Multi Institutional Study on Awareness of Oral Cancer among Final Year Bangladeshi Dental Students and Intern Doctors

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M. Anwar Sadat, Afsana Jabeen, Khadiza Akter Mim, Shadly Benzadid, and 16 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5739237/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Oral cancer is widely recognized as a global health concern, with an aggressive nature and high mortality rates, especially in Southeast Asia where risk factors like betel quid and tobacco use are common. Although early detection can greatly improve prognosis, limited data exists on the knowledge, attitudes, and practices (KAP) of dental students and interns in Bangladesh regarding oral cancer prevention. This study aimed to assess these aspects among future dental practitioners. Materials and Methods: A cross-sectional, questionnaire-based survey was conducted from January to March 2023 among final-year dental students and intern doctors from multiple institutions in Bangladesh. The survey utilized a 35-item questionnaire covering demographics, knowledge, practices, and attitudes toward oral cancer prevention. Results: A total of 335 participants completed the survey. Approximately 79.1% demonstrated good knowledge of oral cancer; however, only 10.6% identified all risk factors. Furthermore, 60% exhibited poor preventive practices, with just 24.1% regularly screening patients. Attitudes were predominantly unfavorable, with 88.1% lacking confidence in screening activities. Age and gender were significantly associated with practice and attitude scores, with older and male participants scoring higher (P < 0.05). Conclusion: The findings reveal substantial gaps in the KAP of Bangladeshi dental students and interns concerning oral cancer prevention. Addressing these gaps through curriculum enhancements, including early and practical training in cancer detection, could better prepare future practitioners for effective oral cancer management and prevention. Oral cancer prevention Knowledge Attitudes Practices Dental students Interns Bangladesh Introduction Lip and oral cavity cancers are regarded as a major global health issue, accounting for the 16th most common neoplasm worldwide, with nearly 377,713 new cases and 177,757 deaths recorded in 2020 1 . Oral cancer primarily occurs in the lips, tongue, mouth, salivary glands, and oropharynx, with oral squamous cell carcinoma being the most common form of this disease 2 . These cancers primarily impact middle-aged and older men, with the highest incidence observed between the sixth and eighth decades of life. In South East Asia, oral cancer prevalence is relatively higher because of the cultural use of betel quid and different forms of tobacco which are major risk factors of oral cancer 3 . Bangladesh is no different in that case. Typically, oral cancers are known for their rapid progression and poor prognosis 4 ; however, early diagnosis can lead to more favorable outcomes 5 . Preventing these lesions involves minimizing exposure to risk factors and detecting and monitoring potentially malignant oral conditions. Unfortunately, a recent systematic analysis revealed that healthcare practitioners frequently overlook oral malignancies, and the ensuing delay in referrals is a major factor to the disease's late stages 6 . Due to their direct patient interaction, general dentists can play a crucial role in the prevention and early identification of oral cancer 7 . Numerous studies have been carried out globally to examine the level of awareness among current and future dental professionals 8 Some of these studies identified gaps or deficiencies in knowledge, attitudes, and practices related to oral cancer prevention 9 , highlighting the need to strengthen oral cancer education within undergraduate and graduate dental programs. Furthermore, expanding continuing education programs for healthcare providers is crucial to improve awareness, attitudes, and preventive practices related to oral cancer detection and prevention. In Bangladesh, the incidence of oral cancer continues to rise. Despite advancements in treatment, mortality rates remain elevated, emphasizing the urgent need to prioritize prevention and early diagnosis. General dental practitioners are strategically placed to undertake this role, necessitating thorough knowledge of oral cancer and preventive strategies. However, no research to date has evaluated oral cancer awareness among intern doctors and dental students in Bangladesh. This study sought to fill this gap by assessing the knowledge, attitudes, and practices concerning oral cancer prevention and early detection within these groups, offering valuable insights into factors that shape their preventive approaches. Methodology A cross-sectional, questionnaire-based study was conducted from January to March 2023, targeting final-year undergraduate dental students and intern doctors across four selected dental institutions in Bangladesh 10 . Ethical clearance was granted by the Department of Public Health, North South University, Dhaka. Following an initial institutional review of the study protocol, college principals were briefed on the study's objectives and data collection procedures. Students at each institution were approached post-lecture and provided with a concise overview of the study. Informed consent was obtained from all participants prior to questionnaire administration. Participation was entirely voluntary, and respondents were assured that their responses would remain completely anonymous and confidential. Those who consented received guidance on how to complete the questionnaire. A 35-item, custom-designed questionnaire was created following a review of validated instruments from previous studies 2 , 7 , 11 , 12 on oral cancer awareness. The questionnaire was initially pilot-tested with a small group of 20 participants (comprised of 10 final-year students and 10 interns) to confirm the clarity, simplicity, and relevance of each question. Feedback from this pilot phase led to minor revisions, refining question wording and enhancing the flow of responses. Content validity was assessed by two senior oral medicine experts, with adjustments made to align questions with local curriculum and clinical relevance. Reliability was assessed using a test–retest approach, where 20 students from the pilot group completed the questionnaire twice, with a two-week interval between each completion. Pearson’s correlation coefficient was used to analyze the responses, demonstrating stability with a significant reliability coefficient. Internal consistency was assessed through Cronbach’s alpha, which produced an acceptable value of α = 0.78, reflecting good consistency across items within each section. The questionnaire consisted of four sections. The first section captured demographic information, including age, gender, and level of education. The second section assessed knowledge of oral cancer signs, symptoms, and risk factors, comprising 13 close-ended questions. Each correct answer received a score of 1, and the cumulative knowledge score ranged from 0 to 13. A cut-off of ≥ 7 (54%) was set to classify participants as having “good knowledge” and < 7 as “poor knowledge,” based on previous studies 2 , 7 . The third section covered practices related to oral cancer prevention, including screening frequency and engagement in preventive counseling. This section consisted of 11 questions, where respondents indicated the frequency of specific practices. Responses were scored on a binary scale (1 for regular practice, 0 for infrequent or no practice). Scores ranged from 0 to 1, with a score > 6 indicating “good practice” and ≤ 6 representing “poor practice” levels. One question addressed perceived barriers to routine screening, including options such as lack of time, training, or confidence in screening efficacy. In the questionnaire’s final section, participants expressed their attitudes on oral cancer prevention by rating eight statements using 5-point Likert scale options from “strongly agree” to “strongly disagree,”. Each positive response was assigned a score of 1, while negative responses received a score of 0, allowing for a maximum score of 8. A cut-off score of 6 was used; scores above 4 were classified as indicating favorable attitudes, whereas scores of 4 or below were categorized as unfavorable. Data were entered into Excel Sheet and analyzed with the SPSS version 22.0. Incomplete or missing responses were excluded. For continuous variables, descriptive statistics—mean, standard deviation, and percentages—were obtained, applying a significance threshold of P < 0.05. Independent samples t-tests evaluated the role of age and gender on KAP scores, while the effect of educational level was analyzed using ANOVA method. Results A total of 335 final-year dental students and intern doctors participated in this study. Table 1 presents the socio-demographic characteristics of the participants. Among them, the majority (83.9%) were aged 25 or younger, while 16.1% were over 25 years. Female participants constituted 71.3% (n = 239) of the sample, with male participants accounting for 28.7% (n = 96). Regarding educational level, 58.2% were final-year dental students, and 41.8% were intern doctors. Table 2 illustrates that all participants accurately identified the most common type of oral cancer, with 91.4% recognizing the primary cancer sites and 60.37% identifying the tongue areas most prone to cancer. However, only 10.6% acknowledged all risk factors, reflecting