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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 33  |  Issue : 1  |  Page : 40-46

Knowledge, awareness and outlook on the COVID-19 disease among the dental professionals in Tamil Nadu


Department of Oral Medicine and Radiology, SRM Dental College, Chennai, Tamil Nadu, India

Date of Submission19-Jul-2020
Date of Decision24-Oct-2020
Date of Acceptance10-Jan-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Dr. K S. Sethna Muth Lakshmi
Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu - 600 089
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_149_20

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   Abstract 


Aim: The aim of this study was to analyze the knowledge, level of awareness, and the attitude of the dental professionals towards the pandemic disease (COVID-19). Materials and Methods: This questionnaire-based survey was conducted among 295 dental professionals residing in Tamil Nadu through an online portal. The questionnaire consisted of four sections that addressed the demographic data, knowledge, awareness, and outlook of the COVID-19 disease by dental professionals. All the received responses were tabulated and the results were represented graphically. Result: The result of the study showed significant awareness among dental professionals towards COVID-19. The dental professionals needed more attention towards the precautions to be followed during this pandemic as personal protection and a safe environment are essential for a secure practice. Conclusion: This study emphasizes the role of oral health professionals in the prevention of the transmission of coronavirus among the public along with the management of dental emergencies with appropriate personal protective measures. This study also enforced the need to enrich the knowledge about infection, transmission, prevention, and control towards COVID-19. This may act as a source of information for the future pandemic crisis.

Keywords: COVID-19, dental office, dental professionals, SARS-CoV-2, universal precautions


How to cite this article:
Muth Lakshmi K S, Krithika C L, Kannan A, Aniyan Y. Knowledge, awareness and outlook on the COVID-19 disease among the dental professionals in Tamil Nadu. J Indian Acad Oral Med Radiol 2021;33:40-6

How to cite this URL:
Muth Lakshmi K S, Krithika C L, Kannan A, Aniyan Y. Knowledge, awareness and outlook on the COVID-19 disease among the dental professionals in Tamil Nadu. J Indian Acad Oral Med Radiol [serial online] 2021 [cited 2021 Apr 14];33:40-6. Available from: https://www.jiaomr.in/text.asp?2021/33/1/40/312197




   Introduction Top


In late December 2019, patients with peculiar symptoms of pneumonia were reported in the Wuhan city of Central China. The primary cases were related to the Hunan seafood market and the etiology was unknown. The broncho alveolar-lavage sample obtained from the affected patients were subjected to whole-genome sequencing. Genome sequencing revealed that the virus was closely related to bat SARS-like CoV; CoV-RaTG13 detected in bat Rhinolophus affinis. The CSG (Coronavirus Study Group) of the ICTV (The International Committee on Taxonomy of Viruses) studied the new viral strain and named as novel CoronaVirus-19 (nCoV-19)[1] which is a single-stranded enveloped RNA virus belonging to Coronavirdiae family and Orthocoronavirinae subfamily.[2] The ICTV renamed the nCoV-19 as SARS-CoV-2 (Severe Acute Respiratory Syndrome-CoronaVirus-2).[2] SARS-CoV-2 is the causal organism of the third pandemic attack from the Coronavirdiae family in less than two decades. The earlier pandemic included Severe Acute Respiratory Syndrome caused by SARS-CoV (Severe Acute Respiratory Syndrome- CoronaVirus) in 2002, Middle Eastern Respiratory Syndrome caused by MERS-CoV (Middle Eastern Respiratory Syndrome-Corona Virus) in 2012.[2] SARS-CoV-2 is considered to be transmitted from bats or pangolins to humans and later it progressed as human to human transmission disease.[2]

On 11th February, 2020 the WHO declared SARS-CoV-2 to be the cause of COVID-19 pandemic disease.[3] The human to human transmission of the virus occurs through respiratory droplets, salivary droplets, close contact with infected persons or contaminated inanimate objects. The incubation period of the disease is from 4 to 14 days.[4] The WHO considered COVID-19 as a public health emergency of international concern as the confirmed cases by June 22, 2020 was 8,807,398 and the deceased cases by June 22, 2020 were 4,64,483 worldwide with 216 countries affected.[5] In India by 22nd June 2020 4, 26, 639 confirmed cases and the deceased cases were 13,712.[6]

On March 15, 2020, the New York Times quoted that the dental professional to be at greater occupational risk during this pandemic.[7] As dental professionals work in a closed environment causing close contact with the patients, direct exposure to the aerosols and salivary droplets during the procedure, they are considered to be in the first line exposure for the coronavirus.[8] Dental professionals are also considered as the potential carriers for SARS-CoV-2.

