Knowledge, Attitude, Awareness About Treatment Protocols For Most Commonly Encountered Oral Lesions Among Dentists

Abstract

Background: Oral lesions, ranging from benign to potentially malignant disorders, are frequently encountered in dental practice. Dentists play a crucial role in early detection and management, necessitating a thorough understanding of treatment protocols. Objective: To assess the knowledge, attitudes, and awareness of dentists regarding treatment protocols for common oral lesions. Methods: A descriptive study was conducted over three months (August-October 2024) among 100 dentists in Chennai. A 20-item questionnaire was distributed via Google Forms, and responses were analyzed using MS Excel. Results: Findings revealed varid levels of knowledge. Around 70% correctly identified correct medications for various common oral lesions. Conclusion: The study highlights strengths in managing common oral conditions but identifies gaps in addressing complex lesions, underscoring the need for continuous professional education.

Keywords

Introduction

Oral lesions are frequently encountered in dental practice, ranging from benign conditions to potentially malignant disorders. Accurate diagnosis and prompt intervention are essential for effective management and the prevention of complications.¹ Dentists play a vital role in recognizing and treating oral lesions, making their knowledge, attitudes, and awareness of treatment protocols critical for ensuring optimal patient care. Oral mucosal lesions (OMLs) encompass a wide range of conditions, from benign developmental anomalies to potentially life-threatening malignancies.² These lesions can manifest with symptoms such as burning sensations, swelling, irritation, and pain. However, many OMLs, particularly early-stage oral squamous cell carcinoma (OSCC)—the most common type of oral cancer—are asymptomatic. This absence of early warning signs often results in delayed diagnosis and treatment, as patients typically seek medical attention only when the disease has reached an advanced stage.³ Routine oral cancer screenings during dental check-ups have become a cost-effective strategy to address this challenge. By conducting a visual examination of the oral cavity, dental practitioners can detect potential OMLs and early signs of OSCC. ³This proactive approach enables dentists to make informed decisions about lesion management, whether through close monitoring or referring patients for further evaluation when cancer is suspected. A solid understanding of treatment protocols not only facilitates proper management but also aids in the early detection of conditions that may progress to more severe stages, such as oral cancers.⁴ Moreover, a dentist’s commitment to continuous learning and staying updated on advances in treatment strategies significantly influences the quality of care delivered. Awareness of the latest diagnostic tools, clinical guidelines, and patient-centered practices is essential to effectively address the diverse challenges posed by oral lesions.⁵ This study investigates the knowledge, attitudes, and awareness of dentists regarding treatment protocols for commonly encountered oral lesions.

MATERIALS AND METHODS

A descriptive study was conducted to evaluate the knowledge, attitudes, and awareness of treatment protocols for commonly encountered oral lesions among dentists. The research was carried out over three months, from August to October 2024, encompassing data collection, analysis, and report preparation. The study targeted dentists in Chennai and was approved by the Department of Oral Medicine and Radiology, with ethical clearance obtained from the Institutional Review Board. Using convenience sampling, a sample of 100 participants was selected. Demographic information was recorded, and a 20-item questionnaire was distributed via Google Forms across various social media platforms, primarily WhatsApp. Informed consent was obtained to maintain confidentiality and privacy, and participants were briefed about the questionnaire to encourage accurate responses. The data collected through Google Forms was analyzed using MS Excel to compile the final report.

