Patient’s Knowledge and Attitude Regarding Oral Cancer Screening in Dental Practice
In recent years the oral cancer incidence is increasing and is a real problem in the worldwide. This study aimed to evaluate dental patient’s knowledge and perception of oral cancer and screening in dental practice. A questionnaire survey of 92 adults, having no previous history of oral cancer was done. The collected data were about their knowledge of oral cancer, ‘screening’ experience, attitude and perception on being screened, preventive behaviour (regarding risk factors), appropriateness of a psychological counselling before screening participation. Adults were selected from the patients addressing for dental treatments to the Faculty of Dental Medicine. Seventy-seven percent of participants knew little or nothing about oral cancer and 72% did not know that dentist can usually screens for oral cancer. Ninety-two per cent would like to be informed by the dentist if they were being screened for oral cancer and 97% would like to be informed and helped by their dentists to reduce their risk. Ninety percent are willing to have psychological counselling before screening participation, considering being useful in dealing possible situations of oral cancer. The participants to this study seem generally having no knowledge that oral cancer screening can be done in the dental office but they express their interest in participating in such an investigation. Also, they would like to be informed and greet their dentist assistance to decrease the risk of developing oral cancer. They considered as opportune the psychological counselling before screening participation, considering being useful in dealing possible situations of oral cancer.
Keywords: Psychological counsellingawarenessearly detection of oral canceroral cancer screening
Currently cancer is a major public health problem and is reported as one of the leading causes of
morbidity and mortality worldwide. The number of new cases is expected to rise by about 70% over the
next two decades. The cancer is a group of diseases involving abnormal cell growth with the potential to
invade or spread to other parts of the body and is considered a chronic disease that causes disability and
invalidity. It is seen as a multifactorial disease caused by a combination of environmental factors and
predisposing genetic factors that at any given time and under favourable conditions can have an effect in
predisposed individuals (World Health Organization, 2015).
Oral cancer is a type of head and neck cancer affecting the mouth, lip and oral cavity, that is, oral
mucosa, gums, hard palate, tongue and floor of the mouth.Two of the most important risk factors of
cancer aretobacco use and alcohol consumption. If this two factors are combined, the risk of oral cancer
can be increase (Pelucchi, Gallus, Garavello, Bosetti and La Vecchia, 2006). Also, the risk of oral cancer
increases with the quantity of alcohol consumed and is elevated among substantial alcohol consumer (Blot
et al.,1998). Poor nutrition, sun exposure and the human papilloma virus are other factors that have been
involved in the oral cancer occurrence (Kalavrezos, &Scully, 2015).
Oral cancer occurs more often in males, in people from the lower socioeconomic scaleand in
ethnic minority groups, although rates in females are on the rise (Scully, &Felix, 2006). Incidence rates
are currently increasing worldwide, especially among young individuals, aged less than 45 years
(Horowitz, &Nourjah, 1996; Llewellyn, Linklater, Bell, Johnson, &Warnakulasuriya, 2004;
Warnakulasuriya, Mak, &Moller, 2007). Often these individuals are not aware of their own heightened
risk status (Horowitz, Moon, Goodman, &Yellowitz, 1998; Lowry, &Craven, 1999). Education promoting
consciousness about oral cancer may support preventing high-risk behaviours such as tobacco and alcohol
consumption. Also, an awareness of personal risk or susceptibility to illness is a central factor in most
major theories of health behaviour change (Hennessy, Bleakley, Mallya, &Romer, 2014).
An early diagnosis is ensured by the early response of patients and doctors to early signs and
symptoms and may ease diagnosis and treatment before the disease becomes advanced. Monitoring the
signs and symptoms among patients coming for regular dental treatment may help the diagnosis of oral
cancer in incipient stages (Colella, Gaeta, Moscariello and Angelillo, 2008, Greenwood, &Lowry 2001;
López-Jornet, Camacho-Alonso and Molina-Minano, 2010).
Purpose of the Study
Most studies that have been achieved by now have investigated oral cancer knowledge among dentists,
few data are available about the knowledge of dental patients. Because of this, the purpose of the present
study was to investigate patient’s knowledge and attitude about the risk factors of oral cancer and to
investigate communication among clinicians and patients addressing for dental treatments to the Faculty
of Dental Medicine, Ovidius University of Constanta.
Study Population and Procedure
Participants were adults, addressing for dental treatments to the Faculty of Dental Medicine,
Ovidius University of Constanta. The selection of patients was done following two inclusion criteria (1)
age 18 or older with no previous history of oral cancer, and (2) reading, understanding, and capacity to
answer the questionnaire. All patients have agreed to participate in this study; being informed that data
will be statistically processed and they will keep them confidential. No compensation was offered for
patients who showed their willingness and have expressed their agreement to participate in this study.
