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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 1  |  Page : 68-72

Dentist's knowledge regarding oral mucosal lesions: Revealing the diagnostic dilemma


1 Department of Oral Medicine and Radiology, VSPM Dental College, Nagpur, Maharashtra, India
2 Department of Oral Pathology and Microbiology, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India
3 Department of Pedodontics and Preventive Dentistry, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India
4 Department of Oral Pathologist, Mumbai, Maharashtra, India
5 Department of Oral Pathology and Microbiology, VSPM Dental College, Nagpur, Maharashtra, India

Date of Web Publication18-Feb-2019

Correspondence Address:
Dr. Mayur Chaudhary
Department of Oral Medicine and Radiology, VSPM Dental College, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_29_18

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  Abstract 


BACKGROUND: The management of oral mucosal disease necessitates establishing the correct diagnosis from a range of presenting lesions. Practitioners have to possess adequate knowledge about the likely differential diagnosis. Many studies suggest that general practitioners (dentists) fail to detect oral mucosal lesions (OMLs), especially oral precancerous lesion as well as early oral cancer because of their indifferent attitude and knowledge about these lesions.[1],[2],[3],[4],[5],[6],[7],[8],[9] Few studies have investigated the knowledge and opinions of general dental practitioners and specialists other than oral surgeon and medics about OML including oral cancer, as these personnel come across such lesions more frequently as often in their outpatient department and thereby know the planned management of these lesions.
METHOD: The present study aims to identify, compare, and analyze the knowledge and opinions of dentist regarding OML and evaluate the differences between the attitudes of dentist by practice settings in Pune city, by using questionnaire method.[2]
RESULT: most of the dentist found difficulty in diagnosing oral mucosal lesions which are the manifestations of systemic diseases.
CONCLUSION: Here we concluded that most of the dentist found difficulty in diagnosing the oral mucosal lesion. Professional dental education programs and courses can help them to enhance their knowledge, skill and ability in diagnosing the various oral mucosal lesions.

Keywords: Dentist, diagnostic dilemma, oral mucosal lesions


How to cite this article:
Choudhary A, Deshmukh A, Chaudhary M, Chaudhary S, Deshmukh A, Chaudhary T. Dentist's knowledge regarding oral mucosal lesions: Revealing the diagnostic dilemma. Int J Health Allied Sci 2019;8:68-72

How to cite this URL:
Choudhary A, Deshmukh A, Chaudhary M, Chaudhary S, Deshmukh A, Chaudhary T. Dentist's knowledge regarding oral mucosal lesions: Revealing the diagnostic dilemma. Int J Health Allied Sci [serial online] 2019 [cited 2019 Mar 23];8:68-72. Available from: http://www.ijhas.in/text.asp?2019/8/1/68/252449




  Introduction Top


This study carried out to identify the knowledge of the practicing dentist about the oral mucosal lesions (OMLs). This will give us an idea about the awareness and knowledge of the dentist regarding OMLs.

Aim and objective

The aim of the study is to identify, compare, and analyze the knowledge and opinions of dentist regarding OML and evaluate differences between the attitudes of dentist by practice settings.


  Materials and Methods Top


A 300 randomized selected dental practitioners falling in Group I, II, and III mentioned below were included in this study. A self-constructed questionnaire including 17 questions was piloted with three specialists, to improve the design ambiguity. The groups formed were as follows:

  • Group I: 100 general dentists running their own private dental clinics
  • Group II: 100 dentists running polyclinics, i.e., dentists with two or more dental chair/units
  • Group III: 100 dentists employed in Bharati Vidyapeeth Dental College, Pune, Maharashtra, India, working in all departments except Oral Surgery, Oral Medicine, and Oral Pathology.


Questionnaire investigating demographics attributes, dental practice characteristics, OML knowledge, and respondent's opinion [Table 1] was completed in a time span of 6 months (July–December 2016), and all questions were asked by the same author.
Table 1: A systematic questionnaire for Dental practitioners

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Inclusion criteria

All general dental practitioners, dentists working in polyclinics (more than 2 chair units) in Pune, and dentists employed in Bharati Vidyapeeth Dental College, Pune, Maharashtra, India, were included in the study.

