Knowledge, Attitudes, and Risk Factor Awareness Regarding Oral Cancer Among Dentists in Turkey

Knowledge, Attitudes, and Risk Factor Awareness Regarding Oral Cancer Among Dentists in Turkey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, Attitudes, and Risk Factor Awareness Regarding Oral Cancer Among Dentists in Turkey Müfide Bengü Erden, Candan Efeoğlu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7875512/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: This study aimed to evaluate the knowledge, attitudes, and awareness of Turkish dentists regarding oral cancer and to investigate the influence of age and professional specialization on these factors. Methods: A nationwide cross-sectional online survey was conducted among dentists in Turkey using a 30-item questionnaire adapted from previously validated instruments. The survey included sections on sociodemographic data, awareness of risk factors, knowledge of oral cancer, and clinical attitudes. Data were analyzed using Chi-square and Fisher’s exact tests, with post-hoc analyses of standardized residuals. A p value < 0.05 was considered statistically significant. Results: A total of 1,149 dentists participated. Awareness of major risk factors—tobacco (99%), betel chewing (97.9%), alcohol consumption (90.4%), UV exposure (91.5%), and HPV infection (85.7%)—was high. Significant associations were found between awareness levels and both age and professional status (p < 0.001). Younger dentists (22–29 years) showed greater awareness of HPV infection (p < 0.001) and UV exposure (p < 0.001), whereas specialists demonstrated higher knowledge than general practitioners (p < 0.01). Only 28.8% of participants felt confident diagnosing oral cancer, and 37.1% were confident palpating lymph nodes (p < 0.05). Routine oral mucosal examination was reported by 76.2% of respondents (p < 0.01). Conclusion: Despite high awareness of major risk factors, notable gaps remain in clinical confidence and patient education regarding oral cancer. Strengthening undergraduate curricula and implementing continuing education programs focused on oral oncology are essential to improve early detection, enhance diagnostic competence, and promote patient counseling in dental practice. Oral cancer oral cancer awareness oral cancer knowledge dentist Figures Figure 1 Figure 2 Introduction Oral cancer is a global health problem with increasing incidence and mortality rates in both developed and developing countries( 1 ) It currently ranks as the 16th most common cancer worldwide and the 15th leading cause of cancer related deaths. According to the 2022 reports of the International Agency for Research on Cancer, more than 350,000 new cases of oral cancer are diagnosed annually, resulting in approximately 188,320 deaths across 185 countries. The incidence of oral cavity cancers is projected to increase to 415,000 cases in 2025, with mortality expected to rise to 201,000 cases.( 2 ) Histologically, more than 90% of oral cancers are squamous cell carcinomas.( 3 ) In their early stages, oral cancers are often asymptomatic.( 4 ) In both developed and developing countries, cancers of the lip and oral cavity are strongly associated with exposure to various risk factors, including tobacco use (chewing or smoking) ( 5 ), alcohol consumption ( 6 ), human papillomavirus (HPV) infection ( 7 ), and ultraviolet (UV) radiation. ( 8 ) The global five-year survival rate worldwide is approximately 50%. While the survival rate reaches about 80% for stage I cancers, it declines nearly to 20% in advanced stage disease.( 3 , 4 ) Despite advances in cancer treatment, the average five-year survival rate of oral cancer in United States remains a 64%, while 38% in patient with distant metastases. Nevertheless, approximately 70% of patients are still diagnosed at a late stage. ( 9 ) The most critical issue in oral cancer management is achieving early diagnosis ( 10 ), which allows for more conservative treatment, improved prognosis, and a better quality of life. Dentists play a key role in this process; thus, their awareness and knowledge of oral cancer are essential for early detection and timely referral.( 11 ) Therefore, the present study aimed to evaluate the awareness, knowledge, and attitudes of Turkish dentists regarding oral cancer. Materials and Methods This observational cross-sectional study was designed to evaluate knowledge, awareness, and attitudes of dentists regarding oral cancer. The study protocol and questionnaire were reviewed and approved by the Human Ethics Committee of XXX University (Approval No. XXX), and the research was conducted in accordance with the Declaration of Helsinki. The survey instrument was developed using previously published questionnaires that were modified to meet the objectives of the present study.( 12 – 15 ) The final questionnaire consisted of 30 questions, divided into four sections: (i) personal information (7 items), (ii) awareness of risk factors (9 items), (iii) knowledge of oral cancer (7 items), and (iv) attitudes and clinical practices (7 items). The questionnaire was designed using Google Forms and distributed electronically via email through the Turkish Dental Association. The data were collected between February-March 2019. Participation was entirely voluntary. Respondents were required to sign in using their email address to ensure one submission per participant and to prevent duplicate entries. Participants were asked to confirm their consent to participate in the study. All responses were anonymous and confidential, and no identifying personal information was collected. Participants were categorized according to age groups and professional status (specialist/general practitioner). Their responses were compared across these groups. The primary purpose of this study was evaluation of dentists’ perception of oral cancer. Additionally, subgroup analyses were performed according to demographic characteristics. Instrument reliability The reliability of the questionnaire was assessed through a pilot study involving 30 participants, and the Cronbach’s alpha coefficient was calculated as 0.726, demonstrated an acceptable level of internal consistency. The reliability of the questionnaire was evaluated in a pilot study involving 30 participants who were not included in the main sample. Internal consistency was assessed using Cronbach’s alpha, which yielded a coefficient of 0.726, indicating an acceptable level of reliability. Statistical Analysis All data were analyzed using The jamovi project (2025; Version 2.6.45) (Retrieved from https://www.jamovi.org ). Descriptive statistics were presented as frequency (n), percentage (%), mean, and standard deviation (SD). The Chi-square test and Fisher’s exact tests were used to examine associations between categorical variables. Post-hoc tests were conducted for comparisons among multiple groups when significant differences were detected. The Contingency coefficient was reported as a measure of effect size, and a p-value < 0.05 was considered statistically significant. RESULTS A total of 1149 dentists participated in the study. Of the these, 57.1% (n = 648) were female and 42.9% (n = 487) were male. The mean age of the participants was 35.0 ± 11.4 years, ranging from 22 to 81 years. The sociodemographic and work characteristics of the study participants are presented in Table 1 . Table 1 Demographic characteristics of participants Variable n (%) Age (years) Mean ± SD age 35.0 ± 11.4 Professional status Specialist 431 (37.5%) General practitioner 718 (62.5%) Gender Female 648 (57.1%) Male 487 (42.9%) Age groups 20–29 450 (46.8%) 30–39 245 (25.5%) 40–49 126 (13.1%) ≥ 50 140 (14.6%) Graduation year 1960–2000 304 (27.2%) 2001–2010 203 (18.2%) 2011–2015 304 (27.2%) 2016–2020 307 (27.5%) Specialty distribution Oral & maxillofacial surgery 95 (22.0%) Periodontology 65 (15.1%) Orthodontics 79 (18.3%) Prosthodontics 71 (16.5%) Endodontics/Restorative 57 (13.2%) Pediatric dentistry 51 (11.8%) Oral radiology 13 (3.0%) Workplace University hospital 241 (22.2%) Public sector (ADSM) 147 (13.5%) Private clinic 618 (56.9%) Private hospital 81 (7.5%) Awareness of risk factors Most participants correctly identified the major risk factors for oral cancer, including tobacco use (99%), betel quid chewing (97.9%), a history of oral cancer (92.4%), UV exposure (91.5%), and alcohol consumption (90.4%). A substantial proportion also recognized family history of oral cancer (86.1%) and HPV infection (85.7%) as risk factors. Relatively lower levels of awareness was observed for low fruit and vegetable intake (69.6%) and older age (69.6%) as contributing factors. The distribution of participants’ responses regarding risk factor awareness is illustrated in Fig. 1 . Significant associations were observed between participants’ awareness of oral cancer risk factors and both age group and professional status (Table 2 ). Table 2 Association between participants’ knowledge of oral cancer risk factors and age group or professional status (Chi-square test with post-hoc analysis based on standardized residuals). Risk factor Age groups( p ) Contingency coefficient (C) GP vs. SP( p ) Contingency coefficient (C) Post-hoc (significant standardized residuals, z ) Smoking 0.372ᵃ – 0.848ᵃ 0.027 n.s. Alcohol consumption 0.069 0.110 50 years ( z = − 3.20, “yes”); GP ( z = + 2.43“yes”), SP ( z = − 2.43,“yes”) HPV infection < 0.001 0.192 50 years ( z = − 3.65, “yes”); GP ( z = + 4.85, “yes”), SP ( z = − 4.85, “yes”) UV exposure < 0.001 0.163 < 0.001 0.113 22–29 years ( z = + 4.33, “yes”), 30–39 years ( z = 2.06“yes”), 40–49 years ( z = -2.08, “yes”); GP ( z = + 3.81), SP ( z = − 3.81) Family history of oral cancer 0.160 0.097 0.119 0.119 n.s. Older