Enhancing Communication in Dental Clinics through Understanding Oral Medicine Terminology

2.1. Study Design and Sampling

This cross-sectional survey targeted adult patients treated at King Abdulaziz University (KAU) dental clinics using a convenience sampling method. Google Forms was used to create the self-administered questionnaire. The questionnaire was sent to the targeted population through WhatsApp Messenger in the waiting area of dental clinics at KAU between November 2022 and June 2023. General dentists were assigned to manage the process of sending forms to patients, and the forms were limited to one response. The sample size was calculated using G*Power software (version 3.1.7.9). Based on the results of a previous study [5] with a power of 80%, 0.05 alpha, and 0.2 beta, the calculated sample size was 76.

2.2. Ethical Considerations and Participants Consenting

The Research Ethics Committee examined and approved this study for adherence to the Declaration of Helsinki [9] (ethical approval number: #138-120-22) which conformed to the STROBE checklist. Before the questionnaire was administered, all potential participants were provided with a cover letter describing the study's goals and ensuring the confidentiality of their responses. The participants were informed that their participation was entirely voluntary and that they could withdraw anytime. Before completing the questionnaire, each participant provided written informed consent.

2.3. Inclusion and Exclusion Criteria of the Study

Inclusion criteria included a willingness to participate in the questionnaire voluntarily and signing a consent form before starting. All included patients were 18 years old and above and could read and understand either Arabic or English with no restriction on their educational level. Individuals who participated in the face and content validity tests were excluded from the analysis. Dental students and faculty members were excluded from this study.

2.4. Study Tools and Data Collection

The questionnaire comprised 17 questions, most of which were multiple-choice. Additionally, participants could provide written elaboration if none of the provided choices suited their opinion for each question. The questionnaire consisted of two sections: 1) demographic and background data (i.e., age, sex, education level, scientific background, Arabic proficiency) and 2) medical terminology (meaning of tumors, ulcer, vesicle, biopsy, swab, culture, and temporomandibular joint [TMJ]). This questionnaire was modified and adapted for relevance to our study [1]. The questionnaire, in both English and Arabic, is available upon request from the authors.

2.5. Forward and Backward Translation Validity

The questionnaire was constructed in English and incorporated common medical terminology in oral medicine, surgery, and pathology practices. A systematic process was used to translate the original English questionnaire into Arabic. This process was initiated by assigning three translators native to Arabic who were highly proficient in English and one bilingual translator (native to English and Arabic). Everyone produced a written translated version, after which all translators met to discuss the translation and produced a final version [10].

A backward translation (Arabic to English) was performed to confirm the accuracy and quality of the translated English version. The process was completed by two double-blinded translators from the original English questionnaire version and assigned to translate the final Arabic questionnaire into English to confirm its consistency with the original version of the English questionnaire [10]. An expert committee comprising a methodologist, oral medicine professionals, and language professionals reviewed various versions of the questionnaires, and a definite pre-final version was produced for face and content validity testing.

2.6. Face Validity and Content Validity Testing

Two patients attending the KAU clinics with no scientific background were chosen to participate in the survey to assess the questionnaire's face validity before its distribution. The two patients also provided feedback on the survey's clarity, and all comments were considered. Based on their feedback, the questionnaire was revised by two experts in the field to improve its validity.

2.7. Statistical Analysis

Data were automatically transferred from Google survey forms to a password-protected digital online Excel spreadsheet. Descriptive statistics (i.e., means and standard deviations for continuous variables and measures of frequency for categorical variables) were calculated for each question. Comparisons based on sex, age, and scientific background were conducted using the chi-squared test. An independent t-test was conducted to evaluate the difference between the studied groups (men and women, <50 years and ≥50 years, and participants with or without a scientific background) regarding the overall knowledge score. P-values under 0.05 were regarded as statistically significant. SAS version 9.4 and SPSS version 22 were used for the analysis.

2.8. Patient or Public Contributions

In this study, the role and input of the patients who participated in the survey, including their influence on the research findings, are referred to as patient contributions. The patient's contribution to this situation consists of participation in surveys, providing responses and demographic information, and influencing study outcomes. In general, the involvement of patients in this research is essential to meet the study's objectives, which include evaluating patients' understanding of oral medicine terminology and ultimately enhancing patient-provider communication in dental care environments.

3.1. Participants Characteristics and Background

A total of 286 participants were included, with a mean age of 43.4 ± 15.4 years. Men accounted for 66.4% of the participants, and women accounted for 33.6%. Approximately 63.3% of the participants had a scientific background. Regarding educational attainment, a substantial percentage of the participants had a university-level education (82.9%), 15% had completed secondary school (15%), and 2.1% had finished primary school. Regarding linguistic proficiency in Arabic, 97.6% of participants indicated that Arabic was their first language. The demographic data and characteristics of the study participants are summarized in Table 1.

