NeuroQuantology | June 2022 | Volume 20 | Issue 6 | Page 2270-2276 | doi: 10.14704/nq.2022.20.6.

NQ22224
Maher AL Shayeb, / Knowledge & Awareness of Pre-disposing factors of Oral Cancer

Knowledge & Awareness of Pre-disposing

factors of Oral Cancer
Maher AL Shayeb1,2, Aliya Jalil Javed1, Asok Mathew1,2, Naresh Shetty1,2

Abstract
Aim and Objectives
The aim of this study was to assess the knowledge and awareness of pre-disposing factors of Oral cancer among
the dental practitioners and the internship students
Materials and Methods
A self-administered questionnaire was designed to collect information regarding the most common site involved
in oral cancer with tobacco & alcohol, early signs of oral cancer, gender, site involvement with reverse smoking,
pre-disposing factors of oral cancer, family history, in relation with human papillomavirus among a group of dental
practitioners and the internship dental students
Results
According to the survey, 51.4% of the dental practitioners chose floor of the mouth as the most common site prone
to oral cancer with consumption of tobacco followed by tongue (27.1%) & then the gingiva (12.9%). Oropharynx
is considered the least common site (8.6%).

90% of dentist’s state tobacco may induce premalignant changes in the form of red and/or white oral patches.
97.1% of dentist’s concluded patient’s using tobacco & alcohol are more prone to oral cancer. 50% of the dentist
consider there is no association between mouthwash containing alcohol & development of oral cancer.
Conclusion
Increase in habits such as smoking, tobacco chewing (betel quid) & alcohol abuse are more prone to Oral Cancer.
Early detection of Oral Cancer minimizes the morbidity. 2270
HPV 16 and 18 has shown a stronger relationship to oral carcinomas than others. UV rays when exposed
unprotected skin can cause skin cancers. People suffering from HIV or AIDS are more likely to develop oral cancers
as opposed to the general population. The relationship between high alcohol content mouth washes and oral
cancer has not been confirmed.

Key Words: Oral Cancer, pre-disposing factors, awareness

DOI Number: 10.14704/nq.2022.20.6.NQ22224 NeuroQuantology 2022; 20(6):2270-2276

Background and floor of the mouth. Oral cancer is found in

Cancer is the most significant cause of loss of life two-thirds of the world's with around fifty
in economically developed and developing percent in the south of Asia. 1/5th of all oral
countries. It is more common in developing cancer cases, and ¼ the of all oral cancer deaths
countries. Cancer is the second leading cause of occur in India (3). Individuals, lifestyle &
death in United Arab Emirate (1,2). Oral cancer environment are the common causes of oral
is the world's 6th frequently occurring cancer, cancer which is a serious health issue. The aim
with numerous new cases and deaths in the last of this study is to assess the knowledge and
five years. Oral cancer comprises malignancies awareness of pre-disposing factors of Oral
of the mouth, lip, mucosa, gum, tongue, palate, cancer among the dental specialist, general
*Corresponding author: Maher AL Shayeb
Address: *Department of Clinical Sciences, College of Dentistry, Ajman University. Ajman, UAE E-mail: m.alshayeb@ajman.ac.ae
1Department of Clinical Sciences, College of Dentistry, Ajman University. Ajman, UAE
2Centre of Medical and Biomedical Allied Health Sciences Research, Ajman University, Ajman, UAE

Relevant conflicts of interest/financial disclosures: The authors declare that the research was conducted in the absence of
any commercial or financial relationships that could be construed as a potential conflict of interest.
Received: 1 May 2022 Accepted: 14 june 2022

