings and a lesion biopsy [10]. Early diagnosis is theoretically possible since the mouth is a visible part of the human body. However, insufficient knowledge and low awareness of OC may result in late diagnosis. About half of OCs are diagnosed late, highlighting the importance of awareness and knowledge on this issue [11].

Several studies have investigated the behaviors and knowledge of dentists and dental students about OC [7, 12,13,14]. All these studies have underscored the need for dentists to improve the early diagnosis and prevention of OC. Most studies worldwide have conducted questionnaire surveys to determine dentists’ awareness and knowledge [4, 15]. However, only a few studies have examined this topic in Türkiye. Therefore, this study aimed to assess the awareness, knowledge, and behaviors regarding OC among dentists working at universities, state oral and dental health centers, and private clinics and senior dental students.

Materials and methods

Study design

The study group included senior dentistry students in the Faculty of Dentistry at Van Yüzüncü Yıl University (VYYUFD) who had completed all theoretical and clinical practice educations and dentists in Türkiye. This cross-sectional online-based questionnaire survey study was conducted between June and July 2020 and reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines [16, 17]. The survey targeted senior dental students at the VYYUFD and dentists whose email addresses were eligible. In total, 180 dentists and senior dental students were deemed eligible participants. All participants were informed about the study’s aim and provided informed consent.

After reviewing previous studies [18,19,20], an online questionnaire was developed and used in this study. The survey was pilot-tested with 30 undergraduate students and dentists to verify its simplicity and clarity. Two experts in oral medicine (SKT, MET) evaluated the validity of the questionnaire content, which was pre-validated in previous research studies [18, 19].

The survey’s reliability was assessed using the testing and retesting method, in which 30 senior dental students and dentists completed the questionnaire twice within two weeks. Both outcomes were compared using Pearson’s correlation coefficient, which showed a significant stability coefficient, suggesting good test-retest reliability. The internal consistency between items in the survey was evaluated using Cronbach’s alpha. A Cronbach’s alpha of 0.80 was attained, indicating acceptable internal consistency.

An online questionnaire was created using Google Drive, and a link was emailed and shared with all eligible participants in closed groups. A cover letter accompanying the questionnaire explained the study’s aims and methods and assured that participation was anonymous and voluntary and that all provided information would be kept confidential and used for research purposes only. The questionnaire consisted of close-ended questions that collected information on the demographics, knowledge, practices, and attitudes toward OC prevention and early detection among senior dental students and dentists.

The study protocol was approved by the XXX University Non-Invasive Clinical Research Ethics Committee (approval no.: XXX). This study was conducted according to the principles in the Declaration of Helsinki.

Data collection

The survey questions collected information on participants’ demographics (e.g., age, sex, and education level) and knowledge and attitudes toward OC prevention and early detection. The knowledge questions asked participants about their knowledge regarding OC symptoms, signs, and risk factors (16 questions). Each question answered correctly was given a score of “1.” The overall knowledge score ranged from 0 to 16, and this study used (9.6 / 16) 60% as the cut-off; [18, 21] a score > 9.6 points was considered good knowledge of OC, and a score ≤ 9.6 points was considered poor knowledge.

The third part of the questionnaire included 18 items asking participants about identifying potential clinical manifestations of OC. Each potential manifestation for regular OC screening had a “Yes” or “No” checkbox. The answers of dentists and senior dental students for each question were recorded and compared between groups.

In the final part of the questionnaire, the participants were asked about their attitudes and opinions toward OC. The questions evaluated the participants’ specialist choice for consultation of highly suspicious lesions, self-evaluation of good knowledge and adequate education on the early diagnosis and prevention of OC, intention or demand for further education and training on OC, and likely choice for the type of education/training.

Statistical analysis

Statistical analyses were performed using the Number Cruncher Statistical Systems software (version 2007; NCSS, LLC, Kaysville, UT, USA). Descriptive data were expressed in the mean ± standard deviation (SD), median (min–max), or number (percentage), as applicable. The normality of the data distribution was assessed using the Shapiro–Wilk test and box plots. The non-normally distributed variables were compared between groups using the Mann–Whitney U test. The qualitative variables were compared between groups using the chi-square, Fisher’s exact, and Fisher–Freeman–Halton tests. A p-value of < 0.05 was considered statistically significant.

