|Year : 2021 | Volume
| Issue : 5 | Page : 353-358
Knowledge, perception, and attitude on conservative and endodontic practice on COVID pandemic situation: A qualitative research
Sumit Khatore1, Sakshi Kathuria2, Manoj Kumar Rawat3, Amar Ashok Thakare4, Surbhi Abrol5, Sai Prashanth Pinnamaneni6, Rahul VinayChandra Tiwari7
1 Department of Conservative Dentistry and Endodontics, Awadh Dental College and Hospital, Jamshedpur, Jahrkhand, India
2 Dental Surgeron, Turlock, California, USA
3 Department of Dentistry, Pt. Jawaharlal Nehru Government Medical College, Chamba, Himachal Pradesh, India
4 Department of Prosthodontist, College of Dentistry, Al Zufli, Majmaah University, Kingdom of Saudi Arabia
5 Boston Unversity, Boston, Massachusetts, USA
6 Department of Conservative Dentistry and Endodontics, S Nijalingappa Institute of Dental Science and Research, Gulbarga, Karnataka, India
7 Department of OMFS, Narsinbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
|Date of Submission||18-Nov-2020|
|Date of Decision||20-Nov-2020|
|Date of Acceptance||21-Nov-2020|
|Date of Web Publication||05-Jun-2021|
Department of Conservative Dentistry and Endodontics. Awadh Dental College and Hospital, Jamshedpur, Jharkhand
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: The purpose of our study was to analyze the knowledge and attitude of conservative as well as endodontic practice among dental professionals during coronavirus pandemic situation. Methodology: A cross-sectional study was conducted over a period of 3 months among 1256 dental surgeons, which included 400 MDS and 856 BDS dentists. Questionnaire assessed knowledge of the participants about COVID-19, risk assessment about the pandemic, preparedness of the participants, as well as specific precautions in cases which require conservative and endodontic treatment strategies against COVID-19. Results: It was observed that around 83% of the study participants felt that rubber dams are a useful tool to prevent cross-infections, even COVID-19. However, COVID-19 prevention techniques such as use of low-speed handpiece and chemicomechanical techniques were preferred by a smaller number of participants: 25% of participants by former, only 12% for the latter. To prevent aerosol splatter, use of high-volume suction was preferred by 49% of dental surgeons. Conclusion: In our study, we concluded that dental surgeons, who come under high risk category; had good basic knowledge about COVID-19 disease process as well as transmission. However, it is imperative that these clinicians need to be extra cautious in handling cases during this pandemic time and limit the disease spread as well.
Keywords: COVID-19, dental professionals, pandemic, precautionary measures
|How to cite this article:|
Khatore S, Kathuria S, Rawat MK, Thakare AA, Abrol S, Pinnamaneni SP, Tiwari RV. Knowledge, perception, and attitude on conservative and endodontic practice on COVID pandemic situation: A qualitative research. J Pharm Bioall Sci 2021;13, Suppl S1:353-8
|How to cite this URL:|
Khatore S, Kathuria S, Rawat MK, Thakare AA, Abrol S, Pinnamaneni SP, Tiwari RV. Knowledge, perception, and attitude on conservative and endodontic practice on COVID pandemic situation: A qualitative research. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Jan 26];13, Suppl S1:353-8. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/353/317660
| Introduction|| |
COVID-19 has caused a terrifying situation world over, resulting in a devastating pandemic and leading to loss of life and economy everywhere. It is more contagious than other type of coronavirus infections such as MERS and severe acute respiratory syndrome (SARS). According to the International Committee on Taxonomy of Viruses, this virus was named as SARS coronavirus 2 (SARS-CoV-2). This viral infection is caused by the pathogen from the family of Coronaviridae, which has single-stranded RNA as its genetic material. This particular infection resembles SARS and MERS. Till date, four genera of this coronavirus family has been studied, which are α-CoV, β-CoV, γ-CoV, and δ-CoV. In humans and mammals, α-CoV and β-CoV variants affect central nervous system and respiratory as well as gastrointestinal tract systems, and other variants affect mostly broad species. When affected by this disease, the person presents with a plethora of signs and symptoms such as cough, fever, respiratory distress, diarrhea, abnormal opacities in computed tomography scans, and in some cases hemoptysis. Initially it was considered as an zoonotic infection but with evidence from various studies have confirmed the person to person transmission, which is by far the most important route for rapid spreading of this pandemic.