knowledge gaps, particularly in lifestyle-related risks. Additionally, 52.45% correctly identified the demographic most affected by oral cancer, and 69.15% recognized early symptoms. Diagnostic knowledge was high, with 90% affirming the necessity of lymph node palpation and 74.57% accurately describing affected lymph node characteristics. Table 3 highlights practice-related responses, only 24.1% of respondents regularly screen for oral cancer, with 78.5% attributing barriers like time, training, and doubts about screening effectiveness. However, 90.6% discussed risk factors with patients, and 97.07% used diagnostic aids, though only 70.7% had referred cases to specialists. More than half of the respondents (62.8%) felt adequately trained to perform biopsies or use Toluidine blue as a diagnostic aid and performing incisional and punch biopsies. Attitudes toward oral cancer prevention, as summarized in Table 4 , indicated that 61.35% of respondents desired more training. Only 39.4% viewed screening as a dentist’s role, and even fewer emphasized screening at new (25.5%) or recall appointments (21.95%). Overall, a few respondents (28.25%) felt confident in palpating cervical lymph nodes, and 31.3% felt prepared to provide education and advice on risk factors, indicating a noticeable gap in training adequacy. Concerning the assessed knowledge of oral cancer, 79.1% of the respondents demonstrated good knowledge, with an overall mean score of 7.82 (1.80) among participants [table-5]. Regarding practices for oral cancer prevention and early detection, 60% of respondents exhibited poor practices, yielding an overall mean practice score of 6.83 (2.19). However, the majority (88.1%) held unfavorable attitudes toward oral cancer prevention, reflected by an overall mean attitude score of 6.37 (1.69). Regarding whether participants’ age, gender, or educational level significantly influenced knowledge, practice, and attitudes toward oral cancer prevention, the analysis demonstrated notable associations. Age was significantly correlated with both practice and attitude scores, as participants aged over 25 years reported higher mean scores in practice (7.44 ± 1.71) and attitude (6.68 ± 1.53), with statistical significance (p < 0.05). Gender differences were observed in attitude scores, with male respondents achieving a significantly higher mean attitude score (6.88 ± 1.44) compared to females (6.17 ± 1.74) (p < 0.005) [Table-6]. Table 1 Characteristics of survey respondents (n = 335) Variables N % Age <=25 281 83.9 < 25 54 16.1 Gender Male 96 28.7 Female 239 71.3 Level of education Final year 195 58.2 Intern doctor 140 41.8 Table 2 Distribution of students with correct responses to knowledge items (n = 335) Question Male, n (%) Female, n (%) Overall, n (%) Final year Intern Final year Intern Which is the most common oral cancer? 50 (100) 46 (100) 145(100) 94(100) 335(100) What are the two most common sites of oral cancer? 21(42) 27(58.7) 42(29) 58(61.7) 148 (91.4) Which area of tongue are most commonly develop oral cancer? 34(68) 22(47.8) 99(68.3) 54(57.4) 209 (60.37) What are the common risk factors of oral cancer? 5 (10) 5 (10.9) 7 (4.8) 14 (14.9) 31 (10.6) Who are most commonly affected by oral cancer? 36(72) 19 (41.3) 89 (61.4) 33 (35.1) 177 (52.45) What is the most common age of the patients to develop oral cancer? 5 (10) 6 (13) 18 (12.4) 17 (18.1) 46 (53.5) Symptoms of early oral cancer 31 (62.0) 34 (73.9) 96 (66.2) 70 (74.5) 231 (69.15) Common stage of diagnosed oral cancer 36 (72) 31 (67.4) 94 (64.8) 62 (66.0) 223 (67.55) Is lymph node palpation is necessary? 45 (90) 38 (82.6) 139 (95.9) 86 (91.5) 308 (90.0) Characteristics of lymph node 33 (66) 35 (76.1) 117 (80.7) 71 (75.5) 256 (74.57) What are the typical clinical feature of early stage oral cancer diagnosis? 35 (70) 38 (82.6) 121 (83.4) 72 (76.6) 266 (78.15) When examining the toungue, the clinician should? 27 (54) 22 (47.8) 95 (65.5) 69 (73.4) 213 (60.15) In which group the mortality rate is higher? 38 (76) 22 (47.8) 83 (57.2) 35 (37.2) 178 (54.55) Table 3 Distribution of students reporting good practice and experience in oral cancer screening (n = 335) Question Male, n(%) Female, n (%) Overall, n (%) Final year Intern Final year Intern How often would you screen your patients? 8 (16) 11 (23.9) 48 (33.1) 22 (23.4) 89 (24.1) Cause to not screen 10 (20) 3 (6.5) 20 (13.8) 11 (11.7) 261 (78.5) Do you discuss the risk factors? 30 (60) 30 (65.2) 91 (62.8) 52 (55.3) 294(90.6) Do you use diagnostic aids? 41 (82) 36 (78.3) 112 (77.2) 72 (76.6) 325 (97.07) Have you referred to a specialist? 46 (92) 45 (97.8) 116 (80) 87 (92.6) 229 (70.7) Do you feel diagnosis with pathological test is need? 48 (96) 45 (97.8) 140 (96.6) 92 (97.9) 89 (26.9) Have you instructed to perform biopsy? 36 (72) 36 (78.3) 92 (63.4) 65 (69.1) 197 (62.8) Have you instructed to perform Toluidine blue? 10 (20) 16 (34.8) 38 (26.2) 25 (26.6) 155 (42.37) Have you instructed to how to perform incisional and punch biopsy? 33 (66) 35 (76.1) 75 (51.7) 54 (57.4) 291 (62.8) How many oral lesions biopsy? 26 (52) 14 (30.4) 94 (64.8) 21 (22.3) 207 (42.37) Do you discuss about consequences? 42 (84) 42 (91.3) 120 (82.8) 87 (92.6) 261 (87.67) Do you provide educational material? 35 (70) 29 (63) 85 (58.6) 58 (61.7) 294 (63.32) Table 4 Distribution of students who received positive attitude toward oral cancer prevention (n = 335) Question Male, n(%) Female, n (%) Overall, n (%) Final year Intern Final year Intern Adequately trained to examine patients for oral cancer 12 (24) 14 (30.4) 17 (11.7) 9 (9.6) 52 (18.925) Adequately Trained to palpate cervical lymph nodes 20 (40) 15 (32.6) 37 (25.5) 14 (14.9) 86 (28.25) Adequately Trained to referred patients 19 (38) 22 (47.8) 35 (24.1) 26 (27.7) 102 (34.4) Adequately Trained to provide education and advice on risk factors 15 (30.0) 21 (45.7) 38 (26.2) 22 (23.4) 96 (31.325) It is the role for the dentist to screen for oral mucosal pathology 20 (40) 25 (54.3) 47 ( 32.4) 29 (30.9) 121 (39.4) Screen of oral mucosal soft tissues should occur at new patients 12 (24) 16 (34.8) 41 (28.3) 14 (14.9) 83 (25.5) Screen of oral mucosal soft tissues should occur at recall patients 10 (20) 18 (39.1) 23 (15.9) 12 (12.8) 63 (21.95) Need additional training 34 (68) 31 (67.4) 87 (60) 47 (50) 199 (61.35) Table 5 Knowledge, Practice and Attitude Scores Variables N % Mean (SD) Knowledge Good (> 7) 265 79.1 7.82 (1.80) Poor (0–7) 70 20.9 Practice Good(> 6) 134 40.0 6.83 (2.19) Poor (0–6) 201 60.0 Attitude Unfavorable (0–4) 295 88.1 6.37 (1.69) Favorable (> 4) 40 11.9 Table 6 Influence of Age, Sex, and Education on Knowledge, Attitudes, and Practices Toward Oral Cancer Prevention (n = 335) Variables Knowledge Practice Attitude N(%) Mean (SD) P value Mean (SD) P value Mean (SD) P value Age 25 54 (16.1) 7.87(1.62) 7.44(1.71) 6.68 (1.53) Gender Male 96(28.7) 7.71 (1.86) 0.587 7.07 (2.15) 0.006 6.88 (1.44) 0.000 Female 239 (71.3) 7.86 (1.77) 6.74 (2.20) 6.17 (1.74) Level of education Final year 195 (58.2) 7.90 (1.76) 0.700 6.77 (2.38) 0.648 6.51 (1.44) 0.543 Intern doctor 140 (41.80) 7.71 (1.85) 6.92 (1.90) 6.17 (1.96) Discussion This multi-institutional study aimed to assess the awareness of oral cancer among final-year dental students and intern doctors in Bangladesh, focusing on their knowledge and attitudes toward early detection and prevention, as well as the practices related to these aspects. Additionally, the study sought to examine the demographic factors influencing their level of awareness about oral cancer. The current study reveals a critical knowledge gap among Bangladeshi dental students and intern doctors regarding the recognition of oral cancer risk factors, such as tobacco use, smoking, alcohol consumption, and betel quid use, which significantly contribute to the prevalence of oral cancer. The finding that only 10.6% of respondents recognized all risk factors for oral cancer, highlighting gaps in lifestyle-related knowledge, is consistent with similar studies conducted in Palestine 2 and Saudi Arabia 13 . For instance, Shadid et al. 2 reported low awareness among Palestinian dental students and interns regarding critical risk factors, including tobacco use and alcohol consumption, both prevalent lifestyle risks associated with oral cancer. Likewise, Alsaud’s study in Saudi Arabia indicated that many dental students and practitioners failed to identify major lifestyle-related risks, underscoring the need for more targeted education on these factors within the curriculum 13 . However, studies from Brazil 14 and Spain 9 showed different level of awareness which contrasts with the current findings. For example, Soares et al. 14 observed higher awareness levels among Brazilian dental students, who demonstrated familiarity with lifestyle risks, likely due to greater emphasis on public health and preventive education in their training, whereas, a study by López-Jornet et al. 9 in Spain revealed moderate awareness of lifestyle factors among dentists, suggesting that training variations may account for disparities in knowledge of risk factors. On the other hand, this study indicates that, overall, dental students and interns possessed a good knowledge level regarding oral cancer. Notably, the high knowledge level demonstrated by 79.1% of participants is consistent with findings from studies conducted in Saudi Arabia 7 , 15 , although discrepancies are evident in India 16 In particular, the research conducted by Shubayr et al. 15 at Jazan University reported a similar degree of oral cancer awareness among students, interns, and faculty, with a