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Maher AL Shayeb, / Knowledge & Awareness of Pre-disposing factors of Oral Cancer
dentists & dental students of Ajman University.
Oral cancer is a cancer which can be identified
early by screening. Dentists can play an
important role in its early diagnosis by visual &
tactile examination. Assessment of the level of
knowledge and behaviours of dental health care
workers regarding oral cancer is thus important
and it is vital to train such professionals in oral
cancer risk, prevention and control measures
and detection procedures. (4,5)
Cancer is a serious health problem in developed
and developing countries. Fighting against it
requires dentists to be well trained in
diagnosing as well as organizing education
programs. In most countries, there are no
organized oral cancer screening which is the
cause of lack of early detection. (6,7,8)
There is an increase in the rate of oral cancer
due to increase in habits such as smoking, betel
quid chewing and alcohol abuse. Early
diagnosis is the most significant factor
influencing prognosis of oral cancer, instant
referral plays and major role in its prevention.
Diagnostic examination includes health history,
accurately identifying the risk factors and
examination of oral mucosa with vigilance for
suspicious lesions. (9,10)
Many epidemiological studies done in the past
have confirmed a definite association between
smoking and oral carcinoma. These studies
show that there are twice as many smokers
among oral cancer patients when compared to
control population. Studies show that smoking
also increases the already high risk for
developing secondary oral cancers. (11)
Smokeless tobacco (chewing) & betel quid with
tobacco can cause oral cancer with higher
chances than only smoking or only betel quid
chewing. Chewing tobacco on a long term is a
cause of cancer more commonly in women. On
short term there will be gum conditions &
hyperkeratosis. (12)
More than 100 different types of HPV viruses
have been identified. However, the HPV 16 and
18 has shown a stronger relationship to oral
carcinomas than others. HPV is not found in all
oral cancers, but it is usually present in
proliferative verrucous leukoplakia which is a
premalignant lesion. Studies show that 2/3rd
oral cancers harbour HPV DNA in tumor cells,
although their function has not been fully
examined. (13,14)
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Studies show that immune surveillance
decreases with age which in turn results in an
association between age and malignancy.
Studies show that smoking also increases the
already high risk for developing secondary oral
cancers. (14 ). The exposure to the sun or
working outside for long periods of time can
increase the risk of the oral cancer (15)
What may start as benign clinical signs of red
(erythroplakia) or white (leukoplakia) lesion
may become malignant. These are commonly
observed in tobacco users. These lesions can be
observed during a routine dental check-up so
routine visits to a dentist are important.
However not all oral cancers are preceded by
precancerous lesions. (14,15)
Oral cancer is a cancer which can be identified
early by screening. Dentists can play an
important role in its early diagnosis by visual &
tactile examination. Assessment of the level of
knowledge and behaviours of dental health care
workers regarding oral cancer is thus important
and it is vital to train such professionals in oral
cancer risk, prevention and control measures
and detection procedures. (16).
Materials and Methods
A self-administered questionnaire was
designed to collect information regarding the 2271
most common site involved in oral cancer with
tobacco & alcohol, early signs of oral cancer,
gender, site involvement with reverse smoking,
pre-disposing factors of oral cancer, family
history, in relation with human papillomavirus.
This cross-sectional study was carried out
among a sample of 140 participants which
involved dental practitioners and the dental
internship students. The age of the respondents
ranged from 20 -60 years. The majority of the
participants were below 40 years of age. Data
entry and analysis were undertaken using the
computer software statistical package of Social
Sciences.
Results:
A total of 140 questionnaires were collected
from the participants
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Maher AL Shayeb, / Knowledge & Awareness of Pre-disposing factors of Oral Cancer
Table 1. Participants 90% of the dentists, specialist & dental
Speciality Frequenc Percent internship students from our sample consider
y red or white lesions as the early signs of oral
Internship 104 74.3 cancer.
Students
Figure 2: Red or white oral lesion are early signs of oral
24 17.1 cancer
GP
12 8.6
SPECIALIS
T
140 100.0
Total

According to the survey, 67.9% out of 140

dental participants choose oral cancer is more
commonly found in males than in females

51.4% of the specialist, dentist & dental

internship students choose the floor of the
mouth as the most common site of oral cancer 97.1% participants consider patients using
with the use of tobacco followed by the tongue tobacco & alcohol are more prone to oral cancer
(27.1%)
Table.3 Tobacco & alcohol are pre-disposing factors
Table 2. Common Site of oral cancer Tobacco & Alcohol
Site Frequenc Percent Frequ Perc Valid Cumula
y ency ent Percent tive
FLOOR OF 72 51.4 Percent
MOUTH Vali FAL 4 2.9 2.9 2.9
d SE 2272
38 27.1
TONGUE
18 12.9 true 136 97.1 97.1 100.0
GINGIVA
Tot 140 100. 100.0
12 8.6
al 0
OROPHARYNX
140 100.0 Figure 3. Tobacco & alcohol are pre-disposing factors
Total

Figure 1: Common sites of oral cancer

Equal number of participants chose there is no

association between mouthwash containing
alcohol & development of oral cancer.

