Oral Cancer Examination Research Articles

Maryland Dentists’ Knowledge of Oral Cancer Risk Factors and Diagnostic Procedures

A questionnaire was mailed to 800 Maryland general practice dentists to assess their knowledge of risk factors and diagnostic procedures for oral cancer. Two indices were created based on 14 questions on knowledge of oral cancer risk factors and 9 questions on oral cancer diagnostic procedures. Data were analyzed statistically and evaluated with an alpha level of 0.05. Nearly all respondents identified use of tobacco, prior oral cancer lesions, and use of alcohol as risk factors. However, only 36% correctly identified that poor-fitting dentures are not a risk factor and 58% that poor oral hygiene is not a risk factor. Nearly 87% knew how to examine the tongue and surrounding areas, and 32% identified erythroplakia and leukoplakia as conditions associated with oral cancer. Appropriate knowledge about risk factors and diagnostic procedures is essential for dentists to counsel their patients and perform appropriate oral cancer examinations.

Perspectives of Maryland dentists on oral cancer

Maryland's mortality rate for oral and pharyngeal cancer is seventh highest overall in the United States, sixth highest for men and third highest for African-American men. As part of a statewide needs assessment and in follow-up to a mail survey of Maryland general dentists, focus groups were conducted to obtain more in-depth information about why dentists do not provide a comprehensive oral cancer examination for most of their patients and how to solve this problem from a dentist's perspective. A trained focus group moderator conducted two focus groups of general practice dentists in two locations in Maryland. Five major themes emerged from the two focus groups: inaccurate knowledge about oral cancer; inconsistency in oral cancer examinations; lack of confidence in when and how to palpate for abnormalities; lack of time to routinely provide oral cancer examinations; and recommendations to help resolve these issues. The focus groups provided a rich source of ideas on how to best provide dentists with continuing education about oral cancer prevention and early detection. Participants also provided opinions about the need to improve the public's awareness of oral cancer and its prevention. Dentists need to include comprehensive oral cancer examinations as part of their routine oral examinations for all appropriate patients.

U.S. dental hygienists' knowledge and opinions related to providing oral cancer examinations.

Because U.S. dental hygienists play a significant role in providing prevention and early-detection services, it is important to describe and evaluate their oral cancer knowledge and opinions. A pretested survey, cover letter, and prepaid return envelope were mailed to 960 dental hygienists, followed by three complete follow-up mailings. The respondents were not as knowledgeable about oral cancer risk factors and diagnostic procedures as hypothesized. Although the respondents were well informed about certain key aspects of oral cancer risk factors and diagnostic procedures, there were many aspects of these topics in which they were deficient and in some cases misinformed. Dental hygiene curricula should be updated and continuing education coursesabout oral cancer should be developed and implemented.

Practices of Maryland dentists: oral cancer prevention and early detection--baseline data from 1995.

To investigate practices and opinions of general dentists in Maryland, USA, related to oral and pharyngeal cancer prevention and early detection. A pre-tested, 34-item questionnaire, cover letter and addressed, stamped envelope were mailed in the summer, 1995, to a simple random sample of 800 members and non-members of the American Dental Association practicing in Maryland. A reminder postcard was sent 3 weeks after initial mailing; a second complete mailing to all non-respondents 6 weeks after first mailing. Over 90% of dentists asked about patient's current use of tobacco but only 77% assessed patient's history of tobacco use and types and amounts used. Fewer (66%) asked about present use of alcohol. Ninety percent reported providing an oral cancer examination at the initial appointment for patients 40 years of age or older; only 6% provided the examination for edentulous patients and only 40% reported palpating lymph nodes of patients 80% or more of the time. Dentists' reporting on providing oral cancer examinations and taking appropriate health histories are disappointing. These results call for comprehensive educational interventions in terms of changes in dental curricula and as continuing education courses especially since most dentists were interested in continuing education courses on oral cancer prevention and early detection.