A questionnaire survey of 92 adults, having no previous history of oral cancer was done. The
collected data were about their knowledge of oral cancer, ‘screening’ experience, attitude and perception
on being screened, preventive behaviour (regarding the risk factors), appropriateness of a psychological
counselling before screening participation. The questionnaire was designed, was face to face applied and
the results were interpreted by psychologists from the Centre for Counselling and Career Guidance,
Ovidius University of Constanta.
The Survey Tool
All the participants of the study received a questionnaire in the dental clinic; the questionnaires
were face to face administered, and any question that appeared was explained by a dental student. First
the questionnaire assessed: socio-demographic information including age, gender, and education level;
self-reported medical history. Information about family history for oral cancer, tobacco smoking and
alcohol consumption were considered.The entire questionnaire took about twenty minutes to be
The respondents were asked if they tend to use the healthcare services, when was the last visit to
their family doctor, the distance between the last consultation at the dentist and the current appointment
and their reasons for visiting the dentist.
Study participants' knowledge about oral cancer and oral cancer risks factors, smoking status and
alcohol consumption were evaluated. Participants’ knowledge and consciousness about oral cancer was
investigated by asking if they had heard of this disease and what they knew about it, ranging from a lot to
nothing at all (Tomar , &Logan, 2005). Respondents were asked if they smoked in the past and if they are
still smoking in present. The quantity of cigarettes or other type of tobacco was assessed and responses
were used to analyse the smoking status. Respondents were asked to report their alcohol intake. Alcohol
intake was evaluated as how often alcohol is consumed and the quantity consumed. Finally, participants
were asked whether dentists or other physicians give them information, assistance and guidance about
oral cancer and they had to answer by “Yes” and “No”.
The patients’ desire for information, assistance and guidance about oral cancer monitoring and risk
factors was assessed by the following questions: the first one was about their knowledge about the fact
that dentists were qualified to examine for signs of oral cancer, the second one asked if the patients want
to be informed by the dentist if they were examined for signs of oral cancer and the third asked them if
they want to be helped by the dentist to help them to reduce the riskof getting oral cancer. Also,
participants were asked about appropriateness of a psychological counselling before screening
The participants were asked if they would look for help for a list of possible signs of oral cancer,
to find their intentions to ask for help for possible signs of oral cancer persisting for three weeks or more.
These are signs commonly associated with oral cancer: a red area, a white area, a painful ulceration or
swelling in the oral cavity. Also, they were asked to select the health care professional they would go to
ask for help if these signs shall persist for more than three weeks.
The socio-demographic characteristics of participants were summarized in Table
Sixty-two of participants, 67,39% reported that have visited their dentist during the past year
before their current visit. A higher percent, 83 (90, 21%), reported that have visited their family doctor
during the same period. Of all the participants, 28 (45,16%) visited the dentist for pain or other problem
with their teeth, 18 (29,03%) for occasional controls and only 16 (25,8%) visited their dentists for regular
Majority of participants 62 (67,39%) have heard of oral cancer and 13,04% said they had never
heard and 19,56% were not sure if they had heard of it or not. Seventy-one of participants, 77,17%
percent of participants knew little or nothing about oral cancer and only 9% reported that they knew a lot
with 38% of participants reporting being current smokers and 32% being previous smokers who had quit.
Twenty-three percent reported never having alcoholic drinks and 77% reported them two to three times a
week or more. Most the participants didn’t receive information, assistance and guidance about oral cancer
from dentists, or other physicians (85.87%, 79).
When asked whether dentists were qualified to examine for signs of oral cancer, 72% didn’t know
or were unsure that the dentist screens for oral cancer. Moreover, 60% didn’t know if their dentist screens
them for signs of oral cancer on their regular control. Ninety-two percent of participants would like to be
informed by their dentist about being screened for signs of oral cancer, 97% would like information,
assistance and guidance from their dentists to reduce the risk. Ninety percent are willing to have
psychological counselling before screening participation, considering being useful in dealing a possible
situations of oral cancer.
Participants of this study related that they would visit the family doctor instead of their dentist for
eventual signs of oral cancer were 65% for white area, 63% for red area, 54% for an ulceration and 51%
for swelling. In the case of pain in the mouth the majority (51%) indicated they would visit the dentist.
Analysing the results of the present study it can be stated that smokers were less aware that their
dentists screened them routinely.Many of the respondents that has risk factors for oral cancer have little
information about oral cancer. Most the participants didn’t receive information, assistance and guidance
about oral cancer from dentists, or other physicians (85.87%, 79).