significant proportion showing a sound understanding of oral cancer signs and risk factors. Likewise, a study by Kujan et al. 7 in Saudi Arabia highlighted a high level of awareness among Saudi dental undergraduates, especially concerning oral cancer risk factors and early signs. However, contrasting outcomes have been reported in research by Fotedar et al. where inadequate knowledge among dental students, with fewer than half recognizing critical risk factors like tobacco use was reported 16 . The current study revealed that 60% of respondents demonstrated poor practices in oral cancer prevention and early detection. This finding is comparable to results from Shadid et al. 2 where a similar low level of practice among Palestinian dental students and interns was reported, with 85.5% displaying insufficient engagement in preventive practices, emphasizing common barriers such as inadequate training and time constraints. Likewise, Alsaud’s study in Jeddah 13 indicated that only a small minority of dental practitioners routinely performed oral cancer screenings. In contrast, studies from Brazil and India presented higher levels of preventive practices among dental students, suggesting that these disparities may reflect regional differences in educational approaches to clinical training and exposure 14 , 16 . For example, Soares et al. 14 highlighted that Brazilian dental students were more actively engaged in patient education and screening practices, indicating that specific educational programs may be more effective in equipping students with the practical skills necessary for early detection. Regarding the attitudes towards oral cancer prevention, about 88% of respondents demonstrated a poor level of attitudes toward oral cancer prevention which is consistent with studies conducted in Saudi Arabia 13 and Kuwait 17 . For instance, Alsaud’s research in Jeddah demonstrated that a considerable proportion of dental undergraduates and practitioners lacked motivation for preventive practices, often perceiving oral cancer screening as outside their professional role 13 . Likewise, a study by Nazar et al. 17 in Kuwait revealed a limited commitment to preventive measures among primary oral health care dentist. However, findings from Shubayr et al. 15 at Jazan University indicated more favorable attitudes, with the majority of students and interns showing motivation to engage in preventive practices which is in contrast with the current study results. Additionally, Soares et al. 14 reported that Brazilian dental students held generally favorable views toward preventive education indicating an inconsistent findings with the present one. This study’s findings highlight a significant correlation between age and both practice and attitude scores, with participants aged over 25 years showing higher levels, consistent with findings from Cannick et al. 18 in the USA, where older dental students demonstrated improved preventive practices and attitudes, likely due to increased clinical exposure and maturity in professional responsibilities. Similarly, Shubayr et al. 15 noted that older students and interns in Saudi Arabia held more proactive attitudes toward oral cancer prevention, attributed to advanced clinical experience. In contrast, Keser and Pekiner’s study in Turkey 19 observed minimal variation across age groups, possibly due to a consistent curriculum providing equal exposure to oral cancer topics throughout. Gender differences in attitude scores, with males reporting higher scores, align with Alsaud’s findings in Jeddah 13 , where male students exhibited greater confidence in oral cancer prevention, potentially influenced by cultural factors shaping professional engagement. Supporting this, Nazar et al. in Kuwait 17 also noted more favorable attitudes among male dentists, possibly influenced by similar societal factors. Conversely, in Spain 9 , López-Jornet et al. found no significant gender differences, suggesting a more inclusive approach within educational and professional settings in Spain. The absence of a statistically significant association between educational level and knowledge, attitudes, or practices (KAP) regarding oral cancer prevention in this study may result from a uniform curriculum and limited clinical exposure among participants. Resource constraints and varying faculty emphasis on preventive practices may also lead to a more homogenous learning experience, reducing the impact of educational level on KAP outcomes. Nonetheless, such associations have been documented in various international studies. For instance, Soares et al. 14 in Brazil found that interns exhibited significantly higher KAP scores than younger students, attributing this to increased clinical exposure and hands-on experience acquired during later stages of training. Similarly, Shubayr et al. in Saudi Arabia 15 reported more favorable KAP outcomes among senior students and interns, suggesting that accumulated clinical engagement may positively shape preventive attitudes and practices. Conversely, Keser and Pekiner in Turkey 19 observed minimal variation across educational levels, likely due to a standardized curriculum emphasizing oral cancer prevention uniformly across all years of dental education. In Bangladesh, undergraduate dental students commence their study of oral cancer in the third year of their program. Through the oral pathology course, they delve into the risk factors and the carcinogenic mechanisms associated with oral cancer and potentially malignant conditions, engaging in lectures, interactive discussions, and practical assessments using histopathological slides. Progressing to their fourth and fifth years, students encounter oral medicine courses that deepen their theoretical understanding of diagnosing and managing malignant and precancerous oral lesions, guided by experts in oral medicine and surgical practice 20 . Fifth-year students also gain clinical experience at an oral medicine clinic, where they assess, diagnose, and manage cases with faculty oversight. However, this relatively late exposure to practical training and the limited opportunities for hands-on experience may contribute to the observed gaps in students' knowledge and proficiency in oral cancer screening and preventive practices. However, countries like the USA 18 , Brazil 14 and Spain 9 integrate oral cancer education and screening skills into their curricula earlier, providing repeated practical exposure throughout the training period, which enhances both competence and confidence in preventive practices. This study’s significance lies in its ability to provide valuable insights into the adequacy of the current dental curriculum on oral cancer prevention in Bangladeshi dental schools. As a cross-sectional, cost-effective, and efficient approach, it highlights gaps in both theoretical knowledge and practical application among final-year students and interns. Moreover, our findings highlight the importance of continuous educational initiatives designed to strengthen the competencies of both students and practitioners in oral cancer prevention and screening. However, certain limitations must be acknowledged in interpreting these results. Since this study employed a self-reported questionnaire, responses may be subject to bias, and the data may not fully capture the actual levels of knowledge, attitudes, or practices. Furthermore, the study was restricted to final-year students and interns within specific institutions in Bangladesh, which may limit the generalizability of these findings to a broader population of dental professionals in the country. The response rate, while reasonable, also presents a potential nonresponse bias that could influence the representativeness of the results. Despite certain limitations, this study highlights the critical need for curriculum improvements that embed hands-on experience and regular assessments in oral cancer prevention. Dental colleges in Bangladesh should prioritize clinical requirements, such as routine oral cancer screenings, to ensure students graduate with the necessary skills and confidence. Introducing oral cancer topics earlier in the curriculum, alongside practical modules that link theoretical knowledge with clinical or simulated experiences, would further strengthen competence. Continuous assessments and case-based learning could also ensure students not only understand but can effectively apply their knowledge in preventive practices. By implementing these targeted educational initiatives, institutions could play a pivotal role in improving early detection rates and reducing oral cancer morbidity through well-prepared future practitioners. Conclusion Based on the findings of this study, final-year dental students and intern doctors in Bangladesh demonstrated good baseline knowledge of oral cancer, with a majority achieving high knowledge scores. However, critical gaps persist, particularly regarding recognition of risk factors such as lifestyle-related behaviors, with few identifying all risk factors. Additionally, many participants exhibited poor practices in oral cancer screening and prevention, underscoring the need for enhanced training in practical skills. The majority of respondents also displayed unfavorable attitudes toward preventive practices, suggesting limited confidence and engagement in these essential aspects. Age and gender showed significant associations with knowledge and attitudes, with older and male participants scoring higher, respectively. These findings highlight the importance of integrating comprehensive and practical oral cancer training early in dental curricula to equip future practitioners with the necessary skills for effective cancer prevention and early detection. Declarations Human Ethics and Consent to Participate declarations : Not applicable Conflict of interest : None Funding: No Funding Authors’ contribution : S. M. Anwar Sadat and Shadly Benzadid – wrote main manuscript All authors reviewed the manuscript Afsana Jabeen, Khadiza Meem and Md. Tajul Islam analyzed the data Sufia Nasrin Rita, Nazmul Hasan Khandker, Sumonto Kumar Gain, Sabrina Binte Rahman, Aminul Huq, Farhana Zaman, Kamal Uddin, Morshed Alam, Manzur E Mahmud, Amir Shaheen and Shaikh Ahmed Rinku collected data References Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. 