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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 2  |  Page : 153-158

Awareness regarding COVID-19 preparedness among dentists: A cross-sectional survey


1 Mobile Dental Clinic Project, New Delhi, India
2 Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India

Date of Submission25-May-2021
Date of Decision19-Jul-2021
Date of Acceptance01-Apr-2022
Date of Web Publication8-Jun-2022

Correspondence Address:
Swati Jain
Room No.504, Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi - 110002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_89_21

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  Abstract 


Background: Novel coronavirus pandemic has emerged as a grave global health crisis. The pandemic curve is still on the rise. Dental professionals face unique challenges and work pressure due to the fear of the spread of disease while coming in close contact with the potential carriers. Aim: The aim is to assess the knowledge and preparedness level toward novel coronavirus diseases among the dental professionals of India. Methodology: Online survey was carried out from May 2020 to June 2020 on dental health care professionals through snowball sampling. A 24-item structured closed-ended online questionnaire was used. Statistical Analysis Used: Frequency distribution and proportions of the responses were analyzed using the SPSS version 21. Results: A total of 154 dental professionals participated in the study. Majority of the respondents (72.72%) were aware about the correct genomic structure of the virus and aptly identified the early neurological symptom of novel coronavirus disease. 85.71% of the respondents were appropriately informed about the infection control protocol to be followed. However, regarding the protection level to be used while dealing COVID patients, only 24.03% of respondents correctly identified it as Level III. Regarding the amendments required in dental practice and level of preparedness, only 50% of the dental health-care workers were aware of the sequence of donning of personal protective equipment. Conclusions: In the present study, dentists were found to have good knowledge toward novel coronavirus disease with optimum preparedness level for dental practice modification. Dental fraternity is further advised to follow the standard guidelines overcoming this pandemic.

Keywords: COVID-19, dentist, India, pandemic


How to cite this article:
Jain S, Mohanty V, Gangil N, Arora S, Bajaj A. Awareness regarding COVID-19 preparedness among dentists: A cross-sectional survey. J Indian Assoc Public Health Dent 2022;20:153-8

How to cite this URL:
Jain S, Mohanty V, Gangil N, Arora S, Bajaj A. Awareness regarding COVID-19 preparedness among dentists: A cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 Jun 30];20:153-8. Available from: https://www.jiaphd.org/text.asp?2022/20/2/153/346888




  Introduction Top


The novel coronavirus pandemic has emerged as a grave global health crisis and the greatest health-care challenge in recent times. Starting from the Wuhan province of China in 2019, the disease has now spread to all continents. Globally, as on July 20, 2020, there have been 14,348,858 confirmed cases of novel coronavirus disease, including 603,691 deaths, reported to the World Health Organization.[1] The pandemic curve is still on the rise in many countries including India, and the scientists still remain dubious regarding the timeline for curbing the disease.[1],[2],[3]

India is leaving no stone unturned to slow the spread of the virus through strategic measures like nationwide lockdown, for rapid testing, carrying out contact tracing and treating patients, limiting travel, home quarantine strategies, and canceling large gatherings such as sporting events, concerts, and complete closure of schools, colleges, and educational institutions.[4]

However, novel coronavirus disease is much more than a health crisis. It has caused devastating social, economic, and political crises all over the world bringing the world's economy to a standstill. Much can be attributed to halt in economic activity in both advanced and developing countries.[5]

Health-care workers all over the world face unique challenges and work pressure not only due to the fear of the spread of disease while coming in close contact with the potential carriers but also due to their work profile. Dentistry faces a unique challenge as their role in preventing the transmission of novel coronavirus disease is critically important. As per the novel coronavirus disease, occupational risk score calculated by the US Labor Department using three physical attributes of job: (1) contact with others, (2) physical proximity with the other person, and (3) exposure to disease and infection; Dentists have been place at the “high-risk zone” due to their nature of job.[6] All routine dental care have been suspended during the pandemic until preparedness among dentists could be ensured to prevent the spread of novel coronavirus disease. It is essential to ascertain appropriate infection control strategies, especially at dental clinics to render optimum patient care without the fear of the spread of infection.

Limited literature exists highlighting the stage of dentists' preparedness to curtail the spread of novel coronavirus diseases in their clinical setup in India. Thus, the present study aims to assess the knowledge and preparedness toward novel coronavirus diseases among the dental professionals of India.


  Methodology Top


An online survey was carried out by the Mobile Dental Clinic Project, Maulana Azad Institute of Dental Sciences, New Delhi, from May 2020 to June 2020. Dental health-care professionals, faculties, and postgraduate students from all over India who could be contacted online were considered for the survey. Only those dental professionals who gave consent were included in the study. Before the survey, the study design was reviewed and approved by the Institutional Ethical Committee. The study subjects were approached through a snowball sampling method and written informed consent was obtained from all the study subjects after explaining them the purpose and methodology of the study.