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Maher AL Shayeb, / Knowledge & Awareness of Pre-disposing factors of Oral Cancer
Table 4. Mouthwash association with oral cancer
Mouthwash Frequency Percent Table 6. Regular drinking and risk of oral cancer
association Freque Percen
Valid FALSE 70 50.0 ncy t
50.0 DEFINITELY 83 59.3
true 70 INCREASES

Total 140 100.0 PROBABLY 47 33.6

INCREASES
Figure 4. Mouthwash association with oral cancer
PROBABLY 10 7.1
DOESNT
INCREASE

Total 140 100.0

Figure 6: Regular drinking and risk of oral cancer

56.4% chose palate as the most common site

involved with reverse smoking

Table 5. Area affected with reverse Smoking

Reverse Smoking
Site Frequency Percent
BUCCAL MUCOSA 25 17.9

TONGUE 27 19.3
2273
PALATE 79 56.4

FLOOR OF MOUTH 7 5.0 39.3% of the participants say exposure to

sunlight definitely increases the chance of
5 2 1.4 having oral cancer & the other 39.3% say it’s
probably increases the chance of having oral
Total 140 100.0 cancer
Figure 5. Area affected with reverse Smoking Table 7. Exposure to sunlight and risk of oral cancer
Frequen Percent
cy
DEFINITELY 55 39.3
INCREASES

PROBABLY 55 39.3
INCREASES

PROBABLY DOESNT 17 12.1

INCREASE

DEFINITELY 13 9.3
DOESNT INCREASE

59.3% considered regular drinking definitely Total 140 100.0

increases risk of oral cancer

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Maher AL Shayeb, / Knowledge & Awareness of Pre-disposing factors of Oral Cancer
39.3% participants chose with cheek biting
Figure 7. Exposure to sunlight and risk of oral cancer chance of oral cancer probably increases

Table 9. Cheeks biting and oral cancer

Freque Perce
ncy nt
Vali DEFINITELY 8 5.7
d INCREASES

PROBABLY 55 39.3
INCREASES

PROBABLY 52 37.1
DOESNT
INCREASE
65.7% participants chose tobacco use in any 25 17.9
DEFINITELY
form definitely increases the chance of oral
DOESNT
cancer.
INCREASE
Table 8. Tobacco use in any form and oral cancer
Tobacco Total 140 100.0
Freque Perce
ncy nt
Vali DEFINITELY 92 65.7 Figure 9. Cheeks biting and oral cancer
d INCREASES

PROBABLY 44 31.4
INCREASES 2274

PROBABLY 4 2.9
DOESNT
INCREASE

Total 140 100.0

Figure 8. Tobacco use in any form and oral cancer

75.7% chose HPV is one of the main causes of

oral cancer whereas 24.3% chose it’s not.

Table 10. HPV and Oral Cancer

Frequency Percent
Valid FALSE 34 24.3

true 106 75.7

Total 140 100.0

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Maher AL Shayeb, / Knowledge & Awareness of Pre-disposing factors of Oral Cancer
Figure 10. HPV and Oral Cancer In the current study, knowledge level about oral
cancer and its risk factors the has been
investigated. The participant has some
misconceptions about pre-disposing factors of
oral cancer, like in association with alcohol-
based mouthwash but the majority of the
participants have confirmed that oral cancer is
strongly related to smoking, alcohol
consumption & tobacco chewing. According to
the literature, the risk is greater for people who
use both tobacco and alcohol than for those who
use only tobacco or only alcohol.
64.3% consider white patches as the early signs
51.4% of the participants choose the floor of the
of oral cancer
mouth as the most common site that is prone to
Table 11. Signs of Oral cancer
the oral cancer where while tongue was the site
Early Signs of oral cancer Frequency Percent of predilection for oral cancer in Canada and
WHITE PATCHES 90 64.3 Iran and gingiva for Korea and Thailand
(17,18). 90% concluded red & white lesions are
RED PATCHES 16 11.4 the early signs of oral cancer. 56.4% of
participants stated palate is more commonly
SORE LESION 31 22.1 involved with reverse smoking which is similar
to the studies done in past.
BLEEDING 3 2.1
59.3 % of the participants think regular
140 100.0
drinking definitely increases the chance of
Total
having oral cancer, which is one of the pre-
disposing factors. Cancer of the lip can be
Figure 11. Signs of Oral cancer
caused by excessive exposure to sunlight.
39.3% say excessive exposure can cause cancer.
65.7% say tobacco definitely increases chances 2275
of having oral cancer which is proved in many
studies (8,10). 39.3% chose cheek biting can
definitely increase chance of having oral cancer,
whereas according to previous studies it shows
it can cause keratosis, which is of low malignant
potential (19). 75.7% concluded HPV is one of
the main causes of oral cancer where Human
papilloma virus (HPV) has been found in up to
36% of patients with oral cancers in the
literature.
The reason of the patient delay in seeking
treatments for the oral lesions is lack of
education about signs oral cancer & lack of
qualified dentists who give importance to oral
Discussion cancer screening, which can prevent cancer in
Oral cancer is preventable, earlier diagnosis early stages.
increases a patient’s chances of survival as the
mouth is very accessible for a clinical or even Conclusion:
self-examination. However, there is poor public More education is needed among patients to get
awareness of the signs and symptoms of oral checked on having early signs which can be
malignancies and premalignant lesions. Studies preventable. It can be life threatening if not
about dentist & public’s awareness of oral diagnosed & treated early. Men over 50 are at
cancer has been done earlier. (6) greater risk of having oral cancer. Smoking,