age < 0.001 0.157 50 years ( z = − 3.07, “yes”); GP ( z = − 2.68), SP ( z = + 3.95) Betel quid chewing 0.574ᵃ 0.066 0.055ᵃ 0.064 n.s. ᵃ Fisher’s exact test GP: General Practitioner; SP: Specialist; n.s.: not significant. Knowledge About Oral Cancer The majority of dentists (86.7%) correctly identified squamous cell carcinoma as the most common histological type of oral cancer. When participants were asked to identify lesions that are not premalignant, most correctly recognized irritation fibroma (70.0%). However, a proportion of dentists misclassified leukoplakia (11.7%), erythroplakia (6.6%), and erosive lichen planus (11.7%) as non-premalignant lesions. Regarding the age group most commonly associated with oral cancer was correctly identified by 84.9% of participants. A total of 58.5% of participants knew that a biopsy should be performed within 14 days of a suspicious lesion being detected. Of the participants, 47.2% correctly indicated the five-year survival rate for oral cancer and 50.5% correctly identified betel chewing as the primary etiological factor for oral submucosal fibrosis. Overall knowledge performance is presented in Table 3 . Significant variations in knowledge levels were observed according to both age group and professional status (Table 4 ). Table 3 Knowledge of dentists regarding oral cancer charactetistics n (%) What is the most common type of oral cancer? Squamous cell carcinoma 963 (86.7) Verrucous carcinoma 18 (1.6) Adenocarcinoma 56 ( 5 ) Malignant melanoma 74 (6.7) Which of the following is not considered a premalignant lesion? Leukoplakia 128 (11.7) Eryhtroplakia 72 (6.6) Erosive lichen planus 129 (11.7) Irritation fibroma 769 (70.0) In which age group is oral cancer most commonly observed? 20–40 years 164 (15.0) 40–60 years 843 (76.9) 60–80 years 88 (8.0) After how long a biopsy should be performed for a non-healing oral lesion? With in 7 days 57 (5.1) Within 14 days 651 (58.5) Within 4 weeks 314 (28.2) Within 3 months 91 (8.2) What is the five-year survival rate for oral cancer? 10% 179 (16.5) 25% 211 (19.5) 50% 512 (47.2) 90% 182 (16.8) What is the most common etiological factor for oral submucous fibrosis? Betel quid chewing 524 (50.5) Smoking 276 (26.6) Alcohol abuse 45 (4.3) Poor oral hygiene 192 (18.5) Table 4 Association between participants’ knowledge items related to oral cancer and age group or professional status (Chi-square test with post-hoc analysis based on standardized residuals). Knowledge item Age groups( p ) Contingency coefficient (C) GP vs. SP( p ) Contingency coefficient (C) Post-hoc (significant standardized residuals, z ) What is the most common type of oral cancer? 0.001 0.169 < 0.001 0.138 22–29 years ( z = + 4.07, SCC); SP ( z = + 4.33, SCC) Which of the following is not considered a premalignant lesion? < 0.001 0.270 50 years ( z = + 2.80, LP), > 50 years ( z = + 2.83, EP); GP ( z = − 5.22; IF), SP ( z = + 5.22; IF) In which age group is oral cancer most commonly observed? 0.002ᵃ 0.156 0.032ᵃ 0.084 22–29 years ( z = + 4.12, 40–60 years); SP ( z = − 2.11, 40–60 years) After how long a biopsy should be performed for a non-healing oral lesion? < 0.001 0.343 0.005 0.106 22–29 years ( z = + 9.26 14 days; SP ( z = + 2.78, 14 days) What is the five-year survival rate for oral cancer? 0.002 0.167 0.058 0.082 22–29 years ( z = − 3.04, 50%), 30–39 years ( z = + 2.16, 90%) What is the most common etiological factor for oral submucous fibrosis? < 0.001 0.277 50 years ( z = − 2.47, BC); GP ( z = − 3.86, BC), SP ( z = + 3.86, BC) ᵃ Fisher’s exact test. GP:General Practitioner; SP: Specialist; SCC :Squamous Cell Carcinoma; LP: Leukoplakia; EP:Erythroplakia; IF: Irritation Fibroma; BC: Betel quid Chewing; C: Contingency coefficient; n.s.: not significant. Clinical Practices and Attitudes Regarding Oral Cancer A total of 28.8% of participants reported feeling confident about diagnosing oral cancer, while 37.1% felt confident about palpating lymph nodes in the head and neck region. Specifically, 76.2% of dentists routinely examined the oral mucosa, and 80.1% reported asking patients about tobacco use during history taking. In contrast, only 37.1% routinely inquired about alcohol consumption. Additionally, 47.0% stated that they inform patients about oral cancer risk factors, and 46.8% reported having previously examined a patient with oral cancer. Dentists’ clinical practices and attitudes are summarized in Figs. 2 . Significant differences in clinical attitudes and practices were observed according to age group and professional status (Table 5 ). Table 5 Association between participants’ attitudes toward oral cancer and age group or professional status (Chi-square test with post-hoc analysis based on standardized residuals). Attitude item Age groups( p ) Contingency coefficient (C) GP vs. SP( p ) Odds ratio (95% CI) Post-hoc (significant standardized residuals, z ) I routinely perform oral mucosal examinations. 0.443 0.052 0.293 0.859 (0.646–1.14) n.s. I regularly advise my patients about oral cancer risk factors. 50 years ( z = + 4.32, “yes”) I regularly ask my patient about their smoking habit. 0.446 0.052 < 0.001 2.17 (1.62–2.91) SP ( z = + 5.24, “yes”) I regularly ask my patient about their alcohol consumption. 0.543 0.047 0.149 1.20 (0.936–1.54) n.s. I have examined a patient with oral cancer. 50 years ( z = + 5.28, “yes”) I feel confident to diagnose oral cancer based on its clinical appearance. 0.770 0.034 < 0.001 0.637 (0.491–0.827) SP ( z = + 3.40, “yes”) I feel confident palpating head and neck lymph nodes. 0.079 0.084 0.054 0.785 (0.613–1.00) n.s. GP: General Practitioner; SP: Specialist; n.s.: not significant. Post-hoc Power Analysis Post hoc power analyses indicated that the study had adequate sensitivity to detect small-to-moderate effect sizes. For comparisons between general practitioners (GPs) and specialists, the detectable effect size was approximately Cohen’s w = 0.084–0.119 at 80% power and 0.097–0.134 at 90% power. For age group comparisons, the corresponding detectable effect sizes were w = 0.089–0.126 at 80% power and 0.102–0.141 at 90% power. Therefore, significant associations were consistently supported by high statistical power (> 90%), whereas non-significant findings with low observed power should be interpreted with caution due to possible type II error risk. Discussion This study provides a comprehensive insight into the awareness, knowledge, and attitudes of Turkish dentists regarding oral cancer, highlighting both strengths and areas requiring improvement. Unlike previous research, the present study included a large national sample and incorporated comparisons based on professional status (general practitioners vs. specialists), as well as clinical behaviors and perceptions, offering a broader understanding of factors influencing dentists’ engagement in oral cancer prevention and early detection.( 16 – 19 ) Other than skin and oral cancers, no other type of cancer can be diagnosed through visual examination alone. Despite this, it continues to be diagnosed predominantly at advanced stages, leading to high morbidity and mortality rates. Dentists play a pivotal role in the early detection; therefore, assessing their awareness and attitudes is crucial for identifying barriers to timely diagnosis and for guiding educational interventions. ( 20 – 22 ) Among the 1,149 participants, 57.1% were female and 42.9% were male, and the highest participation rate was 46.8% among those aged 22–29 years. The mean age of the participants was 35.0 ± 11.4 years. Another study conducted in Turkey, individuals aged 25–35 showed the highest participation rate.( 18 ) This predominance of younger respondents can be attributed to the online distribution method of the questionnaire via email, which tends to elicit greater engagement from younger, digitally active professionals. In the present study, the highest levels of awareness regarding oral cancer risk factors were observed for tobacco use (99%), betel quid chewing (97.9%), and alcohol consumption (90.4%). These findings are consistent with previous studies reporting a high recognition of tobacco and alcohol as primary etiological factors for oral cancer.( 15 , 18 , 23 – 26 ) These were followed by UV exposure (91.5%) and HPV infection (85.7%). Spaulonci et al. reported similar awareness levels, with 88.9% of respondents identifying HPV and 85.7% recognizing UV exposure as risk factors.( 27 ) Betel quid use and other forms of smokeless tobacco are more prevalent in specific demographic groups in South Asia, often linked to socioeconomic disadvantage and habitual cultural practices.( 28 ) The high recognition of this factor among Turkish dentists may reflect greater educational exposure to global literature and risk awareness in contemporary dental curricula. Moreover, 84.9% of participants identified advanced age as a risk factor, markedly higher than rates reported in Ireland (55%)( 11 ) and Turkey (64.5%) ( 18 ). Significant differences in oral cancer risk factor awareness were observed according to both age group and professional status. Younger dentists (22–29 years) demonstrated greater awareness of low fruit and vegetable intake, HPV infection, UV exposure, and older age ( p 50 years were less aware of these risk factors ( p < 0.05). Similarly, specialists exhibited significantly higher awareness than GPs above mentioned risk factors (p < 0.05). These findings indicate that younger and specialist dentists possess better awareness of risk factors, underscoring the need for targeted continuing education among older and general practitioners. Interestingly, despite their relatively lower knowledge of these risk factors, dentists aged > 50 years reported advising patients about them more frequently ( p < 0.05), suggesting stronger patient communication habits with experience. In contrast, younger dentists (22–29 years) were more likely to report not providing such counseling ( p < 0.05), indicating that preventive communication practices tend to increase with professional maturity. Akbari et al., found that 87.2% of general dentists and 100% of specialists correctly identified squamous cell carcinoma (SCC) as the most common malignancy of the oral cavity.