Attention to COVID-19 Pandemic among Dental Experts of Kerala State, India: A Knowledge, Attitude, and Practice Study.

BACKGROUND: Dentists are the common preys for the transmission of pandemic disease because of the airborne spread via routine dental checkups. This study which is a cross-sectional one gives the idea about awareness and alertness of dentists about COVID-19 in Kerala, India.
MATERIALS AND METHODS: The survey comprised 25 closed-ended questions. The survey was separated into two sections. The initial segment of the poll was identified with the socio-segment qualities that were researched, while the subsequent part was worried about dental practitioners' perspectives toward the management of COVID-19 and the apparent danger of defilement in dental facilities.
RESULTS: Coronavirus management in dental clinics differs regarding adherence to the rules. An aggregate of 750 respondents finished the form, out of which 686 (91.46%) complete reactions were incorporated. The majority of the respondents concurred on inquiries regarding the knowledge, practice, and mentality of dental specialists toward the COVID-19 pandemic.
CONCLUSION: The feedback of most dental specialists with respect to the readiness and view of disease control measures against the COVID-19 pandemic was positive. Dental facilities need to adhere more to the central and state government suggestions in alertness of their facilities or by tutoring their dental specialists and staff. Copyright:

INTRODUCTION

Coronavirus Disease (COVID-19) infection was first appeared in Wuhan, China, in December 2019.[1] The novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has rapidly extended from Wuhan to a large portion of Hubei region and to the remainder of the world.[2] On January 30, 2020, the World Health Organization (WHO) declared that coronavirus episodes as a pandemic.[3] The first instance of COVID-19 in India, an MBBS student who had returned home from Wuhan University, was tested positive on January 30 in Kerala's Thrissur district.[4]

COVID-19 and dental treatment

Dentistry is experiencing its difficult stretch yet, with the coronavirus pandemic. Dental specialists are at the greatest danger of contracting and transferring the coronavirus, alongside other medical care providers. Dental facilities in the country over have stayed shut for more than 5 months. With the disease still on the ascent, there is no expectation of improvement at any point in the near future, deteriorated by zero profit by dental specialists and supporting staffs. In spite of ultracareful widespread regulation and quarantine efforts, COVID-19 actually continues to rise.[5] Furthermore, studies have indicated that 2019-nCoV can spread directly or by indirectly through saliva.[6] A large number of dental treatments produce aerosols, which duplicates the chance of spread of the infection, making dentistry one of the high danger professions.[78] Dentists may assume a significant part in controlling the transmission of the contamination by giving notice to defensive equipment and sanitization, since they work inside the oral cavity and make in contact with the saliva of various patients. In this way, utilizing the reasonable personal protective equipment, for example, gloves, masks, eyeglasses, and face shields during ordinary dental treatments, has the most significance in the spread of and contamination with different viral and bacterial agents.[9]

Moreover, studies have demonstrated that the infection will be alive for fixed periods on different surfaces infected by the virus within the last 9 days.[6] Besides, the use of protective equipment in full by dental specialists, airing of the environment, and sterilization of the surfaces that patients are in contact with are likewise essential. Recommendations gave in these circumstances suggesting that dental specialists should put off nonemergency treatments.[101112] On the opposite side, it was suggested that the body temperature of the patient should be monitored (37.5°C and over), and data should be secured from the patient about their health status during the most recent 7 days, travel history, and the danger of been in contact with contaminated individuals.[13] Considering the rules gave up to now, dental specialists being educated about the COVID-19 pandemic and its transmission courses are significant as to the decrease of the danger of cross-disease between the patient, dental specialist, and dental aide, accordingly hindering the pandemic. Accordingly, this study is engaged to survey the knowledge levels and perceptions of dental specialists in Kerala, concerning the protective steps that should be taken before and after dental procedures, and the dental treatments that should be performed during the pandemic.

MATERIALS AND METHODS

This cross-sectional examination was conducted at dental hospitals and private clinics in Kerala. The poll with 25 inquiries was made in light of the rules distributed by the FDI World Dental Federation, Indian Dental Association, during the COVID-19 pandemic, was coordinated utilizing Google Forms, and send to 750 members. The members included general and expert specialists. A randomized selection of samples was done through dental groups present on social networks. Participation in this study was completely voluntary and anonymous. It was viewed as that the members who reacted to the anonymous questionnaire had given their consent to partake in the investigation. The study was conducted from May 1 to September 1, 2020.

About the survey designing, the questions were set up in English and in the form of multiple choices. The survey was partitioned into two sections. The initial segment of the poll was identified with the socio-segment qualities that were explored, while the subsequent part was worried about dental practitioners' mentalities toward the management of COVID-19 and the apparent danger of contamination in dental facilities. At first, a pilot study was led on arbitrarily chosen 20 dental specialists to validate the questionnaire and its Cronbach's alpha was acquired to be 0.78. The pilot study members were excluded from the last investigation. The poll was coordinated to a sum of 750 dental specialists working in Kerala, through an online link by means of web-based media stages, for example, WhatsApp and Facebook.