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Anwar Sadat","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYNACNgYGfjBJihYJyQaStRgcIFYL/+wG5g8/yuzqjG8kP3vwoYJBnl/sAH4tEncOsEn2nEuWMLuRZm444wyD4czZCQSsuZHAxsDbxgzUkmAmzdvGkGBwm4AW+RsJzB//ttVLGM9I/0acFoMbCQxAlYclDCRyiLTFEOgwaZlzxyVnnHlTBiQkCPtFDuSwN2XV/Pzt6dskPlTYyPNLE9ACDOYPEFoArFKCkHIUrQdIUT0KRsEoGAUjCQAAVic9/PayPdIAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-0842-6455","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":true,"prefix":"Dr.","firstName":"S.","middleName":"M. Anwar","lastName":"Sadat","suffix":""},{"id":396051246,"identity":"02f16fcd-93d0-404a-9e0a-432282904792","order_by":1,"name":"Afsana Jabeen","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Afsana","middleName":"","lastName":"Jabeen","suffix":""},{"id":396051247,"identity":"3c377952-e99a-4385-a0fe-d6a2e1d00129","order_by":2,"name":"Khadiza Akter Mim","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Khadiza","middleName":"Akter","lastName":"Mim","suffix":""},{"id":396051248,"identity":"74538693-b7e9-4eba-9927-924dad55a8cb","order_by":3,"name":"Shadly Benzadid","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Shadly","middleName":"","lastName":"Benzadid","suffix":""},{"id":396051249,"identity":"af732425-45cb-409f-a88c-24f4b89ce3c3","order_by":4,"name":"Sufia Nasrin Rita","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Sufia","middleName":"Nasrin","lastName":"Rita","suffix":""},{"id":396051250,"identity":"0fd800e3-e14b-4d46-8191-d47cea9f093a","order_by":5,"name":"Nazmul Hasan Khandker","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Nazmul","middleName":"Hasan","lastName":"Khandker","suffix":""},{"id":396051251,"identity":"e9223efd-5327-4f85-922c-1558c8efd968","order_by":6,"name":"Sumonto Kumar Gain","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Sumonto","middleName":"Kumar","lastName":"Gain","suffix":""},{"id":396051252,"identity":"4a74bf01-a26f-4012-ba9e-cf79b3a81875","order_by":7,"name":"Sabrina Binte Rahman","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Sabrina","middleName":"Binte","lastName":"Rahman","suffix":""},{"id":396051253,"identity":"a5b543e2-713e-46d1-93d7-24e1afd6b906","order_by":8,"name":"Aminul Huq","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Aminul","middleName":"","lastName":"Huq","suffix":""},{"id":396051254,"identity":"ec659573-dd29-4dec-ac03-89fa2610162d","order_by":9,"name":"Farhana Zaman","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Farhana","middleName":"","lastName":"Zaman","suffix":""},{"id":396051255,"identity":"5db2bd25-b818-4ba6-afea-40014d3b0b5c","order_by":10,"name":"Kamal Uddin","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Kamal","middleName":"","lastName":"Uddin","suffix":""},{"id":396051256,"identity":"1ed7db45-ea6f-4d05-aad9-0ec7c545e9b2","order_by":11,"name":"Morshed Alam","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Morshed","middleName":"","lastName":"Alam","suffix":""},{"id":396051257,"identity":"47de2ad6-1a0f-4cae-bf29-212d5ddec14d","order_by":12,"name":"Manjur E Mahmud","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Manjur","middleName":"E","lastName":"Mahmud","suffix":""},{"id":396051258,"identity":"6f8b4b30-3aff-4bc3-8e62-94d84b1cdfef","order_by":13,"name":"Amir Shaheen","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Amir","middleName":"","lastName":"Shaheen","suffix":""},{"id":396051259,"identity":"92585b28-3b99-42d8-a719-eacb3c1f1d03","order_by":14,"name":"Shaikh Ahmed Rinku","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Shaikh","middleName":"Ahmed","lastName":"Rinku","suffix":""},{"id":396055138,"identity":"3982ae0b-0c84-4fa9-8524-59e17b78cc2f","order_by":15,"name":"Mushfiq Hasan Shaikh","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Mushfiq","middleName":"Hasan","lastName":"Shaikh","suffix":""},{"id":396055139,"identity":"2b3c81b3-e301-46ae-92c5-c3e7bcb1c8c7","order_by":16,"name":"Mohammad Hayatun Nabi","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Hayatun","lastName":"Nabi","suffix":""},{"id":396055140,"identity":"2df1bfaa-e175-4f1f-947e-5ce43a7b95ab","order_by":17,"name":"Selim Reza","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Selim","middleName":"","lastName":"Reza","suffix":""},{"id":396055141,"identity":"81b87334-890b-415b-bb96-406ae160d5af","order_by":18,"name":"Asad Uz Zaman","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Asad","middleName":"Uz","lastName":"Zaman","suffix":""},{"id":396055142,"identity":"b4a3f6a6-e3fe-4584-81ff-292fd28e2b2b","order_by":19,"name":"Md. Tajul Islam","email":"","orcid":"","institution":"Oral Cancer Care and Research (OCCR)","correspondingAuthor":false,"prefix":"","firstName":"Md.","middleName":"Tajul","lastName":"Islam","suffix":""}],"badges":[],"createdAt":"2024-12-31 05:07:41","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5739237/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5739237/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72736170,"identity":"de7747d5-5c62-4512-a8a2-abc21ffcb5c0","added_by":"auto","created_at":"2025-01-01 08:28:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":676469,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5739237/v1/085b4f5c-0c9f-4a3e-b80c-00d31b1f55f6.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eMulti Institutional Study on Awareness of Oral Cancer among Final Year Bangladeshi Dental Students and Intern Doctors\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eLip and oral cavity cancers are regarded as a major global health issue, accounting for the 16th most common neoplasm worldwide, with nearly 377,713 new cases and 177,757 deaths recorded in 2020\u003csup\u003e1\u003c/sup\u003e. Oral cancer primarily occurs in the lips, tongue, mouth, salivary glands, and oropharynx, with oral squamous cell carcinoma being the most common form of this disease\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. These cancers primarily impact middle-aged and older men, with the highest incidence observed between the sixth and eighth decades of life. In South East Asia, oral cancer prevalence is relatively higher because of the cultural use of betel quid and different forms of tobacco which are major risk factors of oral cancer\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Bangladesh is no different in that case. Typically, oral cancers are known for their rapid progression and poor prognosis\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e; however, early diagnosis can lead to more favorable outcomes\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Preventing these lesions involves minimizing exposure to risk factors and detecting and monitoring potentially malignant oral conditions. Unfortunately, a recent systematic analysis revealed that healthcare practitioners frequently overlook oral malignancies, and the ensuing delay in referrals is a major factor to the disease's late stages\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Due to their direct patient interaction, general dentists can play a crucial role in the prevention and early identification of oral cancer\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Numerous studies have been carried out globally to examine the level of awareness among current and future dental professionals\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Some of these studies identified gaps or deficiencies in knowledge, attitudes, and practices related to oral cancer prevention\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, highlighting the need to strengthen oral cancer education within undergraduate and graduate dental programs. Furthermore, expanding continuing education programs for healthcare providers is crucial to improve awareness, attitudes, and preventive practices related to oral cancer detection and prevention.\u003c/p\u003e \u003cp\u003eIn Bangladesh, the incidence of oral cancer continues to rise. Despite advancements in treatment, mortality rates remain elevated, emphasizing the urgent need to prioritize prevention and early diagnosis. General dental practitioners are strategically placed to undertake this role, necessitating thorough knowledge of oral cancer and preventive strategies. However, no research to date has evaluated oral cancer awareness among intern doctors and dental students in Bangladesh. This study sought to fill this gap by assessing the knowledge, attitudes, and practices concerning oral cancer prevention and early detection within these groups, offering valuable insights into factors that shape their preventive approaches.