Due to these inherent characteristics, dental clinics, and dental professionals are considered to be at higher risk for cross infections.[8] This necessitates the dental professionals to be aware of COVID-19 and its consequences. It also enforces them to act as a leader to break the chain in their community by reinforcing Infection Prevention and Control (IPC) in their clinic setup. Hence, the aim of this study was to assess the knowledge, awareness and outlook towards COVID-19 in the dental professionals residing in Tamil Nadu.


   Materials and Methods Top


The study was carried out in the department of Oral Medicine and Radiology, of a dental college in Chennai, Tamil Nadu, India and the study protocol was approved by the Institutional Ethical Committee, (Institutional review board reference No: SRMDC/2020/PG/007 dated May 15) and Helsinki declaration (2013) was followed. This study was conducted over a period of 1 month from May 2020 to June 2020. The sample size was calculated in G*Power version 3.1.9.7 with α err prob as 0.05, Power (1–β err prob) as 0.80 and with Df as 3, the sample size of 273 was derived for the prospective questionnaire study. We sent the questionnaires around the sample size and we received 295 responses for this study.

Our study population included dental professionals who were practicing in Tamil Nadu. Despite their differences in the practicing sector, they were included in the study. The sample was selected based on the inclusion and exclusion criteria. The inclusion criteria included the dental professionals who practiced in the private sector, government and institutional sector. The exclusion criteria included non-practicing dental professionals and who were not willing to participate in the survey.

Study tool

The questions on the survey were developed after reviewing pertinent literature about COVID-19. The questionnaire was designed in English and consisted of four sections about the socio-demographic data, knowledge, awareness, and attitude towards COVID-19. The questionnaire was pilot tested by a small group of 20 dental professionals who were requested to complete the survey and indicate any doubtful questions to the chief investigator. The finalized questionnaire was uploaded online through Google forms and the link was shared through email and social media platforms.

Statistical analysis

The collected responses were analysed using Microsoft Excel software. A descriptive statistical analysis was used to describe the data included in the survey. To describe the continuous variables, mean and standard deviation was used. The percentage was used to describe the categorical data. The responses were tabulated and represented graphically.


   Results Top


Demographic data

A total of 295 responses were received from the Google form link. The inclusion of mandatory fields in the online survey form guaranteed that there was no acceptance of incomplete responses. The study included 170 female and 125 male dental professionals. The dental professionals participated were in the age range of 21 years to 44 years with a mean of 27 years. The essential data included the demographic data. Among the participants, 166 were graduates and 129 were post graduates; 156 were young dental professionals, who had experience less than 3 years, 100 had 3-5 years of experience and 39 had more than 5 years of experience; 222 participants were general practitioners and 73 were consultants; 175 practiced in private, 110 in institutional sector and 10 in government sector.

Knowledge about COVID-19 was assessed in the second section which included the incubation period, symptoms, routes of transmission and its viability in room temperature. They are represented in [Table 1]. The data revealed that most of the dental health care professionals were aware about the incubation period and symptoms of SARS-CoV-2 but had less knowledge about viability of SARS-CoV-2 at room temperature.
Table 1: Represents the assessment of knowledge about COVID-19 among the participants

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Awareness and attitude among dental professionals was assessed in the following section. 91.8% (271) participants considered dental practice as perilous during this pandemic while 8.1% (24) participants considered dental practice as not perilous. 54.6% (161) participants agreed with all the routes of transmission in a dental setup while 33.9% (100) agreed upon aerosol contamination was higher among the dental setup. 59% (174) participants had prepared their dental setup for the pandemic while 41% (121) did not prepare for the pandemic. Educating the staff assistants and patients regarding the risk experienced in dental settings was also a part of the prevention strategy and 76.3% (225) had educated their patients/assistants regarding the risk involved in COVID-19. This reveals the essential role of dental professionals to educate the staff and patients about the risk endangered in dental treatment at this pandemic situation.