Results

The response rate to the online survey was 93.3%, with 100 dentists (59.5%) and 68 (40.5%) senior dental students completely answering all items; 12 participants who answered the survey incompletely were excluded. Of the 168 participants, 48.8% were female and 51.2% were male. Their mean age was 27.04 ± 5.56 (range: 21–51) years. The dentists’ mean time since graduation was 6.38 ± 5.64 (range: 1–27) years. The participants’ descriptive data are summarized in Table 1.

Table 1 Descriptive data of the participants
Full size table

Among participants, 69% performed a routine oral mucosa examination. Of the 31% who did not perform a routine oral mucosa examination, 92.3% conducted oral mucosa screening if they thought the patient was at high risk for potential oral malignancy. The participants’ behaviors and knowledge regarding OC-related or predisposing factors according to graduation status were examined (Table 2). Among participants, 53% provided information about OC-related or predisposing risk factors to their patients, and 63.7% performed a further examination for those with a suspicious oral lesion. In addition, 33% of the dentists and 51.5% of the dental students had poor knowledge of OC-related or possibly predisposing factors.

Table 2 The comparison of behaviors and knowledge level of the dentists and senior dental students on possible oral cancer-related or predisposing factors
Full size table

Significantly more dentists than senior dental students performed routine oral mucosa examinations for OC (p < 0.05). Additionally, significantly more dentists than senior dental students performed routine evaluations of OC-related and predisposing risk factors, including HPV, smoking, alcohol use, trauma-related non-healing oral lesions caused by long-term incompatible prostheses, and poor oral hygiene (p < 0.05). However, other risk factors did not differ significantly between the dentists and senior dental students (p > 0.05).

The dentists were significantly better able to identify potential clinical manifestations of OC based on the pattern, size, and changes of the lesion, non-healing wounds, treatment-refractory lesions, painful/painless ulcerative lesions, diffuse erythematous lesions, and irregular lesions with obscure margins than the senior dental students (p < 0.05). However, the ability to identify other items did not differ significantly between the dentists and senior dental students (p > 0.05). The participants’ awareness of potential clinical manifestations of OC was also evaluated using an 18-item scale. It was found to be significantly higher among the dentists than the dental students (p < 0.01; Table 3).

Table 3 Comparison the identification of potential clinical manifestations of oral cancer by the participants
Full size table

The participants’ attitudes toward patients with suspected OC are shown in Table 4. Among them, 74.4% reported that a dentist should examine oral lesions, and 25.6% preferred a physician. The participants’ choice of specialist for consultation for a patient with a highly suspicious OC were primarily oral and maxillofacial surgeons (43.4%), another dentist (26.2%), or ear, nose, and throat specialists (20.6%). In addition, 16.1% (n = 27) had sufficient knowledge regarding the early diagnosis and prevention of OC. Among participants, 98.8% (n = 166) needed further education and information about OC, with 13.3% (n = 22) preferring an information package, 23.5% (n = 39) preferring training courses, and 63.3% (n = 105) preferring seminars on this topic.

Table 4 The attitudes of the participants for patients with suspected oral cancer
Full size table

Discussion

Despite recent developments in the diagnostic and therapeutic modalities for managing and surgically treating OC, five-year overall survival rates have remained below 50% for many decades [2]. Routine oral examinations by dentists and consultations for patients with suspected lesions are helpful for early diagnosis of OC. Dentists’ awareness of OC risk factors and lifestyle modifications can help to prevent OC and improve survival rates among patients [18]. Many studies worldwide have investigated dentists’ knowledge, awareness, and practices for preventing and early diagnosing OC [13, 15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41]; however, no study has compared the knowledge levels of dentists and senior dental students regarding OC.

The survey response rate among participants with delivery confirmation appears higher in our study (93.3%) than in previous studies using online surveys [13, 25, 42]. We believe this difference is due to the following reasons. In this cross-sectional study, we administered a questionnaire to our own dental students (SKT and MB). We also administered the questionnaire to dentists who resided in the same region. This high participation rate was achieved with the support of the city’s dental association chamber. This difference can also be attributed to the greater tendency of the specifically selected study population to participate in scientific research and the use of a reliable data collection method. We consider these to be the reasons for the higher response rate in our study compared to previous studies [13, 21, 24,25,26,27,28,29, 34, 42].