( 29 ) This slightly higher recognition rate among specialists aligns with the results of the present study, in which 92.3% of specialists and 83.2% of general practitioners identified SCC as the most prevalent form of oral cancer. In the present study, the proportion of dentists who incorrectly identified leukoplakia (11.7%) and erythroplakia (6.6%) as non-premalignant lesions was remarkably low. Ojha et al. ( 30 ) found lower recognition rates 65% for leukoplakia and just above 50% for erythroplakia, consistently Kebabcıoğlu et al. ( 15 ) reported that 64.1% of dentists identified these lesions as precancerous. These findings suggest that participants in the current study demonstrate substantially higher knowledge of premalignant and non-premalignant oral lesions than those in other studies. In the study by Akbari et al., the highest level of knowledge was observed among dentists with less than 5 years of work experience( 29 ), and Taheri et al. also reported that knowledge levels significantly decreased as the number of years since graduation increased.( 31 ) Consistent with these findings, participants aged 22–29 years in the present study provided significantly more correct responses in the knowledge domain compared to older age groups (p < 0.001). This suggests that recent graduates may possess more up-to-date theoretical knowledge in dental education. Professional background also influenced attitudes toward oral cancer prevention and diagnosis. Specialists were significantly more likely than general practitioners to ask patients about smoking habits ( p < 0.05; OR = 2.17, 95% CI: 1.62–2.91) and to express confidence in diagnosing oral cancer based on clinical appearance ( p < 0.05; OR = 0.637, 95% CI: 0.491–0.827). The findings show specialists have stronger diagnostic confidence and preventive behaviour due to greater experience and training. General practitioners may benefit from extra training in early detection and patient counselling in routine dental care. Sarı et al.( 16 ) reported that more than half of general dentists did not perform oral mucosal examinations in high-risk patients. In contrast, the present study showed a more favorable pattern, with 76.2% of participants routinely performing such examinations, similar to Shamala et al. ( 32 ). Sangoi et al.( 33 ) found even higher rates, with 91% of dentists routinely examining the oral mucosa and 89.1% having encountered at least one oral cancer case, while Brazilian studies reported comparable findings (62%–89.3%).( 33 , 34 ) In our study, 50.7% of participants had seen at least one oral cancer patient, consistent with Shamala et al. ( 32 ). The higher rates in earlier research may reflect more frequent mucosal examinations, and the close relationship between these two measures further supports this interpretation. Ahmed et al. reported that many participants refrained from performing oral mucosal examinations because they felt insufficient knowledge about oral cancer.( 17 ) Consistently, in the present study, only 28.8% of participants felt confident diagnosing oral cancer based on clinical appearance, and 37.1% felt competent in performing lymph node examinations. These findings align with previous studies. ( 15 , 17 , 35 ) Compared with findings from Yemen, where Alaizari et al. ( 25 ) reported higher confidence levels (58.3% for diagnosis, 68.3% for lymph node palpation) but lower risk-factor awareness, this discrepancy suggests that some dentists may overestimate diagnostic ability due to limited biopsy-confirmed experience or lack of structured feedback. This highlights the ongoing need evidence-based training in oral cancer examination within undergraduate and continuing education programs. Statistical Strengths and Limitations The large sample size and high post hoc power enhance the reliability of the study’s significant findings, while non-significant associations may reflect small effect sizes rather than the absence of relationships. The main limitations include the cross-sectional design, reliance on self-reported data, and uneven distribution across age and professional groups, which may have influenced subgroup comparisons. Additionally, the online format could have introduced volunteer bias, favoring respondents more interested in oral cancer. Despite these limitations, the results align with international evidence, indicating that gaps in oral cancer awareness and preventive behavior among dentists are a global rather than a regional concern. Clinical and Educational Implications To translate these findings into practice, dental education and health policy should prioritize oral oncology training. Undergraduate programs should include modules on cancer prevention, biopsy referral, and patient communication, while continuing education should address knowledge gaps, particularly among older practitioners. Conclusion This cross-sectional study provides a comprehensive overview of Turkish dentists' awareness, knowledge, and attitudes regarding oral cancer. The findings indicate that, although awareness of the major risk factors is generally high, there are still significant gaps in areas such as routine oral mucosa and lymph node examinations, informing patients about risk factors of oral cancers. These results are consistent with global reports indicating that dentists are still not sufficiently prepared for the early diagnosis of oral cancer and patient education. Strengthening both undergraduate and postgraduate oral oncology education, together with structured continuing professional development, is essential to bridge these gaps and improve early detection and patient outcomes. Declarations Abbreviations Not applicable. Ethics approval and consent to participate This study has Ege University Human Research Ethics Committee approval. (Approval no. 19-11T/53) The research was conducted in accordance with the principles of the Declaration of Helsinki.All participants were informed about the study, and online informed consent was obtained from all participants prior to data collection. Consent for publication Not applicable. No individual identifying information, images, or clinical details of participants are included in this manuscript. Availability of data and materials The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This study was funded by Ege University Scientific Research Projects with the code TDH-2019-20605. Authors' contributions M.B.E. conceptualized the study, designed the questionnaire, performed the data collection, conducted the statistical analyses, and drafted the manuscript. C.E contributed to the interpretation of findings, manuscript revisions, critical review, and supervised the overall study process. All authors read and approved the final version of the manuscript. Acknowledgements The authors would like to thank all participating dentists and Turkish Dental Association for their valuable contribution to this study. Conflict of interest The authors declare no conflict of interest regarding the study. Data Availability Statement The data that support the findings of this study are available from the corresponding author. References Fidele NB, Patrick SMN, Okonji OC, Kazadi EK. 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Knowledge, Attitudes, Practices, and Perceptions of Brazilian Dentists About Oral Cancer. Journal of Cancer Education. 2025 Apr 1;40(2):228–33. Leão JC, Góes P, Sobrinho CB, Porter S. Knowledge and clinical expertise regarding oral cancer among Brazilian dentists. Int J Oral Maxillofac Surg. 2005 Jun;34(4):436–9. Hashim R, Abo-Fanas A, Al-Tak A, Al-Kadri A, Abu Ebaid Y. Early detection of oral cancer- Dentists’ knowledge and practices in the United Arab Emirates. Asian Pacific Journal of Cancer Prevention. 2018;19(8):2351–5. Additional Declarations No competing interests reported. Supplementary Files Questionnaire.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Erden","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYBACAyjN2MDAfABIS8iQooUtAaSFhxQtPGA2YS3m7L2HX/NU3JPtl+75/OpGjQUPA/vhoxvwabHsOZdmzXOm2HjmnLPbrHOOAR3Gk5Z2A6/DbuSYGfO2JSRuuJG7zTiHDahFgscMv5b7b4Ba/iUk7r+R88w45x8xWm7wGD/mbQDaIpHD/Di3jQgtlj05ZoxzjiUYz7iRZsac2yfBw0bIL+bsZ4w/vKlJkO2fkfz4c863Ojl+9sPH8GoBAjYJFAYbAeUgwPwBnTEKRsEoGAWjAAUAAPmaSHg8CWppAAAAAElFTkSuQmCC","orcid":"","institution":"Izmir Tinaztepe University","correspondingAuthor":true,"prefix":"","firstName":"Müfide","middleName":"Bengü","lastName":"Erden","suffix":""},{"id":554306297,"identity":"1d86e6b6-143e-4dcf-b9da-75e0446dcff3","order_by":1,"name":"Candan Efeoğlu","email":"","orcid":"","institution":"Dokuz Eylul University","correspondingAuthor":false,"prefix":"","firstName":"Candan","middleName":"","lastName":"Efeoğlu","suffix":""}],"badges":[],"createdAt":"2025-10-16 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01:52:35","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":120688,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7875512/v1/5082a59dda7bc10ea9009e8a.html"},{"id":97487699,"identity":"6926bce4-8087-47c9-9472-993ca32b3123","added_by":"auto","created_at":"2025-12-05 01:52:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24455,"visible":true,"origin":"","legend":"\u003cp\u003eAwareness about oral cancer risk factors\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7875512/v1/169379dfcc0dc29df1efc5f1.png"},{"id":97487700,"identity":"6a46a5d5-918a-4258-946f-0e816fca37e6","added_by":"auto","created_at":"2025-12-05 01:52:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19227,"visible":true,"origin":"","legend":"\u003cp\u003eClinical practice \u0026nbsp;and attitude about oral cancer\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7875512/v1/5e95c0ac315094242b8f7c87.png"},{"id":102903685,"identity":"98dd4eeb-9fc8-4240-b15d-ed5f97e83101","added_by":"auto","created_at":"2026-02-18 08:42:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1106054,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7875512/v1/2122d864-7f3c-4a77-9a9d-c8102d72455a.pdf"},{"id":97487698,"identity":"fc3453d7-8acf-40f1-a9d4-611c8e7447a6","added_by":"auto","created_at":"2025-12-05 01:52:35","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18925,"visible":true,"origin":"","legend":"","description":"","filename":"Questionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7875512/v1/b0b467a256a5383ccddfe965.