Tele-screening was practiced by predominant participants 62.2% (183) while 32.2% (95) did not practice tele-screening and 5.8% (17) were not aware about it. 71.2% (210) had deferred their non emergency treatment during this pandemic, while 28.8% (85) did not defer. Responses in regards to prevention strategy are tabulated in [Table 2] and [Figure 1] outlines the structured questionnaire for patients during their dental visit.
Table 2: Represents the responses in regards to prevention strategy by participants towards COVID-19

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Figure 1: The figure outlines the structured questions to be asked by the dental professionals to patients during their dental visit

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Following universal precautions in the dental office during this pandemic is essential and maintaining good hand hygiene is mandatory. [Chart 1] depicts the preference of medium for hand-hygiene by participants. [Chart 2] and [Chart 3] depict the responses of the participants towards the donning of Personal Protective Equipments (PPE) and doffing of PPE. Our participants had various opinions about the sequence of donning and doffing of PPE, out of which 30.8% (91) participants were aware about the correct sequence for donning and 24.1% (71) participants were aware about the correct sequence of doffing the PPE. The attitude of the participants with regard to the reporting of suspected COVID-19 individuals to the medical authority and to the delivery of dental treatment for COVID-19 recovered individuals is depicted in the [Table 3].

Table 3: Represents the attitude of participants in regards to the management of suspected COVID-19 individuals and treatment plan for COVID-19 recovered individuals

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   Discussion Top


This survey was conducted with an aim to provide an insight about the knowledge, awareness and attitude towards COVID-19 among the dental professionals. We had predominantly 170 female participants and young dental professionals (156) with less than 3 years of experience. Our participants were mainly graduates (166) and general practitioners (222).

88.8% (262) of the dental professionals who participated in this study had awareness about the incubation period and responded as more than 3 days, as the knowledge about incubation period is necessary for treating the patients at appropriate time. 98.6% (291) of the dental professionals were aware of all the common symptoms which included fever, cough and shortness of the breath. It is also essential to know the other symptoms such as nausea, altered taste sensation and reduced sensation to odor[9] but was not included in the questionnaire due to the rare occurrence. The literature also reveals few other symptoms such as leukopenia, thrombocytopenia and elevated C-reactive protein in COVID-19 affected individuals.[10] 80% of patients present with symptoms while there are reports of asymptomatic patients who can also act as “carriers” and spread infection rapidly.[11]

In this study, only 23.4% (69) of participants showed awareness about the viability of SARS-CoV-2 in room temperature. SARS-CoV-2 is a transmissible aerosol infection that is transmitted through cough and respiratory droplets from infected individuals.[12] These droplets from infected individuals are settled on surrounding inanimate objects.[12] Frequent touching of facial areas increases the self-inoculation and transmission of the virus.[13] When infected individuals cough or expectorate respiratory droplets it can lodge on inanimate objects and can stay on the various objects from 2 h to 9 days.[14] Survival depends on the room temperature, if the room temperature is above 30°C, the virus can survive only for shorter duration.[14] The WHO ensures environmental cleaning and disinfection procedure to avoid further infection and spread. 0.1% sodium hypochlorite or 70% ethanol for 1 min can be effective against SARS-CoV-2.[14]

In this study, dental health care professionals had a fair knowledge about the routes of transmission of SARS-CoV-2. SARS-CoV-2 has a higher chance of rapid transmission through aerosol procedure health care professionals.[15] The transmission occurs through the suspension of nasopharyngeal and oropharyngeal (saliva) droplets into air as smaller particles and to a longer distance.[16],[17] Dental health professionals are at greater risk during this pandemic as treating the patients necessitates close contact to the patient's oral cavity and generation of aerosols during procedure. SARS-CoV-2 is found in the secretory saliva as their entry is facilitated by the spike protein (S) and it binds to Angiotensin-Converting Enzyme -2 (ACE-2) receptors.[16],[17],[18] ACE-2 receptors are found in the salivary glands and present in secretory saliva.[16],[17],[18] The nasopharyngeal secretions harbor coronavirus and the literature reveals that the secretory saliva also shows SARS-CoV-2. Hence the amount of transmission through the oro-pharyngeal secretion (saliva) may potentially transmit the virus particles. It also affects the blood system and few cases of vertical transmission through blood had been reported.[19],[20]

This study revealed that the dental health care professionals had a good knowledge and awareness about the tele-screening practice. The dental professionals play a vital role in infection, prevention, and control of COVID-19 in their community. As a part of the prevention strategy and infection control, the dental professionals were advised to follow tele-screening, structured questionnaire,[21] and triaging in the dental setup. This facilitates categorizing patients into those requiring emergency, urgent and elective dental care. This questionnaire also revealed that the dental professionals had awareness about the structured questionnaire and triaging protocol which is essential.

