|Year : 2022 | Volume
| Issue : 4 | Page : 356-361
Knowledge, attitude, perception of practicing dentists toward coronavirus disease 2019 in Andhra Pradesh – A cross-sectional study
Rashmika Kolikipudi, L Vamsi Krishna Reddy, Vineela Parlapalli, Siva Kumar Pydi, Nagarjuna Pottem, Yaswanth Sai Rachuru
Department of Public Health Dentistry, Anil Neerukonda Institute of Dental Sciences, Visakhapatnam, Andhra Pradesh, India
|Date of Submission||12-Jul-2021|
|Date of Decision||22-Jun-2022|
|Date of Acceptance||27-Aug-2022|
|Date of Web Publication||19-Dec-2022|
Department of Public Health Dentistry, Anil Neerukonda Institute of Dental Sciences, Sangivalasa, Visakhapatnam - 531 162, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
The epidemic of Coronavirus disease 2019 (COVID-19), originated in Wuhan, China, has become a major public health challenge not only for China but also countries around the world. The repercussions of the current rapid spread of COVID-19, which has affected millions of people worldwide, ranging from being isolated and quarantined to fatality have resulted in considerable psychological stress and fear. Aim: The aim of the study is to assess the knowledge, attitude and perception of practicing dentists toward COVID-19 in Visakhapatnam. Materials and Methods: A self-administered, pretested, and validated questionnaire was designed and mailed to the dental professionals assessing information regarding sociodemographic details, knowledge, attitude, and perception toward COVID-19 among dental practitioners in Visakhapatnam. Convenience sampling was used and a total of 264 participants were included in the study based on inclusion and exclusion criteria. Results: The correct incubation period of the virus was recognized by 43% of participants. Participants in age groups 50–60, 40–50, were more likely to perceive COVID-19 as a very dangerous disease compared to 30–40 and 23–30 years of age groups. Study participants with 15–20 and 20–25 years of practice were more likely to treat those patients and ask them to go to the hospital (74%, 67%, respectively). On the other hand, dentists with 1–5, 5–10, years of practice were more likely to refuse to treat and ask him/her to leave clinic (75%, 63%, of participants, respectively). The study participants showed satisfactory knowledge and a positive attitude toward COVID-19. Conclusion: Although we had faced the prospect of a second wave of virus transmission, we must take certain measures and make changes to minimize the effects of next coming waves of the COVID-19 outbreak on dental practice. This is the time for change and there should be support and enthusiasm for providing valid solutions to reduce this disruption which can be achieved through increasing their accessibility to materials provided by dental health-care authorities, which specifies the best and safest approaches for dealing with patients during and after the outbreak.
Keywords: Aerosols, coronavirus disease 2019, dental care, personal protective equipment, severe acute respiratory syndrome coronavirus 2
|How to cite this article:|
Kolikipudi R, Reddy L V, Parlapalli V, Pydi SK, Pottem N, Rachuru YS. Knowledge, attitude, perception of practicing dentists toward coronavirus disease 2019 in Andhra Pradesh – A cross-sectional study. J Indian Assoc Public Health Dent 2022;20:356-61
|How to cite this URL:|
Kolikipudi R, Reddy L V, Parlapalli V, Pydi SK, Pottem N, Rachuru YS. Knowledge, attitude, perception of practicing dentists toward coronavirus disease 2019 in Andhra Pradesh – A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2023 Feb 9];20:356-61. Available from: https://www.jiaphd.org/text.asp?2022/20/4/356/364012
| Introduction|| |
On January 30th, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic, which was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is a novel coronavirus that has spread throughout the world and had been declared a public health emergency of international concern. COVID-19, as the disease is now known, is the third coronavirus to infect humans in recent years, following the outbreaks of SARS-CoV in 2002 and Middle East respiratory syndrome coronavirus in 2012. On the same day, India reported the first case of COVID-19. Test positive rate
(positive cases identified for every 100 tests) in India on a daily basis. On May 29, it was 9.4%, down from 13.4% the week earlier.
Human-to-human transmission of the SARS-CoV-2 virus occurs by respiratory and salivary droplets, as well as direct contact with cases or contaminated surfaces. Given the global spread of SARS-CoV-2 from China to all other parts of the world, it is critical to develop feasible preventive strategies in dental settings. However, other nonspecific symptoms may include sore throat, nasal congestion, headache, diarrhoea, nausea and vomiting. Even though this transmission mechanism is not yet fully understood, airborne transmission of the virus may occur during medical procedures that produce aerosols. Basic precautions to be taken to reduce the people at their risk. Communication through multiple information sources is crucial to encourage realistic risk perceptions and practical precautions. Vaccines created and used to stop the spread of SARS-CoV-2, as well as any tool used to administer the vaccination, are covered countermeasures.