The rate of early OC diagnosis is higher among dentists than physicians since they are provided detailed education on oral cavity examination. Macpherson et al. [43] reported that 58% of dentists performed a routine OC examination as part of the dental examination, and 48% could assess whether a suspected lesion required urgent referral. Hollows et al. [44] reported that only 40% of patients with suspicious oral lesions referred to a physician by their dentist sought advanced medical treatment. Physicians were the most contacted healthcare professionals for patient groups with limited access to healthcare services, including older adults, those with alcoholism and/or tobacco abuse, and those with low socioeconomic status.

The core curriculum of dentistry faculties in Türkiye has lacked standardization for many years, and various curricula have been adopted. However, in 2016, the Council of Higher Education in the Republic of Türkiye issued the Undergraduate Dental Education National Core Curriculum. This framework outlines the basic components and principles of dental education to facilitate competence- and qualification-based learning and the adoption of a well-designed education program that meets the minimum competencies in compliance with international standards [45]. The scope of this core curriculum was to provide education regarding malignant neoplasms of the oral cavity, their associated risk factors, signs, and symptoms and to improve the skills of dental students for suspecting malignancies and referring patients with preliminary diagnoses to a specialist.

A literature review highlighted the unmet need for special education programs and experience for OC screening, including among primary care healthcare professionals. Several studies have shown that most healthcare professionals are willing to be educated on examination techniques, signs and symptoms (non-healing ulcers and red or white spots of unknown origin), preventive measures (lifestyle modifications, smoking cessation, and limiting alcohol consumption), and referral issues [43, 46, 47]. In our study, only 3% of participants were very well informed about the clinical appearance of OC during their education. This finding underscores the importance of including up-to-date data on risk factors in the curricula of dentistry faculties and improving continuing education for dental professionals after graduation.

The role of some risk factors in OC development has been proven, and many studies have investigated the level of awareness of primary care physicians and dentists of these risk factors and their diagnostic value, reporting similar results [43, 48]. Greenwood and Lowry [27] found that dentists identified tobacco usage (93.7%) and alcohol consumption (85.3%) as the main risk factors for OC, respectively. In our study, despite their differing education levels, most participants identified the potential risk factors as tobacco/alcohol usage, previous OC, and sun exposure. However, Pavão Spaulonci et al. reported that 90–100% of Brazilian dentists could identify the potential risk factors as tobacco/alcohol use, HPV, and sun exposure [42]. Other large-scale surveys by Amer et al. [49] and Formosa et al. [50] showed similar results for identifying risk factors for OC. Unlike these studies, in our study, tobacco use, alcohol consumption, HPV, and sun exposure were identified as the main risk factors for OC. Notably, these rates were relatively higher than the results of a Malaysian study by Bhagavathula et al. [51] in which only 61% of the dentists and 14% of the dental students identified tobacco and alcohol as OC risk factors. These findings suggest that the level of awareness about the hazardous effects of tobacco and alcohol use and sun exposure among dentists remains low in Türkiye. Therefore, dental professionals should be provided with more comprehensive education or continuing education on OC-related risk factors.

HPV has been identified as a major risk factor for oropharyngeal squamous cell carcinoma (SCC) [52]. HPV-related SCCs have a unique pathophysiology; as such, SCC caused by tobacco use can be treated more effectively with combined chemotherapy and radiation therapy [53]. In our study, very few participants were able to identify HPV as a risk factor for OC, emphasizing the need to increase awareness of HPV and its preventive measures, such as vaccination, among dental professionals through the curricula of the dentistry faculties.

In our study, 7.4% of the senior dental students and 40% of the dentists identified non-healing lesions and chronic trauma caused by incompatible prostheses as risk factors for OC. While the difference was significant between the dentists and dental students, the rate of participants who could identify trauma due to incompatible prostheses as a risk factor for OC was relatively low. Some authors have advocated that injuries caused by incompatible prostheses do not cause OC; however, such injuries may mask the true symptoms of malignancy by changing the appearance of the oral cavity and delaying diagnosis [42, 49]. In our study, 4% of the senior dental students and 21% of the dentists identified poor oral hygiene as a potential risk factor for OC. This finding is consistent with Oji and Chukwuneke [54], who reported that poor oral hygiene was strongly associated with OC. However, further large-scale, prospective studies are warranted to elucidate its role in OC development.

