Oral Cancers Mimicking Apical Lesions: A Survey Study

ABSTRACT Objectives Although most periapical radiolucent lesions are inflammatory in origin and arise from pulpal necrosis, a proportion represent non-endodontic and malignant pathologies that can mimic endodontic disease, leading to misdiagnosis or delayed diagnosis. This study aimed to evaluate dental students' knowledge and clinical decision-making regarding oral cancers that may mimic apical lesions. Material and Methods This descriptive survey study included 3rd-, 4th-, and 5th-year students in the clinical phase of their education, recruited through convenience sampling (n = 249). A structured 18-item questionnaire was developed based on the current literature. Six items with a single, unequivocal correct answer were combined into a composite knowledge/clinical decision score (0–6). Data were analyzed using chi-square and Kruskal–Wallis tests, with statistical significance set at P < 0.05. Results Correct-answer rates across the six knowledge items ranged from 69.1% to 80.7%, with the highest rates for recognizing Stafne bone cavity (80.7%) and suspecting metastasis (80.3%). Overall, 36.5% of participants answered all items correctly. The knowledge/clinical decision score differed significantly across class levels (P < 0.001) but did not increase linearly with seniority. The highest mean was observed among third-year students (5.03 ± 1.26), and the lowest among fourth-year students (3.43 ± 1.77). Significant disagreement was found regarding biopsy timing and the necessity of histopathological examination. Conclusion Students' knowledge was generally moderate to high; however, the divergence in attitudes toward biopsy and histopathology, together with the relative decline among fourth-year students, is noteworthy. The findings suggest that differential diagnosis and histopathology training should be reinforced throughout all clinical years to support the early diagnosis of oral cancer.