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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 5  |  Issue : 3  |  Page : 225-229

Knowledge, attitude, and practices of Saudi Dental students regarding oral/oropharyngeal cancer: A cross-sectional study


College of Dentistry, King Saud University, Riyadh, Saudi Arabia

Date of Submission14-Aug-2021
Date of Decision23-Mar-2022
Date of Acceptance18-Apr-2022
Date of Web Publication08-Jul-2022

Correspondence Address:
Bader Fatani
College of Dentistry, King Saud University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_105_21

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  Abstract 


Background: Oral cancers are well known for their disastrous and fatal consequences. This type of cancer manifests itself in various forms, ranging from simple ulcerative lesions to proliferative growths. The reduction of morbidity and mortality of cancer can be achieved via its early recognition through screening and patient awareness and can improve the outcome of the disease comparatively. Even though most of the dentists who were surveyed said that they are inclined to provide head-and-neck examinations for their patients, studies show that dentists generally lack the knowledge required for diagnosing oral cancer lesions. Objective: This study aims to assess and evaluate the knowledge, attitude, and practices of dental students regarding oral cancer at King Saud University. Materials and Methods: The data were collected from the dental students at King Saud University in Riyadh, Saudi Arabia, from May 2021 to August 2021. The targeted subjects were dental students – male and female students older than 20 years – studying at King Saud University. Results: A sample of 206 dental students was analyzed. It was found that most dental students have heard about oral cancer (93.2%) and knew that it was preventable (77.7%). They also knew that it was treatable (93.7%) and has the ability to metastasize (93.2%). The relationship between the knowledge of oral cancer and the gender of the students was not statistically significant (all P > 0.050). There were significant relationships between oral cancer knowledge and age of the student (P < 0.001) and oral cancer treatability and age (P = 0.002). Similarly, oral cancer knowledge (P ≤ 0.001), treatability knowledge (P = 0.007), and metastasis knowledge (P = 0.030) were significantly related to the progression of academic years. Conclusion: Our study showed that dental students have significant knowledge and awareness regarding oral cancer including the clinical appearance, signs, and symptoms of oral cancer. Moreover, few dental students even considered themselves very well informed and qualified to detect oral cancer in patients. Therefore, we assume that increasing the dental students' clinical practice as well as their self-confidence could highly influence the early detection of oral cancer for patients in future.

Keywords: Awareness, dental students, knowledge, oral cancer


How to cite this article:
Fatani B, Alabood AA, Almuqrin RF. Knowledge, attitude, and practices of Saudi Dental students regarding oral/oropharyngeal cancer: A cross-sectional study. J Nat Sci Med 2022;5:225-9

How to cite this URL:
Fatani B, Alabood AA, Almuqrin RF. Knowledge, attitude, and practices of Saudi Dental students regarding oral/oropharyngeal cancer: A cross-sectional study. J Nat Sci Med [serial online] 2022 [cited 2022 Aug 17];5:225-9. Available from: https://www.jnsmonline.org/text.asp?2022/5/3/225/350291




  Introduction Top


Oral cancers are commonly developed in specific places in the body such as the oral cavity, lips, pharynx, and nasopharynx.[1] Oral squamous cell carcinoma is a term commonly used to describe oral cancers.[1] Oral squamous cell carcinoma constitutes more than 90% of oral cancers.[1],[2] These kinds of malignancies have preventable risk factors, such as smoking and human papillomavirus (HPV) infection. However, oral cancers are well known for their fatality rate and disastrous consequences and have one of the highest mortality rates when it comes to cancer compared to other malignancies.[3],[4],[5] Most common individual etiological factors that affect the development of oral cancers are the extreme intake of alcohol, ultraviolet exposure in case of lip cancer, chewing of betel quids, lower consumption of healthy dietary resources, and the use of tobacco, with further increase in the risk, if these factors are used together.[1],[2],[6],[7] Other factors include lack of awareness, low socioeconomic status, and poor oral hygiene.[8],[9] Reduction in morbidity and mortality from cancer can be established through its early recognition, screening, and awareness, which could improve the outcomes of the disease compared to its late recognition.[1],[10] The stage and grade of disease progression are critically important factors related to morbidity and mortality. Thus, an early diagnosis of oral cancer is considered an important key factor in reducing the spread of the disease.[8] A 5-year survival rate of oral cancer is 50% compared to 80% when the disease is detected in its early stage.[11] Even though the oral cavity is reachable for examination and oral cancer has a distinct clinical feature, oral cancers are only usually discovered in their advanced stages.[12] Moreover, oral cancers present themselves in various forms ranging from simple ulcerative lesions to proliferative growths.[8] The community knowledge and awareness of oral cancers are generally shown to be poor, yet certain evidence showed that some groups could be more aware of it than others.[3] In addition to that, the absence of awareness and knowledge in patients regarding oral cancers has disrupted the treatment's initiation.[1] Most of the dentists stated that they implemented head-and-neck examinations on their patients. However, a lot of studies show a lack of awareness and knowledge of the diagnosis as well as the risk factors in oral cancer between dentists.[9] The knowledge and awareness of oral cancers are relevant factors for the treatment process.[3] Medical and dental practitioners have a huge role in preventing and detecting oral cancer in its early stage.[1] Previous studies show that dental students had a higher knowledge regarding potentially malignant oral disorders than medical students and female students in particular exhibited a greater awareness.[13] The need for an increase in the knowledge and awareness of oral cancer within the population of health-care professionals is significant in detecting the affliction during its early stage.[14] Since undergrad dental students are the future clinicians, their awareness and knowledge regarding oral cancers must be continuously assessed and upgraded.[1] This study aims to assess and evaluate the knowledge, attitude, and practices of dental students at King Saud University when it comes to oral cancer.