In our study, 21% of dentists also identified malnutrition as a risk factor for OC. However, none of the dental students identified malnutrition as a risk factor, indicating a significant difference between the groups. Debate regarding the possible role of malnutrition in the development of all cancers, including OC, is ongoing. Shivappa et al. [55] investigated the inflammatory potential of diet and risk of oropharyngeal cancer in the Italian population, finding that a proinflammatory diet and tobacco/alcohol use correlated positively with OC. However, Dholam and Chouksey [56] found no significant correlation between diet and OC. Another study by Scully [57] concluded that further randomized clinical trials were needed to elucidate the effectiveness of dietary supplementation in minimizing OC risk and eliminating the need for chemotherapy.

In our study, very few dentists and dental students identified stress as a risk factor for OC. While a recent study showed that emotional stress increased OC risk [42], Dholam and Chouksey [56] recognized that emotional stress was a symptom of modern life and individuals refrained from seeking immediate help due to commitments at work or home, which might delay the diagnosis but not impact the etiology of OC. Similarly, our results indicate that emotional stress and malnutrition were considered secondary risk factors for OC in addition to well-established risk factors such as HPV, tobacco and alcohol use.

Our study also examined the identification of clinical manifestations of suspected lesions as the next step in diagnosing OC. The level of knowledge on the pattern, size, and changes of lesions, non-healing wounds, treatment-refractory lesions, painful/painless ulcerative lesions, diffuse erythematous lesions, and irregular lesions with obscure margins was significantly higher among the actively working dentists than among the dental students. In their study including only dental specialists, Kebapcioglu and Pekiner [7] reported that 35.9% considered small, painless, white areas as the clinical properties of OC, while 26.5% considered small, painless, red areas as the main signs of an OC lesion.

Vijay and Suresan [21] showed that most dentists (82%) considered non-scrapable, white lesions the most common manifestation, while only 9.6% considered red erosions the most common manifestation. Clovis et al. [30] reported that most dentists (77%) correctly identified small, painless, red lesions as precancerous OC lesions. In our study, the relatively low response rate could be attributed to inadequate knowledge of both the risk factors and clinical characteristics of OC.

An effective development plan should be created on early OC diagnosis and potentially malignant entities encountered in clinical practice and provided to both undergraduates and qualified professionals through continuing education [18]. Studies have shown that the rate of early OC diagnosis is significantly higher among dentists who attend training courses or conferences [34, 58]. Considering the importance and relevance of continuing education, 98.8% of our participants needed further education and information about OC. We believe that these findings contribute to the body of knowledge in the literature and pave the way for future studies examining the curricula of dentistry faculties.

Our study had some limitations related to its scope, potential biases, and the nature of its cross-sectional design. It primarily used close-ended questions, which may limit the depth of understanding regarding the reasons behind certain behaviors or attitudes and cause a lack of qualitative insights. It also relied solely upon an online survey, and participants who were not comfortable or proficient with the internet and digital tools could not be accessed. Its number of participants was also low, and larger study groups are needed for more robust results.

Conclusion

In conclusion, the findings of this survey emphasize an unmet need for basic education about OC prevention and early detection at VYYUFD. Dentists had higher knowledge and behavior scores for OC prevention and early detection than senior dental students. Dental students at VYYUFD require more comprehensive education about OC to fill the gap and overcome current shortcomings. We believe all dental students should be provided with a clinical core curriculum on OC that is compatible with global standards.

Data availability

The datasets generated and/or analyzed during the current study have been shared. All data generated or analysed during this study are included in this published article [and its supplementary information files].

References

  1. Horowitz AM, Drury TF, Goodman HS, Yellowitz JA. Oral pharyngeal cancer prevention and early detection. Dentists’ opinions and practices. JADA. 2000;131(4):453–62.

    CAS  PubMed  Google Scholar 

  2. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol. 2009;45(4–5):309–16.