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA cross-sectional, questionnaire-based study was conducted from January to March 2023, targeting final-year undergraduate dental students and intern doctors across four selected dental institutions in Bangladesh \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Ethical clearance was granted by the Department of Public Health, North South University, Dhaka. Following an initial institutional review of the study protocol, college principals were briefed on the study's objectives and data collection procedures. Students at each institution were approached post-lecture and provided with a concise overview of the study. Informed consent was obtained from all participants prior to questionnaire administration. Participation was entirely voluntary, and respondents were assured that their responses would remain completely anonymous and confidential. Those who consented received guidance on how to complete the questionnaire.\u003c/p\u003e\u003cp\u003eA 35-item, custom-designed questionnaire was created following a review of validated instruments from previous studies\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e on oral cancer awareness. The questionnaire was initially pilot-tested with a small group of 20 participants (comprised of 10 final-year students and 10 interns) to confirm the clarity, simplicity, and relevance of each question. Feedback from this pilot phase led to minor revisions, refining question wording and enhancing the flow of responses. Content validity was assessed by two senior oral medicine experts, with adjustments made to align questions with local curriculum and clinical relevance. Reliability was assessed using a test\u0026ndash;retest approach, where 20 students from the pilot group completed the questionnaire twice, with a two-week interval between each completion. Pearson\u0026rsquo;s correlation coefficient was used to analyze the responses, demonstrating stability with a significant reliability coefficient. Internal consistency was assessed through Cronbach\u0026rsquo;s alpha, which produced an acceptable value of α\u0026thinsp;=\u0026thinsp;0.78, reflecting good consistency across items within each section.\u003c/p\u003e\u003cp\u003eThe questionnaire consisted of four sections. The first section captured demographic information, including age, gender, and level of education. The second section assessed knowledge of oral cancer signs, symptoms, and risk factors, comprising 13 close-ended questions. Each correct answer received a score of 1, and the cumulative knowledge score ranged from 0 to 13. A cut-off of \u0026ge;\u0026thinsp;7 (54%) was set to classify participants as having \u0026ldquo;good knowledge\u0026rdquo; and \u0026lt;\u0026thinsp;7 as \u0026ldquo;poor knowledge,\u0026rdquo; based on previous studies\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The third section covered practices related to oral cancer prevention, including screening frequency and engagement in preventive counseling. This section consisted of 11 questions, where respondents indicated the frequency of specific practices. Responses were scored on a binary scale (1 for regular practice, 0 for infrequent or no practice). Scores ranged from 0 to 1, with a score\u0026thinsp;\u0026gt;\u0026thinsp;6 indicating \u0026ldquo;good practice\u0026rdquo; and \u0026le;\u0026thinsp;6 representing \u0026ldquo;poor practice\u0026rdquo; levels. One question addressed perceived barriers to routine screening, including options such as lack of time, training, or confidence in screening efficacy. In the questionnaire\u0026rsquo;s final section, participants expressed their attitudes on oral cancer prevention by rating eight statements using 5-point Likert scale options from \u0026ldquo;strongly agree\u0026rdquo; to \u0026ldquo;strongly disagree,\u0026rdquo;. Each positive response was assigned a score of 1, while negative responses received a score of 0, allowing for a maximum score of 8. A cut-off score of 6 was used; scores above 4 were classified as indicating favorable attitudes, whereas scores of 4 or below were categorized as unfavorable.\u003c/p\u003e\u003cp\u003eData were entered into Excel Sheet and analyzed with the SPSS version 22.0. Incomplete or missing responses were excluded. For continuous variables, descriptive statistics\u0026mdash;mean, standard deviation, and percentages\u0026mdash;were obtained, applying a significance threshold of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Independent samples t-tests evaluated the role of age and gender on KAP scores, while the effect of educational level was analyzed using ANOVA method.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA total of 335 final-year dental students and intern doctors participated in this study. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the socio-demographic characteristics of the participants. Among them, the majority (83.9%) were aged 25 or younger, while 16.1% were over 25 years. Female participants constituted 71.3% (n\u0026thinsp;=\u0026thinsp;239) of the sample, with male participants accounting for 28.7% (n\u0026thinsp;=\u0026thinsp;96). Regarding educational level, 58.2% were final-year dental students, and 41.8% were intern doctors.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates that all participants accurately identified the most common type of oral cancer, with 91.4% recognizing the primary cancer sites and 60.37% identifying the tongue areas most prone to cancer. However, only 10.6% acknowledged all risk factors, reflecting knowledge gaps, particularly in lifestyle-related risks. Additionally, 52.45% correctly identified the demographic most affected by oral cancer, and 69.15% recognized early symptoms. Diagnostic knowledge was high, with 90% affirming the necessity of lymph node palpation and 74.57% accurately describing affected lymph node characteristics.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e highlights practice-related responses, only 24.1% of respondents regularly screen for oral cancer, with 78.5% attributing barriers like time, training, and doubts about screening effectiveness. However, 90.6% discussed risk factors with patients, and 97.07% used diagnostic aids, though only 70.7% had referred cases to specialists. More than half of the respondents (62.8%) felt adequately trained to perform biopsies or use Toluidine blue as a diagnostic aid and performing incisional and punch biopsies.\u003c/p\u003e\u003cp\u003eAttitudes toward oral cancer prevention, as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, indicated that 61.35% of respondents desired more training. Only 39.4% viewed screening as a dentist\u0026rsquo;s role, and even fewer emphasized screening at new (25.5%) or recall appointments (21.95%). Overall, a few respondents (28.25%) felt confident in palpating cervical lymph nodes, and 31.3% felt prepared to provide education and advice on risk factors, indicating a noticeable gap in training adequacy.\u003c/p\u003e\u003cp\u003eConcerning the assessed knowledge of oral cancer, 79.1% of the respondents demonstrated good knowledge, with an overall mean score of 7.82 (1.80) among participants [table-5]. Regarding practices for oral cancer prevention and early detection, 60% of respondents exhibited poor practices, yielding an overall mean practice score of 6.83 (2.19). However, the majority (88.1%) held unfavorable attitudes toward oral cancer prevention, reflected by an overall mean attitude score of 6.37 (1.69).\u003c/p\u003e\u003cp\u003eRegarding whether participants\u0026rsquo; age, gender, or educational level significantly influenced knowledge, practice, and attitudes toward oral cancer prevention, the analysis demonstrated notable associations. Age was significantly correlated with both practice and attitude scores, as participants aged over 25 years reported higher mean scores in practice (7.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71) and attitude (6.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53), with statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Gender differences were observed in attitude scores, with male respondents achieving a significantly higher mean attitude score (6.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44) compared to females (6.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.005) [Table-6].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of survey respondents (n\u0026thinsp;=\u0026thinsp;335)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;=25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntern doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of students with correct responses to knowledge items (n\u0026thinsp;=\u0026thinsp;335)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOverall, n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFinal year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFinal year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhich is the most common oral cancer?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e335(100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat are the two most common sites of oral cancer?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(58.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42(29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58(61.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e148 (91.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhich area of tongue are most commonly develop oral cancer?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99(68.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54(57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e209 (60.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat are the common risk factors of oral cancer?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e31 (10.