Assessment of Knowledge and Awareness among Dentists about COVID-19 Infection: A Qualitative Study.

BACKGROUND: This study was an attempt to evaluate the knowledge and awareness among dentists about COVID-19 infection.
METHODOLOGY: This study was conducted among 580 dental professionals that comprised graduates (BDS), masters (MDS), postgraduates, and PhD fellows. A questionnaire containing information about knowledge, attitude, and awareness about COVID-19 infection was administered and recorded.
RESULTS: A total of 493 (85%) respondents replied correct answer that SARS-CoV-2 causes COVID-19. A total of 464 (80%) respondents replied that SARS-CoV-2 is the highest infectious virus among all. A total of 510 (88%) respondents replied the correct answer that 2-14 days is the incubation period of COVID-19 virus. Only 116 (20%) respondents replied the correct answer that MERS has high mortality. Only 87 (15%) respondents were aware of the appropriate mortality rate of COVID-19 disease. A total of 455 (78.4%) respondents had knowledge of the method of detecting COVID-19 infection (real-time reverse transcription-polymerase chain reaction). Knowledge level was good as seen in 81%, fair in 9.5%, and poor in 10.5% of the respondents.
CONCLUSION: The authors found that dental professionals had fair knowledge and awareness regarding COVID-19 infection. Copyright:

INTRODUCTION

It was December 30 2019, when China in its Wuhan city first reported few cases of pneumonia-like infections. The World Health Organization (WHO) termed it as COVID-19 caused by SARS-CoV-2, a single-stranded RNA virus. It was marked as a world health emergency which raised the alarm to have sufficient protection against this deadly virus. The term “novel” is used because it is a new strain to the already-existing family.[1] It is well established from various studies and research work done so far that it is a virus of highly infectious nature. The mode of transfer is via respiratory droplets either through sneezing or coughing.[2] It is also known that if the infected person sneezes or coughs, the droplets which are emitted through his/her mouth spread in the air and after certain period of time it falls on surfaces and if somebody accidentally touches that surface, the virus can reach that person. It can also be transmitted through shaking hands. Mouth, eyes, and nose are the organs through which virus makes entry into the body.[3] It has an incubation period of 2–14 days, and individuals with this infection may manifest as mild cough, sneezing, fever (up to 101°C), diarrhea, sore throat, etc., In most of the cases, patients do not require intensive care unit admissions except in life-threatening conditions where the level of oxygen falls significantly.[4] It has been reported that the number of asymptomatic carriers has markedly increased, making the situation more difficult. Thus, keeping the present situation in mind, the first prevention is to avoid personal contacts and to maintain sufficient distance. The aim is to break the virus transmission chain by adopting protective measures laid by the WHO time to time.[5] The knowledge and awareness about SARS-CoV-2 is essential not only to prevent getting infected but also to keep others protected. This study was an attempt to evaluate the knowledge and awareness among dentists about COVID-19 infection.

METHODOLOGY

This cross-sectional questionnaire survey was commenced after getting approval from the ethical clearance committee of the institute. We recruited 580 dental professionals that comprised graduates (BDS), masters (MDS), postgraduates, and PhD fellows of both genders. They all agreed to participate in the study and signed a written consent. Data of the recruited participants were obtained through E-mails, which comprised of their demographic profile. A questionnaire was prepared with the help of experts in the field of medicine and dentistry. All participants were provided with the questionnaire in Google Form and were asked to respond accordingly. It was a set of thirty questions comprising demographic details, attitude, knowledge, and preparation against COVID-19. Data from all the participants were collected by E-mails. Correct answer was given 1 number and wrong answer was given 0. The Google Form calculated the correct answer and automatically calculated the score (percentage). Based on the calculated knowledge score (percentage), three categories were made. The first category had score ranging from 0% to 40%, and were termed poor knowledge; the second category had score ranging from 41% to 70%, and were termed fair knowledge; and the third category had score ranging from 70% and above, and were termed good knowledge. The results were aggregated and entered in Google Excel sheet for statistical assessment using SPSS version (16) (IBM Corporation, Armonk, New York, United States of America) for Windows 10. P < 0.05 was taken statistically significant and if < 0.01 as highly statistically significant.

