Oral cancer prevention and oral mucosal examination among dentists in Norway – a cross-sectional study

Introduction: Oral cancer is a highly relevant problem of global public health. It is part of the head and neck cancer which is the sixth most frequent among all types of cancer, and one of the ten most common causes of death. Oral squamous cell carcinoma (OSCC) comprises more than 90% of oral cancers. Despite the progress in research and therapy, survival rate of OSCC has remained 50% for the last 50 years. However, a 70%-90% survival rate can be achieved if the cancer is detected at an early stage. Modifiable risk factors such as tobacco and alcohol use accounts for the major risk factors, and around 70% of oral cancers are preceded by precancerous lesions. It is therefore important to perform thorough oral mucosal examination for early detection of potentially malignant changes in the mucosa. This justifies intense efforts to equip the oral health professional with knowledge on correct examination of oral mucosa, recognizing potentially malignant lesions of oral mucosa and early lesions of OSCC, as well as on oral cancer prevention. Aim: The overall aim of this study was to investigate knowledge, attitudes and practices related to oral cancer prevention and oral mucosal examination among dentists in Norway. Methods: The study was a cross-sectional survey based on an electronically administered questionnaire. Study population comprised all actively practicing dentists currently employed in the Public Dental Health Care (PDHC) in Norway. The project was registered in Norway at the Norwegian Centre for Research Data (NSD). Results: The overall response rate in the present study was 23.7%. Tobacco and prior oral cancer lesions were correctly identified as the main risk factors by majority of the dentists. Whereas wide variability was observed in the knowledge regarding the most common sites for oral cancer, rim of the tongue and floor of the mouth were correctly identified by most of the participants (68.2% and 60.7% respectively). Erythroplakia (83.2%) and leukoplakia (80.4%) were identified correctly by most of the participants in the study as the most prevalent lesion with malignant potential. “Small, painless, indurated ulceration” was identified by 73.6% of the participants, while other common clinical presentations, such as “small, painless white and red area” were correctly listed by 31.4% and 46.4% respectively. A large number of the participants reported to give counselling to their patients regarding tobacco cessation, while giving counselling regarding excessive alcohol use was not so common. Majority of the respondents reported to perform examination of oral mucosa on both new (83.3%) and recall (77.7%) patients. The most common listed barriers to performing oral mucosal screening were reported to be lack of training and/or experience. Conclusions: Results from the current study highlight strengths as well as gaps in dentists’ knowledge and practices related to oral cancer prevention and mucosal examination. Data from this study can be used as foundation to reinforce dental curriculum in order to enhance dentists’ awareness and knowledge related to oral cancer prevention