  Materials and Methods Top


This research is an observational cross-sectional study with a sample size of 206 dental students at King Saud University. The permission was acquired from the Research Ethics Committee of King Khalid University Hospital. The data were collected from dental students at King Saud University in Riyadh, Saudi Arabia. All information regarding the research questionnaire was explained, and the consent form was approved by each participant. The study was conducted from May 2021 to August 2021. The targeted subjects were dental students – males and females above the age of 20 studying at King Saud University in Riyadh, Saudi Arabia. Those under 20 years or nondental students or those who are not studying at King Saud University were excluded. First, a simple random sampling of 159 electronic questionnaires (also referred to as “SurveyMonkey”) was distributed to the dental students at King Saud University through e-mail and WhatsApp. Second, a random sampling through face-to-face interviews (47 in total) was conducted with the dental students at King Saud University. Since the Cochran formula for population proportion assumes normal distribution at a 95% confidence level, it was considered suitable for determining appropriate sample size. With a margin of error of 5% and with a population size of 490, it was decided that a minimum sample size of 134 participants were to be considered from the dental students at King Saud University. Some inspiration from the Malaysian study was also taken and considered in our research.

Statistical analysis

Data were checked for completeness and correctness. Variables were presented as frequencies and percentages. The relationship between oral cancer knowledge and demographic characteristics was assessed by Chi-square test. The analysis was performed in 95% confidence interval using the Statistical Package for the Social Sciences, version 23.0 (IBM, Armonk, NY, USA).


  Results Top


A total of 206 dental students were interviewed for this study. Among them, 102 (49.5%) were female. Their age distribution (in years) was as follows: <21 = 30.6%, 21–22 = 38.3%, 23–24 = 18.9%, and >24 = 12.1% [Table 1]. The majority heard about oral cancer (93.2%), and knew that it was preventable (77.7%). They also knew that it was treatable (93.7%) and metastasize (93.2%) [Table 2].
Table 1: Demographic characteristics of the respondents

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Table 2: Basic knowledge about oral cancer

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The most known risk factor for developing oral cancer was tobacco (94.2%), and the least known risk factor was old age (78.6%). The most common site for oral cancer according to the respondents was floor of the mouth (38.3%), and the least known site was lips (2.9%) [Chart 1] and [Chart 2].



The most common two precancerous lesions – leukoplakia and erythroplakia were known by 78.2% of the dental students. The most common form of oral cancer was squamous cell carcinoma, known by 74.3% of the students. Again, most of the students (82%) knew that oral cancer can manifest without initial complaint or symptoms. However, when asked about their qualification to detect oral cancer, 18% disagreed, and 15.5% extremely disagreed. Most of the dental students would suggest a referral to oral medicine if suspected an oral malignancy, 68% [Table 3].
Table 3: Oral cancer knowledge

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The relationship between oral cancer knowledge and gender was not statistically significant (all P > 0.050) [Table 4]. There were significant relationships between oral cancer knowledge and age (P < 0.001) and oral cancer treatability and age (P = 0.002) [Table 5]. Similarly, oral cancer knowledge (P ≤ 0.001), treatability knowledge (P = 0.007), and metastasis knowledge (P = 0.030) were significantly related with the progression of academic years (education) [Table 6].
Table 4: Relationship between oral cancer knowledge and gender

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Table 5: Relationship between oral cancer knowledge and age

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Table 6: Relationship between oral cancer knowledge and age

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  Discussion Top


A lot of studies illustrate the knowledge about oral cancer among dental students. However, dental students' knowledge, attitude, and practices regarding oral cancer must be continuously assessed and upgraded. A study was conducted in a Malaysian private university showing that 99% of dental students have had heard about oral cancer. In correlation to it, our study showed almost a similar result with 93.2% of dental students had heard of oral cancer before.[1] Regarding oral cancers' treatability, a slight difference was observed in the students' awareness in the Malaysian private university, which was 86.4%, compared to the awareness of students in King Saud University, which was 93.7%. However, regarding the knowledge of the prevention of oral cancer, a similar result was observed in both universities.[1] With regard to the clinical appearance of oral cancer, our study showed that 18% of dental students considered themselves very well informed. Contrary to that, a significant difference was found in the study of the Malaysian dental students as only 2.8% of dental students considered themselves very well informed regarding the clinical appearance of oral cancer.[2] Another study conducted in Kantipur College showed a significantly similar result with only 3.0% of students agreeing that they are very well informed regarding the clinical appearance of oral cancer.[15] However, our study demonstrated that 68% of dental students would refer a patient to oral medicine if they suspected an oral malignancy. However, 87.8% was noted in the other study.[2] A significant knowledge was observed in the awareness of students at King Saud University regarding the risk factors in oral cancers such as the use of tobacco, chewing of betel quids, and alcohol consumption. It was also noted that those who were academically progressed in terms of their year of study showed more awareness of it. However, a study in Kanpur city showed that the dental students had average knowledge and awareness of oral cancer and its clinical presentations.[16] In our study, the dental students' knowledge was shown to be significantly higher regarding the color of oral cancer (red, white, and mixed) and showed a similar result to the Malaysian private university study.[1] Previous studies have shown that dental students had a higher knowledge regarding potentially malignant oral disorders and that the female students exhibited a greater awareness.[13] In correlation to that, our study showed that the dental students had a significant knowledge regarding oral cancer. However, the relationship between oral cancer knowledge and gender was not statistically significant (all P > 0.050).