    Article  PubMed  Google Scholar 

  3. Duzlu M, Karamert R, Bakkal FK, Cevizci R, Tutar H, Zorlu ME, et al. The demographics and histopathological features of oral cavity cancers in Turkey. Turkish J Med Sci. 2016;46(6):1672–6.

    Article  Google Scholar 

  4. Johnson NW, Warnakulasuriya S, Gupta PC, Dimba E, Chindia M, Otoh EC, et al. Global oral health inequalities in incidence and outcomes for oral cancer: causes and solutions. Adv Dent Res. 2011;23(2):237–46.

    Article  CAS  PubMed  Google Scholar 

  5. Lin WJ, Jiang RS, Wu SH, Chen FJ, Liu SA. Smoking, alcohol, and betel quid and oral cancer: a prospective cohort study. J Oncol. 2011;2011:525976.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Oztürk BCU, Yaman E, Kaya AO, Yıldız R, Benekli M, Büyükberber S. The risk factors, premalignant lesions and chemoprevention oral cavity cancers. Int J Hematol Oncol. 2009;19(2):117–26.

    Google Scholar 

  7. Kebabcioglu O, Pekiner FN. Assessing oral cancer awareness among dentists. Journal of cancer education. J Am Assoc Cancer Edu. 2018;33(5):1020–6.

    Article  Google Scholar 

  8. Freedman ND, Park Y, Subar AF, Hollenbeck AR, Leitzmann MF, Schatzkin A, et al. Fruit and vegetable intake and head and neck cancer risk in a large United States prospective cohort study. Int J Cancer. 2008;122(10):2330–6.

    Article  CAS  PubMed  Google Scholar 

  9. Jafari A, Najafi S, Moradi F, Kharazifard M, Khami M. Delay in the diagnosis and treatment of oral cancer. J Dent Shiraz Iran. 2013;14(3):146–50.

    CAS  Google Scholar 

  10. Reichart PA, Philipsen HP. Oral erythroplakia–a review. Oral Oncol. 2005;41(6):551–61.

    Article  PubMed  Google Scholar 

  11. Graham JA, Horowitz AM, Canto MT. Coverage and quality of oral cancer information in selected popular press: May 1998 to July 2003. J Public Health Dent. 2004;64(4):231–6.

    Article  PubMed  Google Scholar 

  12. Joseph BK, Sundaram DB, Ellepola AN. Assessing oral cancer knowledge among undergraduate dental students in Kuwait University. J Cancer Edu. 2015;30(3):415–20.

    Article  Google Scholar 

  13. Lopez-Jornet P, Camacho-Alonso F, Molina-Minano F. Knowledge and attitudes about oral cancer among dentists in Spain. J Evaluat Clin Prac. 2010;16(1):129–33.

    Article  Google Scholar 

  14. Idrees M, Halimi R, Gadiraju S, Frydrych AM, Kujan O. Clinical competency of dental health professionals and students in diagnosing oral mucosal lesions. Oral Dis. 2023 Sep;20. https://doi.org/10.1111/odi.14743

  15. Merten JW, Parker A, Williams A, King JL, Largo-Wight E, Osmani M. Cancer risk factor knowledge among young adults. J Cancer Edu. 2017;32(4):865–70.

    Article  Google Scholar 

  16. Eysenbach G, Correction. Improving the quality of web surveys: the Checklist for reporting results of internet E-Surveys (CHERRIES). J Med Internet Res. 2012;14(1). https://doi.org/10.2196/jmir.2042. https://www.jmir.org/2012/1/e8. e8 URL.

  17. Shadid RM, Abu Ali MA, Kujan O. Knowledge, attitudes, and practices of oral cancer prevention among dental students and interns: an online cross–sectional questionnaire in Palestine. BMC Oral Health. 2022;22(1):381. https://doi.org/10.1186/s12903-022-02415-8.)

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fanaras N, Warnakulasuriya S. Oral cancer diagnosis in primary care. Prim Dent J. 2016;5(1):64–8.

    Article  PubMed  Google Scholar 

  19. Alaizari NA, Al-Maweri SA. Oral cancer: knowledge, practices and opinions of dentists in Yemen. Asian Pac J Cancer Prevent. 2014;15(14):5627–31.