Emergence of this new strain of coronavirus has been amounted to the environmental devastation, which has been caused by humans, resulting in spread of infections from animals to humans. It rapidly spreads, especially in hospital or clinical setting, resulting in serious nosocomial infection. Medical staff are the most susceptible to this particular infection, as they acquire it from the nosocomial settings, which comes under high-risk category. Dental clinics also come under high risk category setting as close contact is very much possible with a virus infected individual and the treating dental doctor. Considering that COVID-19 is extremely contagious, it is generally recommended that the patients suffering from this infection are not supposed to be treated for dental diseases, but emergencies can always turn the situation around. This becomes even more challenging when prolonged incubation period of the disease is considered, which is 5–14 days, where the detection of symptoms is ambiguous, leading to extensive spread in this lay period., Hence, asymptomatic patients are a great threat to dental settings, so proper awareness needs to be there in the dental team to handle any type of situations related to COVID-19. Guidelines have been by various health organizations such as CDC and ADA as well as the WHO to slow down the spread of infection of coronavirus. They emphasize on the use of personal protective equipment, thorough screening of the patients and staff, disinfection of the premises of the clinic, rubber dam isolation, etc., It is essential to be familiar with these guidelines and deal with the prevention as well as control of this disease in a sophisticated manner.[1.13] We carried out this research to assess the knowledge as well as awareness about this infection, how to handle situations in these pandemic times among dental professionals.
Aim of the study
The purpose of our study was to analyze the knowledge, perception, and attitude of conservative as well as endodontic practice among dental professionals during coronavirus pandemic situation.
| Methodology|| |
A cross-sectional study was conducted over a period of 3 months among 1256 dental surgeons, which included 400 MDS and 856 BDS dentists. An online Google Form containing 31 close-ended questions was circulated to assess knowledge, attitude, and preparedness of COVID-19 among Indian dentists. Participants' confidentiality was maintained throughout the study. The questionnaire was created in English language and was divided into five parts concerning with demographic characteristics, knowledge about COVID-19 infection, perception of risk in the present situation, how prepared were they to handle this situation, and finally specific precautions in cases which required conservative and endodontic treatments.
Cronbach's alpha test was used to assess the validity of the questionnaire given to the dental surgeons, which also evaluated that if the questions were easily understandable for the study participants. For knowledge as well as risk perception questionnaire segment, the test values were 0.835 and 0.821, respectively, which established that the questions were well structured and easily understandable among the participants. The collected data were analyzed with the help of Statistical Package for the Social Sciences (SPSS ver 22.0, IBM Corporation, USA), where the categorical variables were n%, and for continuous variables, standard deviation and mean were calculated. P < 0.05 was considered statistically significant.
| Results|| |
Only 12% of the dental participants had undertaken training for COVID-19 prevention [Table 1]. As far as knowledge about COVID-19 disease was concerned, around 68% of the dental participants were aware about various diseases caused by coronavirus. 77% of the dental participants were aware that real-time polymerase chain reaction was a gold standard test to diagnose COVID-19. However, only 43% of the dental participants knew about the actual incubation period of the disease, which was important to understand and control the disease process [Table 2]. 12% of dentists had wrong perception that COVID-19 was not contagious, and 37% of them believed that wearing just surgical masks will suffice during the time of treatment. However, fortunately, 72% of dentists believed that PPE kits are necessary to prevent COVID-19 spread, which was encouraging. 68% of all participants believed that high aerosol splatter procedures such as ultrasonic scaling and usage of high handpiece should be undertaken with great care, as it causes cross-contamination as well as infection spread [Table 3]. Around 73% of dentists felt the need to train their staff members against COVID-19 prevention techniques. 86% of participants also advocated the use of pulse oximeter and thermal screening for all the patients as well as staff members on a regular basis. In these days, telephonic consultations have become popular for nonemergency cases, but only 12% of the dentists believed that it can be a helpful alternative to conventional visit to dentists for elective procedures. High-efficiency particulate air (HEPA) filters to filter out pathogens from the air were only preferred by 13% of participants [Table 4]. It was observed that around 83% of the study participants felt that rubber dams are a useful tool to prevent cross-infections, even COVID-19, which was also statistically significant (P = 0.001). Disinfection of frequently touched areas by sodium chloride was important according to almost 91% of participants. Most of the participants (83%) were also in favor of using single-use disposable instruments to prevent infection spread. However, COVID-19 prevention techniques such as use of low-speed handpiece and chemicomechanical techniques were preferred by a smaller number of participants: 25% of participants by former, only 12% for the latter. To prevent aerosol splatter, use of high-volume suction was preferred by 49% of dental surgeons, which was not statistically significant (P = 0.603) [Table 5].
