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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 94-99

Knowledge, attitude, and awareness among dentists regarding COVID-19 pandemic in West Bengal


Department of Pedodontics and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India

Date of Submission18-Aug-2020
Date of Decision07-Dec-2020
Date of Acceptance02-Feb-2021
Date of Web Publication22-Jun-2021

Correspondence Address:
Khooshbu Gayen
Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_39_20

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  Abstract 


Background: Coronavirus disease-2019 (COVID-19) has been declared a global public health emergency, the rapid and extensive spread of COVID-19 pandemic.
Objective: The aim of this study is to assess the knowledge, attitude, and awareness among the dentists of West Bengal regarding coronavirus disease (COVID-19).
Materials and Methods: The study population for this survey are the dentists of West Bengal who work in government sector or in any private clinics. An online questionnaire comprising 28 questions was sent to the sample size. The questionnaire was composed of series of questions about the knowledge of dentists regarding the incubation period, symptoms, mode of transmission of coronavirus disease, their awareness about the infection control measures, and the attitude toward treating the patients with COVID-19.
Results: A total of 107 dentists responded to this survey. Of them, 7.5% have completed their postgraduation in any specific subject, 30.2% are under postgraduate training, and 62.3% are practicing after completion of their graduation. Eighty percent of the dentists involved in the study have correctly reported the incubation period which is 7–14 days. Majority of the dentists were aware of the symptoms of COVID-19, which would help them in identifying the patients at risk of getting COVID-19 infection. Sixty-seven percent of them found it necessary to make the sitting arrangement at significant distances in the waiting area as a preventive measure. Majority of them considered that dentists should play an important role in spreading awareness regarding COVID-19.
Conclusion: The dentists were found to have a good knowledge about the symptoms, mode of transmission, and the preventive measures. They were advised to follow the guidelines issued by the Centers for Disease Control and Prevention and the World Health Organization and remain well informed about the recommended disease management protocols so that no stone is left unturned in defeating this pandemic.

Keywords: Coronavirus disease-2019, hand hygiene, infection control, personal protective equipment


How to cite this article:
Gayen K, Galui S, Das L, Saha S, Sarkar S. Knowledge, attitude, and awareness among dentists regarding COVID-19 pandemic in West Bengal. J Oral Res Rev 2021;13:94-9

How to cite this URL:
Gayen K, Galui S, Das L, Saha S, Sarkar S. Knowledge, attitude, and awareness among dentists regarding COVID-19 pandemic in West Bengal. J Oral Res Rev [serial online] 2021 [cited 2021 Aug 4];13:94-9. Available from: https://www.jorr.org/text.asp?2021/13/2/94/319021




  Introduction Top


At the beginning of the new decade, on January 30, 2020, the World Health Organization (WHO) announced a Public Health Emergency of International Concern against the outbreak of coronavirus disease and since then, it has rapidly achieved a pandemic status (as declared by the WHO on March 11, 2020).[1] The novel virus was initially named 2019-nCoV and later by the International Committee on Taxonomy of Viruses named as “ severe acute respiratory syndrome coronavirus 2”(“SARS-CoV-2”) based on the taxonomic analysis and the phylogenetics of this novel coronavirus.[2] The first case of SARS-CoV-2 was reported in Wuhan, Hubei province, in China in last December and it seemed to have originated from bats suggesting an animal-to-person spread.[2] This rapidly spreading novel virus seems to be more contagious than SARS-CoV and Middle East respiratory syndrome coronavirus.[3] The human-to-human route of transmission of the disease is responsible for its rapid spread across different continents. The possible suggested route is through airborne droplets, coming in contact with a contaminated surface or an infected person.[3]

The health-care workers are at the highest risk of contracting this infection due to this mode of transmission. A large number of cases have been reported among medical staff, being infected while working with infected individuals.[4] In a dental setup, dentist and dental equipments remain in close proximity of the patient so there is always a high chance of acquiring infection from the microdroplets of infected patients and a similar possibility of transmitting infection between staff and other patients. The characteristics of the disease adding to the challenges of medical staff are its relatively prolonged incubation period and asymptomatic infection in many patients.[5],[6] Hence, patients who are infected with COVID-19 and present no symptoms are the greatest threat to dentists when they come seeking treatment. Thus, to combat the disease and its spread, dentists should entertain a high level of knowledge and awareness about COVID-19.