Exclusion criteria

Staff employed in the Department of Oral Surgery, Oral Medicine, and Oral Pathology from Bharati Vidyapeeth Dental College, Pune, Maharashtra, India, were excluded from the study.


  Results Top


Answers to a systematic questionnaire were obtained from 300 dentists who were divided into three groups (Group I, II, and III), each group comprising 100 dentists. The statistical analysis was performed using Chi-square as well as Kappa tests using GraphPad Prism software 8.0.0 (GraphPad Software Inc., San Diego CA)

The results of the above study show that there exists difference in attitudes of dentists about OML in Group I, II, and III, where 53%, 60%, and 46% of Group I, II, and III had some or other difficulty in diagnosing OML (0.13 NS, P > 0.05) [Table 2]. A systematic graphical representation of the differences in attitudes of dentists about OML following references from literature, examination of patients having OML, difficulty in diagnosing OML, knowledge about biopsy techniques, and making biopsy and treatment of OML has been shown in [Graph 1].
Table 2: Differences in percentages between the attitudes of each group of dentist about oral mucosal lesions (n=100)

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The most common OML found was aphthous ulcer. There even existed difference in the prescription of medications among dentist of Group I, II, and III. Around 33%, 47%, and 24% of Group I, II, and III, respectively, prescribed anti-inflammatory or local anesthetics to their patients, respectively (0.002 S, P < 0.05). A systematic tabulated and graphical representation of the medications prescribed for aphthous ulcers is given in [Table 3] and [Graph 2].
Table 3: Medications for the management of aphthous ulcer (n=100)

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There existed a minor difference in the opinion of dentists in Group I (75%), II (67%), and III (65%) in collaborating with other departments for accurate diagnosis of OML. Most of the dentists in Group I, II, and III preferred to obtain the opinion of a dermatologist for diagnosing OML [Table 4] and [Graph 3].
Table 4: Departments those dentists collaborated for the management of oral mucosal lesion (n=100)

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Most of the dentists in Group I (73%), Group II (93%), and Group III (72%) found difficulty in diagnosing OMLs which were the manifestations of systemic diseases, followed by pemphigoid, pemphigus, and oral lichen planus [Table 5].
Table 5: Oral mucosal lesion that dentists found difficult in diagnosing (n=100)

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  Discussion Top


A systematic study comprising of questionnaire investigating demographics attributes, dental practice characteristics, OML knowledge, and respondent's opinion was completed in a time span of 6 months (July–December 2016), and all questions were asked by the same author to 300 dentists divided into three respective groups. Although dentists working in academic institutions claimed to follow the literature even though they had less intention to treat the patients of OML because it was easy for them to refer these patients to relevant specialist department as well as there was access for consultation with oral medicine, oral surgery, and oral pathology departments compared to those in private practice. Our study varies with the study by Ergun et al.,[1] as 53%–60% of the dentist's from Pune performing private dental practice found difficulty in diagnosing OML as compared to 85%, whereas 14%–34% of them failed to upgrade their knowledge as compared with 62% and 20%–30% did not undertake biopsy due to lack of knowledge as compared to 93%. Our study goes in accordance with the study of Ergun et al.[1] where only 25% of dentists in academic institution except the Department of Oral Medicine and Oral Surgery attempted to make biopsy. This might be due to the following of systematic research protocols in the institutions. There is a need to develop continuing dental education (CDE) and continuing medical education (CME) for meeting the expectations of dentists as was suggested by one of the studies of Maryland dentists.[10] The variation in our study in comparison with that of Ergun et al. might be because over a period of time a private dentist has changed his attitude toward diagnosing and treating OMLs by attending various CDE's, CME's, and workshops conducted by numerous associations, especially the Indian Dental Association and Indian Medical Association. When dentists at private setup encounters patients with OML, they may tend to treat their patients independently and may rarely consult for specialists, probably due to lack of opportunities for consultation or referral and an attitude of being sole oral health-care provider for patient's oral disease. It was also disappointing that most of the dentist's in private set up preferred to consult dermatologists (67%–75%) and internal medicine (12%–27%) as opposed to oral medicine and oral surgeons. This is because dentists may have thought that the underlying cause of the OML is the dermatological or other systemic diseases and are best treated by expertise in a particular field. Greenwood and Lowry[3] in 2001 stated that general dental practitioner is more knowledgeable in diagnosing premalignant lesion and oral cancer compared to the general medical practitioner. Even McCann et al.[11] in 2005 concluded that doctors and medical students are inadequately trained and educated about oral diseases with obvious consequences. The lesions that dentist's found difficult to diagnose clinically were allergic stomatitis, fungal infections, pemphigus, pemphigoid, carcinomas, and oral manifestations of systemic diseases. It is possibly that dentists might have rarely seen patients with such lesions at undergraduate duration. Thus, it should be mandatory for a private dentist to gain a thorough knowledge of OMLs by attending various CDEs and CMEs.