RESULTS

In a study involving 100 dentists, the results revealed varied levels of knowledge regarding the treatment protocols for common oral lesions. Dexamethasone was correctly identified as the first-line treatment for oral lichen planus by 55% of respondents, while 50% correctly selected hyaluronidase plus beta-carotene as the most effective treatment for oral submucous fibrosis. Nystatin was recognized by 66% as the treatment for oral candidiasis, and 59% identified tretinoin as potentially reducing the progression of oral leukoplakia. Pentoxifylline was correctly identified by 64% for managing oral submucous fibrosis, and 79% correctly selected carbamazepine as the first-line treatment for trigeminal neuralgia. For pyogenic granuloma, 37% chose triamcinolone as the topical medication, and 50% identified dexamethasone as effective. Valacyclovir was preferred for recurrent herpes labialis by 64%, while 75% correctly identified acyclovir as the first-line treatment for oral herpes infection. Topical corticosteroids were chosen by 63% as the first-line treatment for canker sores, and 64% correctly identified topical lidocaine for traumatic ulcer pain. Fluconazole was selected by 61% for severe oral candidiasis, and 66% identified prednisone as the treatment for oral mucosal lesions in pemphigus vulgaris. For localized squamous cell carcinoma, 63% selected cisplatin, while 75% recommended observation for leukoedema. Topical nystatin was identified by 69% as the treatment for denture stomatitis, and 70% selected topical corticosteroids as the treatment for erythema multiforme. Lastly, 60% correctly identified amoxicillin 500 mg plus clavulanic acid 125 mg as the optimal treatment for dental abscesses.

DISCUSSION

Our study findings align and contrast with previous research on dentists' knowledge and management of oral lesions, highlighting both areas of competency and gaps requiring attention.  The 66% recognition of nystatin for oral candidiasis in our study parallels findings by Mohammad H. Al-Shayyab, where 78.2% prescribed nystatin, indicating a consistent understanding of antifungal protocols.⁶ The identification of acyclovir (75%) as the first-line treatment for oral herpes infection aligns with Pratikshya et al., who emphasized its effectiveness in treating herpes, including in immunocompromised patients.⁷ Similarly, A. Ashik Ahamed noted awareness of intravenous acyclovir use, albeit at a lower percentage (54%). While 64% of participants in our study correctly identified valacyclovir for recurrent herpes labialis, suggesting regional disparities in confidence and awareness.^8,9 In Shahad Alharbi et al.'s research, 60% rarely or never managed oral lesions in practice, contrasting with the current study, where higher knowledge levels (e.g., 79% for carbamazepine in trigeminal neuralgia) indicate stronger theoretical familiarity. ¹⁰However, this theoretical knowledge may not always translate into practical management. In the present study, 59% identified tretinoin as potentially reducing leukoplakia progression, which reflects a moderate level of knowledge. Conversely, Dr. Aqsa J. Tamboli reported a much higher 90.9% confidence level in managing oral submucous fibrosis, signaling better familiarity with specific conditions in her study.¹¹ Similarly, Ola Alshuhail (2023) found 78.5% of senior dental students demonstrated adequate knowledge of oral lesions, a level higher than the 50-66% range seen for some conditions in this study.¹² The overall management accuracy of 43–86% reported by Poelman MR et al. aligns with the our study's findings, such as 55% identifying dexamethasone for oral lichen planus and 60% recognizing amoxicillin with clavulanic acid for dental abscesses.¹³  These ranges highlight the variability in dentists’ proficiency in managing specific lesions. While 75% in the our study recommended observation for leukoplakia, which aligns with guidelines for non-invasive management, a lack of consensus persists on when to escalate care, reflecting gaps in decision-making consistency. ¹⁴ Regional and demographic variations (e.g., senior students vs. practicing dentists) also contribute to disparities. Continuous education tailored to specific gaps, such as cancerous lesion management (as noted by Emre Balaban)⁸, and practical training to reinforce theoretical knowledge (highlighted by Shahad Alharbi)¹⁰ could bridge these inconsistencies. Efforts to enhance diagnostic and treatment skills, particularly for potentially malignant disorders and less commonly encountered lesions, are essential for improving outcomes. Regular updates to clinical guidelines and hands-on workshops could ensure more comprehensive care, addressing both the gaps identified in this study and those reported in earlier research.¹⁴

CONCLUSION

The study highlights significant variability in dentists' knowledge of treatment protocols for common oral lesions, reflecting both areas of strength and opportunities for improvement. While there is commendable awareness regarding certain conditions, such as the management of oral candidiasis, oral herpes, and trigeminal neuralgia, notable gaps exist in addressing more complex or less frequently encountered lesions, such as pyogenic granuloma and leukoplakia. Overall, enhancing dentists' confidence and competency in oral lesion management is critical for early detection, timely intervention, and improved patient outcomes, ultimately contributing to better public oral health care.

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