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ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 35-38

A study on awareness of early detection and screening of potentially malignant oral disorders and oral cancer


1 Department of Oral Pathology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India
2 Department of Oral Pathology, Indira Gandhi Institute of Dental Sciences, Pondicherry, India

Date of Web Publication20-Mar-2017

Correspondence Address:
M Devi
Department of Oral Pathology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Kanchipuram - 603 319, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.202576

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  Abstract 

Background: Squamous cell carcinoma accounts for more than 90% of oral malignancies. The incidence of squamous cell carcinoma of oral cavity differs widely in various parts of the world. It is well within the scope of General Dental Practitioners (GDPs) to carry out certain diagnostic investigations such as exfoliative cytology and oral tissue biopsy to determine the nature of the lesion.
Aim: The aim of this study was to assess the awareness concerning the early detection and screening of potentially malignant oral disorders and oral cancer among general dental practitioners of Tamil Nadu.
Materials and Methods: Questionnaires were sent to 194 general dental practitioners. The completed questionnaire was collected immediately. Confidentiality of the participants was guaranteed.
Statistical Analysis: The statistical analysis included the use of descriptive statistics.
Results: Approximately 97% of the participants conducted intraoral soft tissue examination; 86.5% recorded the tobacco habits of the patients and approximately 97% said that they counsel the patient to stop tobacco habits. A total of 23% said potentially malignant oral disorders (PMOD) was scrapable in nature and 77% said it was nonscrapable. A total of 69% of the dentists answered that white lesions had more probability to change into oral cancer. In this study, 92% mentioned that if they suspect oral cancer in their patients then they would examine the regional lymph nodes. When questioned about the best technique for early diagnosis of oral cancer, 24% assumed exfoliative cytology, 73% accepted biopsy. A total of 43% revealed that they had performed these diagnostic procedures in their clinics. A total of 75% dentists suggested that they needed a consultant oral pathologist. A total of 78% participants had attended continuing dental education programs related to oral cancer. On confirming the diagnosis of cancer, 75% referred their patients to regional cancer centres.
Conclusion: The findings on the awareness concerning the early detection and screening of PMOD and oral cancer among GDPs show the need for clinicopathologic correlation.

Keywords: General dental practitioners, oral cancer, potentially malignant oral disorders, screening


How to cite this article:
Devi M, Vijayalakshmi D, Dhivya K, Vezhavendhan N. A study on awareness of early detection and screening of potentially malignant oral disorders and oral cancer. J NTR Univ Health Sci 2017;6:35-8

How to cite this URL:
Devi M, Vijayalakshmi D, Dhivya K, Vezhavendhan N. A study on awareness of early detection and screening of potentially malignant oral disorders and oral cancer. J NTR Univ Health Sci [serial online] 2017 [cited 2019 Nov 13];6:35-8. Available from: http://www.jdrntruhs.org/text.asp?2017/6/1/35/202576




  Introduction Top


Squamous cell carcinoma accounts for more than 90% of all oral malignancies. The incidence of squamous cell carcinoma of the oral cavity differs widely in various parts of the world on the basis of environmental differences or lifestyle and habits among certain population. The screening and early detection of potentially malignant oral disorders (PMODs) and oral cancer are the only means for controlling the disease. General dental practitioners (GDPs) can play a significant role in this direction.[1] Awareness of these lesions, early detection, and prevention is critically important and is the best way to manage the disease.

It is well within the scope of GDPs to carry out certain diagnostic investigations such as exfoliative cytology and oral tissue biopsy to determine the nature of the lesion.[2] Additional information regarding the demographic data, the history of the lesion, detailed medical history, the clinical appearance, and the exact site of investigative procedure performed should be recorded to obtain an accurate diagnosis.[2]

The assessment level of the knowledge, attitude, and behavior of the GDPs regarding these lesions is important for successful judgment and diagnosis. Inaccurate diagnosis or a delay in diagnosis of these lesions may have profound implications for both the patients and practitioners.[3] Hence, the present study was conducted on a convenient group of GDPs in Tamil Nadu, aiming to assess the awareness and practice regarding early detection of PMODs and oral cancer.


  Materials and Methods Top


A self-administered questionnaire (SAQ) was constructed and personally handed over to 194 GDPs selected randomly from different districts of Tamil Nadu, India. A time of 10 minutes was given to complete the questionnaire. The completed questionnaire was collected immediately. Confidentiality of the participants was guaranteed. The informed consents of the participants were also obtained.

The questionnaire consisted of 15 questions and the questions were designed such that 11 out of 15 had the options “Yes” or “No.” Four questions were in multiple choice formats. The questionnaire included demographic variables of the responding practitioners such as age, gender, professional qualification, years of experience, and centre of practice. Questionnaire variables included whether the GDPs routinely carry out intraoral soft tissue examination, recording the tobacco habit of patients, counseling the patients to stop the habit, clinical appearance of precancerous white lesions, whether they were scrapable or nonscrapable, probability of red and white lesions to change into oral cancer, examination of regional lymph nodes, knowledge about the risk of metastasis, diagnostic procedure carried out to detect PMODs and oral cancer and its cost effect, the need for consulting an oral pathologist to give opinion in diagnosing the lesion and the desire for further updating the knowledge of PMODs and oral cancer. Finally, the respondents were asked about the referral place of the diagnosed patients. The collected data were entered in Microsoft Excel windows 2007. The statistical analysis included the use of descriptive statistics.