Objectives

For dentist and their dental staff, there are recommendations of practical guidelines by the American Dental Association, the Centers for Disease Control and Prevention (CDC), and the WHO to be followed in practices, to control the spread of COVID-19.[7],[8],[9] Some guidelines and reports also included useful information about the disease to increase the knowledge and awareness among the dentists which will further contribute in disease control and prevention.[8] Despite all this, many dental clinics fail to apply proper infection control measures and sound prevention measures. Thus, the objective of this study is to assess the knowledge and awareness among the dentists of West Bengal about COVID-19 and the attitude toward infection control practices and preventive measures.


  Materials and Methods Top


Study design and population

This was a questionnaire-based survey based on the current interim guidelines and information available. Prior to the implementation of this study, the questionnaire design, validation, and strategies to enroll maximum number of dentists were discussed. Our study population include the dentists practicing in West Bengal either in private clinic or in government sectors. A link was sent to all the participants which contained a brief introduction about the study including it's objective, background, instructions about how to fill the questionnaire and also the voluntary nature of participation.

Data collection

The survey was prepared in the form of an online questionnaire form using Google Forms to collect the data. The study was conducted on the month of May 2020. To ensure maximal participation, both convenience sampling (participating dentists were directly contacted by the researchers to participate in the study) and snowball sampling (participating dentists were asked to forward the questionnaire to their known dentists) were used. The questionnaire was distributed through various social media platforms like Facebook and WhatsApp. The survey was basically multiple-choice questionnaire, designed in English and divided into four sections:

  1. Baseline characteristics included age, gender, and dentists' professional characteristics
  2. The knowledge section consisted of questions to assess the general knowledge of dentists about the signs and symptoms, incubation period, and mode of transmission of COVID-19
  3. The awareness section included questions about awareness of dentists about the preventive measures of COVID-19 infections and their applications
  4. The last section included questions to evaluate the perception of the dentist toward the preventive measures.


Data analysis

Descriptive statistical analysis was used to describe items included in this survey. Percentages were used to describe the categorical data.


  Results Top


Characteristics of the participating dentists

A total of 107 dentists from West Bengal responded to this survey among which 48.1% were male and 51.9% were female. The majority of the responders were from the age group of 24–31 years. Among the participants, only 7.5% had completed their postgraduation, whereas 30.2% were postgraduate trainee and the majority, 62.3%, had completed their graduation only. [Figure 1] About 44.9% of the participating dentists are practicing in government sector and 55.1% have their private dental practice. [Table 1]
Figure 1: Pie chart representing educational qualification-wise participation

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Table 1: Characteristics of the participants

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Knowledge about COVID-19 infection

The majority of the participating dentists have acquired knowledge about the serious health issue of COVID-19 infection. More than half of the participants know correctly about the incubation period of 1–14 days. The majority reported fever, cough, sore throat, and shortness of breath as symptoms of COVID-19. [Figure 2] Different views were reported regarding the mode of transmission of the disease. [Table 2]
Figure 2: Bar graph representing responses on the symptoms of COVID-19

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Table 2: Knowledge of the dentists about the coronavirus disease-2019 infection

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Awareness about the measures of prevention of COVID-19 infection

All the participating dentists reported the necessity of cleaning hands with alcohol-based hand rub and majority of them considered using personal protective equipment (PPE) while attending each and every patient for the prevention of transmission of COVID-19 infection in dental clinics. Hundred percent of the participants considered that dentists are at a high risk of getting infected while performing dental procedures. [Figure 3] About 75.5% of dentists gave an opinion in favor of using N95 face masks while attending every patient, while 24.5% of them found it to be used only often when it is necessary. [Table 3]
Figure 3: Pie chart representing responses on preferred disinfectants for clinical apparatus

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Table 3: Awareness about preventive measures of coronavirus disease-2019 infections

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Attitude toward prevention of COVID-19 infection

