Assessment of knowledge and attitudes of dental students about precancerous lesions of the oral mucosa

Cilj: Cilj ovog istraživanja bio je procijeniti znanje i stavove studenata dentalne medicine Medicinskog fakulteta Sveučilišta u Rijeci, Medicinskog fakulteta Sveučilišta u Splitu i Stomatološkog fakulteta Sveučilišta u Zagrebu o prekanceroznim lezijama oralne sluznice te utvrditi postoje li razlike u znanju i stavovima između studenata od četvrte do šeste godine studija Dentalne medicine svakog fakulteta te između studija Dentalne medicine različitih fakulteta. Materijali i metode: U ovom radu provedeno je presječno istraživanje, metodom internetskog upitnika. Anketni upitnik, sastavljen za potrebe ovog istraživanja, sadržavao je 30 pitanja. U prvom su dijelu prikupljeni opći podaci o ispitaniku (spol, dob, fakultet, godina studija), a u drugom ispitani znanje i stavovi o prekanceroznim lezijama oralne sluznice putem otvorenih pitanja te zatvorenih pitanja višestrukog izbora odgovora. U istraživanju su dobrovoljno sudjelovali studenti četvrte, pete i šeste godine integriranog studija Dentalne medicine Medicinskog fakulteta Sveučilišta u Splitu, Medicinskog fakulteta Sveučilišta u Rijeci te Stomatološkog fakulteta Sveučilišta u Zagrebu. Ukupno je sudjelovalo 128 studenata, od kojih 47 s Medicinskog fakulteta Sveučilišta u Splitu, 33 s Medicinskog fakulteta Sveučilišta u Rijeci i 48 sa Stomatološkog fakulteta Sveučilišta u Zagrebu. Podaci su uneseni u program Microsoft Office Excel 2007 te nakon toga obrađeni u programskom paketu STATISTICA 11.0 Rezultati: Studenti triju odabranih fakulteta pokazali su dobro znanje o prekanceroznim lezijama oralne sluznice uz iznimku nekoliko pitanja gdje je postotak točnih odgovora bio vrlo nizak kod ispitanika sva tri fakulteta. Svega 18 (47,4 %) studenata četvrte godine točno je istaknulo eritroplakiju kao prekanceroznu leziju oralne sluznice s najvećim potencijalom maligne alteracije, ali taj postotak raste na petoj (63,2 %) i šestoj (86,5 %) godini studija. Mali broj ispitanika, njih 9 (27,3 %) s Medicinskog fakulteta Sveučilišta u Rijeci, 7 (14,9 %) s Medicinskog fakulteta Sveučilišta u Splitu i 10 (20,8 %) sa Stomatološkog fakulteta Sveučilišta u Zagrebu točno su naveli sva obilježja leukoplakije (najčešće bolest starije životne dobi, neprozirna bijela promjena, u nastanku značajnu ulogu imaju dugotrajne i učestale lokalne iritacije), iako većina ispitanih studenata (60 %) prepoznaje leukoplakiju kao najčešću prekancerozu oralne sluznice i ispravno prepoznaje kliničke oblike najrizičnije za malignu alteraciju. Najveći dio ispitanika (njih 22, odn. 46,8 %) s Medicinskog fakulteta Sveučilišta u Splitu naveo je samo dno usne šupljine kao najrizičniji predio usne šupljine za malignu alteraciju prekancerozne lezije, dok svega 19 (40,4 %) studenata ispravno prepoznaje sve najrizičnije predjele. Studenti dentalne medicine nisu sasvim dobro upoznati s novijim znanstvenim spoznajama o rizičnim čimbenicima za malignu alteraciju prekanceroznih lezija oralne sluznice. Svega 10,9 % ispitanih studenata dentalne medicine navodi sve moguće čimbenike rizika. Veliki dio ispitanika (njih 99, odn. 77,3 %) ispravno prepoznaje kako je nakon dva tjedna perzistiranja suspektne lezije koja ne odgovara na terapiju pacijenta potrebno uputiti na daljnju dijagnostičku obradu. Svoje znanje o prekanceroznim lezijama oralne sluznice studenti dentalne medicine najčešće su ocijenili vrlo dobrim (55 ispitanika, odn. 43 % njih), a njih čak 99 (77,3 %) navodi Oralnu medicinu kao kolegij na kojem su imali priliku najviše čuti o ovoj temi. Najveći broj studenata triju odabranih fakulteta, njih čak 49 (38,3 %), izjašnjavaju se da su tijekom kliničkih vježbi imali mogućnost obaviti manje od pet kliničkih pregleda pacijenata s prekanceroznom lezijom, što je poražavajući podatak kada je poznata važnost kliničkog iskustva za detekciju prekanceroznih lezija i time prevenciju oralnog karcinoma. Najviše njih, čak 120 (93,8 %) ispitanika ocijenilo je informiranost pacijenata o čimbenicima rizika za razvoj raka usne šupljine kao lošu ili vrlo lošu. Zaključak: U ovom radu pokazali smo kako postoji razlika u znanju i stavovima studenata dentalne medicine triju odabranih fakulteta o prekanceroznim lezijama oralne sluznice, iako ona nije značajna, te kako se znanje o prekanceroznim lezijama mijenja s godinama studija, od četvrte do šeste godine. Uloga studenata, kao budućih doktora dentalne medicine ključna je u ranoj dijagnozi prekanceroznih lezija i prevenciji raka usne šupljine, stoga je iznimno važna edukacija i podizanje svijesti o ovoj tematici tijekom nastavnog procesa.Objective: The aim of this research was to assess knowledge and attitudes of dental students of