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eKnowledge, Attitudes, and Risk Factor Awareness Regarding Oral Cancer Among Dentists in Turkey\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOral cancer is a global health problem with increasing incidence and mortality rates in both developed and developing countries(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) It currently ranks as the 16th most common cancer worldwide and the 15th leading cause of cancer related deaths. According to the 2022 reports of the International Agency for Research on Cancer, more than 350,000 new cases of oral cancer are diagnosed annually, resulting in approximately 188,320 deaths across 185 countries. The incidence of oral cavity cancers is projected to increase to 415,000 cases in 2025, with mortality expected to rise to 201,000 cases.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eHistologically, more than 90% of oral cancers are squamous cell carcinomas.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) In their early stages, oral cancers are often asymptomatic.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) In both developed and developing countries, cancers of the lip and oral cavity are strongly associated with exposure to various risk factors, including tobacco use (chewing or smoking) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), alcohol consumption (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), human papillomavirus (HPV) infection (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), and ultraviolet (UV) radiation. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe global five-year survival rate worldwide is approximately 50%. While the survival rate reaches about 80% for stage I cancers, it declines nearly to 20% in advanced stage disease.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Despite advances in cancer treatment, the average five-year survival rate of oral cancer in United States remains a 64%, while 38% in patient with distant metastases. Nevertheless, approximately 70% of patients are still diagnosed at a late stage. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe most critical issue in oral cancer management is achieving early diagnosis (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), which allows for more conservative treatment, improved prognosis, and a better quality of life. Dentists play a key role in this process; thus, their awareness and knowledge of oral cancer are essential for early detection and timely referral.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Therefore, the present study aimed to evaluate the awareness, knowledge, and attitudes of Turkish dentists regarding oral cancer.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis observational cross-sectional study was designed to evaluate knowledge, awareness, and attitudes of dentists regarding oral cancer. The study protocol and questionnaire were reviewed and approved by the Human Ethics Committee of XXX University (Approval No. XXX), and the research was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003eThe survey instrument was developed using previously published questionnaires that were modified to meet the objectives of the present study.(\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe final questionnaire consisted of 30 questions, divided into four sections: (i) personal information (7 items), (ii) awareness of risk factors (9 items), (iii) knowledge of oral cancer (7 items), and (iv) attitudes and clinical practices (7 items).\u003c/p\u003e\u003cp\u003eThe questionnaire was designed using Google Forms and distributed electronically via email through the Turkish Dental Association. The data were collected between February-March 2019. Participation was entirely voluntary. Respondents were required to sign in using their email address to ensure one submission per participant and to prevent duplicate entries. Participants were asked to confirm their consent to participate in the study. All responses were anonymous and confidential, and no identifying personal information was collected.\u003c/p\u003e\u003cp\u003eParticipants were categorized according to age groups and professional status (specialist/general practitioner). Their responses were compared across these groups.\u003c/p\u003e\u003cp\u003eThe primary purpose of this study was evaluation of dentists\u0026rsquo; perception of oral cancer. Additionally, subgroup analyses were performed according to demographic characteristics.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eInstrument reliability\u003c/h2\u003e\u003cp\u003eThe reliability of the questionnaire was assessed through a pilot study involving 30 participants, and the Cronbach\u0026rsquo;s alpha coefficient was calculated as 0.726, demonstrated an acceptable level of internal consistency.\u003c/p\u003e\u003cp\u003eThe reliability of the questionnaire was evaluated in a pilot study involving 30 participants who were not included in the main sample. Internal consistency was assessed using Cronbach\u0026rsquo;s alpha, which yielded a coefficient of 0.726, indicating an acceptable level of reliability.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eAll data were analyzed using The jamovi project (2025; Version 2.6.45) (Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.jamovi.org\u003c/span\u003e\u003cspan address=\"https://www.jamovi.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Descriptive statistics were presented as frequency (n), percentage (%), mean, and standard deviation (SD). The Chi-square test and Fisher\u0026rsquo;s exact tests were used to examine associations between categorical variables. Post-hoc tests were conducted for comparisons among multiple groups when significant differences were detected. The Contingency coefficient was reported as a measure of effect size, and a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 1149 dentists participated in the study. Of the these, 57.1% (n\u0026thinsp;=\u0026thinsp;648) were female and 42.9% (n\u0026thinsp;=\u0026thinsp;487) were male. The mean age of the participants was 35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4 years, ranging from 22 to 81 years. The sociodemographic and work characteristics of the study participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\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\u003eDemographic characteristics of participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfessional status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecialist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e431 (37.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral practitioner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e718 (62.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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\u003e648 (57.1%)\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\u003e487 (42.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge groups\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e450 (46.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e245 (25.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e126 (13.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e140 (14.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGraduation year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1960\u0026ndash;2000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e304 (27.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2001\u0026ndash;2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e203 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2011\u0026ndash;2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e304 (27.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2016\u0026ndash;2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e307 (27.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSpecialty distribution\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOral \u0026amp; maxillofacial surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95 (22.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeriodontology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65 (15.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrthodontics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (18.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProsthodontics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71 (16.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndodontics/Restorative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57 (13.