  Results Top


Out of the 194 GDPs who answered the questionnaire, 100 participants were male and 94 were females. The mean age of the dentists was approximately 37.6 years. The mean age of males was 38.41 years and for female dentists it was 36.21 years.

On asking whether they routinely carry out intraoral soft tissue examination, 97% (190) answered “yes,” and they also added that it is mandatory during case sheet recording. A total of 86.5% (168) believed that they should record the tobacco habits of the patients, and approximately 97% (190) said that they would counsel the patient to stop the habit if they come across such habits in patients. On asking how does precancerous white lesions appear clinically, according to their knowledge, 23% (44) said it was scrapable and 77% (150) said it was nonscrapable. A total of 85% (166) of the dentists had seen patients with nonscrapable white lesions too.

It was evident that 83% (162) of dentists were aware that few cancerous lesions can present as red lesions. On the other hand, 69% (132) of dentists answered that white lesions had more probability to change into oral cancer.

The majority of the GDPs, 92% (180), in this study mentioned that if they suspect oral cancer in their patients then they would definitely examine the regional lymph nodes, and admitted that delayed diagnosis of oral cancer increases the risk of metastasis.

To estimate the best technique for early diagnosis of oral cancer, according to their clinical experience, 24% (48) assumed exfoliative cytology, 73% (142) accepted biopsy, and 2% (4) mentioned brush biopsy procedures. Only 52% (100) of the respondents felt that the abovementioned diagnostic procedures were economical to be performed in their clinics, out of which 43% (84) revealed that they have performed these diagnostic procedures in their clinics.

Approximately 75% (146) of the dentists suggested that they needed a consultant oral pathologist for the diagnosis of PMODs and oral cancer in their clinic. Most of the GDPs, 78% (152), specified that they will attend continuing dental education programs related to oral cancer. To the question regarding the referral centre, where the respondents send their patients after confirming the diagnosis, 75% (146) referred to regional cancer centre, 16% (32) to nearby dental institution, and 9% (16) to general hospital.


  Discussion Top


The present study was conducted to assess the level of knowledge, attitude, and behavior of GDPs regarding PMODs and oral cancer. It revealed the awareness concerning the early detection and screening of these lesions among GDPs of Tamil Nadu. The results greatly persuade us because many of the GDPs in Tamil Nadu showed significant knowledge in complete intraoral examination and recording their clinical findings.

Not surprisingly, approximately 86.5% of the GDPs record the tobacco habits of the patients. This clearly points out that the GDPs are aware about the predisposing and etiological factors of PMODs and oral cancer. Despite their knowledge, a subset of 3% of GDPs claimed that they failed to counsel their patients to stop the habits. This creates a gap between the actual implementation of clinical practice with risk factors of PMODs and oral cancer. Morse et al. in 1996 and Schlecht et al.in 2001 showed that recommendation to stop tobacco habits have the potential to reduce the incidence of PMODs and oral cancer.[4],[5]

Approximately 77% of GDPs were able to differentiate between scrapable and nonscrapable white lesions and correlated with PMODs. Alonge and Narendiran in 2003 also showed positive acquaintance regarding the PMODs and oral cancer knowledge associated with the performance of clinical examination.[6] Another deplorable revelation was that approximately 69% of GDPs believed that white lesions have more probability to progress to oral cancer when compared to red lesions. The results of this study reflect the fact that most of the GDPs lack the knowledge of several clinical variants of PMOD and the significance of their behavioral pattern. Kunjan et al. in 2006 showed similar results to our study relating that visual screening of red or white lesion is effective in the early detection and prevention of oral cancer.[7]

Almost 92% of the respondents suggested that they would definitely examine the regional lymph nodes if they suspect oral cancer. However, they admitted that negligence or delay in lymph node examination would increase the risk of metastasis. These results provide further evidence that GDPs were aware of the serious consequences of progression of oral cancer.

Our study demonstrated that only 24% GDPs performed exfoliative cytology and 73% performed biopsy as investigative procedure to diagnose PMODs and oral cancer. Only 2% of the dentists felt that brush biopsy procedure can also be carried out for early diagnosis of such lesions. Similarly, Shaila et al. conducted a study among practicing dentists in Kannada, which showed that 43% of the dentists were aware of the recent advances in the field of cytology and many felt that it was not suitable for their clinical usage.