The survey instrument was a structured closed-ended online questionnaire, which was finalized after pretesting and pilot study. Before the start of the pilot study, its validity and reliability were evaluated on 20 forms. Content validity was assessed by a panel of four experts (faculty from the Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences). Items depicting a high degree of the agreement were kept in the final questionnaire. The expert panel further recommended the correct sequencing of questions, and such modifications were included in the final tool. Authenticity of the filling of forms were confirmed by telephonic verification of the respondents.

The pilot survey included responses from 10 random participants. Subjects participating in the pilot study did not repeat the survey. Correlations between the items as well as between individual items and the overall score were estimated to assess the appropriateness of each of the items. None of the initially developed items was removed from the final questionnaire after analyzing the results of the pilot study. The final responses were checked by the investigator to ensure the authenticity of the forms. Finally, the 24-item questionnaire was checked for internal consistency by test–retest method (Cronbach's alpha value = 0.89), was higher than the recommended standard, which is (0.80).

The questionnaire consisted of three sections: (a) sociodemographic information of the study respondents, (b) knowledge regarding novel coronavirus, and (c) dentists' preparedness regarding novel coronavirus pandemic for dental practice. It was then distributed online using various online portals. A total of 154 dental professionals completed the survey.

Statistical analysis

All the responses were entered in the Microsoft Word Excel Sheet 2007 version and processed using the SPSS 21 version IBM SPSS Statistics for Windows, Version 26.0.; IBM Corp. Released 2019. Armonk, NY: IBM Corp. The proportions (% of responses) were calculated for each question.


  Results Top


The present study was conducted on 154 dental health-care professionals, faculty, and postgraduate students from all over the country. Approximately 55% (n = 84) of the responders were females and 44% (n = 70) were males, including 65.94% of postgraduates and 35.06% of dental graduates health-care professionals. Around 18.18% (n = 28) of the respondents were working in government setups and others were from private sectors or postgraduate students. Majority of the responders (49.35%) were having the practice experience of <5 years and 42.20% were having between 5 and 10 years of experience [Table 1].
Table 1: Knowledge regarding novel coronavirus and general preventive strategies

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Regarding the knowledge about novel coronavirus, interestingly, majority of the respondents (72.72%) were aware about the correct genomic structure of the virus (ssRNA). However, the dilemma regarding the attachment process of the virus to the human cell was evident wherein 47.40% and 42.21% identified it as surface glycoproteins and surface proteins, respectively. Most (58.44%) of the respondents aptly identified the early neurological symptom of novel coronavirus disease as loss of smell.

[Table 2] highlights the dentists' preparedness regarding novel coronavirus disease and general preventive strategies. Nearly 85% of the respondents were aptly informed about the protocol to be followed in case a corona-positive patient reports to their clinical practice. However, regarding the protection level to be used while dealing COVID patients, only 24.03% of the respondents correctly identified it as Level III. Regarding the amendments required in dental practice and the level of preparedness to cope up with the present novel coronavirus disease worldwide [Table 3] and [Table 4], only 50% of the dental health-care workers were aware of the sequence of donning of personal protective equipment (PPE). A higher percentage of correct responses with 88.31% came for the infection prevention strategies to prevent or limit the novel coronavirus.
Table 2: Dentist's preparedness regarding novel coronavirus disease and general preventive strategies

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Table 3: Preparedness regarding universal precautions and other related requirements for novel coronavirus disease

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Table 4: Preparedness regarding specific dental treatment procedures

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Regarding the specific dental treatment procedures [Table 4], nearly three-fourth of the respondents were aware about the procedures creating aerosols which are to be completely avoided during the crisis, whereas 22.7% of the respondents were having knowledge about the alternate nonaerosol-producing procedure for the replacement of missing anterior teeth as Maryland Bridge. More than 94% of the respondents aptly identified the use of N95 masks, goggles, gloves, and face shields while providing treatment.


  Discussion Top


The world is going through an unprecedented situation during the novel coronavirus disease pandemic. Owing to the measures enacted to prevent the spread of this pandemic, such as large-scale quarantines, travel restrictions, social distancing measures, and sharp decrease in consumer and business spending are expected to impact every aspect of global economy. Dentistry, the worst affected field of health care, is no exception to this.[7] As per the Centre for Disease Control and Prevention, the United States, “Dental settings have unique characteristics that warrant specific infection control considerations. It is imperative to prioritize the most critical dental services and provide care in a way that minimizes harm to patients from delaying care and harm to personnel from potential exposure to novel coronavirus disease.”[8]

Dental practices are suffering huge financial losses and according to a survey by the Irish Dental Association, around one-fifth of the dentists have closed their practices.[7] The novel coronavirus disease pandemic is negatively impacting the mental health and activity of dentists owing to the high occupational risk, especially concerning novel coronavirus disease.[9] Restrictions on dental facilities have forced patients to suffer in pain. The resumption of dental services is essential for both patients and dentists. Nonetheless, given the possibility that this pandemic will continue for more than a year, dentists must be prepared to function, adopt, and adapt to the new norms of practice and novel coronavirus disease prevention.[9]