RESULTS

Table 1 shows that there were 330 males and 250 females. A total of 184 respondents were in the age group of 18–30 years, 290 were in the age group of 31–40 years, 80 were in the age group of 41–50 years, and 36 respondents were aged >50 years. A total of 348 respondents were form private sector, 128 from public, and 104 were from institute. Work experience was <5 years in 232, 5–10 years in 260, and >10 years in 90 respondents. Education level was BDS in 264, MDS in 232, PGs in 72, and PhDs in 12 respondents. A total of 350 respondents had general infection control training and 270 had infection control training against COVID-19. The difference was statistically nonsignificant (P > 0.05). Table 2 shows the questionnaire to check the level of knowledge. On response to first question, 262 (45%) gave correct answer. A total of 493 (85%) respondents replied correct answer that SARS-CoV-2 causes COVID-19. A total of 464 (80%) respondents replied that SARS-CoV-2 is the highest infectious virus among all. A total of 510 (88%) respondents replied correct answer that 2–14 days is the incubation period of COVID-19 virus. Only 116 (20%) respondents replied correct answer that MERS has a high mortality. Only 87 (15%) respondents were aware of the appropriate mortality rate of COVID-19 disease. A total of 455 (78.4%) respondents had knowledge of method of detecting COVID-19 infection (real-time reverse transcription-polymerase chain reaction [rRT-PCR]). Table 3 shows that in response to the question, how much SARS-CoV-2 patients exhibit mild symptoms, 290 respondents (50%) replied 90%, 165 (28.4%) replied 60%, and 120 (21.6%) replied 35%. A total of 298 (51.3%) respondents replied that dentists should use A1 masks, 145 (25%) replied that they should use A2 masks, and 50 (8.6%) replied do not know. A total of 505 (87%) respondents replied that dentists come under very high risk category, 58 (10%) reported that they are under high risk category, and 17 (3%) reported that they are under low risk category. A total of 481 (83%) respondents replied that personal protective equipment (PPE) protect against SARS-CoV-2, 60 (10.3%) replied no for the same, and 39 (6.7%) replied do not know. In response to providing routine dental treatment to COVID-19-positive patients, 490 (84.4%) replied yes, 55 (9.5%) replied no, and 35 (6%) replied do not know. In response to providing emergency dental treatment to COVID-19-positive patients, 430 (74.1%) replied yes, 110 (18.9%) replied no, and 40 (6.8%) replied do not know. The difference was statistically significant (P < 0.05). Graph 1 shows that the knowledge level was good in 81%, fair in 9.5%, and poor in 10.5% of respondents. The difference was statistically significant (P < 0.05).

Table 1

Demographic profile of the respondents

Parameters	n	P
Gender
Male	330	0.05
Female	250
Age group (years)
18-30	184	0.02
31-40	290
41-50	80
>50	36
Sector
Private	348	0.04
Public	128
Institute	104
Years of practice
<5	232	0.01
5-10	260
>10	90
Education
BDS	264	0.03
MDS	232
PGs	72
PhDs	12
General infection control training
Yes	350	0.05
No	230
Infection control training against COVID-19
Yes	270	0.72
No	310

PGs: Postgraduates

Table 2

Level of knowledge

Question number	Question	Correct answer
1	Which one of the below is coronavirus?
	1. Common cold	5. All: 262 (45%)
	2. MERS
	3. SARS
	4. SARS-CoV-2
	5. All
2	What causes COVID-19?
	1. SARS-CoV	4. SARS-CoV-2: 493 (85%)
	2. MERS
	3. SARS
	4. SARS-CoV-2
	5. All
3	Highest infectious virus is?
	1. SARS-CoV-2	1. SARS-CoV-2: 464 (80%)
	2. MERS
	3. SARS
	4. Do not know
4	COVID-19 virus has an incubation period of?
	1. 2-7 days	2. 2-14 days: 510 (88%)
	2. 2-14 days
	3. 1-21 days
	4. >21 days
5	Which infection has a high mortality?
	1. Common cold	2. MERS: 116 (20%)
	2. MERS
	3. SARS
	4. SARS-CoV-2
6	Overall mortality rate of COVID-19 disease?
	1. 3.2%	2. 6.8%: 87 (15%)
	2. 6.8%
	3. 1.4%
	4. Do not know
7	How we can diagnose COVID-19 infection?
	1. ELISA	2. rRT-PCR: 455 (78.4%)
	2. rRT-PCR
	3. Widal
	4. DNA hybridization

rRT-PCR: Real-time reverse transcription-polymerase chain reaction

Table 3

Risk perception and attitude

Risk	Response	n (%)	P
How much SARS-CoV-2 patients exhibit mild symptoms? (%)	90	290 (50)	0.05
	60	165 (28.4)
	35	120 (21.6)
Which type of masks dentists should use?	A1	298 (51.3)	0.001
	A2	145 (25)
	A1 + A2	87 (15)
	Do not know	50 (8.6)
Dentists come under which category?	Very high risk	505 (87)	0.001
	High risk	58 (10)
	Low risk	17 (3)
Does PPE protect against SARS-CoV-2?	Yes	481 (83)	0.001
	No	60 (10.3)
	Do not know	39 (6.7)
Can routine dental treatment be given to COVID-19-positive patients?	Yes	490 (84.4)	0.001
	No	55 (9.5)
	Do not know	35 (6)
Can emergency dental treatment be given to COVID-19-positive patients?	Yes	430 (74.1)	0.01
	No	110 (18.9)
	Do not know	40 (6.8)