  Conclusion Top


The overall knowledge and awareness about oral cancer among dental students is highly significant to detecting it in its early stage. In addition to that, there were significant relationships between oral cancer knowledge and age (P < 0.001). However, the relationship between oral cancer knowledge and gender was not statistically significant as mentioned in other studies. Our findings based on the sample show that dental students have the relevant knowledge regarding the clinical appearance, signs, and symptoms of oral cancer. However, only a few dental students considered themselves very well informed and qualified to detect oral cancer in patients. Regarding the significance of dental students' knowledge and awareness of oral cancers, we assume that an increase in the dental students' clinical practice and self-confidence could highly affect the early detection of oral cancer by dentists. For future purposes, we recommend inspecting dental students' probable motivations to improve their self-confidence and clinical practice in detecting oral cancers.

Limitation

Further investigations need to be done regarding HPV and its association with oral or oropharyngeal cancer. Our study was limited to dental students at the college of dentistry at King Saud University and further investigations need to be done regarding other dental students in Saudi Arabia.

Acknowledgment

There were no incentives given for the participants.

We would like to thank our participants for their time and contribution in the study.

Ethical approval

This study was evaluated by the Research Ethics Committee of King Khalid University Hospital (KKUH) (IRB project No. E21-6108).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Carter LM, Ogden GR. Oral cancer awareness of general medical and general dental practitioners. Br Dent J 2007;203:E10.  Back to cited text no. 3
    
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Kazmi F, Alkait S, Alghamdi H, Alhussain G, Tabassum A. Assessing knowledge, attitude and practices for oral squamous cell carcinoma among health care professionals in Princess Nourah University, Riyadh, KSA. Asian Pac J Cancer Prev 2020;21:539-45.  Back to cited text no. 4
    
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Keser G, Pekiner FN. Assessing oral cancer awareness among dental students. J Cancer Educ 2019;34:512-8.  Back to cited text no. 7
    
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Shrestha A, Marla V, Shrestha S, Agrawal D. Awareness of undergraduate dental and medical students towards oral cancer. J Cancer Educ 2017;32:778-83.  Back to cited text no. 8
    
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Nazar H, Shyama M, Ariga J, El-Salhy M, Soparkar P, Alsumait A. Oral cancer knowledge, attitudes and practices among primary oral health care dentists in Kuwait. Asian Pac J Cancer Prev 2019;20:1531-6.  Back to cited text no. 9
    
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Tavakoli M, Bater M, Taylor N. Current knowledge and awareness of healthcare professionals of oral cancer: A study at a UK District General Hospital. J Cancer Educ 2021;36:1285-9.  Back to cited text no. 10
    
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Poudel P, Srii R, Marla V. Oral cancer awareness among undergraduate dental students and dental surgeons: A descriptive cross-sectional study. JNMA J Nepal Med Assoc 2020;58:102-7.  Back to cited text no. 11
    
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Jnaneswar A, Goutham BS, Pathi J, Jha K, Suresan V, Kumar G. A cross-sectional survey assessing knowledge, attitude, and practice regarding oral cancer among private medical and dental practitioners in Bhubaneswar City. Indian J Med Paediatr Oncol 2017;38:133-9.  Back to cited text no. 12
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Jayasinghe RD, Sherminie LP, Amarasinghe H, Sitheeque MA. Level of awareness of oral cancer and oral potentially malignant disorders among medical and dental undergraduates. Ceylon Med J 2016;61:77-9.  Back to cited text no. 13
    
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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 Educ 2018;33:1279-84.  Back to cited text no. 14
    
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Pokhrel P, Khadka B. Oral cancer awareness among undergraduate dental students of Kantipur Dental College and Hospital. J Nepal Health Res Counc 2020;18:541-3.  Back to cited text no. 15
    
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Srivastava R, Wazir SS, Jyoti B, Kushwah S, Pradhan D, Priyadarshi P. Perception and outcome of oral cancer awareness among clinical undergraduate dental students of Tertiary health care centre at Kanpur city: A cross-sectional study. Natl J Maxillofac Surg 2020;11:89-93.  Back to cited text no. 16
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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