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Maher AL Shayeb, / Knowledge & Awareness of Pre-disposing factors of Oral Cancer
chewing tobacco & alcohol are the main pre- Sedrak M, Rizzolo D. Understanding the link between hpv
disposing factors. The participants in the and oropharyngeal cancer. JAAPA. 2009;22:42–46
Anis R, Gaballah K. Oral cancer in the UAE: a multicenter,
current study are well aware of the pre- retrospective study. Libyan J Med. 2013;8(1):21782.
disposing factors & early signs of oral cancer. Khan AR, Anwar N, Manan AH, Narayan KA. Case series
Patient’s having family history of oral cancer analysis of oral cancer and their risk factors. Malays
are more prone of having it. Individuals over 40 Dent J. 2008;29:46–50
Dhanuthai K, Rojanawatsirivej S, Subarnbhesaj A,
should get an oral cancer screening done Thosaporn W, Kintarak S. A multicenter study of oral
annually. A diet low in fruits & vegetables may malignant tumors from Thailand. J Oral Maxillofac
play an important role in having oral cancer. Pathol. 2016;20:462–6
Too much exposure to sunlight should be Sargeran K, Murtomaa H, Safavi SM, Vehkalahti M, Teronen
avoided. If person is diagnosed with oral cancer, O. Malignant oral tumors in Iran: Ten-year analysis on
patient and tumor characteristics of 1042 patients in
first of all the habits should be stopped such as Tehran. J Craniofac Surg. 2006;17:1230–3
tobacco chewing, smoking & alcohol Anura A. Traumatic oral mucosal lesions: a mini review
consumption. and clinical update. Oral Health and Dental
Management. 2014;13:254–259.
REFRENCES:
World Health Organization. Regional Office for the Eastern
Mediterranean. United Arab Emirates.
Noncommunicable Diseases (NCD) Country Profiles.
2014.
Loney T, Aw TC, Handysides DG, et al. An analysis of the
health status of the United Arab Emirates: the “Big 4”
public health issues. Glob Health Action 2013;6:20100
Sankaranarayanan, R., Ramadas, K., Amarasinghe, H.,
Subramanian, S. and Johnson, N. (2015). Oral Cancer:
Prevention, Early Detection, and Treatment. Disease
Control Priorities, Third Edition (Volume 3): Cancer,
[online] pp.85–99. doi:10.1596/978-1-46480349-
9_ch5.
Ahmed NH, Naidoo S. Oral cancer knowledge, attitudes,
and practices among dentists in Khartoum State,
Sudan. J Cancer Educ. 2019;34:291–6. 2276
Alami AY, El Sabbagh RF, Hamdan A. Knowledge of oral
cancer among recently graduated medical and dental
professionals in Amman, Jordan. J Dent
Educ. 2013;77:1356–64.
Rawi N, Kawas S, Imad O. Public awareness and attitude
toward oral cancer screening In United Arab Emirates.
J Int Dent Med Res 2012; 5:149-53.
Alkanhal N. Oral cancer awareness among general public
in Saudi Arabia. Dental Sci 2020; 19:120-7.
do Prado NS, Bonan RF, da Silva Leonel AC. Awareness on
oral cancer among patients attending dental school
clinics in Brazil. Med Oral Patol 2020; 25:e89.
Ariyawardana A, Vithanaarachchi N. Awareness of oral
cancer and precancer among patients attending a
hospital in Sri Lanka. Asian Pac J Cancer Prev 2005;
6:58-61.
Agrawal M, Pandey S, Jain S, et al. Oral cancer awareness of
the general public in Gorakhpur city, India. Asian Pac J
Cancer Prev 2012; 13:5195-9.
Rogozinski J. New York: Praeger Publishers; 1990.
Smokeless tobacco in the Western world; pp. 42–4.
McGuirt WF, Wray A. Smokeless tobacco or health: an
international perspective. US Department of Health
and Human Services, NIH Publication; 1993. Oral
carcinoma and smokeless tobacco use: a clinical
profile; pp. 91–5. No. 93-3461.
Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human
papilloma virus and rising oropharyngeal cancer in the
United States. J Clin Oncol. 2011; 29:4294–4294.

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