|Year : 2021 | Volume
| Issue : 5 | Page : 831-835
Knowledge and attitude towards dental clinical practice related to COVID-19 pandemic among dental interns in Saudi Arabia
Suhail Shariff1, Muath Muhammad Benten2, Mohammed Khaled Ahmed Al-Zabidi3, Ghaida Mohammed Alshehri2, Ahad Abdulaziz Almehmadi2, Shahad T F Alhazmi2, Elaf Waleed AlDara2
1 Department of Conservative Dental Sciences, Ibn Sina National College, Jeddah, Saudi Arabia
2 Intern, Dentistry Program, Ibn Sina National College, Jeddah, Saudi Arabia
3 Lecturer of Endodontics, Dentistry Program, Ibn Sina National College, Jeddah, Saudi Arabia
|Date of Submission||16-Dec-2020|
|Date of Decision||07-Jan-2021|
|Date of Acceptance||14-Jan-2021|
|Date of Web Publication||05-Jun-2021|
Assistant Professor, Department of Conservative Dental Sciences, Ibn Sina National College, PO Box 31906, Al Mahjar Street, Jeddah - 21418
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The newly emerged pandemic has created many dilemmas in dental clinical practice all over the world. Most of the practicing dentists and dental students are at higher risk of getting infected and transmitted the disease. The study aimed to explore the knowledge and attitudes among dental interns in Saudi Arabia related to the COVID-19 pandemic. Materials and Methods: An online questionnaire survey was carried out among dental students pursuing their internship at different universities in Saudi Arabia. A combination of convenience and snowball sampling was used to identify interns from each province of the Kingdom. The questionnaire was validated and pretested, which recorded the knowledge, attitude, and concerns related to dental practice and COVID-19. Results: The knowledge related to COVID-19 and its importance in clinical dental practice was below average among dental interns, and only 22.2% gave a correct response to all questions. About 80.8% and 85% of the dental students were worried about contracting the infection during dental practice and transmitting it to family and friends, respectively. Conclusion: Dental students showed satisfactory knowledge, attitude, and practices related to COVID-19, and most of them were aware and adhering to the preventive guidelines set by the ministry of health.
Keywords: COVID-19, dental practice, infection control, prevention
|How to cite this article:|
Shariff S, Benten MM, Ahmed Al-Zabidi MK, Alshehri GM, Almehmadi AA, F Alhazmi ST, AlDara EW. Knowledge and attitude towards dental clinical practice related to COVID-19 pandemic among dental interns in Saudi Arabia. J Pharm Bioall Sci 2021;13, Suppl S1:831-5
|How to cite this URL:|
Shariff S, Benten MM, Ahmed Al-Zabidi MK, Alshehri GM, Almehmadi AA, F Alhazmi ST, AlDara EW. Knowledge and attitude towards dental clinical practice related to COVID-19 pandemic among dental interns in Saudi Arabia. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jul 27];13, Suppl S1:831-5. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/831/317711
| Introduction|| |
The emergence of the newly identified β-coronavirus commonly known as COVID-19 occurred in Wuhan, China, has evolved rapidly into a public health crisis and has spread exponentially to other parts of the world. As of June 23, 2020, a total of 8,993,659 cases of COVID-19 have been confirmed throughout the world including 469,587 deaths and Saudi Arabia has alone reported 164,144 with 1346 deaths. No doubt this pandemic has created much chaos and panic among all sectors of the society including health-care professionals.
The incubation period of COVID-19 is estimated to be from 1 to 14 days, which is also the recommended duration of medical observation and quarantine in infected patients. Patients who are infected often show clinical manifestations that include fever, cough, and shortness of breath. It is reported that more than 80% will experience mild respiratory infections and about half of the infected will have pneumonia. Severe illness has been reported in 15% of the patients, of which 5%–7% need critical care treatment., Some rare cases will have severe respiratory problems, kidney dysfunction, and also could lead to death. Specific symptoms experienced by the patients include dry cough and fever and also nonspecific symptoms such as difficulty in breathing, eye inflammation or redness, pharyngitis, emesis, diarrhea, fatigue, and body pain are also common.,,
The spread of this COVID-19 has challenged all the health-care professionals including dentists, who are at elevated risk of getting infected due to their frequent exposure to body fluids (saliva and blood) and aerosol or droplet generated from the oral cavity during the various dental interventions. Consequently, this particular virus's transmission can occur by inhaling aerosols generated from the infected persons or by direct contact with saliva, mucous membrane, and contaminated instruments and objects., Dentistry involves procedures that generate aerosol production and that make this profession a high-risk category for COVID-19 transmission.,, Knowledge related to this pandemic including its transmission, prevention, and management among dental health professionals is very much essential, as this would help to reduce the risk of getting infected and transmitted. Thus, this survey aimed to explore the knowledge, attitude, and practices toward dental treatment among dental interns studying in the Kingdom of Saudi Arabia.