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWho are most commonly affected by oral cancer?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36(72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89 (61.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e177 (52.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is the most common age of the patients to develop oral cancer?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e46 (53.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptoms of early oral cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (62.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (73.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (66.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e231 (69.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommon stage of diagnosed oral cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94 (64.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62 (66.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e223 (67.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIs lymph node palpation is necessary?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e139 (95.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86 (91.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e308 (90.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics of lymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 (80.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71 (75.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e256 (74.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat are the typical clinical feature of early stage oral cancer diagnosis?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121 (83.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (76.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e266 (78.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhen examining the toungue, the clinician should?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69 (73.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e213 (60.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn which group the mortality rate is higher?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (57.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e178 (54.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of students reporting good practice and experience in oral cancer screening (n\u0026thinsp;=\u0026thinsp;335)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale, n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOverall, n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFinal year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFinal year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow often would you screen your patients?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89 (24.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCause to not screen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e261 (78.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you discuss the risk factors?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52 (55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e294(90.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you use diagnostic aids?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (78.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112 (77.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (76.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e325 (97.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you referred to a specialist?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (97.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87 (92.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e229 (70.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you feel diagnosis with pathological test is need?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (97.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140 (96.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92 (97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89 (26.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you instructed to perform biopsy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (78.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (63.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (69.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e197 (62.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you instructed to perform Toluidine blue?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e155 (42.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you instructed to how to perform incisional and punch biopsy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e291 (62.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow many oral lesions biopsy?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94 (64.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e207 (42.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you discuss about consequences?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120 (82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87 (92.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e261 (87.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you provide educational material?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58 (61.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e294 (63.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of students who received positive attitude toward oral cancer prevention (n\u0026thinsp;=\u0026thinsp;335)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale, n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOverall, n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFinal year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFinal year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequately trained to examine patients for oral cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52 (18.925)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequately Trained to palpate cervical lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86 (28.25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequately Trained to referred patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e102 (34.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdequately Trained to provide education and advice on risk factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96 (31.325)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt is the role for the dentist to screen for oral mucosal pathology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 ( 32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e121 (39.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreen of oral mucosal soft tissues should occur at new patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e83 (25.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreen of oral mucosal soft tissues should occur at recall patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63 (21.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeed additional training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (67.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e199 (61.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKnowledge, Practice and Attitude Scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood (\u0026gt;\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.82 (1.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor (0\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood(\u0026gt;\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.83 (2.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor (0\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnfavorable (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.37 (1.69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFavorable (\u0026gt;\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfluence of Age, Sex, and Education on Knowledge, Attitudes, and Practices Toward Oral Cancer Prevention (n\u0026thinsp;=\u0026thinsp;335)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePractice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eMean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;=25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e281 (83.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.81 (1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.72 (2.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.31 (1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.87(1.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.44(1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.68 (1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96(28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.71 (1.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.07 (2.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.88 (1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239 (71.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.86 (1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.74 (2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.17 (1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.90 (1.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.77 (2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.51 (1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntern doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (41.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.71 (1.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.92 (1.