Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study.

AIM: This study was intended to evaluate the knowledge and apprehension of dental health professionals pertaining to COVID-19.
MATERIALS AND METHODS: In this cross-sectional survey, a self-administered questionnaire survey was used to validate the dental health professional's knowledge and apprehension pertaining to COVID-19. In this regard, a preliminary study with a convenience sample of 124 dentists working in various clinics in southern India was conducted so as to evaluate the knowledge and apprehension of dentists related to COVID-19 in India. This study, while limited in sample size, benefits the general practitioners as target readers to assess the awareness pertaining to COVID-19.
RESULTS: The results of this study reveal that there exists a good knowledge among dental health professionals pertaining to the COVID-19 virus and its oral manifestations in addition to the precautions to be taken for the prevention of COVID-19 in a clinical setup. However, there exists an apprehension as well as lack of awareness pertaining to the laboratory test to be carried out in a patient suspected with COVID-19 infections as well as the role of a mouthwash and the management of contaminated air in the dental clinic.
CONCLUSION: The results elicited that there is a dearth of knowledge and relatively a fair apprehension among dental health professionals pertaining to COVID-19. Copyright:

INTRODUCTION

It is a well-known fact that the novel coronavirus (nCoV) is a unique virus that affected human beings by causing severe respiratory disease and is responsible for a high fatality rate globally.[1] Based on the currently available literature, it is understood that the virus spreads through the airborne transmission.[2] The most frightening pandemic the world has faced in over a century poses a great threat to health-care workers, particularly dental health professionals. Since handpieces, airwater syringes, and ultrasonic scalers generate a significant volume of aerosols in the working area, dentists are surely at a greater risk. Therefore, the likely chance for the spread of infection from a patient to a dentist or dental assistant is high.[3] The incubation period of this virus ranges from 2 to 14 days, with a mean of 5 or 6 days. and nearly four in five virus-positive patients could turn out to be asymptomatic.[45] Literature reveals that maxillofacial surgeons and otorhinolaryngologists in addition to dentists are at high risk for COVID-19.[67] This necessitates the formulation of novel protocols to warrant the operator and patient safety. Therefore, this study was planned.

MATERIALS AND METHODS

A cross-sectional survey was undertaken to evaluate the knowledge and apprehension of dental health professionals pertaining to COVID-19 in India. The study included 124 dentists performing clinical practice in various clinics belonging to different parts of southern India. Most of the participants had a postgraduate qualification and specialists in their field of clinical work while few were general dentists. Before commencing the study, an Institutional Ethical Committee clearance was obtained. Ethical approval for this study was provided by the Government Medical College and Associated Hospital, Rajouri (Regd No.: 677/ODCHRC/RB-E/2020) on March 12, 2020. A self-administered questionnaire with 13 questions was distributed via Google Forms to the E-mails of these dental health professionals. The questionnaire was sent to approximately 200 consultants, but unfortunately, only 124 responded even after repeated reminders. The participants were instructed to answer the questionnaire very precisely without any descriptions. Dental health professionals were instructed to answer the questionnaire using either the right or wrong options, as shown in Table 1. After collecting the filled questionnaires, participants were given instructions about COVID-19 related to precautions, contamination etc. and all their doubts were cleared. Survey questions were aimed to assess the facts whether the dental health professional is totally aware of the COVID-19, oral manifestations that occur in a suspected patient with COVID-19 infection, laboratory test to be carried out in a patient suspected with COVID-19 infections, emergency and nonemergency dental procedures to be carried out at this need of the hour, and precautions for prevention of COVID-19 in a clinical setup. The survey forms were evaluated and critically analyzed.

Table 1

The questionnaire used in the study

Type of questions
1. Are you totally aware of COVID-19?
2. Do you think dental health professionals are at highest risk?
3. Do you know the incubation period for human-to-human transmission?
4. Are you totally aware of the oral manifestations of COVID-19?
5. Have you encountered any patient with suspected oral manifestations of COVID-19?
6. Have you taken total precautions for prevention of COVID-19 in your clinical area?
7. Do you know the laboratory test to be carried out in a patient suspected with COVID-19 infections?
8. Do you follow complete infection control protocol in carrying out your clinical work?
9. Are you totally aware of the difference between the emergency and nonemergency dental procedures to be carried out at this need of the hour?
10. Do you follow proper biomedical waste disposal?
11. Are you aware as to which dental procedure generates the maximum bioaerosol in a dental clinic?
12. Do you know how to manage contaminated air in your dental clinic?
13. Do you know the ideal mouthrinse to be advised before any dental procedure for prevention of contamination from COVID-19?