The information was coded, entered, and analyzed utilizing SPSS 20.0 version (IBM Corp., Armonk, NY, USA). Descriptive statistics, frequencies, and percentages were utilized to sum up information.

RESULTS

Distribution of demographic parameters

A sum of 750 respondents finished the form, out of which 686 (91.46%) complete reactions were included for the statistical analysis. Of the 686 members, 350 (51.2%) were male and 336 (48.9%) were female. The majority of the respondents, 458 (66.7%), had an age range of 25–45 years. Concerning year of practice, around 250 (36.4%) had recorded experience of over 15 years. The majority of the dental specialists (411, 60%) belonged to the west zone followed by north and central zones. The greater part of the respondents (398, 58%) were from the private area and 288 (42%) from the public sector. Lion's share of the members in the examination held a BDS degree and a modest number held a MDS degree, with a distribution of 446 (65%) and 240 (35%) separately. At the point when the respondents were asked some information about their past training or courses of infection control, out of 686 respondents, 665 (97%) uncovered that they had previous training on infection control. Similarly, 631 (92%) respondents expressed that they had attended training on COVID-19.

A large portion of the respondents conceded to inquiries regarding the knowledge, practice, and attitude of dental specialists toward the COVID-19 pandemic. Of these, 91% were refreshed with the most recent news about the spread of COVID-19. Of the respondents, 89% of the respondents started following the Ministry of Health guidelines for disease control with respect to COVID-19. Before the COVID-19 pandemic, 87% of the respondents regularly followed all universal precautionary measures of contamination control for each patient. At the point when found out if their infection control routine changed after the COVID-19 pandemic, 65% agreed with that. The question asked to whether N-95 Mask should be regularly worn in dental practice as a new precaution, and 73% of the respondents consented to that [Table 1].

Table 1

Responses of dentists’ preparedness and perception of infection control measures against the COVID-19 pandemic

Responses regarding	Yes, n (%)	No, n (%)	Not aware, n (%)
Do you have a separate workplan in your clinic after the COVID-19?	466 (68)	137 (20)	82 (12)
Have you started screening your patients before entering the clinic?	432 (63)	123 (18)	130 (19)
Have you equip your clinic with an isolation area for suspicious patients?	240 (35)	343 (50)	102 (15)
Do you have a telescreening facility in your clinic before giving patient appointments?	322 (47)	301 (44)	130 (19)
Do you have an airborne infection isolation area in your clinic?	89 (13)	514 (75)	82 (12)
Do you have an extraoral suction attached to your chair?	205 (30)	432 (63)	48 (7)
Do you have a proper COVID-19 management protocols in your clinic?	219 (32)	370 (54)	96 (14)
Did you install a thermal scanner for screening the patients?	624 (91)	27 (4)	34 (5)
Are patients instructed to gargle an antiseptic mouthwash before every treatment?	308 (45)	301 (44)	76 (11)
Is it compulsory for the patients to wear a face mask in the waiting area?	480 (70)	144 (21)	61 (9)
Is it required to wash/sanitize their hands before entering the clinics?	452 (66)	130 (19)	103 (15)
Is it made mandatory to maintain the social distancing in the waiting area?	548 (80)	48 (7)	89 (13)
Do you receive regular update/news about the spread of corona virus?	624 (91)	54 (8)	7 (1)
Are you updated with the current MoH guidelines for COVID-19 control?	610 (89)	61 (9)	14 (2)
Do you have a good infection control guidelines in your clinic, before the COVID-19 pandemic?	596 (87)	68 (10)	21 (3)
Are you familiar with these infection control protocols before this pandemic?	576 (84)	54 (8)	55 (8)
Did the pandemic change your infection control routine in your clinic?	445 (65)	178 (26)	62 (9)
Do you consider N95 mask is a must while performing the procedure?	500 (73)	150 (22)	35 (5)
How many of you have started using a face shield while treating patients?	555 (81)	89 (13)	41 (6)

COVID-19: Corona virus disease, MoH: Ministry of Health

Distribution of practitioners agreeing that the respective personal protective equipment measures should be used during aerosol-generating procedures

Table 2 shows majority of the practitioners in Kerala started using the various protective equipment such as head cap (100%), face shield (96.3%), and N95 (96.3%) masks while performing a procedure. A lower percentage of good practice was observed among dentists in using overshoes (70.4%) and double gloves (74.1%).