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.17 (1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e This multi-institutional study aimed to assess the awareness of oral cancer among final-year dental students and intern doctors in Bangladesh, focusing on their knowledge and attitudes toward early detection and prevention, as well as the practices related to these aspects. Additionally, the study sought to examine the demographic factors influencing their level of awareness about oral cancer.\u003c/p\u003e \u003cp\u003eThe current study reveals a critical knowledge gap among Bangladeshi dental students and intern doctors regarding the recognition of oral cancer risk factors, such as tobacco use, smoking, alcohol consumption, and betel quid use, which significantly contribute to the prevalence of oral cancer. The finding that only 10.6% of respondents recognized all risk factors for oral cancer, highlighting gaps in lifestyle-related knowledge, is consistent with similar studies conducted in Palestine\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e and Saudi Arabia\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. For instance, Shadid et al.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e reported low awareness among Palestinian dental students and interns regarding critical risk factors, including tobacco use and alcohol consumption, both prevalent lifestyle risks associated with oral cancer. Likewise, Alsaud\u0026rsquo;s study in Saudi Arabia indicated that many dental students and practitioners failed to identify major lifestyle-related risks, underscoring the need for more targeted education on these factors within the curriculum\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. However, studies from Brazil\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e and Spain\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e showed different level of awareness which contrasts with the current findings. For example, Soares et al.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e observed higher awareness levels among Brazilian dental students, who demonstrated familiarity with lifestyle risks, likely due to greater emphasis on public health and preventive education in their training, whereas, a study by L\u0026oacute;pez-Jornet et al.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e in Spain revealed moderate awareness of lifestyle factors among dentists, suggesting that training variations may account for disparities in knowledge of risk factors.\u003c/p\u003e \u003cp\u003eOn the other hand, this study indicates that, overall, dental students and interns possessed a good knowledge level regarding oral cancer. Notably, the high knowledge level demonstrated by 79.1% of participants is consistent with findings from studies conducted in Saudi Arabia\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, although discrepancies are evident in India\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e In particular, the research conducted by Shubayr et al.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e at Jazan University reported a similar degree of oral cancer awareness among students, interns, and faculty, with a significant proportion showing a sound understanding of oral cancer signs and risk factors. Likewise, a study by Kujan et al.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e in Saudi Arabia highlighted a high level of awareness among Saudi dental undergraduates, especially concerning oral cancer risk factors and early signs. However, contrasting outcomes have been reported in research by Fotedar et al. where inadequate knowledge among dental students, with fewer than half recognizing critical risk factors like tobacco use was reported\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe current study revealed that 60% of respondents demonstrated poor practices in oral cancer prevention and early detection. This finding is comparable to results from Shadid et al.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e where a similar low level of practice among Palestinian dental students and interns was reported, with 85.5% displaying insufficient engagement in preventive practices, emphasizing common barriers such as inadequate training and time constraints. Likewise, Alsaud\u0026rsquo;s study in Jeddah\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e indicated that only a small minority of dental practitioners routinely performed oral cancer screenings. In contrast, studies from Brazil and India presented higher levels of preventive practices among dental students, suggesting that these disparities may reflect regional differences in educational approaches to clinical training and exposure\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. For example, Soares et al.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e highlighted that Brazilian dental students were more actively engaged in patient education and screening practices, indicating that specific educational programs may be more effective in equipping students with the practical skills necessary for early detection.\u003c/p\u003e\u003cp\u003eRegarding the attitudes towards oral cancer prevention, about 88% of respondents demonstrated a poor level of attitudes toward oral cancer prevention which is consistent with studies conducted in Saudi Arabia\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and Kuwait\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. For instance, Alsaud\u0026rsquo;s research in Jeddah demonstrated that a considerable proportion of dental undergraduates and practitioners lacked motivation for preventive practices, often perceiving oral cancer screening as outside their professional role\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Likewise, a study by Nazar et al.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e in Kuwait revealed a limited commitment to preventive measures among primary oral health care dentist. However, findings from Shubayr et al.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e at Jazan University indicated more favorable attitudes, with the majority of students and interns showing motivation to engage in preventive practices which is in contrast with the current study results. Additionally, Soares et al.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e reported that Brazilian dental students held generally favorable views toward preventive education indicating an inconsistent findings with the present one.\u003c/p\u003e\u003cp\u003eThis study\u0026rsquo;s findings highlight a significant correlation between age and both practice and attitude scores, with participants aged over 25 years showing higher levels, consistent with findings from Cannick et al.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e in the USA, where older dental students demonstrated improved preventive practices and attitudes, likely due to increased clinical exposure and maturity in professional responsibilities. Similarly, Shubayr et al.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e noted that older students and interns in Saudi Arabia held more proactive attitudes toward oral cancer prevention, attributed to advanced clinical experience. In contrast, Keser and Pekiner\u0026rsquo;s study in Turkey\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e observed minimal variation across age groups, possibly due to a consistent curriculum providing equal exposure to oral cancer topics throughout.\u003c/p\u003e\u003cp\u003eGender differences in attitude scores, with males reporting higher scores, align with Alsaud\u0026rsquo;s findings in Jeddah\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, where male students exhibited greater confidence in oral cancer prevention, potentially influenced by cultural factors shaping professional engagement. Supporting this, Nazar et al. in Kuwait\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e also noted more favorable attitudes among male dentists, possibly influenced by similar societal factors. Conversely, in Spain\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, L\u0026oacute;pez-Jornet et al. found no significant gender differences, suggesting a more inclusive approach within educational and professional settings in Spain.\u003c/p\u003e\u003cp\u003eThe absence of a statistically significant association between educational level and knowledge, attitudes, or practices (KAP) regarding oral cancer prevention in this study may result from a uniform curriculum and limited clinical exposure among participants. Resource constraints and varying faculty emphasis on preventive practices may also lead to a more homogenous learning experience, reducing the impact of educational level on KAP outcomes. Nonetheless, such associations have been documented in various international studies. For instance, Soares et al.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e in Brazil found that interns exhibited significantly higher KAP scores than younger students, attributing this to increased clinical exposure and hands-on experience acquired during later stages of training. Similarly, Shubayr et al. in Saudi Arabia\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e reported more favorable KAP outcomes among senior students and interns, suggesting that accumulated clinical engagement may positively shape preventive attitudes and practices. Conversely, Keser and Pekiner in Turkey\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e observed minimal variation across educational levels, likely due to a standardized curriculum emphasizing oral cancer prevention uniformly across all years of dental education.