3.2. Medical Terminology

3.2.1. Type of Lesions: Tumor, Malignant, Benign Tumor, Cancer, Ulcer, and Vesicle

For the term “tumor,” 70.3% perceived it as a mass that could either be cancerous or not, 13.3% believed it to be cancer, 8.7% associated it with swelling, 0.3% described it as unrestricted growth yet to be classified, and 7.3% were unsure of the definition. For “malignant tumor,” 2.4% believed it could be cancerous, 81.1% identified it as a cancerous tumor, 11.9% as uncertain, and 4.5% considered it non-cancerous. Regarding “benign tumor,” 7.7% thought it might or might not be cancerous, 6.6% perceived it as cancerous, 74.1% identified it as non-cancerous, and 11.5% were unsure of its definition. Finally, for “cancer,” 88.1% defined it as a disease that can spread to other body organs, 5.6% believed it to be an untreatable disease, 4.5% were uncertain, and 1.7% thought of it as an infectious disease. Regarding “ulcer,” 11.2% described it as a cyst full of fluids; 8% considered it a tender, soft mass; 55.6% described it as tissue with a scrapped surface; and 25.2% were unsure. For “vesicle,” 46.2% believed it to be a cyst full of fluids, 10.1% thought it was a tender, soft mass, 5.6% described it as a tissue with a scrapped surface, 37.4% admitted they did not know, and 0.3% had other descriptions, as shown in Fig. (1).

Table 1.

Variables		Frequency	Percent
Age (Mean± SD)		43.4 ± 15.4
Gender	Male	190	66.4%
	Female	96	33.6%
Scientific background	Yes	181	63.3%
	No	105	36.7%
Highest level of education	Primary School	6	2.1%
	Secondary School	43	15%
	University education	237	82.9%
Arabic as the first language	Yes, Arabic is my first language	279	97.6%
	No, but I am proficient in Arabic and can speak it fluently	4	1.4%
	No, but I can speak, read, and understand Arabic easily	1	0.3%
	No, but I can slightly speak and understand Arabic	2	0.7%

3.2.3. Anatomical Structures: Lymph Nodes and Temporomandibular Joint

Regarding the term “lymph nodes,” 5.6% perceived them as cancerous masses and 48.3% identified them as glands that eliminate body toxins. Additionally, 17.1% thought they were glands that secrete saliva, and 29% were unsure. Finally, for “TMJ,” 8.7% believed it is a joint connecting the jaw with the ear, and 1.7% thought it connects the jaw with the neck. Furthermore, 44.8% rightly perceived it as a joint connecting the lower jaw with the upper jaw, and another 44.8% admitted they did not know, as shown in Fig. (3).

3.3. Influence of Demographic Data on Understanding Terminologies Utilized in the Oral Medicine Clinics

3.4. Influence of Scientific Backgrounds on Understanding Terminologies Utilized in the Oral Medicine Clinics

Participants with a scientific background had higher accuracy in identifying “malignant tumor” than those without (88.9% vs. 77.6%, P = 0.041). Similarly, for the term “lymph nodes,” those with a scientific background demonstrated superior knowledge (65.4% vs. 40.5%, P < 0.001). Other terms where the scientific background group outperformed included “ulcer” (67.9% vs. 50.2%, P = 0.009), “vesicle” (66.7% vs. 38.5%, P < 0.001), “biopsy” (70.4% vs. 50.2%, P < 0.001), “sample culture” (69.1% vs. 48.8%, P < 0.001), and “TMJ” (63.0% vs. 37.1%, P < 0.001). The overall knowledge score was also significantly higher for participants with a scientific background (8.01±2.75) than those without (6.23±2.79, P < 0.001). Other terms, such as “tumor,” “benign tumor,” “cancer,” and “swab,” did not present statistically significant differences between the two groups, as shown in Table 4.

4.1. Medical Terminology

Understanding medical terminology is significant because it enables people to actively control their dental health and produce better results [11]. However, studies have shown that, even in highly specialized medical settings, patient knowledge levels are frequently lower than anticipated [12]. No prior research has considered how people comprehend the language used in oral medicine. However, this practice is widely used in primary and secondary care dentistry [11].