All the dentists that participated in the study think that it is very important to educate people about COVID-19 infection with the aim of prevention of its spread. In case, a patient visit the clinic with flu like symptoms, 28.8% of the participating dentists reported that they will consider doing the needful to the patients first and then sending them to the nearest hospital for medical advice, whereas 71.2% of them reported that they will prefer to avoid working in patients having similar symptoms of COVID-19 and will immediately send then for seeking medical advice. [Figure 4] Regarding the precautionary actions, 67% of the dentists believed that it is necessary to ask them at a certain distance in the waiting area and 33% of them consider providing mask and hand sanitizer to everyone. [Table 4]
Figure 4: Pie chart representing percentage-wise responses on risks of acquiring COVID-19

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Table 4: Attitude toward prevention of coronavirus disease-2019 infection

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  Discussion Top


People who come in close contact with an infected individual are at a high risk for transmission of COVID-19. According to US CDC, a “close contact” is defined as: “Being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time or having direct contact with infectious secretions of a COVID-19 case.”[10] The dentists while working are always in close proximity to the patient and some procedures are very time-consuming. In this scenario, dentists always remain at higher risk of getting infected with COVID-19. To combat this pandemic situation, all health-care workers including dentists must be very well prepared. This survey provides an inside on the level of knowledge, attitude, and awareness of dentists of West Bengal about infection control and preventive measures at the time of COVID-19 outbreak. The knowledge score found among the dentists is quite promising as far as the role of dentists is concerned in combating the COVID-19 outbreak.

Dentists in this survey differ in their knowledge about the incubation period. Correct knowledge about the incubation period of COVID-19 is essential to determine the safe period of treating a suspected patient.[11] The estimated incubation period of COVID-19 is up to 14 days.[6],[12] Appropriate hand hygiene practice portrays an important role in preventing the spread of infection. “Five Moments of hand hygiene” by the WHO defines key moments when and how health-care providers must carry out hand hygiene.[13] However, the question in our survey was if they consider performing hand hygiene procedure, before and after performing the treatment. Through various epidemiological studies, it had been found that cleaning hands with 70%–90% alcohol-based hand rubs was effective in controlling the spread of severe acute respiratory syndrome.[14] The dentists in this survey are very well aware of the main symptoms and the atypical symptoms of COVID-19 which will further help them in identifying risks so that they can take necessary actions and consider appropriate management. Infected patients can be asymptomatic also which remains a potential threat to every practicing dentists and their preventive measures have a bigger role to play.

Awareness about PPE was high among all the participants. All the practicing dentists and their assistants should receive training on the proper use of PPE about putting on and removing PPE in a proper way without self-contamination. PPE includes protective eyewear, masks, gloves, caps, face shields, and protective outwear. Besides being aware of how and when a PPE kit is required, the correct sequence of “donning and doffing” of PPE is also important to know. The N95 mask was preferred while performing aerosol-generating procedures like using high speed and piece, air–water syringe, and ultrasonic scaler. Other than N95 respirators that offer a higher level of protection such as N95, European Standard Filtering Face Piece 2, or equivalent, can also be considered. An Interim Infection Prevention and Control recommendation has been provided by the CDC in health-care settings for PPE for patients with suspected or confirmed coronavirus disease-2019 (COVID-19).[15] Based on relevant guidelines, dentists should consider adequate personal protective measures. Breaking out of the pandemic of this novel virus infection has put all the health-care providers on alert as they remain at a high risk of contracting infection.

As reported by Gupta et al., during the ZIKV pandemic, the source of acquiring knowledge by the dentists in the Tricity area in India was Internet followed by social media.[9] However as this is the development of new strain of infectious agent, there might not be sufficient data available over the Internet; hence, the dentist must access trusted sites like WHO, the CDC, or the websites of health ministries of their respective countries to gather more information.

Since the responses of the present study were collected when COVID-19 had started spreading to whole over the world, the characteristics of the virus was little known to all the practicing dentists and there was very less information available regarding the patients who got cured of COVID-19, so most participating dentists replied that they consider COVID-19 a very serious public health issue which can affect the future of dentistry.

Regarding what to do in case of attending a patient who is sneezing or coughing, the attitude of dentists varied. Majority of the dentists said that they would not prefer to do treatment in patients who are showing some flu-like symptoms while some of them would prefer to do the emergency procedures with adequate protective measures. All dentists agreed that educating people can help in better prevention of the disease and they have considered that dentists can play an important role in spreading awareness regarding the disease and the protective measures.