    Article  Google Scholar 

  20. Seoane-Lestón J, Velo-Noya J, Warnakulasuriya S, Varela-Centelles P, Gonzalez-Mosquera A, Villa-Vigil MA, et al. Knowledge of oral cancer and preventive attitudes of Spanish dentists. Primary effects of a pilot educational intervention. Med Oral Patologia Oral y Cir Bucal. 2010;15(3):e422–6.

    Article  Google Scholar 

  21. Vijay Kumar KV, Suresan V. Knowledge, attitude and screening practices of general dentists concerning oral cancer in Bangalore city. Indian J Cancer. 2012;49(1):33–8.

    Article  CAS  PubMed  Google Scholar 

  22. Kujan O, Alzoghaibi I, Azzeghaiby S, Altamimi MA, Tarakji B, Hanouneh S, Idress M, Alenzi FQ, Iqbal M, Taifour S. Knowledge and attitudes of Saudi dental undergraduates on cancer. J Cancer Educ. 2014;29(4):735–8.

    Article  PubMed  Google Scholar 

  23. Decuseara G, MacCarthy D, Menezes G. Oral cancer: knowledge, practices and opinions of dentists in Ireland. J Ir Dent Assoc. 2011;57(4):209–14.

    PubMed  Google Scholar 

  24. Colella G, Gaeta GM, Moscariello A, Angelillo IF. Oral cancer and dentists: knowledge, attitudes, and practices in Italy. Oral Oncol. 2008;44(4):393–9.

    Article  PubMed  Google Scholar 

  25. Haresaku S, Makino M, Sugiyama S, Naito T, Mariño RJ. Comparison of practices, knowledge, confidence, and attitude toward oral cancer among oral health professionals between Japan and Australia. J Cancer Edu. 2018;33(2):429–35.

    Article  Google Scholar 

  26. Gajendra S, Cruz GD, Kumar JV. Oral cancer prevention and early detection: knowledge, practices, and opinions of oral health care providers in New York State. J Cancer Edu. 2006;21(3):157–62.

    Article  Google Scholar 

  27. Greenwood M, Lowry RJ. Primary care clinicians’ knowledge of oral cancer: a study of dentists and doctors in the North East of England. Br Dent J. 2001;191(9):510–2.

    Article  CAS  PubMed  Google Scholar 

  28. Pentenero M, Chiecchio A, Gandolfo S. Impact of academic and continuing education on oral cancer knowledge, attitude and practice among dentists in north-western Italy. J Cancer Edu. 2014;29(1):151–7.

    Article  Google Scholar 

  29. Rocha-Buelvas A, Hidalgo-Patiño C, Collela G, Angelillo I. Oral cancer and dentists: knowledge, attitudes and practices in a South Colombian context. Acta Odontol Latinoamerican. 2012;25(2):155–62.

    Google Scholar 

  30. Clovis JB, Horowitz AM, Poel DH. Oral and pharyngeal cancer: knowledge and opinions of dentists in British Columbia and Nova Scotia. J Can Dent Assoc. 2002;68(7):415–20.

    PubMed  Google Scholar 

  31. Maybury C, Horowitz AM, Goodman HS. Outcomes of oral cancer early detection and prevention statewide model in Maryland. J Public Health Dent. 2012;72(Suppl 1):S34–8.

    PubMed  Google Scholar 

  32. Applebaum E, Ruhlen TN, Kronenberg FR, Hayes C, Peters ES. Oral cancer knowledge, attitudes and practices: a survey of dentists and primary care physicians in Massachusetts. JADA. 2009;140(4):461–7.

    PubMed  Google Scholar 

  33. Horowitz AM, Siriphant P, Sheikh A, Child WL. Perspectives of Maryland dentists on oral cancer. JADA. 2001;132(1):65–72.

    CAS  PubMed  Google Scholar 

  34. Hertrampf K, Wenz HJ, Koller M, Grund S, Wiltfang J. Early detection of oral cancer: dentists’ opinions and practices before and after educational interventions in Northern-Germany. J Craniomaxillofac Surg. 2013;41(8):e201–7.

    Article  PubMed  Google Scholar 

  35. Patton LL, Elter JR, Southerland JH, Strauss RP. Knowledge of oral cancer risk factors and diagnostic concepts among North Carolina dentists. Implications for diagnosis and referral. JADA. 2005;136(5):602–10. quiz 82.