Our findings indicate variable comprehension of medical terms related to lesions. A significant 70.3% of participants correctly understood that a “tumor” could be either cancerous or benign, aligning with a prior outpatient study where 65% displayed similar knowledge [1]. Conversely, another study found that only 20% of patients understood this [5]. The high percentage of correct answers could be because most participants had a university-level education. Another explanation could be that our survey was sent through WhatsApp while waiting. Therefore, patients might have used an Internet search to answer [13]. Approximately 81% of our survey participants correctly defined “malignant” as a cancerous tumor, which is higher than the 65% found in a breast clinic environment [12] but closer to Hayes et al.'s findings of 70% [1]. The terms “ulcer” and “vesicle” showed that over half of the participants were familiar with their definitions, although Hayes et al. reported a higher 91% accuracy for the vesicle definition [1]. The terms “vesicle” and “ulcer” might be more commonly understood by the general population due to their broader application across multiple medical specialties and their frequent occurrence in daily life. For instance, conditions like cold sores or skin blisters are vesicles. Peptic ulcers or mouth ulcers are regularly encountered or discussed, making these terms more relatable and familiar to many individuals than specialized terms like “cancer” or “tumor.”

When it comes to diagnostic procedures, our study had a higher number of respondents who correctly described the term “biopsy,” in contrast with the 29% and 12% reported in 2 other studies [1, 5], respectively. Similar results were shown with both terms “sample culture” and “swab” attributed to the frequent media coverage and public discussions surrounding coronavirus disease 2019 testing methods, where swabbing became a commonplace term [14].

Focusing on anatomical structures, for the term “lymph nodes,” only 47.6% provided the correct definition. This contrasts with Hamilton's study, in which a mere 23% defined the lymph node as part of the lymphatic system, and the majority remained uninformed [5]. These conflicting results could be attributed to several factors, including different study populations, settings, and educational systems. When participants were queried about “TMJ,” our results were consistent with findings from another study where approximately 50% of participants displayed comparable knowledge [15].

Uncovering the level of understanding of these medical terminologies will provide a better assessment of the clarity of information that oral medicine providers convey to their patients. It will also help discover areas that require further efforts from oral medicine providers to educate their patients and enhance patient-dentist communication and mutual understanding, leading to better decision-making, a stress-free environment, and a higher quality of life.

4.2. Knowledge Gaps between Participants

Gender disparities in the comprehension of medical terminology were evident, with women consistently demonstrating a superior grasp over a range of terms compared to men. This difference may allude to factors such as educational background, exposure to healthcare environments, and sex-specific communication patterns. Women's superior performance in recognizing terms like “malignant tumor,” “benign tumor,” and “lymph nodes,” among others, may suggest that they are more actively engaged in health discussions or have more frequent encounters with healthcare systems. However, it is intriguing that terms such as “tumor” and “cancer” did not display the same-sex bias, possibly indicating that these terms are so commonly used in public discourse that gender disparities are minimized. The distinct overall knowledge score further emphasizes the potential differences in health literacy between genders. Recognizing these disparities is crucial for healthcare providers to effectively tailor patient education and communication strategies.

Age appears to play a pivotal role in the comprehension of medical terminology. Participants aged 50 and above displayed a more refined understanding of terms such as “ulcer,” “vesicle,” and “sample culture” compared to their younger counterparts. This could be attributed to their potentially increased interactions with healthcare settings or generational differences in the emphasis on specific medical conditions [16]. Conversely, the younger demographic's superior grasp of “biopsy” might suggest more recent exposure to this terminology or differences in health information access across generations. Various terms, including “tumor,” “malignant tumor,” and others, including the overall knowledge score, transcended age differences, pointing to a uniform understanding or shared cultural exposure to these concepts across generations. This highlights the need for age-tailored health education approaches to ensure that all age groups maintain comprehensive medical literacy.

The scientific background appears to significantly influence proficiency in understanding specific medical terminology. Participants with a scientific background showcased a marked advantage in correctly identifying terms like “malignant tumor,” “lymph nodes,” “ulcer,” “vesicle,” “biopsy,” “sample culture,” and “TMJ.” This pronounced difference might stem from their formal education, exposure to scientific literature, or more frequent interactions with healthcare settings and professionals [17]. The tangible edge in the overall knowledge score further emphasized the impact of having a scientific foundation on medical literacy. Nonetheless, terms such as “tumor,” “benign tumor,” “cancer,” and “swab” seem to be universally understood, hinting that they might be embedded more deeply in common discourse, irrespective of one's academic orientation. This insight emphasizes the role of educational exposure in shaping health and the importance of targeted health communication in various demographic groups. Patient perceptions and interpretations of medical knowledge may be influenced by their personal experiences, cultural beliefs, and individual values. Healthcare professionals must be aware and respectful of diverse viewpoints, focusing on communication and educational efforts regarding the unique requirements of each patient [17, 18]. Regardless of the patient's scientific background, healthcare personnel must communicate with patients clearly to ensure their accurate understanding [19]. Awareness of oral medicine, including terminology, should not be limited to the general population. Medical students and practitioners should also know targets to improve their significant lack of knowledge [20].