the Faculty of Medicine of the University of Rijeka, School of Medicine in Split and the School of Dental Medicine of the University of Zagreb about precancerous lesions of oral mucosa and to determine whether there are differences in knowledge and attitudes between students from fourth to sixth year of dental study of each faculty as well as between dental studies of different faculties. Materials and methods: In this paper, a cross-sectional study has been carried out using a questionnaire method. The questionnaire was composed of 30 questions. In the first part, general information about the study participant were gathered and, in the second part, knowledge and attitudes about precancerous lesions of oral mucosa. Students of fourth, fifth and sixth year of integrated dental study of the School of Medicine in Split, Faculty of Medicine of the University of Rijeka and the School of Dental Medicine of the University of Zagreb voluntarily participated in this research. A total of 128 students participated, 47 from the School of Medicine in Split, 33 from the Faculty of Medicine of the University of Rijeka and 48 from the School of Dental Medicine of the University of Zagreb. The gathered data were entered in the Microsoft Office Excel 2007 software and after that processed in the software package STATISTICA 11.0. Results: Students from the three selected faculties showed good knowledge on precancerous lesions of oral mucosa with an exception of a few questions where the percentage of correct answers was very low in study participants on all three faculties. Only 18 (47,4%) fourth year students correctly emphasized erythroplakia as precancerous lesion of oral mucosa with highest malignant alteration potential, however, this percentage rises significantly on the fifth (63,2%) and sixth (86,5%) study year. A small number of study participants, 9 (27,3%) from the Faculty of Medicine of the University of Rijeka, 7 (14,9%) from the School of Medicine in Split and 10 (20,8%) from the School of Dental Medicine of the University of Zagreb accurately stated all the characteristics of leukoplakia (most often an old age disease, non-transparent white patches, prolonged and frequent local irritations play a significant role in emergence), even though the majority of students who participated in the study (60%) recognized leukoplakia as the most common precancerous lesion of oral mucosa and accurately recognized the most risky clinical forms for malignant alteration. The largest share of study participants (22, i.e., 46,8%) from the School of Medicine in Split listed only the bottom of the oral cavity as the most at risk part of oral cavity for malignant alteration of precancerous lesion, while only 19 (40,4%) students accurately recognized all the most at risk parts of cavity. Dental students are not quite familiar with the newest scientific knowledge on risk factors for malignant alteration of precancerous lesions of the oral mucosa. Only 10,9% of dental students who participated in the study lists all possible risk factors. A great share of study participants (99, i.e., 77,3%) correctly recognizes that it is necessary to direct the patient to further diagnostic processing after two weeks of persistence of suspected lesion that does not respond to treatment. Dental students most often rated their knowledge about precancerous lesions of oral mucosa as very good (55, i.e., 43%), and as many as 99 (77.3%) mentioned Oral medicine as the course where they had the opportunity to hear the most about this topic. The largest share of students from selected faculties, 49 (38,3%) professes that during clinical exercises they had the possibility to carry out less than five clinical examinations of patients with precancerous lesions which is a devastating information given the fact that the importance of clinical experience for detection of precancerous lesions, and with this also prevention of oral cancer, is well known. Most of them, as much as 120 (93,8%) of study participants rated the level at which the patient is informed about the risk factors for developing oral cavity cancer as bad or extremely bad. Conclusion: In this paper, we have shown that there is a difference in knowledge and attitudes of dental students of the three selected faculties about precancerous lesions of oral mucosa even though it is not that significant, as well as that the knowledge on precancerous lesions changes as the academic years progress from fourth to sixth year. Role of students as future dental practitioners is crucial in early diagnostics of precancerous lesions and prevention of oral cavity cancer, therefore, the education and awareness-raising on this topic during education is of key importance