Multi-Institutional Assessment of Dental Students' Knowledge in Oral Soft Tissue Pathological Entities

This study provides a descriptive, multi-institutional comparison of dental students' recognition accuracy and management decisions of oral soft tissue pathological entities across four US dental schools. While prior single-institution studies have evaluated diagnostic ability, this work provides a multi-institutional comparison to identify recognition and decision-making variability as well as potential educational implications.

A voluntary, anonymous online survey with twenty image-based multiple-choice questions was administered to 160 students. Each question included an image, patient demographics, and key case details. Management questions were provided with reference diagnoses to prevent conflation of diagnostic and management errors. Descriptive statistics, t-tests, logistic regression, chi-square tests, and multi-rater kappa statistics were used to analyze performance, with effect sizes, reference groups, and 95% confidence intervals reported. Model fit for logistic models was assessed using likelihood ratio tests.

Students demonstrated a high level of recognition for conditions like candida (84%) and tobacco keratosis (95%). Subtle or clinically variable lesions were more challenging, such as erosive lichen planus (50%) and idiopathic leukoplakia (58%). Management accuracy frequently lagged behind recognition accuracy. Significant inter-school differences were observed for both recognition (χ² = 27.66, p < 0.0001) and management (χ² = 30.80, p < 0.0001), with students from School #4 outperforming peers. Kappa values remained low (< 0.2 for most items), indicating wide variability and limited internal agreement.

Students demonstrated strong theoretical knowledge of common oral pathological entities but variability in identifying and managing rare or diagnostically nuanced conditions. Because this survey evaluates recognition rather than competence, findings highlight the need for case-based, competency-aligned teaching approaches to strengthen diagnostic reasoning and management decision-making.