  Conclusion Top


The result of this study concluded that most of the dentist's practicing in Pune experience difficulties in diagnosing OML, which could be applied to other cities also to evaluate upgradation of dentist's knowledge about OML. The results also suggested that a statistically significant difference exists between the groups of dentist's depending on individual and institutional conditions. Postgraduate dental education should teach dentist the clinical skills and ability to distinguish OML to reach definitive diagnosis and then treat accordingly. Furthermore, CDE, CME, as well as Workshop's may prove useful in the professional development of dentists.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ergun S, Ozel S, Koray M, Kürklü E, Ak G, Tanyeri H, et al. Dentists' knowledge and opinions about oral mucosal lesions. Int J Oral Maxillofac Surg 2009;38:1283-8.  Back to cited text no. 1
    
2.
Alonge OK, Narendran S. Opinions about oral cancer prevention and early detection among dentists practising along the Texas-Mexico border. Oral Dis 2003;9:41-5.  Back to cited text no. 2
    
3.
Greenwood M, Lowry RJ. Primary care clinicians' knowledge of oral cancer: A study of dentists and doctors in the North East of England. Br Dent J 2001;191:510-2.  Back to cited text no. 3
    
4.
Kujan O, Duxbury AJ, Glenny AM, Thakker NS, Sloan P. Opinions and attitudes of the UK's GDPs and specialists in oral surgery, oral medicine and surgical dentistry on oral cancer screening. Oral Dis 2006;12:194-9.  Back to cited text no. 4
    
5.
Yellowitz JA, Goodman HS. Assessing physicians' and dentists' oral cancer knowledge, opinions and practices. J Am Dent Assoc 1995;126:53-60.  Back to cited text no. 5
    
6.
Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in U.S. adults: Data from the third national health and nutrition examination survey, 1988-1994. J Am Dent Assoc 2004;135:1279-86.  Back to cited text no. 6
    
7.
Jahanbani J, Sandvik L, Lyberg T, Ahlfors E. Evaluation of oral mucosal lesions in 598 referred Iranian patients. Open Dent J 2009;3:42-7.  Back to cited text no. 7
    
8.
Pentenero M, Broccoletti R, Carbone M, Conrotto D, Gandolfo S. The prevalence of oral mucosal lesions in adults from the Turin area. Oral Dis 2008;14:356-66.  Back to cited text no. 8
    
9.
Kovac-Kovacic M, Skaleric U. The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. J Oral Pathol Med 2000;29:331-5.  Back to cited text no. 9
    
10.
Horowitz AM, Siriphant P, Sheikh A, Child WL. Perspectives of Maryland dentists on oral cancer. J Am Dent Assoc 2001;132:65-72.  Back to cited text no. 10
    
11.
McCann PJ, Sweeney MP, Gibson J, Bagg J. Training in oral disease, diagnosis and treatment for medical students and doctors in the United Kingdom. Br J Oral Maxillofac Surg 2005;43:61-4.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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