Dental treatments for patients with COVID-19 or suspected of being infected by the virus are recommended to be postponed, except in cases of emergency; however, undiagnosed infected subjects with no or very mild symptoms may be seen for dental treatment. Furthermore, because many dental offices around the world have returned to providing routine or nonurgent dental care, limited knowledge and awareness, a lack of protocols and tests, and ineffective personal protective equipment (PPE) use may reduce the level of safety of patients, dentists, and dental care workforce, increasing the spread of infection in the community.
The basic concept in mode of viral transmission is mainly through inhalation/ingestion/direct mucous contact with saliva droplets, respiratory fluids and aerosols, they can also survive on surfaces and objects that are exposed to infected body fluids. Splatters and aerosols produced during ordinary dental treatments, together with the physical contact to the patient's face, raise the risk of cross-infection in dentistry, which is regarded as high. The typical definition of splatter is a mixture of air, water, and/or solid materials; the water droplets in splatter range in size from 50 micrometres to several millimetres and are visible to the unaided eye. Dentists and other health-care workers who work in wards with pneumonia patients are more likely to contract infectious infections as a result of their daily activities. A dead body often has fluids like saliva, phlegm, and blood oozing out and those could be a source of virus. Operating envelopes and disinfection processes to prevent cross-infection are plausible, but hypothetical, without data on airborne SARS-Cov-2 transmission from actual dental care circumstances. The SARS-CoV-2 virus, which shares 79% genetic similarity with the SARS-CoV from the 2003 SARS outbreak, was identified as the disease-causing agent. As a result, it appears that more caution is required. However, undiscovered infected persons without or with very minor symptoms may be seen for dental treatment. Patients with COVID-19 or suspected to be infected by the virus are advised to postpone dental treatments, unless necessary. The likelihood of methicillin-resistant Staphylococcus aureus, spread will be lowered through infection prevention methods. Well-designed questionnaires are a useful method to collect data easily from participants in studies. Questionnaires used to investigate dentists' knowledge, attitudes, and perceptions about viral infection control in the dental environment reveal that awareness and precautionary measures taken by dentists on patients with a viral infection are not always completely satisfactory. Both dentists' perceptions of the risk of SARS-CoV-2 infection, as well as the protective measures they took during the lockdown and at work restarts where nonurgent dental treatment had been suspended, are speculative and understudied. Hence, the aim of the study is to assess the knowledge, attitude, perception, and fear and anxiety among practicing dentists toward COVID-19 in Visakhapatnam.
| Materials and Methods|| |
This cross-sectional questionnaire-based study has been carried out following the STROBE guidelines specified for this type of study. The approval was obtained from the Institution Ethical Committee, under Ref No. ANIDS\IEC\2121014. The study was conducted in Visakhapatnam, Andhra Pradesh, among dental practitioners to investigate their knowledge, attitude, and perceptions toward COVID-19 from December 1–12, 2020, to January 30, 2021. A structured self-administered online questionnaire was administered for this cross-sectional survey to evaluate knowledge, attitudes, and perceptions regarding COVID-19 among dental practitioners. Three expert reviewers evaluated the questionnaire for validity, and a pilot study with participants was conducted during early October 2020 to collect responses from 30 dentists who were not part of the study to check reliability. Three experienced researchers familiar with the topic assessed the questionnaire's face validity based on the relevance and structure of the questions. Participants' replies were gathered twice, with a 1-week gap between each collection. Cronbach's alpha was used to calculate test–retest reliability, and the result was 0.89, which indicates strong reliability. The questionnaire has been mailed to the practitioners which consists of 34 closed-ended questions and the answers were recorded using a three-point Likert scale. The questionnaire was divided into four main parts. The first constituted the study participants' demographic information (age and gender). The second part elicited the knowledge of oral health professionals toward COVID-19 by giving correct or incorrect options for every question. The third part assessed attitudes toward COVID-19 infection. The fifth part was considered for preventive practice. Each response was scored as “1” (correct) and “0” (wrong), with knowledge scores ranging from 0 to 7 and attitude scores ranging from 0 to 9. Comparisons of knowledge and attitude scores based on gender and practice questions were evaluated. The correlation between knowledge and attitude scores was established based on practice questions. The questionnaire was circulated among the target population in the form of an online Google form, and the recruitment was done through various social media platforms and contact information obtained from the database. The sample size was assessed using the formula N = z2pq/L2, considering the prevalence of knowledge in the previous study 78%. Hence, a sample size of 274 was obtained, which was rounded off to 280. Each participant scores average was taken which was later converted to percentage to get an overview on their general knowledge, attitude, and perception.