Among 73% respondents, who accepted biopsy as an early diagnostic procedure for oral cancer, only 43% of GDPs reveal that they performed biopsy in their clinics. Diamanti et al. in 2002 suggested many factors make a biopsy problematic and the reason for not undertaking it in general practice includes fear of medicolegal implications, unfamiliarity with biopsy techniques, and a lack of faith in personal diagnostic skills, as well as the contention that biopsy is a specialist procedure.[8] Bataineh et al. in 2015 concluded that there was a significant difference between the theoretical information related to oral biopsy and the practical application of this information among the GDPs.[3] Therefore, they must be aware not only of where, when, and how to perform a biopsy, but also when to refer a patient to a specialist.

In our study, approximately 75% of dentists suggested that they need a consultant oral pathologist for diagnosing in their clinic. Kondori et al. concluded that high rates of clinical misdiagnosis by GDPs were noted, and henceforth, indicated that a specialist is necessary for histopathological diagnosis.[9] An oral pathology consultant can contribute considerably to the control of oral cancer by detecting the dysplasia and squamous cell carcinoma at the earliest, thereby availing treatment to the patient at an early stage.

This study establishes that 78% of GDPs attended continuing dental education programs related to oral cancer. Wardh et al. in 2009 suggested that the need for continual educational programs for dentists will make them more knowledgeable. Such trainings will create increased awareness regarding the early detection and prevention of oral cancer in clinical practice securely and assertively.[10]

Approximately 75% of the GDPs indicated that refer their patients diagnosed with cancer to a regional cancer centre. Similarly, Ravikumar et al. also showed that 80% of the practitioners selected regional cancer centre as the referral point for a patient with oral cancer. This reflects the knowledge of the GDPs on the high mortality rate of oral cancer.[11]


  Conclusion Top


Routine screening programs and application of diagnostic investigative procedures should be emphasized by GDPs for prevention of PMODs and oral cancer.[12] Greater emphasis should be given on teaching of oral cancer during the undergraduate level. The findings on the awareness concerning the early detection and screening of PMODs and oral cancer among GDPs show the need for clinicopathologic correlation. In order to help GDPs detect suspicious oral lesions, continuing dental education programs pertaining to the practical aspects of oral cancer should be conducted. The knowledge and attitude of the GDPs towards early detection of these lesions will be of more value in patient welfare.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shaila M, Shetty P, Decruz AM, Pai P. The Self-Reported Knowledge, Attitude and the Practices Regarding the Early Detection of Oral Cancer and Precancerous Lesions among the Practising Dentists of Dakshina Kannada—A Pilot Study. J Clin Diagn Res 2013;7:1491.  Back to cited text no. 1
    
2.
Murgod V, Angadi PV, Hallikerimath S, Kale AD, Hebbal M. Attitudes of general dental practitioners towards biopsy procedures. J Clin Exp Dent 2011;3:418-23.  Back to cited text no. 2
    
3.
Bataineh AB, Hammad HM, Darweesh IA. Attitude toward oral biopsy among general dental practitioners: Awareness and practice. J Orofac Sci 2015;7:19.  Back to cited text no. 3
  [Full text]  
4.
Morse DE, Katz RV, Pendrys DG, Holford TR, Krutchkoff DJ, Eisenberg E, et al. Smoking and drinking in relation to oral epithelial dysplasia. Cancer Epidemiol Biomarkers Prev 1996;5:769-77.  Back to cited text no. 4
    
5.
Schlecht NF, Pintos J, Kowalski LP, Franco EL. Effect of type of alcoholic beverage on the risks of upper aerodigestive tract cancers in Brazil. Cancer Causes Control 2001;12:579-87.  Back to cited text no. 5
    
6.
Alonge OK, Narendran S. Opinions about oral cancer prevention and early detection among dentists practising along the Texas–Mexico border. Oral Dis 2003;9:41-5.  Back to cited text no. 6
    
7.
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;12:194-9.  Back to cited text no. 7
    
8.
Diamanti N, Duxbury AJ, Ariyaratnam S, Macfarlane TV. Attitudes to biopsy procedures in general dental practice. Br Dent J 2002;192:588-92.  Back to cited text no. 8
    
9.
Kondori I, Mottin RW, Laskin DM. Accuracy of dentists in the clinical diagnosis of oral lesions. Quintessence Int 2011;42:575-7.  Back to cited text no. 9
    
10.
Wårdh I, Paulsson G, Fridlund B. Nursing staff's understanding of oral health care for patients with cancer diagnoses: An intervention study. J Clin Nurs 2009;18:799-806.  Back to cited text no. 10
    
11.
Kulkarni RS, Arun PD, Rai R, Kanth VS, Sargaiyan V, Kandasamy S. Awareness and practice concerning oral cancer among Ayurveda and Homeopathy practitioners in Davangere District: A speciality-wise analysis. J Nat Sci Biol Med 2015;6:116.  Back to cited text no. 11
    
12.
Nazar SA. Awareness Of Early Detection And Prevention Of Oral Cancer among Dentists-A Review. IOSR J Dent Med Sci; 1:10-2.  Back to cited text no. 12
    




 

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Abstract
Introduction
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