Oral cancer and precancer in Oral Pathology and Medicine curricula of Mexican dental schools

OBJECTIVE

To identify the teaching-learning process characteristics of Oral Pathology and Medicine (OP&M) related to oral potentially malignant disorders (OPMDs) and oral cancer (OC), in the dental schools' curricula in Mexico, to analyze the approach given to this topic worldwide, and to provide the possible solution strategies.

MATERIALS AND METHODS

Questionnaires were sent to OP&M deans and professors from public Mexican Universities to explore the curriculum and academic profile of the dental schools. The recommendations gathered from a workshop with expert professors on the challenges in OPMD/OC teaching were reported.

RESULTS

Twenty-two dental schools participated (22 deans, 30 professors). The most widely used strategies were clinical-case resolving (86%) and presentations (73%). Although 77.3% of the programs included maxillofacial lesions, only 40.9% contemplated OPMD/OC. Only 45% of the programs developed community activities for early OC detection. The workshop recommendations were (i) multidisciplinary approach to OPMD/OC teaching, involving OP&M professors in other dental and nondental courses; (ii) implementation of the most effective teaching techniques (currently, problem-based learning and clinical-case presentation) in OP&M curricula; (iii) education of OP&M professors on teaching-learning processes.

CONCLUSIONS

These recommendations from the Mexican context, integrated with similar experiences from other countries could contribute to develop a unique, internationally acknowledged OP&M curriculum.

Evaluation of the diagnostic ability of oral lesions on clinical images among undergraduate dental students

INTRODUCTION

The dentist should be able to carry out systematic oral examinations of the mucosa of patients in order to diagnose any alterations at an early stage.

MATERIALS AND METHODS

An observational, analytical, prospective, and longitudinal study was carried out. 161 students were evaluated at the beginning of their clinical practice in their 4th year of dental school (September 2019), at the beginning and at the end of their 5th year of dental school (June 2021). Thirty oral lesions were projected, and the students were asked to provide an answer; if the lesions were benign, malignant, or potentially malignant, whether they should be biopsied and/or treated and a presumptive diagnosis.

RESULTS

Significant improvement (p < .001) was obtained between the 2019 and 2021 results, in relation to the classification, need for biopsy and treatment of lesions. For differential diagnosis, no significant difference (p = .985) was obtained between the 2019 and 2021 responses. Malignant lesions and PMD obtained mixed results, with the best results corresponding to OSCC.

DISCUSSION

In this study, a correct lesion classification by the students was over 50%. As for the OSCC, the results were superior to the rest of the images, reaching more than 95% correct.

CONCLUSION

Theoretical-practical training from universities and continuing education for graduates in relation to oral mucosal pathologies should be further promoted.

Factors important in the correct evaluation of oral high-risk lesions during the telehealth era

BACKGROUND

Considering that early detection of squamous cell carcinoma (SCC) improves prognosis and clinical examination is the primary detection method, we identified factors related to the clinical evaluation of oral mucosal lesions. Due to the growing role of telehealth, our study was based on clinical image evaluation.

SUBJECTS AND METHODS

Oral medicine specialists and dental students evaluated six images of benign, potentially malignant, or SCC lesions (18 images in total). We analyzed the role of personal factors of the examiners and the visual pathological features of the lesion upon which the participants based their evaluation.

RESULTS

One hundred thirty-three subjects participated. Half of the benign images were correctly evaluated. On average 1.2 (±SD1.3) cancer pictures were recognized correctly and 3.66 (±SD1.42) images were considered potentially malignant. Potentially malignant lesions were correctly evaluated at an average of 4.08 (±SD1.48) images. For cancer and potentially malignant lesion images, there were significantly better results among clinicians with the worst results from the fourth-year students. Student results correlated significantly with years of study, number of weeks spent in the oral medicine clinic, and interest in oral pathology. Consideration of lesion irregularity yielded a correct diagnosis, whereas wrong answers were based on color changes. Lesion size and margins were considered equally important.

CONCLUSIONS

Using clinical images as part of the diagnostic process provides good results, though increased clinical experience for graduates and undergraduates may be necessary to improve accuracy. Therefore, emphasizing the important visual parameters of malignancy may be valuable in the current telehealth era.

A Prospective Comparative Analysis Regarding the Assessment of Oral Mucosal Disease Using a Validated Questionnaire to Improve the Teaching of Dental Students

Structured examination and treatment are essential in medicine. For dental students, a structured approach to the assessment of oral mucosal lesions is missing thus far. To validate an approach, a structured questionnaire was compared with the habitually used free description of oral lesions (white lesions, ulcers, hyperplasia). Thirty-three dental students were divided into two groups (Group 1 (n = 17) used the free description; Group 2 (n = 16) used a guided questionnaire) to characterize mucosal lesions in patients and make a tentative diagnosis. Although no difference was found between the groups regarding the suspected diagnosis or the histopathological findings, there was a significant advantage of the structured questionnaire in all aspects of the description compared to the free description (p = 0.000018). Thus, a structured description is an important aspect in the evaluation of oral mucosal changes, and a guided questionnaire should be implemented in the study of dentistry.