The collected data are entered into Microsoft Word Excel Sheet 2019 version and were analyzed using IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp, Released 2012.
Descriptive statistics were used for the analysis of mean, frequency and percentage of data distribution of study variables.
Chi-square test was used to find out the differences between age groups and gender with respect to knowledge, attitude, and perception regarding COVID-19. Statistical significance was set at P ≤ 0.05.
| Results|| |
A total of 264 participants submitted the completed questionnaire with a total of 34 questions comprised of 4 sec about knowledge attitude and perception toward COVID-19. The demographic information of the participants is presented in [Table 1] Majority of the respondents were male 135 (51.14%) and the remaining were female respondents 129 (48.86%). There were majority of 30–40 years old participants 98 (37.12%), followed by 23–30 years 90 (34.09), 40–50 years old participants 64 (24.24%), and the remaining were 50–60 years old participants 12 (4.55%).
|Table 1: Sociodemographic characteristics of the dental practitioners n (264)|
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There were majority of BDS-graduated practitioners 160 (60.61%) were as the remaining were MDS graduates 104 (39.39%). The practitioners who participated in this study are those who work for full-time and part-time workers. The majority of the participants were full-time practitioners 193 (73.11%) and rest of them were part-time practitioners 71 (26.89%). Based on the experience of the practitioners, there were a greater number of practitioners with the experience of 10–15 years 82 (31.06%), followed by 5–10 years of experienced participants 67 (25.38%), 15–20 years of experience 52 (19.70%), 1–5 years of experienced participants were 36 (13.64%), and the most experienced practitioners, i.e., 20–25 years 27 (10.23%).
Regarding the knowledge of the practitioners, majority of the participants agreed that PPE such as dental goggles, FFP2 (KN95) masks, and gloves are useful in protecting them from a patient suspected to have COVID-19 180 (68.1%); 100 (37.8%) agrees that COVID-19 be transmitted by Hands shaking [Table 2]. 113 (42.8%) say that it is important to change both masks and gloves to decrease the possibility of transmitting infections to patients and themselves.
|Table 2: Knowledge of dental practitioners toward coronavirus disease 2019|
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Regarding attitude and perceptions of the practitioners 228 (86.36%) perceive that COVID-19 is moderately dangerous [Table 3]. Majority of the participants 234 (88.6%) agreed that it is important to educate people about COVID-19 to prevent the spread of the disease. 226 (85.6%) were preferring to avoid working with a patient who is suspected of COVID-19.
|Table 3: Attitude and perceptions of dental practitioners toward coronavirus disease 2019|
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[Table 4] shows the scores received by respondents with minimum and maximum scores regarding knowledge 20, 24 (22.86 ± 1.354), attitude 12, 27 (13.54 ± 1.826), and perception 19, 24 (20.02±0.696).
Participants in 40–50, and 50–60 age groups were more likely to perceive it as a very dangerous disease (67%, 75% of participants, respectively) compared to 30–40 and 23–30 age groups (62% and 53% of participants, respectively [Figure 1].
|Figure 1: Distributions of different risk perception categories among different age groups of participants (n = 264)|
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Dentists with 15–20 and 20–25 years of practice were more likely to treat those patients and ask them to go to the hospital (74%, 67% respectively). On the other hand, dentists with 5–10, 10–15, years of practice were more likely to refer a patient to the hospital without treating them (24%, 21%, of participants, respectively) [Figure 2].
