Oral cavity cancer (OCC) is a public health problem, with approximately 355,000 new cases and over 177,000 deaths occurring globally per year. In comparison with many other cancers, 5-year survival rates for OCC are relatively poor and there has been limited improvement in these rates over the past few decades. Delay from first symptom to referral for diagnosis is a risk factor for advanced stage presentation and subsequent poorer survival. By contrast, the treatment of small, early-stage lesions is associated with reduced morbidity and mortality. The oral cavity has been described as a site which is relatively easy to examine, and it has therefore been proposed that improvement in outcomes should be possible through implementation of guidelines associated with the examination of the mouth and surrounding tissues for oral cancer and oral potentially malignant disorders (OPMDs), this process is described as a conventional oral examination (COE). An initial review of the literature showed that although there have been a number of systematic reviews and numerous clinical guidelines on the topic of the COE, there has been limited consistency and insufficient evidence available to support clear practice. Uncertainties remain around a number of factors associated with the examination process including: a) the method of conducting the COE, b) the target population, i.e. high risk or universal approach, c) the frequency of the oral cancer examination procedure, and d) the extent to which adjunct tools are used. Additionally, there is some ambiguity and limited information available on the clinical practice and views of oral health care professionals (OHCPs) and patients around these issues and the barriers and facilitators to implementing the COE in the primary dental care setting. This thesis describes three studies which were undertaken to try and address the identified gaps in the knowledge and evidence base. The first study was a systematic overview of systematic reviews and published clinical guidelines and aimed to identify best practice in relation to oral cavity cancer early detection/ screening. The themes explored were based on the four factors associated with the examination process which were outlined above. The findings were used to develop the subsequent two studies. The second study explored the findings of the systematic overview among OHCPs in dental primary care in Scotland and the Sultanate of Oman (the home country of the author of this thesis). Qualitative in-depth interviews were undertaken with the dental professionals to investigate current practice in relation to the COE process and to identify barriers and facilitators to implementation. Analysis was performed using an up-to-date model of behaviour change – the Behaviour Change Wheel. The interviews also asked for views on the development of risk-based tools to facilitate the prevention and early detection of OCC. The third study was a qualitative survey of dental primary care patients from the two countries to explore their perceptions of the barriers and facilitators to a COE and to obtain their views on the acceptability of risk-based interventions.

Oral cavity cancer (OCC) is a public health problem, with approximately 355,000 new cases and over 177,000 deaths occurring globally per year. In comparison with many other cancers, 5-year survival rates for OCC are relatively poor and there has been limited improvement in these rates over the past ...