Alice M. Horowitz

Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries1

This report presents the results of systematic reviews of effectiveness, applicability, other positive and negative effects, economic evaluations, and barriers to use of selected population-based interventions intended to prevent or control dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (the Task Force) about the use of these selected interventions. The Task Force recommendations are presented in this supplement.

Maryland family physicians' knowledge, opinions and practices about oral cancer

The objective of this study was to assess family physicians knowledge, opinions and practices regarding oral cancers in the state of Maryland, USA. A 40-item, self-administered questionnaire was mailed to all members of the Maryland Academy of Family Physicians. Unweighted data (n=240) were analyzed using SAS and SUDAAN software; results were evaluated using an alpha < or =0.05. Family physicians (FPs) were aware of the major risk factors for oral cancers, but misinformation existed about the non-risk factors. Approximately 77% asked their patients the eight questions related to risk factors for oral cancer when taking a medical history but less than 24% provided an oral cancer examination to patients 40 years of age and over. Nearly 64% were interested in a continuing education course about oral cancer. This survey identified gaps in knowledge and practices among FPs but it is encouraging that they expressed interest in continuing education courses on this topic.

Knowledge of Risk Factors and Risk Behaviors Related to Coronary Heart Disease among Blue and White Collar Males

In this report the data regarding coronary heart disease (CHD) from the 1990 Health Promotion and Disease Prevention Supplement of the National Health Interview Survey are used to examine the relationship between risk factor knowledge and health related behaviors among currently employed white collar(N=5,349) and blue collar(N=4,158) men workers. Blue collar employees have less knowledge about CHD risk factors, less favorable risk factors status, and poorer health practices than their white collar workers. Despite these findings within each occupational group, the relationship of knowledge to either risk factor status or health practices is similar. Knowledge is generally related to the attempts to change behaviors. However, for the different risk factors, the associations vary. For example, knowledge of cigarette smoking as a risk factor of CHD is negatively associated with reported ever smoking or current smoking, but not with heavy smoking. In contrast, knowledge of overweight, high serum cholesterol, and high blood pressure as CHD risk factors is not associated with risk factor status.These results suggest that while difference in level of knowledge and risk profiles remain between blue collar and white collar employees, the associations between knowledge and risk profiles are similar. Programs located at worksites must continue to provide education opportunities about the risk factors, especially among blue collar workers.

Prevention of Oral Diseases

Health care consumers and providers alike are placing greater emphasis on achieving health through disease prevention. Today, health and wellness are promoted as achievable priorities in our society—and oral health is included (Goldhaber, 1977; Green & Johnson, 1982; Iverson, 1980; Iverson & Kolbe, 1983; U.S. Department of HEW, 1979; World Health Organization, 1980). Although a treatment tradition and expectation—on the part of both dentistry and the public—has prevailed since dentistry was formally established, this orientation need not and, indeed, should not continue. Oral diseases should not be considered as inevitable, as one of life’s burdens that must be endured. Preventive measures are available now to prevent or control the two major oral diseases—dental caries and periodontal diseases. An intact dentition with healthy surrounding tissues is an achievable goal. How to achieve this goal is the theme of this chapter.

An assessment of oral cancer prevention curricula in U.S. medical schools.

BACKGROUNDnOral cancer is readily detectable through routine examination, but five-year survival rates remain low. Physicians bear the same responsibilities as dentists in the early detection of oral cancers, because high-risk patients utilize medical services more often than dental services.nnnMETHODSnBecause physicians practices are largely influenced by their training, this study assessed the level of oral cancer education provided to undergraduate U.S. medical students. Health history and physical diagnosis course curricula were assessed for relevant content.nnnRESULTSnThe response rate from the U.S. medical schools was 63.2%. When compared with the gold standard, the average score was 43% of the optimum. Seven percent of the schools did not require inspection of the mouth, 29% required inspection of all oral structures, and intraoral palpation was advocated by 43% of the schools. Although most schools included questions about alcohol and tobacco use, only 13% asked about sunlight exposure.nnnCONCLUSIONnPreliminary oral cancer training in medical schools regarding physical assessment and elicitation of signs, symptoms, and high-risk behaviors lacks both adequacy and comprehensiveness.