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePediatric dentistry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (11.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOral radiology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (3.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorkplace\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e241 (22.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic sector (ADSM)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e147 (13.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e618 (56.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (7.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eAwareness of risk factors\u003c/h3\u003e\n\u003cp\u003eMost participants correctly identified the major risk factors for oral cancer, including tobacco use (99%), betel quid chewing (97.9%), a history of oral cancer (92.4%), UV exposure (91.5%), and alcohol consumption (90.4%). A substantial proportion also recognized family history of oral cancer (86.1%) and HPV infection (85.7%) as risk factors. Relatively lower levels of awareness was observed for low fruit and vegetable intake (69.6%) and older age (69.6%) as contributing factors. The distribution of participants\u0026rsquo; responses regarding risk factor awareness is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Significant associations were observed between participants\u0026rsquo; awareness of oral cancer risk factors and both age group and professional status (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\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\u003eAssociation between participants\u0026rsquo; knowledge of oral cancer risk factors and age group or professional status (Chi-square test with post-hoc analysis based on standardized residuals).\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=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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\"\u003e\u003cp\u003eRisk factor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge groups(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eContingency coefficient (C)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGP vs. SP(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eContingency coefficient (C)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePost-hoc (significant standardized residuals, \u003cem\u003ez\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.372ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.848ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en.s.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol consumption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;4.41); SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of oral cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.338\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en.s.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow fruit and vegetable intake\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u0026ndash;29 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;2.37, \u0026ldquo;yes\u0026rdquo;), \u0026gt;\u0026thinsp;50 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.20, \u0026ldquo;yes\u0026rdquo;); GP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;2.43\u0026ldquo;yes\u0026rdquo;), SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.43,\u0026ldquo;yes\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHPV infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u0026ndash;29 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;3.43, \u0026ldquo;yes\u0026rdquo;), \u0026gt;\u0026thinsp;50 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.65, \u0026ldquo;yes\u0026rdquo;); GP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;4.85, \u0026ldquo;yes\u0026rdquo;), SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.85, \u0026ldquo;yes\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUV exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u0026ndash;29 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;4.33, \u0026ldquo;yes\u0026rdquo;), 30\u0026ndash;39 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.06\u0026ldquo;yes\u0026rdquo;), 40\u0026ndash;49 years (\u003cem\u003ez\u003c/em\u003e = -2.08, \u0026ldquo;yes\u0026rdquo;);\u003c/p\u003e\u003cp\u003eGP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;3.81), SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.81)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily history of oral cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en.s.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOlder age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30\u0026ndash;39 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;2.52, \u0026ldquo;yes\u0026rdquo;), \u0026gt;\u0026thinsp;50 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.07, \u0026ldquo;yes\u0026rdquo;); GP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.68), SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;3.95)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBetel quid chewing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.574ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.055ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en.s.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eᵃ Fisher\u0026rsquo;s exact test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eGP: General Practitioner; SP: Specialist; n.s.: not significant.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eKnowledge About Oral Cancer\u003c/h3\u003e\n\u003cp\u003eThe majority of dentists (86.7%) correctly identified squamous cell carcinoma as the most common histological type of oral cancer. When participants were asked to identify lesions that are not premalignant, most correctly recognized irritation fibroma (70.0%). However, a proportion of dentists misclassified leukoplakia (11.7%), erythroplakia (6.6%), and erosive lichen planus (11.7%) as non-premalignant lesions. Regarding the age group most commonly associated with oral cancer was correctly identified by 84.9% of participants.\u003c/p\u003e\u003cp\u003eA total of 58.5% of participants knew that a biopsy should be performed within 14 days of a suspicious lesion being detected. Of the participants, 47.2% correctly indicated the five-year survival rate for oral cancer and 50.5% correctly identified betel chewing as the primary etiological factor for oral submucosal fibrosis. Overall knowledge performance is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Significant variations in knowledge levels were observed according to both age group and professional status (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\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\u003eKnowledge of dentists regarding oral cancer charactetistics\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=\"char\" char=\".\" 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\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat is the most common type of oral cancer?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSquamous cell carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e963\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(86.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVerrucous carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdenocarcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMalignant melanoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(6.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhich of the following is not considered a premalignant lesion?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeukoplakia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(11.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEryhtroplakia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(6.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eErosive lichen planus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(11.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIrritation fibroma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(70.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn which age group is oral cancer most commonly observed?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(15.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026ndash;60 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(76.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u0026ndash;80 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(8.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfter how long a biopsy should be performed for a non-healing oral lesion?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWith in 7 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(5.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithin 14 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e651\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(58.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithin 4 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(28.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithin 3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(8.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat is the five-year survival rate for oral cancer?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(16.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(19.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e512\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(47.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(16.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat is the most common etiological factor for oral submucous fibrosis?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBetel quid chewing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e524\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(50.