SURVEY OF U.S. DENTISTS' KNOWLEDGE AND OPINIONS ABOUT ORAL PHARYNGEAL CANCER

Oral pharyngeal cancer constitutes the most life-threatening of all dental and craniofacial conditions. The U.S. five-year survival rate of 52 percent for these cancers is one of the lowest and has not changed in decades. The authors mailed a pretested survey to 7,000 randomly selected general dentists. They obtained information on 3,200 dentists' levels of knowledge about oral pharyngeal cancer risks and diagnostic procedures for providing an oral cancer examination, as well as about related opinions and interest in continuing education, or CE, courses on the topic. The authors carried out analyses using unweighted data; they used both bivariate and logistic analytical techniques and evaluated at a significance level of P < or = .01. Based on responses to 14 questions, the average knowledge of oral cancer risks score was 8.4. About one-half of dentists surveyed knew the two most common sites of intraoral cancer and that most oral cancers are diagnosed at a late stage. The reported knowledge of these dentists regarding oral cancer suggests that they are not as knowledgeable as they could be about cancer prevention and early detection and that they recognize these deficiencies. Most of the dentists were interested in oral cancer CE. Dentists need to know where in the mouth to look and what types of lesions to look for to provide a comprehensive oral cancer examination.

Oral Pharyngeal Cancer Prevention and Early Detection: Dentists' Opinions and Practices

The five-year survival rate for patients in the United States diagnosed with oral pharyngeal cancer is 52 percent, which suggests that these cancers are diagnosed at late stages. The authors conducted this study to determine U.S. dentists' opinions and practices regarding oral cancer prevention and early detection. The authors mailed a pretested survey to 7,000 randomly selected general practitioners. A total of 3,200 dentists provided information on how they conduct oral cancer examinations, their use of health history questions to assess patients' oral cancer risks and their oral cancer training and practices. The authors carried out analyses using unweighted data; both bivariate and logistic analytical techniques at a P < or = .01 level of significance were used. On average, dentists assessed about five of the eight health history items on the survey. Eighty-six percent indicated that they did not conduct oral cancer examinations on edentulous patients 18 years of age or older; 81 percent, however, reported that they conducted oral cancer examinations for 100 percent of their patients 40 years of age or older on their initial appointment. The reported practices of these dentists regarding oral cancer, in conjunction with their opinions about key aspects of these practices and their training, point to a need for systematic educational updates in oral cancer prevention and early detection. Dentists need to determine their patients' risks for oral cancers and provide routine and comprehensive oral cancer examinations.

Oral cancer educational materials for the general public: 1998.

Previous studies have shown that US adults are not well informed about oral cancers and only 15 percent ever have had an oral cancer examination. This study sought to determine the quantity and adequacy of educational materials designed to inform or educate US adults about risks for, and signs and symptoms of, oral cancer and the need for an oral cancer examination. Letters requesting copies of oral cancer educational materials produced by the organization or agency--leaflets, fact sheets, pamphlets, videos, posters--were sent to 172 national and state organizations or agencies. To determine the adequacy of the items, a previously developed, tested, and used form based on current science was adapted for this study. In addition, the SMOG index was used to determine readability for printed items. Seventy-seven percent or 132 of the selected organizations responded to queries. A total of 59 items were received that focused on or included the topic of oral cancer. Twenty of these 59 items focused specifically on oral cancer; the balance, on other topics, but mentioned oral cancer. The readability ranged from sixth to 13th grade. This study demonstrates a dearth of educational materials about oral and pharyngeal cancers; most are written at too high a grade level for the general public. These findings may help to explain why the public is so uninformed about these neoplasms.

Providing Oral Cancer Examinations for Older Adults

Although cancer is not a part of the aging process, malignant neoplasms occur primarily in older adults. As the size of the elderly population increases, there will be many more older adults at risk for oral cancer. Many older adults do not seek dental care because they do not think they need it; and, therefore, they do not receive routine oral examinations. Dental practitioners need to encourage older patients to seek dental care so they can receive oral cancer examinations.

