Supplementary Material for: Assessment of the Factors Influencing Early Detection Practices of Oral Carcinomas by Dentists: A Cross-Sectional Study

Introduction
Oral cancer (OC) is the second most common type of cancer in Pakistan, and early diagnosis can improve survival rates. However, 75% of these cases are diagnosed at an advanced stage. To reduce the incidence and mortality associated with OC, emphasis should be placed on the detailed screening of the oral cavity by dentists. Prevention and early detection practices are important because they increase five-year survival and reduce recurrence. This study aimed to assess the early detection practices of OC by dentists and determine the factors influencing their screening practices.
Methods
This cross-sectional study was conducted from June 1, 2022, to October 31, 2022, among 235 dentists from the public and private sectors of Islamabad, Pakistan. A validated survey questionnaire with 62 closed-ended items was used. The outcome variable “early detection practices of oral carcinomas” was measured on a scale of 0-8 based on the steps involved in the screening practices. Knowledge scores related to clinical presentation (0-14) and risk factors (0-16) of OC were generated by assigning one point to each correct response. Multivariate linear regression analysis was used to evaluate factors influencing early detection practice scores.
Results
81.7% of participants had low knowledge related to clinical presentation (mean score=7.5, SD=2.2), and 55.3% had high knowledge (mean score=10.4, SD=2.06) related to the risk factors of oral cancers. The mean score for practices related to the early detection of oral carcinomas was 5.4 (SD=2.04). The duration since attending professional development courses significantly predicted early detection practice scores (P<0.001). With increasing duration, the early detection practice scores decreased. Moreover, “guidelines about OC examinations” significantly predicted practice scores (higher scores where written guidelines were present) (P<0.001).
Conclusion
This study highlights that the early detection of OC improves prognosis, reduces mortality, and minimizes treatment costs. These results emphasize regular professional development courses for the early detection of OC among dentists. This indicates that early detection practices are better in facilities with written guidelines, further emphasizing the need for comprehensive educational materials and training of dentists to improve screening practices. Healthcare authorities should put efforts into implementing a continuous dental education system tailored to the needs of dentists in Pakistan.

引言
口腔癌（Oral cancer, OC）是巴基斯坦第二大常见癌症类型，早期诊断可显著提升患者生存率，但目前75%的确诊病例已处于疾病晚期。为降低口腔癌相关的发病率与死亡率，应重视牙医对口腔的详细筛查工作。预防与早期筛查实践至关重要，其可提升患者五年生存率并降低疾病复发风险。本研究旨在评估牙医开展的口腔癌早期筛查实践，并明确影响其筛查行为的相关因素。
方法
本横断面研究于2022年6月1日至2022年10月31日期间，在巴基斯坦伊斯兰堡的公立与私立医疗机构的235名牙医中开展。研究采用经过效度验证的调查问卷，共包含62道封闭式题目。结局变量「口腔癌早期筛查实践」基于筛查流程涉及的步骤，以0-8分的量表进行评分。针对口腔癌临床表现（0-14分）与危险因素（0-16分）的知识得分，通过每答对一题计1分的方式生成。采用多元线性回归分析评估影响早期筛查实践得分的相关因素。
结果
81.7%的参与者在口腔癌临床表现相关知识方面得分较低（平均得分=7.5，标准差（Standard Deviation, SD）=2.2），而55.3%的参与者在口腔癌危险因素相关知识方面得分较高（平均得分=10.4，标准差SD=2.06）。口腔癌早期筛查相关实践的平均得分为5.4（标准差SD=2.04）。参加专业进修课程后的时长可显著预测早期筛查实践得分（P<0.001），且该时长越长，早期筛查实践得分越低。此外，「口腔癌检查相关指南」同样可显著预测实践得分（存在书面指南时得分更高）（P<0.001）。
结论
本研究表明，口腔癌早期筛查可改善患者预后、降低死亡率并减少治疗成本。研究结果强调，需为牙医定期开展针对口腔癌早期筛查的专业进修课程。研究同时显示，拥有书面指南的医疗机构其早期筛查实践表现更佳，进一步凸显了需制定全面的教育材料并开展牙医培训，以优化筛查实践。医疗管理部门应着力构建贴合巴基斯坦牙医实际需求的持续口腔教育体系。