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(26.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlcohol abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(4.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor oral hygiene\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(18.5)\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\u003eAssociation between participants\u0026rsquo; knowledge items related to oral cancer and age group or professional status (Chi-square test with post-hoc analysis based on standardized residuals).\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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\"\u003e\u003cp\u003eKnowledge item\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge groups(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eContingency coefficient (C)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGP vs. SP(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eContingency coefficient (C)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePost-hoc (significant standardized residuals, \u003cem\u003ez\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat is the most common type of oral cancer?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u0026ndash;29 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;4.07, SCC); SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;4.33, SCC)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhich of the following is not considered a premalignant lesion?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.270\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;2.80, LP), \u0026gt;\u0026thinsp;50 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;2.83, EP);\u003c/p\u003e \u003cp\u003eGP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.22; IF), SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;5.22; IF)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn which age group is oral cancer most commonly observed?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.002ᵃ\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.032ᵃ\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u0026ndash;29 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;4.12, 40\u0026ndash;60 years); SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.11, 40\u0026ndash;60 years)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfter how long a biopsy should be performed for a non-healing oral lesion?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u0026ndash;29 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;9.26 14 days; SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;2.78, 14 days)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat is the five-year survival rate for oral cancer?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u0026ndash;29 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.04, 50%), 30\u0026ndash;39 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;2.16, 90%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat is the most common etiological factor for oral submucous fibrosis?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u0026ndash;29 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;6.14, BC); 40\u0026ndash;49 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.57, BC), \u0026gt;\u0026thinsp;50 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;2.47, BC);\u003c/p\u003e\u003cp\u003eGP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.86, BC), SP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;3.86, BC)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eᵃ Fisher\u0026rsquo;s exact test.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eGP:General Practitioner; SP: Specialist; SCC :Squamous Cell Carcinoma; LP: Leukoplakia; EP:Erythroplakia;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eIF: Irritation Fibroma; BC: Betel quid Chewing; C: Contingency coefficient; n.s.: not significant.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eClinical Practices and Attitudes Regarding Oral Cancer\u003c/h2\u003e\u003cp\u003eA total of 28.8% of participants reported feeling confident about diagnosing oral cancer, while 37.1% felt confident about palpating lymph nodes in the head and neck region.\u003c/p\u003e\u003cp\u003eSpecifically, 76.2% of dentists routinely examined the oral mucosa, and 80.1% reported asking patients about tobacco use during history taking. In contrast, only 37.1% routinely inquired about alcohol consumption. Additionally, 47.0% stated that they inform patients about oral cancer risk factors, and 46.8% reported having previously examined a patient with oral cancer. Dentists\u0026rsquo; clinical practices and attitudes are summarized in Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Significant differences in clinical attitudes and practices were observed according to age group and professional status (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\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\u003eAssociation between participants\u0026rsquo; attitudes toward oral cancer and age group or professional status (Chi-square test with post-hoc analysis based on standardized residuals).\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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\"\u003e\u003cp\u003eAttitude item\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge groups(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eContingency coefficient (C)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGP vs. SP(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOdds ratio (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePost-hoc (significant standardized residuals, \u003cem\u003ez\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI routinely perform oral mucosal examinations.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.443\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.859 (0.646\u0026ndash;1.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en.s.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI regularly advise my patients about oral cancer risk factors.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.13 (0.890\u0026ndash;1.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;4.32, \u0026ldquo;yes\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI regularly ask my patient about their smoking habit.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.17 (1.62\u0026ndash;2.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;5.24, \u0026ldquo;yes\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI regularly ask my patient about their alcohol consumption.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.543\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.20 (0.936\u0026ndash;1.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en.s.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI have examined a patient with oral cancer.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.878 (0.691\u0026ndash;1.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;50 years (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;5.28, \u0026ldquo;yes\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI feel confident to diagnose oral cancer based on its clinical appearance.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.770\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.637 (0.491\u0026ndash;0.827)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSP (\u003cem\u003ez\u003c/em\u003e\u0026thinsp;=\u0026thinsp;+\u0026thinsp;3.40, \u0026ldquo;yes\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI feel confident palpating head and neck lymph nodes.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.785 (0.613\u0026ndash;1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en.s.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eGP: General Practitioner; SP: Specialist; n.s.: not significant.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePost-hoc Power Analysis\u003c/h3\u003e\n\u003cp\u003ePost hoc power analyses indicated that the study had adequate sensitivity to detect small-to-moderate effect sizes. For comparisons between general practitioners (GPs) and specialists, the detectable effect size was approximately Cohen\u0026rsquo;s w\u0026thinsp;=\u0026thinsp;0.084\u0026ndash;0.119 at 80% power and 0.097\u0026ndash;0.134 at 90% power. For age group comparisons, the corresponding detectable effect sizes were w\u0026thinsp;=\u0026thinsp;0.089\u0026ndash;0.126 at 80% power and 0.102\u0026ndash;0.141 at 90% power.\u003c/p\u003e\u003cp\u003eTherefore, significant associations were consistently supported by high statistical power (\u0026gt;\u0026thinsp;90%), whereas non-significant findings with low observed power should be interpreted with caution due to possible type II error risk.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides a comprehensive insight into the awareness, knowledge, and attitudes of Turkish dentists regarding oral cancer, highlighting both strengths and areas requiring improvement. Unlike previous research, the present study included a large national sample and incorporated comparisons based on professional status (general practitioners vs. specialists), as well as clinical behaviors and perceptions, offering a broader understanding of factors influencing dentists\u0026rsquo; engagement in oral cancer prevention and early detection.