The present situation demands implementation of strategies for prevention of infection among populations who are at high risk including preexposure and postexposure prophylaxis. Till date, there is no evidence-based specific treatment protocol for COVID-19 and the management is basically supportive.[16] The current mainstay approach is to control the source of infection, use infection prevention protocol, provide diagnosis as early as possible, isolation of infected individuals, and supportive care.

Despite the findings, it is important to stress that the study is prone to some limitations, one of them is the relatively low response rate, resulting in a smaller than expected sample size. This may be due to the short period of data collection and the inaccessibility to reach out to dentists in this pandemic situation as only those who were active on social media during the period of collection were the ones to participate in this study and also due to the cross-sectional nature of the study and the employed sampling technique, the self-selection bias on the side of the respondents could have occurred. Hence, this could result in the presence of social desirability bias in the selection and sampling error.


  Conclusion Top


In this present survey, the dentists of West Bengal were found to obtain good knowledge and awareness about COVID-19 symptoms, mode of transmission, and preventive measures in dental clinics. There is a strong need of implementation of periodic educational interventions through webinars and training programs on infection prevention practices. Updated guidelines released by reputable institutions should be provided to all the registered dentists by the regional and national dental associations in this pandemic to make sure that all the practicing dentists are well informed about the recommended disease management protocols.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical clearance

Memo no- DCH/ 1141.



 
  References Top

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Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020;99:481-7.  Back to cited text no. 2
    
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Khader, Y., Al Nsour, M., Al-Batayneh, O., Saadeh, R., Bashier, H., Alfaqih, M., Al-Azzam, S. and AlShurman, B., 2020. Dentists' Awareness, Perception, and Attitude Regarding COVID-19 and Infection Control: Cross-Sectional Study Among Jordanian Dentists. JMIR Public Health and Surveillance, 6,p.e18798.  Back to cited text no. 3
    
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Secon H. Nearly 3,400 Chinese healthcare workers have gotten the coronavirus and 13 have died. 2020. https://www.businessinsider.com/healthcare-workers-getting-coronavirus-500-infected-2020-2 Published 5 March 2020. [Last Accessed on 2020 July 7].  Back to cited text no. 4
    
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Backer J, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020. Eurosurveillance. 2020;25(5).  Back to cited text no. 5
    
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The American Dental Association. Coronavirus Frequently Asked Questions; 2020. Available from: https://success.ada.org/en/practice-management/patients/coronavirus-frequently-asked-questions. . [Last accessed on 2020 June 15].  Back to cited text no. 7
    
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Centers for Disease Control and Prevention. CDC Recommendation: Postpone Non-Urgent Dental Procedures, Surgeries, and Visits; 2020. Available from: https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html. [Last accessed on 2020 July 10].  Back to cited text no. 8
    
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World Health Organization. Clinical Management of Severe Acute Respiratory Infection when COVID-19 Is Suspected; 2020. Available from: https://tinyurl.com/s23yv4p. [Last accessed on 2020 June 15].  Back to cited text no. 9
    
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Information for Healthcare Professionals; 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html. [Last accessed on 2020 Mar 19].  Back to cited text no. 10
    
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Gaffar BO, El Tantawi M, Al-Ansari AA, AlAgl AS, Farooqi FA, Almas KM. Knowledge and practices of dentists regarding MERS-CoV. A cross-sectional survey in Saudi Arabia. Saudi Med J 2019;40:714-20.  Back to cited text no. 11
    
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Baseer M, Ansari S, AlShamrani S, Alakras A, Mahrous Backer JA, Klinkenberg D, et al. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill 2020;25.  Back to cited text no. 12
    
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Modi PD, Kumar P, Solanki R, Modi J, Chandramani S, Gill N. Hand hygiene practices among Indian medical undergraduates: A questionnaire-based survey. Cureus 2017;9:e1463.  Back to cited text no. 13
    
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Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings; 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/infection control/controlrecommendations.html. [Last accessed on 2020 Mar 20].  Back to cited text no. 14
    
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Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323:1061.  Back to cited text no. 16
    


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