| Discussion|| |
Coronavirus infection has infected millions of people worldwide, especially the health-care professionals. Dental professionals work in close contact with blood and saliva, so they also come under this very high-risk category. Even though during daily practice, those professional have been handling cases with tuberculosis and HIV, but handling a pandemic is proving to be a tough task ahead for them. SARS infection in a dental clinical setting was first observed in the year 2003, but this infection has an acute phase of fever, which prevented them to visit clinic again during the symptomatic period. So, people used to self- isolate themselves due to the acute phase which is not the case in COVID infection, where asymptomatic patients spread the infection further rapidly. However, in case of COVID, the situation is much worse due to asymptomatic patients, where the presence of virus in saliva results in spreading in clinic setting much faster. Aerosol splatter has proven to be the most effective way for the spread of coronavirus, which can spread to a distance of even 18” or more. ADA has, therefore, provided some guidelines, so that only emergency treatment should be given preference over the elective ones with minimal contact or preferable no contact methods like teledentistry. Dental surgeons are these days very much concerned about working in this pandemic situation. Hence, adequate knowledge regarding COVID disease, will be the only way ahead. In an endodontic setting, COVID patients should be entertained only for emergency treatments or palliative (pharmacologically) with adequate precautionary measures. It is imperative to handle working in the pandemic situation, to divide dental procedures on the basis of the urgency. The treatments can be divided into ones which are emergency procedures and procedures that are elective and can be postponed for a later date. According to the CDC guidelines, it is mandatory to wear N95 masks with eye goggles or face shields for the dental professionals to reduce cross-contamination due to aerosol. In case of endodontic microscopes, a plastic barrier can be created attached to the binoculars, so that a physical barrier is created. Whenever possible, extraoral radiography like cone-beam computed tomography needs to be encouraged to have minimal contact with the patient. If intraoral radiographs are a necessity, it should be in limited amount. To limit the aerosol spread, usage of rubber dam has been strongly advocated, so that maximum coverage of patient tissues is there and less of blood and saliva contact. This can reduce the airborne spread by 90%. Vacuum suction can also be utilized as it removed the contaminated air up to 2.83 m3/min. HEPA filters are also an effective device, which removes 99.97% of the airborne particles measuring 0.3 μm, which can be utilized to purify air in dental settings.
Single visit treatments need to be encouraged, so that canal disinfection can be done in cases of symptomatic apical periodontitis or in cases of apical abscess. If treatment cannot be completed in a single setting, after complete debridement of canal, intracanal antibacterial medicament needs to be placed in cases requiring immediate intervention. Vital pulp therapies are effective in case where single sittings are preferred as they can reduce pain as well as are successful treatment strategies. To minimize posttreatment pain and discomfort, occlusal reduction would be an ideal strategy. In case of traumatic injuries, it is advisable to refer the patient to a dental setting where special equipment are present to handle such situations; meanwhile, the avulsed tooth needs to be transported properly in a storage medium like milk. IADT guidelines need to be followed for any recovered COVID patients. However, pharmacological interventions should take a front seat during these pandemic times. In our study, we noticed that most of the dental professionals were aware of the pandemic situation as well as the measures taken to control the same in their clinics. The respondents have recorded a good judgment about the risk perception as they know they fall in the high-risk exposure category and showed a positive attitude toward performing dental treatment in the current COVID-19 crisis. However, certain modifications were needed their way of working to adjust to the COVID era of working.
| Conclusion|| |
Dental surgeons come under high-risk group, so they need to extra prepared to handle and prevent the spread of COVID-19. They should follow the guidelines given by the WHO and CDC verbatim along with training programs, so that safe as well efficient treatment can be provided to the patients in this pandemic era.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
Hassan SA, Sheikh FN, Jamal S, Ezeh JK, Akhtar A. Coronavirus (COVID-19): A review of clinical features, diagnosis, and treatment. Cureus 2020;12:e7355.