Maryland Dentists' Knowledge of Oral Cancer Risk Factors and Diagnostic Procedures

A questionnaire was mailed to 800 Maryland general practice dentists to assess their knowledge of risk factors and diagnostic procedures for oral cancer. Two indices were created based on 14 questions on knowledge of oral cancer risk factors and 9 questions on oral cancer diagnostic procedures. Data were analyzed statistically and evaluated with an alpha level of 0.05. Nearly all respondents identified use of tobacco, prior oral cancer lesions, and use of alcohol as risk factors. However, only 36% correctly identified that poor-fitting dentures are not a risk factor and 58% that poor oral hygiene is not a risk factor. Nearly 87% knew how to examine the tongue and surrounding areas, and 32% identified erythroplakia and leukoplakia as conditions associated with oral cancer. Appropriate knowledge about risk factors and diagnostic procedures is essential for dentists to counsel their patients and perform appropriate oral cancer examinations.

Views of oral cancer prevention and early detection: Maryland physicians.

The purpose of this study was to obtain in-depth information on Maryland physicians knowledge, opinions and practices about oral cancer examinations. The qualitative descriptive study used one focus group conducted in a conference facility and nine one-on-one interviews at private medical offices. A criterion-purposeful sampling was used for selection of participants. Generally, we found low awareness of, and surprise about, Marylands high oral cancer mortality rates. Physicians were not surprised that they detect more lesions than dentists, although most physicians did not provide oral cancer examinations on a routine basis. Physicians were interested in attending continuing medical education (CME) courses on oral cancer prevention and early detection but only if worked into other CME programs on cancer. They were very interested in having hands-on training on performing an oral cancer examination. These findings will be used to implement educational interventions for Maryland physicians to help increase early detection of oral cancers.

A comparison of selected evidence reviews and recommendations on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries

Medical Subject Headings (MeSH): cariostatic agents, community dentistry, community health planning, community health services, decision making, dental caries, evidencebased medicine, facial injuries, fluoridation, intervention studies, meta-analysis, mouth protectors, oral health, pharyngeal neoplasms, pit and fissure sealants, practice guidelines, preventive dentistry, preventive health services, public health dentistry, public health practice, review literature, tooth injuries

Use of skin and oral cancer examinations in the United States, 1998

BACKGROUNDnFindings from previous surveys suggest low utilization of oral cancer examinations, even though this examination is noninvasive. The purpose of this analysis is to compare the use of an oral cancer examination (OCE) and a skin cancer examination (SCE) in the past 12 months within the United States. Both exams are noninvasive and include a visual component.nnnMETHODSnWeighted data from the Adult Prevention Supplement of the 1998 National Health Interview Survey (NHIS) for adults 40 years of age or older were analyzed using SAS and SUDAAN. A ratio compared the percentage reporting an OCE (%OCE) with the percentage reporting a SCE (%SCE).nnnRESULTSnThe percentage having an OCE in the past year (13.8%) was very similar to the percentage having a SCE (13.5%) during that same period. With increasing age group, the %OCE/%SCE ratio varied inversely from 1.60 (C.I. 1.42-1.78) among persons 40-49 years to 0.62 (C.I. 0.55-0.69) among persons 70+ years. The ratio was similar in whites and blacks, males and females, and Hispanics and non-Hispanics. There was a positive gradient in the ratio by education and family income.nnnCONCLUSIONSnOverall, less than 15% of the population is receiving either of these examinations, although the American Cancer Society recommends both of them on an annual basis for individuals 40 years of age and older. To increase detection of these cancers at early stages, extensive educational and media campaigns for the public and providers identifying risk factors and the availability of and the need for these examinations are required.

Oral Cancer Prevention and Early Detection: Using the PRECEDE-PROCEED Framework to Guide the Training of Health Professional Students

Abstract Background. Teaching cancer prevention and detection is important in health professional education. It is desirable to select a comprehensive framework for teaching oral cancer (OC) prevention and detection skills. Methods. The PRECEDE-PROCEED model was used to design a randomized pretest and posttest study of the OC prevention and detection skills of dental students (nu2009=u2009104). OC knowledge, opinions, and competencies were evaluated. Results. Second year students in the intervention group were more competent than those in the control group. Conclusions. The novel use of PRECEDE-PROCEED sets a precedent for designing a standardized OC curriculum for a wide range of health professional disciplines. J Cancer Educ. 2007;22:250–253.