    PubMed  Google Scholar 

  36. Kujan O, Duxbury AJ, Glenny AM, Thakker NS, Sloan P. Opinions and attitudes of the UK’s GDPs and specialists in oral surgery, oral medicine and surgical dentistry on oral cancer screening. Oral Dis. 2006;12(2):194–9.

    Article  CAS  PubMed  Google Scholar 

  37. Yellowitz JA, Horowitz AM, Drury TF, Goodman HS. Survey of U.S. dentists’ knowledge and opinions about oral pharyngeal cancer.JADA. 2000;131(5):653–61.

  38. Alami AY, El Sabbagh RF, Hamdan A. Knowledge of oral cancer among recently graduated medical and dental professionals in Amman, Jordan. J Dent Edu. 2013;77(10):1356–64.

    Article  Google Scholar 

  39. Gaballah K, Faden A, Fakih FJ, Alsaadi AY, Noshi NF, Kujan O. Diagnostic accuracy of oral Cancer and suspicious malignant mucosal changes among future dentists. Healthc (Basel). 2021;9(3):263. https://doi.org/10.3390/healthcare9030263

    Article  Google Scholar 

  40. Tarakji B. Knowledge, awareness, and attitude among dental students regarding oral cancer in Saudi Arabia. Ann Afr Med. 2022 Oct-Dec;21(4):444–50. https://doi.org/10.4103/aam.aam_185_21

  41. Shamala A, Halboub E, Al-Maweri SA, Al-Sharani H, Al-Hadi M, Ali R, Laradhi H, Murshed H, Mohammed MM, Ali K. Oral cancer knowledge, attitudes, and practices among senior dental students in Yemen: a multi-institution study. BMC Oral Health. 2023;23(1):435. https://doi.org/10.1186/s12903-023-03149-x

    Article  PubMed  PubMed Central  Google Scholar 

  42. Pavão Spaulonci G, Salgado de Souza R, Gallego Arias Pecorari V, Lauria Dib L. Oral cancer Knowledge Assessment: newly graduated versus Senior Dental clinicians. Int J Dent. 2018;2018:9368918.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Macpherson LM, McCann MF, Gibson J, Binnie VI, Stephen KW. The role of primary healthcare professionals in oral cancer prevention and detection. Br Dent J. 2003;195(5):277–81. discussion 63.

    Article  CAS  PubMed  Google Scholar 

  44. Hollows P, McAndrew PG, Perini MG. Delays in the referral and treatment of oral squamous cell carcinoma. Br Dent J. 2000;188(5):262–5.

    Article  CAS  PubMed  Google Scholar 

  45. https://www.yok.gov.tr/Documents/Kurumsal/egitim_ogretim_dairesi/Ulusal-cekirdek-egitimi-programlari/dis_hekimligi.pdf. (Accessed on 12 December 2022).

  46. Tanriover O, Hidiroglu S, Save D, Akan H, Ay P, Karavus M, et al. Knowledge of oral cancer, preventive attitudes, and behaviors of primary care physicians in Turkey. Eur J Cancer Prevent. 2014;23(5):464–8.

    Article  Google Scholar 

  47. Brocklehurst PR, Baker SR, Speight PM. A qualitative study examining the experience of primary care dentists in the detection and management of potentially malignant lesions. 1. Factors influencing detection and the decision to refer. Br Dent J. 2010;208(2):E3. discussion 72 – 3.

    Article  CAS  PubMed  Google Scholar 

  48. Carter LM, Ogden GR. Oral cancer awareness of general medical and general dental practitioners. Br Dent J. 2007;203(5):E10. discussion 248-9.

    Article  CAS  PubMed  Google Scholar 

  49. Amer HW, Wahed AA, Badawi OA, Emara AS. Oral cancer awareness level within the dental community: results from a large scale survey in cairo. J Cancer Edu. 2018;33(6):1279–84.

    Article  Google Scholar 

  50. Formosa J, Jenner R, Nguyen-Thi MD, Stephens C, Wilson C, Ariyawardana A. Awareness and knowledge of oral cancer and potentially malignant oral disorders among dental patients in far north Queensland, Australia. Asian Pac J Cancer Prevet. 2015;16(10):4429–34.