(\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eOther than skin and oral cancers, no other type of cancer can be diagnosed through visual examination alone. Despite this, it continues to be diagnosed predominantly at advanced stages, leading to high morbidity and mortality rates. Dentists play a pivotal role in the early detection; therefore, assessing their awareness and attitudes is crucial for identifying barriers to timely diagnosis and for guiding educational interventions. (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAmong the 1,149 participants, 57.1% were female and 42.9% were male, and the highest participation rate was 46.8% among those aged 22\u0026ndash;29 years. The mean age of the participants was 35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4 years. Another study conducted in Turkey, individuals aged 25\u0026ndash;35 showed the highest participation rate.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) This predominance of younger respondents can be attributed to the online distribution method of the questionnaire via email, which tends to elicit greater engagement from younger, digitally active professionals.\u003c/p\u003e\u003cp\u003eIn the present study, the highest levels of awareness regarding oral cancer risk factors were observed for tobacco use (99%), betel quid chewing (97.9%), and alcohol consumption (90.4%). These findings are consistent with previous studies reporting a high recognition of tobacco and alcohol as primary etiological factors for oral cancer.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) These were followed by UV exposure (91.5%) and HPV infection (85.7%). Spaulonci et al. reported similar awareness levels, with 88.9% of respondents identifying HPV and 85.7% recognizing UV exposure as risk factors.(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) Betel quid use and other forms of smokeless tobacco are more prevalent in specific demographic groups in South Asia, often linked to socioeconomic disadvantage and habitual cultural practices.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) The high recognition of this factor among Turkish dentists may reflect greater educational exposure to global literature and risk awareness in contemporary dental curricula. Moreover, 84.9% of participants identified advanced age as a risk factor, markedly higher than rates reported in Ireland (55%)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and Turkey (64.5%) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSignificant differences in oral cancer risk factor awareness were observed according to both age group and professional status. Younger dentists (22\u0026ndash;29 years) demonstrated greater awareness of low fruit and vegetable intake, HPV infection, UV exposure, and older age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) as risk factors for oral cancer. Conversely, dentist aged\u0026thinsp;\u0026gt;\u0026thinsp;50 years were less aware of these risk factors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eSimilarly, specialists exhibited significantly higher awareness than GPs above mentioned risk factors (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These findings indicate that younger and specialist dentists possess better awareness of risk factors, underscoring the need for targeted continuing education among older and general practitioners. Interestingly, despite their relatively lower knowledge of these risk factors, dentists aged\u0026thinsp;\u0026gt;\u0026thinsp;50 years reported advising patients about them more frequently (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), suggesting stronger patient communication habits with experience. In contrast, younger dentists (22\u0026ndash;29 years) were more likely to report not providing such counseling (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that preventive communication practices tend to increase with professional maturity.\u003c/p\u003e\u003cp\u003eAkbari et al., found that 87.2% of general dentists and 100% of specialists correctly identified squamous cell carcinoma (SCC) as the most common malignancy of the oral cavity.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) This slightly higher recognition rate among specialists aligns with the results of the present study, in which 92.3% of specialists and 83.2% of general practitioners identified SCC as the most prevalent form of oral cancer.\u003c/p\u003e\u003cp\u003eIn the present study, the proportion of dentists who incorrectly identified leukoplakia (11.7%) and erythroplakia (6.6%) as non-premalignant lesions was remarkably low. Ojha et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) found lower recognition rates 65% for leukoplakia and just above 50% for erythroplakia, consistently Kebabcıoğlu et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) reported that 64.1% of dentists identified these lesions as precancerous. These findings suggest that participants in the current study demonstrate substantially higher knowledge of premalignant and non-premalignant oral lesions than those in other studies.\u003c/p\u003e\u003cp\u003eIn the study by Akbari et al., the highest level of knowledge was observed among dentists with less than 5 years of work experience(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), and Taheri et al. also reported that knowledge levels significantly decreased as the number of years since graduation increased.(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) Consistent with these findings, participants aged 22\u0026ndash;29 years in the present study provided significantly more correct responses in the knowledge domain compared to older age groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This suggests that recent graduates may possess more up-to-date theoretical knowledge in dental education.\u003c/p\u003e\u003cp\u003eProfessional background also influenced attitudes toward oral cancer prevention and diagnosis. Specialists were significantly more likely than general practitioners to ask patients about smoking habits (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; OR\u0026thinsp;=\u0026thinsp;2.17, 95% CI: 1.62\u0026ndash;2.91) and to express confidence in diagnosing oral cancer based on clinical appearance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; OR\u0026thinsp;=\u0026thinsp;0.637, 95% CI: 0.491\u0026ndash;0.827). The findings show specialists have stronger diagnostic confidence and preventive behaviour due to greater experience and training. General practitioners may benefit from extra training in early detection and patient counselling in routine dental care.\u003c/p\u003e\u003cp\u003eSarı et al.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) reported that more than half of general dentists did not perform oral mucosal examinations in high-risk patients. In contrast, the present study showed a more favorable pattern, with 76.2% of participants routinely performing such examinations, similar to Shamala et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Sangoi et al.(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) found even higher rates, with 91% of dentists routinely examining the oral mucosa and 89.1% having encountered at least one oral cancer case, while Brazilian studies reported comparable findings (62%\u0026ndash;89.3%).(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) In our study, 50.7% of participants had seen at least one oral cancer patient, consistent with Shamala et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The higher rates in earlier research may reflect more frequent mucosal examinations, and the close relationship between these two measures further supports this interpretation.\u003c/p\u003e\u003cp\u003eAhmed et al. reported that many participants refrained from performing oral mucosal examinations because they felt insufficient knowledge about oral cancer.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) Consistently, in the present study, only 28.8% of participants felt confident diagnosing oral cancer based on clinical appearance, and 37.1% felt competent in performing lymph node examinations. These findings align with previous studies. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) Compared with findings from Yemen, where Alaizari et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) reported higher confidence levels (58.3% for diagnosis, 68.3% for lymph node palpation) but lower risk-factor awareness, this discrepancy suggests that some dentists may overestimate diagnostic ability due to limited biopsy-confirmed experience or lack of structured feedback. This highlights the ongoing need evidence-based training in oral cancer examination within undergraduate and continuing education programs.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Strengths and Limitations\u003c/h2\u003e\u003cp\u003eThe large sample size and high post hoc power enhance the reliability of the study\u0026rsquo;s significant findings, while non-significant associations may reflect small effect sizes rather than the absence of relationships. The main limitations include the cross-sectional design, reliance on self-reported data, and uneven distribution across age and professional groups, which may have influenced subgroup comparisons. Additionally, the online format could have introduced volunteer bias, favoring respondents more interested in oral cancer. Despite these limitations, the results align with international evidence, indicating that gaps in oral cancer awareness and preventive behavior among dentists are a global rather than a regional concern.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eClinical and Educational Implications\u003c/h2\u003e\u003cp\u003eTo translate these findings into practice, dental education and health policy should prioritize oral oncology training. Undergraduate programs should include modules on cancer prevention, biopsy referral, and patient communication, while continuing education should address knowledge gaps, particularly among older practitioners.