The present study reported the dentists' preparedness to curtail the spread of novel coronavirus diseases in their clinical setup. For this purpose, a questionnaire focusing on closed-ended questions was used to gather information about dentists' knowledge about novel coronavirus disease and understanding of necessities in dental clinic to deter the spread of infection. Questionnaire-based studies are proven to gather information on participant preferences, attitudes, opinions, and experiences;[10],[11] however, careful data collection and interpretation are required. A valid questionnaire allows to gather higher quality data of good comparability, with reduced efforts and improving data integrity.[12]

In the present study, it is seen that the majority of the participants were aware of the mode of spread and transmission of novel coronavirus disease and also about coronavirus microbiology. This knowledge is an essential part of infection control measures as the virus is spreading very fast. Dentists in this study varied in their knowledge about the novel coronavirus attachment to the host cell, i.e., the virulence factor, but it is essential to know the right pathogenesis that will help in understanding signs and symptoms in patients as well as the stage of disease. Dental care settings invariably carry the risk of novel coronavirus disease infection due to the specificity of its procedures, which involves face-to-face communication with patients, frequent exposure to saliva and blood, and generation of aerosols during the procedure.[13] As per the guidelines of the Ministry of Health and Family Welfare, India; it has been advised that in view of the pandemic; Dentists, auxiliaries, as well as patients undergoing dental procedures are at high risk of cross-infection as the most dental procedures require close contact with the patient's oral cavity, saliva, blood, and respiratory tract secretions. Saliva is rich in novel coronavirus load.[14]

It was seen in the study that most dentists were having the knowledge of preparedness of their clinics regard to novel coronavirus disease. Many dentists agreed that the ultrasonic and sonic transmissions during nonsurgical procedures had the highest incidence of particle transmission. As per the Occupational Safety and Health Act for novel coronavirus disease, the occupations that are involved with aerosol production fall into the category of very high risk.[15]

All dentists agreed that they could help in spreading awareness regarding the disease with the use of Information, Education, and Communication material and education sessions. Majority of dentists were agreed that hand hygiene and PPE were effective in preventing novel coronavirus disease. In the present study, it was seen that most of the dentists were aware about the basic steps of donning of PPE. Correct donning of filtering face piece respirators protects workers against inhaling infectious particles such as viruses and bacteria.[16] Moreover, the correct doffing technique protects workers from exposure to infectious materials that may have settled on the respirator itself. However, in this study, it was found that most dentists were unaware of levels of PPE.

Most of the participants were of the view that in dental health-care settings, the main infection prevention strategies to prevent novel corona virus infection transmission includes use of telemedicine, proper triage, compulsory use of for everyone, minimum aerosol-generation procedures, and fumigation of area after every patient. In a recent study by Kampf et al., it was reviewed that inanimate surface human coronaviruses can remain infectious for up to 9 days.[17] A surface disinfection with 0.1% sodium hypochlorite, 0.5% hydrogen peroxide, or 62%–71% ethanol can be regarded as effective against coronaviruses.[16]

As the study was conducted at the time when the Novel Corona virus disease was spreading, respondents had little knowledge about the characteristics of the virus and were less aware regarding the definitive treatment protocol of novel coronavirus disease. There could be a larger sample size to conclude that has increased the generalization in the study. In addition, the data presented in this study are self-reported and partly dependent on the participants' honesty and recall ability. Despite these limitations, our findings provide valuable information about the knowledge and perceptions of dentists during a peak period of the pandemic.


  Conclusions Top


In the present study, dentists were found to have good knowledge toward novel coronavirus disease prevention. In addition, optimum knowledge and preparedness level regarding novel coronavirus disease is associated with optimistic attitudes and appropriate safe practices toward novel coronavirus disease. The present study provides an insight on knowledge and practice among dental fraternity, and observes a satisfactory level of information regarding prevention and safe practices among them.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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2.
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Cantore N, Hartwich F, Lavopa A, Haverkamp K, Laplane A, Rodousakis N. Coronavirus: The Economic Impact. Available from: https://www.unido.org/stories/coronavirus-economic-impact. [Last accessed on 2020 May 12].  Back to cited text no. 5
    
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Center for Disease Control. Guidance for Dental Settings. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. [Last accessed on 2020 Jul 20].  Back to cited text no. 8
    
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Vergara-Buenaventura A, Chavez-Tuñon M, Castro-Ruiz C. The mental health consequences of coronavirus disease 2019 pandemic in dentistry. Disaster Med Public Health Prep 2020;14:e31-4.  Back to cited text no. 9
    
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Lewis A, Oppenheim A. Questionnaire Design, Interviewing and Attitude Measurement. 1st ed. London: Pinter; 1992.  Back to cited text no. 10
    
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Ministry of Health and Family Welfare. Guidelines for Dental Professionals in COVID-19 Situation. Available from: https://www.mohfw.gov.in/pdf/DentalAdvisoryF.pdf. [Last accessed on 2020 Jul 20].  Back to cited text no. 14
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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