| Materials and Methods|| |
Our study was a cross-sectional study done among dental interns in dental schools in Saudi Arabia. The survey was conducted using a validated questionnaire, which was tested for its content and face validity that was done by a group of expert evaluation. We used a principal component analysis (common factor analysis) to check the construct validity. The questions with low correlation coefficient (r = <0.7) were excluded. The questionnaire showed an internal consistency of 0.791. The questions were then classified based on three components, such as knowledge, attitude, and practices.
A minimum of 146 sample size was calculated considering values of the standard deviation of scores obtained from the pilot study done in 25 interns.
We used the sample size formula,
Where S= standard deviation (10.19), Z= 1.96, mean = 9.87; d= mean difference (0.2316); α= significant level (95%) and 1-β= power of study (80%).
The Institutional Ethics Committee of the institution approved and gave permission for this survey. The questionnaire was sent randomly to selected dental interns after contacting them either through phone and/or e-mail. We used a mixed method of convenience and snowball sampling where interns from each province were identified and asked to answer the questionnaire. They were also requested to forward to their colleagues and other dental interns from other provinces to ensure a larger participation. The participants were briefed about the need and benefits of the study and anonymity of their responses was assured.
Data collected were entered into MS Excel by a calibrated investigator and statistical analysis was done using SPSS ver 23 (IBM Corp. USA) by an independent biostatistician. Categorical variables were summarized as proportions and frequencies and any possible relationship of the variables was analyzed using Pearson's Chi-square test. Continuous variables obtained were expressed as mean and standard deviation. The significance value (P value) ≤ 0.05 is considered statistically significant.
| Results|| |
In our study, we had included a total of 203 dental interns from various provinces of Saudi Arabia who gave consent to participate in the research. The mean age of the participants was 24.12 ± 2.25 years that included 54.2% (n = 110) females and 45.8% (n = 93) males. The responses to questions related to the COVID-19 infections are depicted in [Table 1]. The participants who gave correct responses to all the knowledge questions were 22.2% (n = 45) and there was no statistically significant relationship of these responses with the gender of the participants (P = 0.220) [Table 2]. The mean score of knowledge questions was 7.45 ± 2.63 and there was no statistically significant difference observed in these mean scores between male (7.34 ± 2.55) and female (7.55 ± 2.71) interns, (t(201) = 0.542, P = 0.588).
|Table 2: Relationship of gender with participants answered all knowledge questions correctly|
Click here to view
When we inquired about the participant's practices during the COVID-19 times, 69.5% reported that they did not go to crowded places and 66.5% agreed that they followed preventive guidelines along with usage of N95 masks. Attendance to online courses that are related to the dental practice and COVID-19 was reported among 69.5% of the participants and 59.6% mentioned that they searched for scholarly/research articles on dentistry and clinical practice during COVID-19 pandemic. When we assessed the attitude and concerns of the participants, it was found that 80.8% were worried about contracting the COVID-19 infection when providing dental care for the patients. Approximately 71% of the participants had the opinion that nonemergency dental appointments should be performed with adequate precaution with the use of personal protective equipment (PPE). The majority of the participants were worried about spreading infections to their family and friends (85.7%) and also worried about the spread through aerosols during dental procedures (86.2%) [Table 3].
|Table 3: Opinions of dental interns related to clinical practice during COVID-19 pandemic times|
Click here to view
| Discussion|| |
It is very much evident that COVID-19 transmission risk is higher for people those who come in close proximity with the infected persons that include dentists who do procedures directly in the oral cavity. Thus, there is a huge risk of getting infected and transmitted to other health-care workers and relatives. The dentist's immediate and appropriate responses have a crucial role to control the spread of this pandemic. In our study, the majority of the interns had good knowledge regarding the clinical symptoms of COVID-19.
Clinical appointments should be made after performing an initial screening through teleconferencing methods, which will help to record the travel history, movement history for both patients and relatives in his/her residence. It would also help the dentist to discuss the protocols and preventive guidelines that they should follow when coming for dental appointments considering the incubation period of the virus, which is 0–14 days. Patients, who are recently recovered or still active with infections, should be considered for treatment after getting a physician's consent and treatment should be done following all the preventing guidelines.