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This cross-sectional study provides a comprehensive overview of Turkish dentists' awareness, knowledge, and attitudes regarding oral cancer. The findings indicate that, although awareness of the major risk factors is generally high, there are still significant gaps in areas such as routine oral mucosa and lymph node examinations, informing patients about risk factors of oral cancers. These results are consistent with global reports indicating that dentists are still not sufficiently prepared for the early diagnosis of oral cancer and patient education. Strengthening both undergraduate and postgraduate oral oncology education, together with structured continuing professional development, is essential to bridge these gaps and improve early detection and patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has Ege University Human Research Ethics Committee approval. (Approval no. 19-11T/53) The research was conducted in accordance with the principles of the Declaration of Helsinki.All participants were informed about the study, and online informed consent was obtained from all participants prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. No individual identifying information, images, or clinical details of participants are included in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Ege University Scientific Research Projects with the code TDH-2019-20605.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.B.E. conceptualized the study, designed the questionnaire, performed the data collection, conducted the statistical analyses, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eC.E contributed to the interpretation of findings, manuscript revisions, critical review, and supervised the overall study process.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participating dentists and Turkish Dental Association for their valuable contribution to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest regarding the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFidele NB, Patrick SMN, Okonji OC, Kazadi EK. Oral cancer awareness and knowledge: Survey of dentists in Democratic Republic of the Congo. J Cancer Policy. 2022 Jun 1;32.\u003c/li\u003e\n \u003cli\u003ehttps://gco.iarc.fr/tomorrow/en/dataviz/isotype?types=1\u0026amp;single_unit=5000\u0026amp;populations=900\u0026amp;group_populations=0\u0026amp;multiple_populations=0\u0026amp;years=2025\u0026amp;cancers=1) .\u003c/li\u003e\n \u003cli\u003eWarnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol. 2009 Apr;45(4\u0026ndash;5):309\u0026ndash;16.\u003c/li\u003e\n \u003cli\u003eHuang J, Chan SC, Ko S, Lok V, Zhang L, Lin X, et al. Disease burden, risk factors, and trends of lip, oral cavity, pharyngeal cancers: A global analysis. Cancer Med. 2023 Sep 30;12(17):18153\u0026ndash;64.\u003c/li\u003e\n \u003cli\u003eProia NK, Paszkiewicz GM, Sullivan Nasca MA, Franke GE, Pauly JL. Smoking and Smokeless Tobacco-Associated Human Buccal Cell Mutations and Their Association with Oral Cancer\u0026mdash;A Review. 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BMC Oral Health. 2024 Dec 1;24(1).\u003c/li\u003e\n \u003cli\u003eRupel K, Biasotto M, Gobbo M, Poropat A, Bogdan Preda MT, Borruso G, et al. Knowledge and awareness of oral cancer: A cross-sectional survey in Trieste, Italy. Frontiers in Oral Health. 2023 Jan 30;4.\u003c/li\u003e\n \u003cli\u003eFord PJ, Farah CS. Early detection and diagnosis of oral cancer: Strategies for improvement. J Cancer Policy [Internet]. 2013;1(1\u0026ndash;2):e2\u0026ndash;7. Available from: http://dx.doi.org/10.1016/j.jcpo.2013.04.002\u003c/li\u003e\n \u003cli\u003eApplebaum E, Ruhlen TN, Kronenberg FR, Hayes C, Peters ES. Oral cancer knowledge, attitudes and practices: A survey of dentists and primary care physicians in Massachusetts. Journal of the American Dental Association [Internet]. 2009;140(4):461\u0026ndash;7. Available from: http://dx.doi.org/10.14219/jada.archive.2009.0196\u003c/li\u003e\n \u003cli\u003eColella G, Gaeta GM, Moscariello A, Angelillo IF. Oral cancer and dentists: Knowledge, attitudes, and practices in Italy. Oral Oncol. 2008;44(4):393\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eAlaizari NA, Al-Maweri SA. Oral cancer: Knowledge, practices and opinions of dentists in Yemen. Asian Pacific Journal of Cancer Prevention. 2014;15(14):5627\u0026ndash;31.\u003c/li\u003e\n \u003cli\u003eJoseph BK, Sundaram DB, Sharma P. Oral cancer awareness among dentists in Kuwait. Medical Principles and Practice. 2012;21(2):164\u0026ndash;70.\u003c/li\u003e\n \u003cli\u003eNazar H, Ariga J, Shyama M. Oral Cancer Knowledge, Attitudes, and Practices among Newly Graduated Dentists in Kuwait. Asian Pacific Journal of Cancer Prevention. 2022 Feb 1;23(2):459\u0026ndash;65.\u003c/li\u003e\n \u003cli\u003eJboor DH, Al-Darwish MS, Nur U. Oral cancer knowledge, attitude, and practice of dentists in the state of Qatar. 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Knowledge of Oral Cancer among Online Respondent General Dentists: A Cross-sectional Survey. Journal of the Nepal Medical Association. 2021 Nov 1;59(243):1120\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eTaheri JB, Namazi Z, Azimi S, Mehdipour M, Behrovan R, Far KR. Knowledge of oral precancerous lesions considering years since graduation among dentists in the capital city of Iran: A pathway to early oral cancer diagnosis and referral? Asian Pacific Journal of Cancer Prevention. 2018 Aug 1;19(8):2103\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eShamala A, Halboub E, Al-Maweri SA, Al-Sharani H, Al-Hadi M, Ali R, et al. Oral cancer knowledge, attitudes, and practices among senior dental students in Yemen: a multi-institution study. BMC Oral Health. 2023 Dec 1;23(1).\u003c/li\u003e\n \u003cli\u003eSangoi MGR, Dias YM, Katz N, Visioli F, Rados PV, Martins MD, et al. Knowledge, Attitudes, Practices, and Perceptions of Brazilian Dentists About Oral Cancer. Journal of Cancer Education. 2025 Apr 1;40(2):228\u0026ndash;33.\u003c/li\u003e\n \u003cli\u003eLe\u0026atilde;o JC, G\u0026oacute;es P, Sobrinho CB, Porter S. Knowledge and clinical expertise regarding oral cancer among Brazilian dentists. Int J Oral Maxillofac Surg. 2005 Jun;34(4):436\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eHashim R, Abo-Fanas A, Al-Tak A, Al-Kadri A, Abu Ebaid Y. Early detection of oral cancer- Dentists\u0026rsquo; knowledge and practices in the United Arab Emirates. Asian Pacific Journal of Cancer Prevention. 2018;19(8):2351\u0026ndash;5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","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, oral cancer awareness, oral cancer knowledge, dentist","lastPublishedDoi":"10.21203/rs.3.rs-7875512/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7875512/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate the knowledge, attitudes, and awareness of Turkish dentists regarding oral cancer and to investigate the influence of age and professional specialization on these factors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA nationwide cross-sectional online survey was conducted among dentists in Turkey using a 30-item questionnaire adapted from previously validated instruments. The survey included sections on sociodemographic data, awareness of risk factors, knowledge of oral cancer, and clinical attitudes. Data were analyzed using Chi-square and Fisher\u0026rsquo;s exact tests, with post-hoc analyses of standardized residuals. A p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 1,149 dentists participated. Awareness of major risk factors\u0026mdash;tobacco (99%), betel chewing (97.9%), alcohol consumption (90.4%), UV exposure (91.5%), and HPV infection (85.7%)\u0026mdash;was high. Significant associations were found between awareness levels and both age and professional status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Younger dentists (22\u0026ndash;29 years) showed greater awareness of HPV infection (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and UV exposure (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas specialists demonstrated higher knowledge than general practitioners (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Only 28.8% of participants felt confident diagnosing oral cancer, and 37.1% were confident palpating lymph nodes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Routine oral mucosal examination was reported by 76.2% of respondents (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDespite high awareness of major risk factors, notable gaps remain in clinical confidence and patient education regarding oral cancer. Strengthening undergraduate curricula and implementing continuing education programs focused on oral oncology are essential to improve early detection, enhance diagnostic competence, and promote patient counseling in dental practice.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitudes, and Risk Factor Awareness Regarding Oral Cancer Among Dentists in Turkey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-05 01:52:30","doi":"10.21203/rs.3.rs-7875512/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":"335698d9-966a-48da-8d51-79d649365c7a","owner":[],"postedDate":"December 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-18T08:41:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-05 01:52:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7875512","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7875512","identity":"rs-7875512","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}