|Figure 2: Distribution of different approaches for dealing with suspected COVID-19 patients among dentists with different years of practice (n = 264), COVID-19: Coronavirus disease 2019|
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| Discussion|| |
The current study, which was conducted at the early stage of the COVID-19 outbreak, evaluated the general knowledge level, protection measures, and perceptions related to the COVID-19 outbreak among dentists in Visakhapatnam, Andhra Pradesh. The majority of the participants in this study were male dentists (51.14%), which is in accordance with a study conducted by Almulhim et al. and Mustafa et al. In general, the knowledge level was satisfactory for dentists, however, the results showed that some gaps in the knowledge about the SARSCoV-2 virus do exist among the participants, as only 35.9% were aware of extra precautionary measures that protect dental staff and other patients from COVID– 19. This is in contrast with the findings of a recent study assessing the knowledge of Saudi Arabian dentists about the SARSCoV-2 virus, where 86% of participants were aware of extra precautionary measures. Only 34.5% were able to determine the correct incubation period for the virus. This is in accordance with the findings of a recent study assessing the knowledge of Jordanian dentists about the SARSCoV-2 virus, where only 36.1% identified the correct incubation period. The estimated incubation period was reported as up to 14 days, and in some rare cases, it can be longer. Knowledge can influence the perceptions of HCWs due to their past experiences and beliefs. This asymptomatic period can be extremely dangerous for health care workers HCWs including dental staff, as the disease can spread before any symptoms are detected. Therefore, it is recommended to increase the level of awareness of preventative measures to control its spread. The current study showed that only about 21% of respondents had attended clinical training or lectures on COVID-19. This may be attributed to the period during which the study was conducted when the outbreak in India had just begun and the country was on lockdown. This finding suggests that educational measures should be considered to improve the knowledge level of dental staff. It is also highly recommended to increase dentists' access to materials provided by health-care authorities.
The satisfactory level of knowledge among the majority of the participants suggests that they were exposed to other information sources, including social media and the Internet. Nowadays, these sources are greatly effective and reachable at all times, increasing public awareness. However, information delivered through these sources may not necessarily be accurate, resulting in misinformation about COVID-19 being spread among the public. Information delivered through social media had also been shown to result in the serious issue of international xenophobia.
In this perspective, information from reliable sources such as scientific health authorities and international health organizations are recommended to be the main informative sources.
The current study showed that participants have good knowledge about the mode of transmission and the clinical symptoms. This is important in identifying infected patients and controlling the spread of the disease. This finding is consistent with findings from previous studies about COVID-19, the most reported symptoms in this study were fever, cough, and shortness of breath.
Interestingly, the current study showed that the percentage of dentists who perceived COVID-19 as a very dangerous issue was significantly higher among older dentists (above 50 years old age groups) than younger dentists. This can be explained by studies reporting that progression to the severe form of COVID-19 disease is higher in elderly. In addition, the severe form of COVID-19 may cause severe acute respiratory illness, shock, and even death in some cases, especially in patients with underlying comorbidities, such as hypertension, cardiovascular disorder, diabetes mellitus, chronic renal disease, chronic respiratory disorder, and immunosuppression. There is no approved antiviral treatment against COVID-19 at present; therefore, the only action for health care professionals is to provide supportive care and follow preventive measures to prevent the spread of the infection. As a result, older dentists perceived COVID-19 as a very dangerous issue, as older individuals are generally more prone to serious complications.
The current study showed a significant relationship between the years of practice and the dentists' attitude toward treating patients with symptoms of coughing or sneezing. Dentists with more years of practice were shown to be more likely to treat those patients compared to dentists with less years of practice. Accordingly, the null hypothesis was partially rejected. This can be explained by the fact that the increased years of practice are associated with greater experience in dealing with infectious cases. A previous study also suggested that precaution measures were positively associated with dentists having experience of longer than 10 years.
The majority of participants were aware of whom to contact in case of unprotected exposure to a known or suspected COVID-19 patient (71.2%) and what to do in case of encountering symptoms of COVID-19 (90.3%). This indicates the awareness of dentists in Andhra Pradesh and their role in increasing population awareness regarding infection control and prevention measures. This finding is consistent with previous research findings among dentists in Jordan and Saudi Arabia.
The present study has some limitations. First, the present study was limited by cross-sectional design, only associations can be presented, without cause–effect relationships. Second, the self-reporting nature and the recall ability of the participants during the completion of this survey should be considered. Further future studies, however, are recommended after a period of quarantine with a larger sample size that allows better generalization of the results.
| Conclusion|| |
In general, dentists in Andhra Pradesh, involved in the current survey showed satisfactory knowledge and a positive attitude toward COVID-19 during the outbreak. However, there is still scope for recommendations to improve the knowledge level among dental staff. In addition, it is recommended to increase the dentists' access to materials provided by dental health-care authorities and to specify the best and safest approaches when dealing with COVID-19 patients during and after the outbreak.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]