In our findings, 72.9% agreed that thermal scans are necessary preliminary methods for positive COVID-19 patients. A person with a COVID-19 infection usually experiences an elevated temperature, and this is one of the standard methods used in screening an individual who has the disease. However, an asymptomatic and afebrile infected person could also be contagious. Thermal imaging scanners and noncontact temperature assessment devices could be utilized for screening people's temperature who are visiting dental clinics., Nearly half of the participants only agreed that using 0.23% of povidone-iodine mouthwash before any dental treatment procedures would help to reduce the virus load in the oral cavity. Evidence shows that this preprocedural mouth rinse for at least 15 s can reduce the viral load in the patient's saliva. Some of the other treatment consideration that should be followed to minimize the spread of infection are utilization of extraoral imaging and restriction of intraoral imaging techniques, use of disposable and single-use instruments and devices, rubber dam should be used whenever possible, minimize or avoid aerosol-generating treatments, and procedures should be as minimally invasive as possible.,
The findings of our study showed that the majority of the dental interns had shown satisfactory attitudes in professional and personal life related to COVID-19 pandemic delaying the appointments in nonemergency dental treatments, use of PPE when treating all types of patients, etc., The majority of the interns were also concerned and worried about of spread of infection to their family and friends. Approximately 70% of them agreed that they did not get crowded places during these pandemic times. About 69.5% and 59.6% of the participants reported attendance to online continued dental education courses on dental practice during COVID-19 pandemic and search for scholarly articles regarding the same topic, respectively. Dental interns should utilize this unprecedented period to learn and understand not only the information of pandemic but also should put effort to do research and innovations that can hugely contribute to dentistry as well as public health.
Some of the limitations that should be considered before interpreting our study findings are as follows. There is a possibility of social desirability bias, which was tried to minimize by not asking the participants their name or any identifying details and also assuring the anonymity and confidentiality of the responses they provided. Second, as we followed convenience and snowball sampling techniques, there is a possibility of selection bias. To minimize this, we tried to personally contact the interns either through phone or e-mail.
| Conclusion|| |
In our study, dental interns showed good knowledge, attitude, and practices required to combat the COVID-19 pandemic. Dental interns should mandatorily use the recommended preventive guidelines given by the concerned health authorities such as Ministry of Health, Centers for Disease Control and Prevention, and WHO. They should make utilization of this pandemic time to learn and research innovations that can contribute both to the public and also the scientific community. Dental schools should provide advanced and motivational education methods to educate the residents to prepare for possible future pandemics.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al
. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak-An update on the status. Mil Med Res 2020;7:11.
WHO. Coronavirus Disease (COVID-2019) Situation Reports; 2020.
Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020;25:2000062.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al
. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, Xing F, et al
. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet 2020;395:514-23.
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.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al
. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
Li D, Jin M, Bao P, Zhao W, Zhang S. Clinical characteristics and results of semen tests among men with coronavirus disease 2019. JAMA Netw Open 2020;3:e208292.
Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al
. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 2020;12:8.
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.
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.
Pan Y, Liu H, Chu C, Li X, Liu S, Lu S. Transmission routes of SARS-CoV-2 and protective measures in dental clinics during the COVID-19 pandemic. Am J Dent 2020;33:129-34.
Pereira LJ, Pereira CV, Murata RM, Pardi V, Pereira-Dourado SM. Biological and social aspects of coronavirus disease 2019 (COVID-19) related to oral health. Braz Oral Res 2020;34:e041.
Kamate SK, Sharma S, Thakar S, Srivastava D, Sengupta K, Hadi AJ, et al
. Assessing knowledge, attitudes and practices of dental practitioners regarding the COVID-19 pandemic: A multinational study. Dent Med Probl 2020;57:11-7.
Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J 2020;32:181-6.
Hewlett AL, Kalil AC, Strum RA, Zeger WG, Smith PW. Evaluation of an infrared thermal detection system for fever recognition during the H1N1 influenza pandemic. Infect Control Hosp Epidemiol 2011;32:504-6.
Quilty BJ, Clifford S, Flasche S, Eggo RM, CMMID nCoV working group. Effectiveness of airport screening at detecting travellers infected with novel coronavirus (2019-nCoV). Euro Surveill 2020;25:2002132.
Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In vitro
bactericidal and virucidal efficacy of povidone-iodine gargle/mouthwash against respiratory and oral tract pathogens. Infect Dis Ther 2018;7:249-59.
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.
Coulthard P. Dentistry and coronavirus (COVID-19)-Moral decision-making. Br Dent J 2020;228:503-5.
[Table 1], [Table 2], [Table 3]