\u003c/p\u003e\u003cp\u003eIn Bangladesh, undergraduate dental students commence their study of oral cancer in the third year of their program. Through the oral pathology course, they delve into the risk factors and the carcinogenic mechanisms associated with oral cancer and potentially malignant conditions, engaging in lectures, interactive discussions, and practical assessments using histopathological slides. Progressing to their fourth and fifth years, students encounter oral medicine courses that deepen their theoretical understanding of diagnosing and managing malignant and precancerous oral lesions, guided by experts in oral medicine and surgical practice\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Fifth-year students also gain clinical experience at an oral medicine clinic, where they assess, diagnose, and manage cases with faculty oversight. However, this relatively late exposure to practical training and the limited opportunities for hands-on experience may contribute to the observed gaps in students' knowledge and proficiency in oral cancer screening and preventive practices. However, countries like the USA\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, Brazil\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e and Spain\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e integrate oral cancer education and screening skills into their curricula earlier, providing repeated practical exposure throughout the training period, which enhances both competence and confidence in preventive practices.\u003c/p\u003e\u003cp\u003eThis study\u0026rsquo;s significance lies in its ability to provide valuable insights into the adequacy of the current dental curriculum on oral cancer prevention in Bangladeshi dental schools. As a cross-sectional, cost-effective, and efficient approach, it highlights gaps in both theoretical knowledge and practical application among final-year students and interns. Moreover, our findings highlight the importance of continuous educational initiatives designed to strengthen the competencies of both students and practitioners in oral cancer prevention and screening.\u003c/p\u003e\u003cp\u003eHowever, certain limitations must be acknowledged in interpreting these results. Since this study employed a self-reported questionnaire, responses may be subject to bias, and the data may not fully capture the actual levels of knowledge, attitudes, or practices. Furthermore, the study was restricted to final-year students and interns within specific institutions in Bangladesh, which may limit the generalizability of these findings to a broader population of dental professionals in the country. The response rate, while reasonable, also presents a potential nonresponse bias that could influence the representativeness of the results. Despite certain limitations, this study highlights the critical need for curriculum improvements that embed hands-on experience and regular assessments in oral cancer prevention. Dental colleges in Bangladesh should prioritize clinical requirements, such as routine oral cancer screenings, to ensure students graduate with the necessary skills and confidence. Introducing oral cancer topics earlier in the curriculum, alongside practical modules that link theoretical knowledge with clinical or simulated experiences, would further strengthen competence. Continuous assessments and case-based learning could also ensure students not only understand but can effectively apply their knowledge in preventive practices. By implementing these targeted educational initiatives, institutions could play a pivotal role in improving early detection rates and reducing oral cancer morbidity through well-prepared future practitioners.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e Based on the findings of this study, final-year dental students and intern doctors in Bangladesh demonstrated good baseline knowledge of oral cancer, with a majority achieving high knowledge scores. However, critical gaps persist, particularly regarding recognition of risk factors such as lifestyle-related behaviors, with few identifying all risk factors. Additionally, many participants exhibited poor practices in oral cancer screening and prevention, underscoring the need for enhanced training in practical skills. The majority of respondents also displayed unfavorable attitudes toward preventive practices, suggesting limited confidence and engagement in these essential aspects. Age and gender showed significant associations with knowledge and attitudes, with older and male participants scoring higher, respectively. These findings highlight the importance of integrating comprehensive and practical oral cancer training early in dental curricula to equip future practitioners with the necessary skills for effective cancer prevention and early detection.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No Funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eS. M. Anwar Sadat and Shadly Benzadid \u0026ndash; wrote main manuscript\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript\u003c/p\u003e\n\u003cp\u003eAfsana Jabeen, Khadiza Meem and Md. Tajul Islam analyzed the data\u003c/p\u003e\n\u003cp\u003eSufia Nasrin Rita, Nazmul Hasan Khandker, Sumonto Kumar Gain, Sabrina Binte Rahman, Aminul Huq, Farhana Zaman, Kamal Uddin, Morshed Alam, Manzur E Mahmud, Amir Shaheen and Shaikh Ahmed Rinku collected data\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 71(3):209\u0026ndash;249. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3322/caac.21660\u003c/span\u003e\u003cspan address=\"10.3322/caac.21660\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShadid R, Ali M, Kujan O (2022) Knowledge, attitudes, and practices of oral cancer prevention among dental students and interns: an online cross\u0026ndash;sectional questionnaire in Palestine. BMC Oral Health 22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12903-022-02415-8\u003c/span\u003e\u003cspan address=\"10.1186/s12903-022-02415-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar M, Nanavati R, Modi T, Dobariya C (2016) Oral cancer: Etiology and risk factors: A review. 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J Cancer Educ 34(3):512\u0026ndash;518. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13187-018-1332-x\u003c/span\u003e\u003cspan address=\"10.1007/s13187-018-1332-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCurriculumBook-BMDC-2016.pdf. Accessed November 4 (2024) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.bmdc.org.bd/docs/CurriculumBook-BMDC-2016.pdf\u003c/span\u003e\u003cspan address=\"https://www.bmdc.org.bd/docs/CurriculumBook-BMDC-2016.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Oral Cancer Care and Research (OCCR)","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Oral cancer prevention, Knowledge, Attitudes, Practices, Dental students, Interns, Bangladesh","lastPublishedDoi":"10.21203/rs.3.rs-5739237/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5739237/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Oral cancer is widely recognized as a global health concern, with an aggressive nature and high mortality rates, especially in Southeast Asia where risk factors like betel quid and tobacco use are common. Although early detection can greatly improve prognosis, limited data exists on the knowledge, attitudes, and practices (KAP) of dental students and interns in Bangladesh regarding oral cancer prevention. This study aimed to assess these aspects among future dental practitioners.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods: \u003c/strong\u003eA cross-sectional, questionnaire-based survey was conducted from January to March 2023 among final-year dental students and intern doctors from multiple institutions in Bangladesh. The survey utilized a 35-item questionnaire covering demographics, knowledge, practices, and attitudes toward oral cancer prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 335 participants completed the survey. Approximately 79.1% demonstrated good knowledge of oral cancer; however, only 10.6% identified all risk factors. Furthermore, 60% exhibited poor preventive practices, with just 24.1% regularly screening patients. Attitudes were predominantly unfavorable, with 88.1% lacking confidence in screening activities. Age and gender were significantly associated with practice and attitude scores, with older and male participants scoring higher (P \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe findings reveal substantial gaps in the KAP of Bangladeshi dental students and interns concerning oral cancer prevention. Addressing these gaps through curriculum enhancements, including early and practical training in cancer detection, could better prepare future practitioners for effective oral cancer management and prevention.\u003c/p\u003e","manuscriptTitle":"Multi Institutional Study on Awareness of Oral Cancer among Final Year Bangladeshi Dental Students and Intern Doctors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-01 08:20:19","doi":"10.21203/rs.3.rs-5739237/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12bdc5bb-2123-4393-a286-092f7e761ffe","owner":[],"postedDate":"January 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-02T09:53:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-01 08:20:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5739237","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5739237","identity":"rs-5739237","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}