PPE: Personal protective equipment

Graph 1

Assessment of level of knowledge

DISCUSSION

COVID-19 infection has spread all over the world affecting millions of people. It has affected not only the general population but also medical as well as dental professionals.[6] Ward boys, nurses, sweepers, and other hospital personnel involving directly or indirectly with the treatment of COVID-19-positive patients have been affected a lot. Dental surgeons are at very high risk of infection. They deal with the oral cavity and are in direct contact with patients' blood and saliva.[7] Although dentists work by following universal precautionary measures, COVID-19 has alarmed the sign that additional preparatory steps are needed to avoid getting infected. Air rotar handpiece, ultrasonic scaling, bone cutting, etc., are dental procedures which generate aerosols. Even if they wear PPE kits, aerosol production and spread cannot be prevented and thus cause infection.[8] WHO and IDA guidelines against COVID-19 prevention have provided some sort of relief to dentists, but stress-free working environment is yet to be awaited. A thorough knowledge, attitude, and awareness regarding SARS-CoV-2 spread, infection, prevention, and management is essential.[9] Hence, the present study was undertaken to evaluate the knowledge, attitude, and awareness among dentists about COVID-19 infection. We recruited 580 dentists (males – 330, females – 250). Majority were in the age group of 31–40 years (290) followed by 18–30 years (184), 41–50 years (80), and >50 years (36). A total of 348 respondents were form private sector, 128 from public sector, and 104 were from institutes. We found that 232 had <5 years, 260 had 5–10 years, and 90 respondents had >10 years of working experience. A total of 264 respondents had pursued BDS, 232 had pursued MDS, 72 were PGs, and 12 respondents had completed PhD. A total of 350 respondents had general infection control training and 270 had infection control training against COVID-19. Ahmed et al.[10] found that 57.2% of doctors were working in a hospital setting. Awareness about COVID-19 infection was seen in 52% of respondents. The results showed that 72% of respondents were practicing sufficient procedures to fight COVID-19. Nearly 81.9% of the respondents took it similar to common flu with identical symptoms, 79% of the respondents replied that the elderly are at high risk of infection, and 73% had never attended COVID-19 awareness lecture, workshop, or Continuing Dental Education (CDE) program. It was seen that only 57.4% were using sodium hypochlorite in their hospitals and 73% were practicing universal precaution for infection control. No significant relationship between their responses with gender and education level existed. We found that 262 (45%) responded correct answer about coronavirus and 493 (85%) replied that COVID-19 is caused by SARS-CoV-2. We found that 464 (80%) respondents replied that SARS-CoV-2 is the highest infectious virus among all viruses, and 510 (88%) respondents replied correct answer that 2–14 days is the incubation period of COVID-19 virus. Only 116 (20%) respondents replied correct answer that MERS has a high mortality. Only 87 (15%) respondents were aware of the appropriate mortality rate of COVID-19 disease and 455 (78.4%) respondents had knowledge of the method of detecting COVID-19 infection (rRT-PCR). Arora et al.[11] in their study found that 80.8% of the dentists had fair knowledge about COVID-19, and 60.7% of the respondents had basic and 49.7% had special infection control training for COVID-19. Nearly 50% of the respondents believed it to highly dangerous, and 41.8% were in agreement to give emergency treatment. Most of the dentists had a view that there is a requirement to improve personal protective measures. We observed that 290 (50%) respondents replied that mild symptoms are seen in 90%, 165 (28.4%) replied 60%, and 120 (21.6%) replied 35%. A total of 298 (51.3%) respondents replied that dentists should use A1 masks, 145 (25%) replied that dentists should use A2 masks, and 50 (8.6%) replied do not know. We found that 505 (87%) respondents consider dentists under very high risk category, 58 (10%) under high risk category, and 17 (3%) under low risk category. Nearly 83% (481) had an opinion that PPE provide protection against SARS-CoV-2. A total of 490 (84.4%) and 430 (74.1%) respondents were in agreement in providing routine and emergency dental treatment to COVID-19-positive patients, respectively. Nemati et al.[12] conducted a study among nurses using a questionnaire to assess the knowledge and attitude about COVID-19. The results showed that 56.5% had good knowledge about the sources, transmission, symptoms, signs, prognosis, treatment, and mortality rate of COVID-19. The WHO and the Ministry of Health were the sources of information in 55.29%, social applications in 48.23%, and media in 42.35% of the respondents.

We found that knowledge level was good in 81%, fair in 9.5%, and poor in 10.5% of the respondents. There is a need to educate the general population as well as dental surgeons about the spread and prevention of COVID-19. A timely precaution may be helpful in preventing the spread of infection.

The limitation of the study was the small sample size.

CONCLUSION

The authors found that dental professionals had fair knowledge and awareness regarding COVID-19 infection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.