    Article  Google Scholar 

  51. Bhagavathula AS, Bin Zakaria N, Jamshed SQ. Knowledge of future dental practitioners towards oral cancer: exploratory findings from a Public University in Malaysia. Int J Dent. 2015;2015:218065.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Morbini P, Benazzo M. Human papillomavirus and head and neck carcinomas: focus on evidence in the babel of published data. Acta Otorhinolaryngol Italica. 2016;36(4):249–58.

    Article  CAS  Google Scholar 

  53. Mallen-St Clair J, Alani M, Wang MB, Srivatsan ES. Human papillomavirus in oropharyngeal cancer: the changing face of a disease. Biochimic Biophysic Acta. 2016;1866(2):141–50.

    CAS  Google Scholar 

  54. Oji C, Chukwuneke F. Poor oral hygiene may be the sole cause of oral cancer. J Maxillofac Oral Surg. 2012;11(4):379–83.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Shivappa N, Hébert JR, Rosato V, Garavello W, Serraino D, La Vecchia C. Inflammatory potential of diet and risk of oral and pharyngeal cancer in a large case-control study from Italy. Int J Cancer. 2017;141(3):471–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Dholam KP, Chouksey GC. Squamous cell carcinoma of the oral cavity and oropharynx in patients aged 18–45 years: a case-control study to evaluate the risk factors with emphasis on stress, diet, oral hygiene, and family history. Indian J Cancer. 2016;53(2):244–51.

    Article  CAS  PubMed  Google Scholar 

  57. Scully C. Oral cancer aetiopathogenesis; past, present and future aspects. Med Oral Patolog Oral Cir Bucal. 2011;16(3):e306–11.

    Article  Google Scholar 

  58. Baumann E, Koller M, Wiltfang J, Wenz HJ, Möller B, Hertrampf K. Challenges of early detection of oral cancer: raising awareness as a first step to successful campaigning. Health Edu Res. 2016;31(2):136–45.

    Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This study received no specific grant from any funding agency in the public, commercial or not-for‐profit sectors.

Author information

Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Hamidiye Faculty of Dentistry, University of Health Sciences, İstanbul, 34668, Türkiye

    Serap Keskin Tunç

  2. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, 06510, Türkiye

    Mehmet Emin Toprak

  3. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İstanbul Aydın University, İstanbul, 34295, Türkiye

    Esra Yüce

  4. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, 65080, Türkiye

    Nihat Efe

  5. Department of Endodontics, Hamidiye Faculty of Dentistry, University of Health Sciences , İstanbul, 34668, Türkiye

    Celalettin Topbaş

Authors
  1. Serap Keskin Tunç
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Emin Toprak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Esra Yüce
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nihat Efe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Celalettin Topbaş
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Author contributions: S.K.T.: Contributed to conception, design, data acquisition and interpretation, drafted and critically revised the manuscript; M.E.T.: Contributed to conception, design, data acquisition and interpretation, drafted, critically revised, edited and submitted the manuscript; E.Y.: Contributed to conception, design, data acquisition and interpretation, drafted and critically revised the manuscript; N.E.: Contributed to conception, design, data acquisition and interpretation, drafted and critically revised the manuscript; C.T.: Contributed to conception, design, data acquisition and interpretation, drafted and critically revised the manuscript. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Serap Keskin Tunç.

Ethics declarations

Ethical approval

This study was carried out after obtaining the approval from the Ethical Committee of the Van Yüzüncü Yıl University (Approval Number: YYU-2020/03-30.9) and conducted in accordance with the principles of the Declaration of Helsinki. A written informed consent was obtained from each participant.

Conflict of interest

The authors declare they have no potential conflict of interest regarding the investigation, authorship, and/or publication of this article.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary Material 2

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tunç, S.K., Toprak, M.E., Yüce, E. et al. Comparison of knowledge, awareness, and behaviors toward oral cancer among dental students and dentists: an online cross-sectional questionnaire in Türkiye. BMC Oral Health 24, 502 (2024). https://doi.org/10.1186/s12903-024-04241-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12903-024-04241-6

Keywords

BMC Oral Health

ISSN: 1472-6831

Contact us