[Figure 2] explains the dental triage to be followed in practice issued by American Dental Association (ADA) in 2020. ADA Interim Guidance for management of emergency and urgent dental care.[22] It is also important to prepare the dental office with required measures to manage the pandemic and hence alterations in the dental health-care setup is necessary.[23] The knowledge about dental triage was known only by 33.2% (98) participants and hence increased awareness is required.
Figure 2: The Triage to be followed in Dental Clinics & Hospitals is outlined by the American Dental Association

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Patients should be screened before they enter the clinic and the dental team should be fully equipped with Personal Protective Equipments (PPE).[24] Screening is done to ensure that the patient does not have any major symptoms such as increase in body temperature, shortness of breath, and decreased oxygen saturation level.[25] The screening equipments commonly used are an infra-red camera scanner, non contact thermometer, and pulse oximeter. This questionnaire revealed that only half the population were well equipped with the screening tools.

The PPE should be used by the dental health team. Our participants had varied opinions about the sequence of donning and doffing of PPE, with only 30.8% (91) participants knowing the correct sequence for donning and 24.1% (71) participants knowing the correct sequence for doffing PPE. Proper procedure to wear PPE (Gown→ Mask→ Face Shield→Gloves) and proper technique to remove the PPE (Gloves→Face shield→Gown→Mask) is mandatory to reduce the risk of transmission.[26],[27],[28] The hands of the health care professionals are considered to harbor various microorganisms and to avoid its spread,[29] the hand hygiene should be practiced using “five moments” by World Health Organization: before touching a patient, before performing any clean procedure, after exposure to body fluid, after touching a patient and after touching the surroundings. The primary aim of good hand hygiene is to remove any organic material, visible soil and microorganisms from the hand.[30] If the hands are dirty visibly, use of soap and water for 40 to 60 s is recommended. If hands are not dirty visibly, alcohol-based hand rub solution can be used for 20–30 s.[29],[30] COVID-19 recovered patients can be treated after 72 h of symptoms resolution or after one negative molecular test for COVID-19.[31] The dental health care professionals had awareness and knowledge about the treatment protocol/duration of the resolved COVID-19 patients. If there was any suspected COVID-19 patient, dedicated telephone numbers were allocated by the medical authorities.[32] This study reveals that only 36.9% participants have knowledge about the medical authority details and hence the awareness of the medical authority during the pandemic situation is essential for emergency needs.

A study by Yousef Khader et al., assessed the knowledge, attitude, and practice regarding COVID-19 among dentists in Jordan.[33] This study stated that predominant participants were aware about the symptoms, mode of transmission of COVID-19, whereas the current study is also similar to the former study and it revealed that dental professionals had knowledge about COVID-19.

Limitations and future prospects

This study was an online questionnaire study and it was limited to dental professionals who were able to be reached out through mail and social media. The future prospects of the study are to emphasize the dental professionals to create awareness among the staff assistants and patients regarding the pandemic situation. The dental professionals are required to formulate the strategies to improve a safer dental environment.


   Conclusion Top


This study points to the need to enrich the knowledge about the infection, transmission, prevention, and control of COVID-19 among dental professionals. The dental professionals had limited conception about precautionary measures to follow during COVID-19. This study has emphasized the role of dental professionals in providing the clinical support system for the pandemic situation. It also highlights the role of oral health professionals in prevention of the transmission of coronavirus among the public. The management of dental emergencies with appropriate personal protective measures is the need of the hour. Hence the dental professionals need to perform their duty of emergency care under standardized guidelines for the betterment and welfare of the patients. This present study may act as a source of information for future pandemic crisis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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