Blood pressure measurement by community dentists.

The benefit and implications of blood pressure (BP) measurement in dental patients are a standard curricular component of most physical evaluation courses in dental schools. However, previous research has indicated that preventive procedures such as oral cancer examinations frequently are not completed or documented. A survey of practicing dentists was conducted in a Midwest metropolitan area to determine the frequency of BP measurement and conditions under which this vital sign is likely to be measured. Two hundred four responses were obtained from a telephone survey which included questions characterizing BP measurement on the basis of patient age and medical diagnosis. The results of the survey indicated that 57.4% of respondents do not check the BP of new patients over the age of 65, while 74% do not check the BP of new patients under 30 years of age. Fourteen percent admitted never measuring BP. The results varied by graduation years and by dentist's completion of AEGD or GPR programs. The results suggest great variation in the recording of BP and the criteria which are applied to those decisions. Further study should investigate factors contributing to low compliance with screening procedures such as the clinical measurement of BP and other health-promotion measures.

Maryland adults' knowledge of oral cancer and having oral cancer examinations.

This study sought to determine (1) knowledge of risk factors for oral cancer, (2) knowledge of signs and symptoms of oral cancers, and (3) factors associated with having had an oral cancer examination among 916 Maryland adults 18 years of age and older. A statewide, random-digit dial, computer-assisted telephone survey was conducted. The pretested instrument consisted of 32 questions that required 12 minutes to complete. Overall, level of knowledge about risk factors for and signs and symptoms of oral cancers was low; misinformation was high. Although 85 percent reported hearing about oral or mouth cancer, only 28 percent of the respondents reported having had an oral cancer examination. Of these, 20 percent had the exam during the past year--the recommended frequency for persons 40 years of age or older. In logistic regression analysis, adults more likely to have had an oral cancer examination included those who thought personal behavior causes more cancer than environmental factors; had more knowledge about risk factors for oral cancer; and were 40-64 years of age, white, and better educated than their counterparts (P < .05). The primary reasons for not having an exam were "no reason/didn't know I should" and "doctor/dentist didn't recommend." These results demonstrate a need for interventions designed to increase knowledge levels of risk factors for, signs, and symptoms of oral cancers and the need for oral cancer examinations; and to increase oral cancer examinations.

Coverage and Quality of Oral Cancer Information in the Popular Press: 1987–98

National data show a lack of knowledge and misinformation about oral cancer and its early detection among the general public. A major source of health information is the popular press. For that reason this study reviewed coverage and quality of news items on the topic of oral cancer in the popular press. In addition, the number and types of tobacco advertisements in women and men's magazines were recorded for a one-year period. Articles from magazines and newspapers were retrieved from the Magazine Index (1987 to April 1998), Newspaper Abstract (1989 to April 1998) and the Health & Wellness (1987 to April 1998) databases. The articles were analyzed both for adequacy of content and information. A total of 50 articles and news items including oral cancer were identified and analyzed, 18 from newspapers and 32 from magazines. Ninety-four percent of the articles mentioned at least one risk factor for oral cancer. More than half of the articles (56%) identified spit tobacco (chewing tobacco or snuff) as the major risk factor for oral cancer, while far fewer mentioned either cigarettes (32%) or cigars (12%). Over 50 percent of the articles did not mention warning signs for oral cancers. Fourteen percent suggested clinical oral cancer examinations by a health professional; only 8 percent advised the use of self-examination. A total of 417 tobacco advertisements (482 pages) were found among 22 magazines for the one-year period. They included 410 cigarette ads, seven cigar ads, and no spit tobacco ads. This study demonstrates the lack of coverage about oral cancer in the popular press in the past decade and provides a partial explanation of the public's lack of knowledge and misinformation about oral cancers.