Knowledge, Practice, and Awareness of Oral Cancer and HPV Infection among Dental Students and Residents: A Cross-Sectional Study

Background and Objectives: Dentists play a very important part in the early identification of oral cancer lesions. This aspect of dental practice depends on the knowledge acquired during the faculty years. The aim of this study was to assess dental students' and residents' levels of awareness in terms of oral cancer. Materials and Methods: The cross-sectional study was conducted at the Faculty of Dental Medicine within the "Grigore T. Popa" University of Medicine and Pharmacy in Iasi, on a sample of 197 students in the fourth and the fifth years and first year residents in general dentistry. To assess their knowledge, a questionnaire was created containing 22 questions about the risk factors for oral cancer, with a focus on HPV infection. Results: Most participants correctly identified smoking, alcohol, and the HPV infection as risk factors and leukoplakia and erythroplasia as potentially malignant lesions. At the opposite site, aspects considered as unsatisfactory focused on the palpation of lymphatic nodules, a procedure largely carried out by 41.6% of the fourth year students, the counseling only of the patients at risk performed by 59.7% of residents, the lack of knowledge about the prevention of oral cancer through anti-HPV immunization found in 39.7% of the fifth year students. Other incorrect answers focused on other types of suspicious lesions, such as actinic cheilitis, as well as certain areas in the oral cavity subject to the frequent onset of oral cancer, such as buccal mucosa. Conclusions: Although the fifth year students and residents have better knowledge than the fourth year students, the gaps in terms of knowledge and practice encountered in all three categories of participants require a reevaluation of the academic curriculum and the focus on the building of the skills necessary for the correct screening of oral cancer.

Perception and Attitude of Dental Students and Interns Regarding the Diagnosis and Management of Oral Mucosal Lesions and Salivary Glands Hypofunction

Background:

The perception and attitude of dental students/graduates regarding diagnosing/managing oral medicine cases are scarcely investigated.

Objective:

The aim of this investigation was to evaluate the level of confidence in diagnosing/managing cases of oral mucosal lesions and salivary glands hypofunction.

Methods:

A 29-items questionnaire descriptive survey was distributed among dental interns and sixth-year students in the city of Jeddah during March-April of 2020.

Results:

A total of 136 (81 interns and 55 sixth-year students) completed the questionnaire, of which 69.9% were from a government school, and 30.1% were from private schools. For oral mucosal lesions [i.e., aphthous/herpes simplex virus ulceration], the majority of government and private schools’ participants reported being confident in their ability to diagnose (88.4% and 87.8%, respectively) and provide treatment (63.2% and 56.1%, respectively). For oral candidiasis, the majority were confident in their ability to diagnose (government: 95.8%; private: 59.1%) and treat (government: 77.9%; private: 65.9%). The confidence in diagnosing lesions suspicious for dysplasia/premalignancy was high in 77.9% of government and 80.5% of private schools. Similar reporting was found regarding salivary hypofunctions (government: 93.7%; private: 90.2%). For the likeness to refer, the majority of participants were likely to refer to oral medicine, as the 1st choice, followed by oral surgery.

Conclusion:

Dental interns/sixth-year students seemed to have high levels of confidence in diagnosing/managing oral mucosal lesions and salivary hypofunctions. However, the partial participation and the subjectivity of reporting may have hindered capturing the full/precise picture.

Knowledge and Practice of Oral Cancer Screening in Teaching Faculty-Comparison of Specialty and Year of Clinical Experience

The purpose of this study was to assess the knowledge, practice, confidence, and perceived barriers to oral cancer screening among teaching faculty in Japan. Results were compared by specialist as well as years of clinical experience. A 25-question survey was used to assess the oral cancer screening practices of faculty dentists at Iwate Medical University, School of Dental Medicine, the only dental school located in the northeast (Tohoku) region of Japan. The study was approved by the Institutional Review Board of Iwate Medical University. The response rate was 83% (n = 110, 71.8% were male). This survey revealed that only 43.6% of the dentists performed oral cancer screening frequently (always or usually) at the initial appointment, and there was no significant differences between specialists and clinical experience. Visual inspection of the oral cavity was the primary screening method, but the frequency and content of the examination (TMJ and tonsil) was significantly different between specialties. A history of cancer and tobacco use motivated providers to perform an examination and was significantly different between various specialists and clinically experienced providers. In contrast, HPV and alcohol consumption were a weak motivator. The confidence level of providers on their examination knowledge/skills was poor, especially among junior faculty. More than 80% of junior faculty indicated a lack of knowledge/skills as a major barrier.