Dentists’ Knowledge, Diagnostic Confidence, and Clinical Decision-Making Regarding Oral Mucosal Lesions and Potentially Malignant Disorders: A Cross-Sectional Survey in Libya and Other Countries

Abstract

Dentists play an important role in the early recognition, assessment, and appropriate referral of oral mucosal lesions and oral potentially malignant disorders (OPMDs). Adequate knowledge, diagnostic confidence, and appropriate clinical decision-making are essential for the timely identification and management of suspicious oral lesions. This study assessed dentists’ knowledge, diagnostic confidence, and clinical decision-making regarding oral mucosal lesions and OPMDs, with particular emphasis on dentists practicing in Libya. Methods: A cross-sectional, web-based survey was conducted between May and August 2026 using a structured, self-administered electronic questionnaire distributed through social media. A total of 215 dentists participated, including 150 practicing in Libya and 65 practicing outside Libya. Knowledge was assessed using five items, with one point assigned for each correct response (total score, 0–5). Participants were categorized as having high (4–5), moderate (3), or low (0–2) knowledge. Categorical variables were summarized using frequencies and percentages, and associations between categorical variables were examined using Pearson’s chi-square test. Statistical significance was set at p < 0.05. Results: Overall, 123 participants (57.2%) demonstrated high knowledge, 68 (31.6%) moderate knowledge, and 24 (11.2%) low knowledge. The proportion of correct responses ranged from 73.0% (157/215) for recognition of erythroplakia as a potentially malignant lesion to 86.5% (186/215) for identification of persistent oral ulcers as suspicious. Tobacco was recognized as an oral cancer risk factor by 179 participants (83.3%), while 181 (84.2%) recognized that an oral ulcer persisting for more than 2 weeks warrants further investigation or referral. Routine oral mucosal examination was reported by 118 participants (54.9%). High confidence in recognizing suspicious lesions and determining biopsy indications was reported by 82 (38.1%) and 74 (34.4%) participants, respectively. Previous formal oral pathology training was reported by 113 participants (52.6%) and was significantly associated with high knowledge (68.1% vs. 45.1%; χ² = 11.63, p < 0.001). No statistically significant differences were observed between dentists practicing in Libya and those practicing outside Libya in leukoplakia identification (p = 0.598), high knowledge (p = 0.650), or routine oral mucosal examination practices (p = 0.488). Conclusions: Although overall knowledge of OPMD recognition and oral cancer risk factors was relatively favorable, routine oral mucosal examination and diagnostic confidence were less consistent. Formal oral pathology training was significantly associated with higher knowledge levels. Targeted continuing professional education, particularly practical and case-based training focused on oral mucosal screening, recognition of suspicious lesions, and indications for biopsy and referral, may help strengthen dentists’ clinical preparedness.