KNOWLEDGE, OPINIONS AND PRACTICES OF GENERAL DENTISTS REGARDING ORAL CANCER: A PILOT SURVEY

The authors mailed a pilot survey to 500 randomly selected general dentists. Although most dentists reported their knowledge of oral cancer to be current, their actual knowledge of oral cancer risk factors and signs and symptoms was inconsistent. Conflicting data were also found between their level of knowledge and their provision of oral cancer examinations. Most respondents agreed that patients should undergo an oral cancer examination annually, yet many do not provide this service.

Factors associated with having oral cancer examinations among US adults 40 years of age or older.

This study describes factors associated with having an oral cancer examination among US adults 40 years of age or older. Data used in this study are from the Cancer Control supplement of the 1992 National Health Interview Survey, which included questions about having had an oral cancer screening examination and knowledge of risk factors for oral cancers. The survey was administered to a national sample 18 years of age and older (n = 12,035). Questions regarding beliefs and opinions about cancers in general also were asked and their associations with responses to having had an oral cancer examination studied. Analyses are limited to those respondents 40 years of age and older (n = 6,538). Fifteen percent of the adults reported having had an oral cancer examination. Of these, 48 percent had the exam during the past year and 31 percent had an exam one to three years ago. Respondents who were above the poverty level, white, non-Hispanic, 40 to 64 years of age, and who had more than a high school education and a higher level of knowledge about risk factors for oral cancer were more likely to have had an oral cancer examination. These findings demonstrate the need for vigorous health education and health promotion interventions aimed at health care providers and the public to increase knowledge about risk factors for oral cancers and to increase oral cancer examinations.

The need for health promotion in oral cancer prevention and early detection.

This review paper provides a rationale for using health promotion to help reduce morbidity and mortality due to oral cancers by identifying barriers to prevention and early detection of these cancers and discussing strategies for change. A literature review of the following areas was conducted: epidemiology of and risk factors for oral cancers; knowledge, opinions, and practices of health care providers and the public regarding prevention, early detection, and control of oral cancers; and policies and regulations that either enhance or act as barriers to the prevention and early detection of oral cancers. Overall, the public is ill-informed about risk factors for and signs and symptoms of oral cancers and relatively few US adults have had an oral cancer examination. Further, health care providers are remiss in providing oral cancer examinations and detecting early oral cancers. To achieve the 13 oral cancer objectives contained in "Healthy People 2000," health care providers and the public must know the risk factors for these cancers as well as their signs and symptoms. Further, health care providers need to provide oral cancer examinations routinely and competently. Equally important, the public needs to know that an examination for oral cancer is available and that they can request one routinely. Thus, a vigorous agenda that includes education, policy, and research initiatives is needed to enhance oral cancer prevention and early detection.

ASSESSING PHYSICIANS' AND DENTISTS' ORAL CANCER KNOWLEDGE, OPINIONS AND PRACTICES

Oral cancer is responsible for more than 8,000 deaths each year. This mortality may be attributed to lack of effective oral examinations by dental and medical primary care clinicians. This pilot project assessed the knowledge, opinions and practices of a group of Maryland physicians and dentists in oral cancer prevention, diagnosis and detection. Dentists performed more oral cancer examinations, although physicians saw more high-risk patients.

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Oral cancer detection. The importance of routine screening for prolongation of survival.

The incidence of oral cancer has increased in the past ten years. Early diagnosis and treatment are essential to long-term survival; however, patients at highest risk visit the dentist infrequently. The reddish, velvety or erythroplakial lesion at the base of the tongue or floor of the mouth is highly suspicious in any patient and requires further evaluation. High-risk patients with less suspicious appearing lesions must be reevaluated on close recall. Prognosis improves vastly when the lesion is detected and treated early. One study demonstrated a 64% five-year survival rate for patients with oral cancer that was diagnosed before regional lymph node involvement versus a 15% five-year survival for patients whose lesions were diagnosed after regional lymph node involvement. By including an oral cancer examination in routine physical examination of patients, the physician and public health nurse can increase the likelihood of early detection of oral cancer.