RESULTS

The results of this study showed that 87.9% of the respondents were aware of the COVID-19, but only 77.77% of the respondents were totally aware of its oral manifestations. 80.6% of the respondents were aware that dentists are at the highest risk for COVID-19 infections than any other professional. 92.7% of the respondents were aware of the incubation period. 100% of the respondents have not encountered any patient with suspected oral manifestations of COVID-19. However, only 32.25% of the respondents knew the laboratory test to be carried out in a patient suspected with COVID-19 infections. It was observed that 90.32% of the respondents were totally aware of the difference between the emergency and nonemergency dental procedures to be carried out at this need of the hour. Almost all of the respondents follow a proper biomedical waste disposal in their clinical setup. Nearly 94.35% of the respondents were aware as to which dental procedure generates the maximum bioaerosol in a dental clinic, thereby increasing the risk of contamination. Unfortunately, only 62.09% of the respondents were aware of how to manage contaminated air in the dental clinic and 42% of the respondents were aware of the ideal mouthrinse to be advised before any dental procedure for prevention of contamination from COVID-19. The results of this study reveal that there exists a good knowledge among dental health professionals pertaining to the COVID-19 virus and its oral manifestations in addition to the precautions to be taken for the prevention of COVID-19 in a clinical setup. However, there exists an apprehension as well as lack of awareness pertaining to the laboratory test to be carried out in a patient suspected with COVID-19 infections as well as the role of a mouthwash and the management of contaminated air in the dental clinic. The results obtained for the study are depicted in Table 2.

Table 2

Results of the questionnaire against appropriate questions

Type of question	Yes (%)	No (%)
1. Are you totally aware of COVID-19?	109 (87.9)	15 (12.1)
2. Which professional do you think are at highest risk?	100 (80.6)	24 (19.4)
3. Do you know the incubation period for human-to-human transmission	115 (92.7)	9 (07.3)
4. Are you totally aware of the oral manifestations of COVID-19?	89 (71.77)	35 (28.23)
5. Have you encountered any patient with suspected oral manifestations of COVID-19?	00 (00)	124 (100)
6. Have you taken total precautions for prevention of COVID-19 in your clinical area?	122 (98.33)	2 (01.67)
7. Do you know the laboratory test to be carried out in a patient suspected with COVID-19 infections?	40 (32.25)	84 (67.75)
8. Do you follow complete infection control protocol in carrying out your clinical work?	113 (91.12)	9 (08.88)
9. Are you totally aware of the emergency and nonemergency dental procedures to be carried out at this need of the hour?	112 (90.32)	12 (09.68)
10. Do you follow proper biomedical waste disposal?	122 (98.33)	2 (01.67)
11. Are you aware as to which procedure produces the maximum bioaerosol in a dental clinic?	117 (94.35)	7 (05.65)
12. Do you know how to manage contaminated air in your clinic?	77 (62.09)	47 (37.91)
13. Do you know the ideal mouthrinse to be advised before any dental procedure for prevention of contamination from COVID-19?	51 (41.12)	73 (58.88)

DISCUSSION

Bioaerosols are considered to be biological particles suspended in gaseous media.[8] It is a well-known fact that a subgingival scaling using an ultrasonic scaler in the management of periodontally week teeth can produce aerosols.[910] These bioaerosols are dangerous for dentists.[11] Therefore, this study was planned. The results of this study show that 94.35% of the respondents were aware that subgingival scaling would generate more aerosols compared to other dental procedures. 90.32% of the respondents were aware of the emergency and nonemergency dental procedures to be carried out at this need of the hour. A recent study emphasized that equivalent precedence is needed for infection control protocols in dental setup.[12] The results of this study reveal that 91.12% of the respondents follow complete infection control protocol in carrying out their clinical work. It is desirable to employ extraoral radiographs such as orthopantomographs or oblique lateral views as an alternative to intraoral radiographs for screening in patients with sensitive gag reflex.[1314] A rubber dam should be used for dental treatment.[15] Literature has shown that SARS and MERS are extremely susceptible to Betadine rinse.[1617] The results of this study reveal that 41.12% of the respondents were unaware of this fact. Antiretraction high-speed dental handpiece should be used.[18] A well-ventilated dental clinic can reduce the amount of contaminated air by venting the exhaust air and also by avoiding the recirculation of contaminated air.[19] Disinfecting the surfaces following each patient visit is essential.[20] The results of this study show that 62.09% of the respondents were unaware of how to manage contaminated air in their clinic. However, 91.12% of the respondents follow complete infection control protocol in carrying out their clinical work. Biomedical waste is an infectious medical waste.[16] The results of this study show that 94.35% of the respondents follow proper biomedical waste disposal. It was clearly evident since COVID-19 epidemic, elective surgeries in the maxillofacial region progressively decreased worldwide in order to prevent risk. The same trend continued in India as well. A recent study noticed a huge reduction of outpatient visits (−87%) and outpatient (−86%) and inpatient surgical procedures (−78%) within 4 weeks after the beginning of the pandemic.[21]

CONCLUSION

Our results clearly reveal that there is a dearth of knowledge and relatively a fair apprehension among dental health professionals pertaining to COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.