Table 2

Percentage and number of practitioners agreeing that the respective personal protective equipment measures should be used during aerosol-generating procedures

Protective equipment	Yes, n (%)	No, n (%)
N95 mask	660 (96.3)	26 (3.7)
Face shield/goggle	660 (96.3)	26 (3.7)
Overshoes	483 (70.4)	203 (29.6)
Gown	636 (92.6)	50 (7.4)
Head cap	686 (100)	0 (0)
Double gloves	508 (74.1)	178 (25.9)

Dentists' practice toward coronavirus after the announcement of the first case of COVID-19

Table 3 portrays the assessment of the members about the specific preventive practices. The larger part of the dental specialists utilize appropriate protective measures in their centers, including washing hands after every patient (100%), cleaning hands by utilizing liquor-based hand rub or soap and water (96.8%), and cleaning and sanitizing the clinic after patient treatment (94.1%). A lower level of good practice was seen among dental specialists in giving patients sanitizer and aprons in the sitting areas (61%); wearing the individual protective gear by the aide (62%); and cleaning all surfaces, seats, and entryways of the sitting area each 2 h with chloride arrangement or any sort of sterilizer (78.3%).

Table 3

Dentists’ responses regarding practice after the announcement of COVID-19

Preventive measures	Yes, n (%)	No, n (%)
Wash my hands using soap/sanitizer	664 (96.8)	22 (3.2)
Clean and disinfect my clinic	645 (94.1)	41 (5.9)
Wear personal protective equipment	546 (79.7)	140 (20.3)
Provide personal protective equipment for supporting staff	425 (62)	261 (38)
Wash my hands before and after patient treatment	686 (100)	0
Avoid crowding and started giving appointments	575 (83.9)	111 (16.1)
Provide patients sanitizer and disposable aprons	418 (61)	267 (39)
Disinfect the dental chair and all instruments after every patients	537 (78.3)	149 (21.7)

Fear of dentists toward COVID-19

Table 4 is a portrayal of the fear of dental experts toward COVID-19. Over 92.3% of the dental specialists were reluctant to treat a patient suspected or confirmed infected with COVID-19 and feared getting contaminated with COVID-19 from a partner. By far, most of the members (99%) feared the effect of the COVID-19 emergency on dental specialists' job.

Table 4

Fear of dentists toward COVID disease-19

Items	Yes, n (%)	No, n (%)
Are you scared to offer treatment for a suspected or confirmed COVID-19 patient?	633 (92.3)	53 (7.7)
Are you scared of cross infection from a colleague in your clinic?	533 (77.6)	153 (22.4)
Did your assistant discontinue the job due to COVID-19 scenario?	616 (89.9)	69 (10.1)
Are you scared of the financial impact of COVID-19 on you?	679 (99)	7 (1)

COVID-19: Corona virus disease

DISCUSSION

Coronavirus has become significant medical services trepidation around the world. At present, in India, private and public dental facilities are attending only emergency cases. In any case, the dental specialists are unpracticed to rehearse dentistry during such a pandemic. Provision of dental services during this occasions is troublesome on account of the high transmission risk.[14] To the best of our insight, this is the first cross-sectional review directed to evaluate the knowledge and practice of dental specialists toward COVID-19 in Kerala.

Among proposed PPE, head cap, N95 cover, and face shield/goggle were suggested by the greater part. Overshoes and double gloves were made a decision about not helpful by most of the respondents, and this evaluation might be identified with the restricted proof available.[15] The current examination reveals to us that most of dental specialists were hesitant to get contaminated from patients (92.3%) or their associates (77.6%). The reaction is in accordance with an examination led among dental specialists from different nations, where they revealed their dread of getting tainted while working during the current viral outbreak.[16] Toward the start of any treatment, flushing with an antimicrobial mouthwash significantly decreases the microbial load.[1718] Such mouthwash flushing is suggested in the current pandemic; anyway, most of dental specialists were uninformed about it.

Treating COVID-19 patients require the dental specialist to obey and keep refreshed with the ongoing rules suggested by the Centers for Disease Control and Prevention and WHO very clearly.[19202122] Association in the COVID-19 awareness programs coordinated by different organizations should be inspired.

Limitations

In spite of receiving all the suitable strides to decrease bias, the investigation was as yet susceptible to certain restrictions. The significant impediment was short duration for data collection which might have brought about a smaller than expected example. Utilizing web-based media for information collection would have disposed of the professionals who were inexperienced with online media or the individuals who were busy with dealing with personal affairs. A few states or districts across the country were more affected than others which may impact the administration and health-care preventive measures executed by a specific region that could likewise impact the aftereffect of the study.

CONCLUSION

Dental medical services workforce needs to comprehend the ramifications of expected transmission of the SARS-CoV-2 infection in a clinical arrangement. Consequently, they need to keep themselves refreshed with any new data with respect to this illness. New perspectives, for example, teledentistry, will assist dental specialists with helping patients without adding the danger of cross contamination. The current situation requires the need to strike harmony between the protections of the health workers yet offering ideal dental types of assistance to the patients requiring emergency intervention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.