It should be taken into consideration that there are some limitations in this study, one of them
being the number of participants. It is difficult to demonstrate that the results of this study would be
similar when the study population would be extended. Another limiting factor is that until now have not
been conducted such studies on population Romania and therefore there were no comparative data.
Therefor it is necessary to extend the study to a larger number of patients and conducting similar studies
in other regions. The results should, therefore, be interpreted with caution.
Additionally, this study suggest that patients are having no knowledge of being screened for oral
cancer. Although oral cancer screening may indeed be taking place by a regular control, dentists don't
communicate this to their patients.
Health promotion education is an important part of preventive medicine; prevention or cessation of
tobacco and alcohol use may contribute to good general and oral health (Dyer,&Robinson 2006).
Communication between patients and family doctors or dentists could improve oral cancer knowledge
and motivate individuals for improving their well-being.
The participants to this study seem generally having no knowledge that oral cancer screening can
be done in the dental office but they express their interest in participating in such an investigation. Also,
they would like to be informed and greet their dentist assistance to decrease the risk of developing oral
cancer. The participants did not demonstrate anxiety, concern or worry about receiving this information.
Also they considered to be opportune the eventually psychological counselling before screening
participation, considering being useful in dealing a possible situations of oral cancer.
- Blot, W. J., McLaughlin, J. K., Winn, D. M., Austin, D. F., Greenberg, R. S., Preston-Martin, S., & Fraumeni, J. F. (1988). Smoking and drinking in relation to oral and pharyngeal cancer. Cancer research, 48(11), 3282-3287.
- Colella, G., Gaeta, G. M., Moscariello, A., & Angelillo, I. F. (2008). Oral cancer and dentists: knowledge, attitudes, and practices in Italy. Oral oncology, 44(4), 393-399.
- Dyer, T. A., & Robinson, P. G. (2006). General health promotion in general dental practice —The involvement of the dental team Part 2: A qualitative and quantitative investigation of the views of practice principals in South Yorkshire. British dental journal, 201(1), 45-51.
- Greenwood, M., & Lowry, R. J. (2001). Oral cancer: Primary care clinicians' knowledge of oral cancer: a study of dentists and doctors in the North East of England. British dental journal, 191(9), 510-512.
- Hennessy, M., Bleakley, A., Mallya, G., & Romer, D. (2014) Beliefs Associated with intention to ban smoking in households with smokers. Nicotine Tob Res ,16 (1), 69-77.
- Horowitz, A. M., Moon, H. S., Goodman, H. S., & Yellowitz, J. A. (1998). Maryland adults' knowledge of oral cancer and having oral cancer examinations. Journal of public health dentistry, 58(4), 281-287.
- Horowitz, A. M., & Nourjah, P. A. (1996). Factors associated with having oral cancer examinations among US adults 40 years of age or older. Journal of public health dentistry, 56(6), 331-335.
- Kalavrezos, N., & Scully, C. (2015). Mouth Cancer for Clinicians Part 5: Risk Factors (Other). Dental update, 42(8), 766-8.
- Llewellyn, C. D., Linklater, K., Bell, J., Johnson, N. W., & Warnakulasuriya, S. (2004). An analysis of risk factors for oral cancer in young people: a case-control study. Oral oncology, 40(3), 304-313. López-Jornet, P., Camacho Alonso, F., & Molina Miñano, F. (2010). Knowledge and attitudes about oral cancer among dentists in Spain. Journal of evaluation in clinical practice, 16(1), 129-133.
- Lowry, R. J., & Craven, M. A. (1999). Health promotion: Smokers and drinkers awareness of oral cancer: a qualitative study using focus groups. British dental journal, 187(12), 668-670.
- Pelucchi, C., Gallus, S., Garavello, W., Bosetti, C., & La Vecchia, C. (2006). Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol Research & Health, 29(3), 193-199.
- Scully, C., & Felix, D. H. (2006). Oral Medicine—Update for the dental practitioner Orofacial pain. British dental journal, 200(2), 75-83.
- Tomar, S. L., & Logan, H. L. (2005). Florida adults' oral cancer knowledge and examination experiences. Journal of public health dentistry, 65(4), 221-230.
- Warnakulasuriya, S., Mak, V., & Möller, H. (2007). Oral cancer survival in young people in South East England. Oral oncology, 43(10), 982-986.
- World Health Organization. Cancer Fact Sheet N°297". Update February 2015. Retrieved 27 August 2016.
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
About this article
Cite this paper as:
Click here to view the available options for cite this article.