Lin H, Liu W, Gao H, Nie J, Fan Q. Trends in transmissibility of 2019 novel coronavirus-infected pneumonia in Wuhan and 29 provinces in China. SSRN Electron J 2020. medRxiv 2020.02.21.20026468; doi: https://doi.org/10.1101/2020.02.21.20026468
. [Last accessed on 2020 Oct 08].
Fan Y, Zhao K, Shi ZL, Zhou P. Bat coronaviruses in China. Viruses 2019;11:210.
Fehr AR, Perlman S. Coronaviruses: An overview of their replication and pathogenesis. Methods Mol Biol 2015;1282:1-23.
Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020;12:9.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al
. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.
Chowell G, Abdirizak F, Lee S, Lee J, Jung E, Nishiura H, et al
. Transmission characteristics of MERS and SARS in the healthcare setting: A comparative study. BMC Med 2015;13:210.
Ong SW, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al
. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA 2020;323:1610-2.
Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92:401-2.
Carlos W, Dela Cruz C, Cao B, Pasnick S, Jamil S. Novel Wuhan (2019-nCoV) Coronavirus. Am J Respir Crit Care Med 2020;201:P7-8.
Al-Shawi MM, Darwish MA, Abdel Wahab MM, Al-Shamlan NA. Misconceptions of parents about antibiotic use in upper respiratory tract infections: A survey in primary schools of the eastern province, KSA. J Family Community Med 2018;25:5-12.
Zhang Z, Liu S, Xiang M, Li S, Zhao D, Huang C, et al
. Protecting healthcare personnel from 2019-nCoV infection risks: Lessons and suggestions. Front Med 2020;14:229-31.
Cleveland JL, Gray SK, Harte JA, Robison VA, Moorman AC, Gooch BF. Transmission of blood-borne pathogens in US dental health care settings: 2016 update. J Am Dent Assoc 2016;147:729-38.
To KK, Tsang OT, Yip CC, Chan KH, Wu TC, Chan JM, et al
. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis. 2020;149:841-3.
Samaranayke LP, Peiris M. Severe acute respiratory syndrome and dentistry. A retrospective view. J Am Dent Assoc 2004;135:1292-302.
Harrel SK, Molinau J. Aerosols and splatter in dentistry: A brief review of literature and infection control implications. J Am Dent Assoc 2004;135:429-37.
Halepas S, Femini EM. A punch of prevention is a worth pound of cure. Proactive dentist in the wake of COVID-19. J Oral Maxillofac Surg 2020;78:860-1.
Hau YS, Kim JK, Hur J, Chang MC. How about actively using telemedicine during the COVID-19 pandemic? J Med Syst 2020;44:108.
Shacham M, Hamama-Raz Y, Kolerman R, Mijiritsky O, Ben-Ezra M, Mijiritsky E. COVID-19 factors and psychological factors associated with elevated psychological distress among dentists and dental hygienists in Israel. Int J Environ Res Public Health 2020;17:2900.
Cochran MA, Miller CH, Sheldrake MA. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assoc 1989;119:141-4.
Narayana TV, Mohanty L, Sreenath G, Vidhyadhari P. Role of preprocedural rinse and high volume evacuator in reducing bacterial contamination in bioaerosols. J Oral Maxillofac Pathol 2016;20:59-65.
] [Full text]
Howard J. Guidance for Filtration and Air-Cleaning. Cincinnati, OH: Department of Health and Human Services (DHHS) National Institute for Occupational Safety and Health (NIOSH) Publication; 2003. p. 136.
Li Z, Cao L, Fan M, Xu Q. Direct pulp capping with calcium hydroxide or mineral trioxide aggregate: A meta-analysis. J Endod 2015;41:1412-7.
Nguyen D, Nagendrababu V, Pulikkotil SJ, Rossi-Fedele G. Effect of occlusal reduction on postendodontic pain: A systematic review and meta-analysis of randomised clinical trials. Aust Endod J 2020;46:282-94.
Diangelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, et al
. Guidelines for the management of traumatic dental injuries: 1. fractures and luxations of permanent teeth. Pediatr Dent 2017;39:401-11.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]