Knowledge, Attitude and Practice Survey of Dental Students and Dental Practitioner about COVID 19

Keywords

Knowledge; Attitude; Practice; COVID 19; Dental Students; Dental Practitioners.

Introduction

Coronavirus Disease 2019 (COVID-19) is a quickly expanding pandemic caused by a novel coronavirus (SARS-COV-2) previously known as 2019-nCov.[1, 2] COVID-19 was first disclosed in December 2019 among patients with viral pneumonia symptoms in Wuhan, a city in People republic of China.[3, 4] This virus is spreading from person-to-person through inhalation of aerosols from an affected individual.[3] Elderly patients and patients with co- morbidity like High blood pressure, Heart diseases, pneumonic diseases, cancer, or diabetes are highly susceptible to developed the disease.[5, 6]

Primary mitigatingactions includes regular hand washing with sanitisers or soap, social distancing between one another, and respiratory hygiene involving covering of mouth and nose while coughing or sneezing.[7, 8] Lack of clear understanding of the disease among UG can result in delayed recognition of patient and treatingthem leads to intense spread of infections. Over 1000+frontline workers have succumbed to COVID-19, along with precarious condition of health infrastructure and a big barrier to the fight against the COVID-19 at the same time it is difficult to treat other strategically important disease like tuberculosis. Among the fromtline workers, the risk of cross-infection is greater among dentists since they work with patients in close contact compare to other practitioner. Furthermore, dental operation itself poses a riskier surroundings because of producing aerosol and droplets out of the patients oral cavity (Meng et al. 2020; Ather et al. 2020; Isha et al. 2020). Recent data suggesting that SARS-CoV-2 virus might remain alive and infectious in aerosols and droplets for more than an hour, which poses grave threats for dentists to be infected and it spread to their colleagues, families and other patients (Van Doremalen et al. 2020; Ahmed et al. 2020). Dentists may also get infected from unrecognised and under surveillance COVID-19 individuals.Thus, contamination may occur even before the indication appear (Atas¸ and Yildirim 2020) and indirect contact with contaminated surfaces and instruments (Fallahi et al. 2020) may result in mortality among individuals.

Previously our team has a rich experience in working on various research projects across multiple disciplines (Govindaraju and Gurunathan 2017; A. Christabel et al. 2016; Soh and Narayanan 2013; Mehta et al. 2019; Ezhilarasan, Apoorva, and Ashok Vardhan 2019; Campeau et al. 2014; Kumar and S 2016; S. L. Christabel 2015; Kumar and Rahman 2017; Sridharan, Ramani, and Patankar 2017; Ramesh et al. 2016; Thamaraiselvan et al. 2015; Thangaraj et al. 2016; Ponnulakshmi et al. 2019; “Fluoride, Fluoridated Toothpaste Efficacy and Its Safety in Children - Review” 2018) Now the growing trend in this area motivated us to pursue this project.

For this reason, the Centers for Disease Control and Prevention (CDC) and the WHO recommend various guidelines to prevent COVID-19 cross-infection in the dental office (Khader et al. 2020). A multi- country study ending revealed that dentists around the world are in a state of anxiety and fear due to the COVID- 19 pandemic (Ahmed et al. 2020). The rapid spread of COVID-19 in India, countrywide lockdown, and social distancing measures to slow down the spread of disease have made it difficult for imparting extensive social professional education or training material to prevent cross- infection in dental settings and largely to dental practitioners. However, various professional organisations have been using internet and social media platforms to disseminate the scientifically validated protocols, emergency dental treatment guidelines to contain the disease spread through dental practice. The importance is paramount for dental health care workers of India to be equipped with up-to- date knowledge and practices toward COVID-19. Therefore, the current study aimed to assess the knowledge, attitude, and practices of dental students and dental practitioner.

Materials and Methods

This study was patterned as a cross-sectional online survey. Prior to the initiation of the study, the questionnaire was created according to necessary requirements, and then it is validated .The data was collected through an online questionnaire using Google forms. On clicking the link, the participants could view the survey questions. The questionnaire was created in form of a quiz . It was designed in English language. All the data was accessed only by the principal investigator and to fill this survey no personal details like e-mail address was requested.The questionnaire was distributed personally via a link and as well as posted on various social media platforms like Facebook, WhatsApp and telegram. In this survey convenience sampling i.e the researchers themselves contacted the UG students to participate in the study by sending them a link and snowball sampling i.e. the participating UG students were asked to forward the questionnaire to their batch mates/juniors/seniors so that maximal participation could occur. The questionnaires was divided into 4 sections and had a total of 19 questions. The 1st section contained demographic details like age, gender and educational qualification (medical UG /dental UG). This section did not have any marks. The 2nd, 3rd and 4th sections assessed the knowledge (5 questions), attitudes (5 questions) and practice (5 questions) of dental students and dental practitioner regarding covid 19.

Data Analysis

The data was collected and the analysis was done using IBM SPSS for windows, v.20.0.chi square test was applied and statistical significance level was set at p <0.05.

Result

In our study, 300 response were received from the participants. Upon which total of 150 dental students and 150 dental practitioner participated. It also include 71 % of females and 29% of males.

Knowledge

In the knowledge section, over all 90% dental practitioner and 80% of Dental students responded correctly. Scoring for knowledge, each correct answer was given a score of 5 while each wrong answer was given a score of 0. In total there were 5 questions and each question in the knowledge section had only one correct answer and three wrong answers. This way, a respondent could score a maximum of 25 and a minimum of 0 in this section. Statistically significant difference was noted in the dental students and dental practitioner (p=0.004).

Practice

To evaluate the practice of Dental students and dental practitioner towards the disease, 5 questions were asked. Classification of the dental respondents on the basis of poor, averageand good attitude score.

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Figure 1:

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Graph 1. Knowledge of dental student and dental practitioner.

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Figure 2:

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Graph 2. Attitude of dental student and dental practitioner.

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Figure 3:

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Graph 3. Practice of dental student and dental practitioner.

Discussion

The recent outbreak of COIVD-19 disease and its repercussions have gripped the entire human community and has caused wide spread public health concerns. Based on our findings, the KAP towards COVID-19 score was significantly higher among Dental practitioner as compared to dental students. Inspite of all the positive efforts taken by the World Health Organisations and Government across the world and particularly in India, the number of cases are rising every day in inelastic manner, because the nature of the spread of the infection and the difficulty in its containment.[9] It is important to remember that COVID-19 does not differentiate between borders, ethnicities, age or gender. 21 Theearly death in cases of COVID-19 occurred primarily in elderly people, possibly due to weak immune system. Health care professionals are having higher chances of getting infected. So, it is essential that at the undergraduate level students should be educated, empowered, sensitised and provided appropriate, adequate and relevant knowledge regarding the disease. The infection control procedures, the personal protective gears for safety and handling even asymptomatic patients is of utmost importance for these students. In the knowledge section, over all 90% dental practitioner and 80% of mental students responded correctly. In the attitude section, overall 89.66% dental practitioner and 80.83% dental students .In the practices section, overall 85 % dental practitioner and 80 % dental students responded correctly. The Knowledge,attitude and practices related to COVID-19 were found to be reasonable among our participants but little improvement need for the dental students.While carrying out a dental procedure, a four-handed technique helps to decrease the spread of possible infections by using high volume saliva evacuators that would reduce the aerosols and droplet production.

Dental clinicians are probably at high risk of getting infected. Hence, it should be mandatory for all to take all preventive measures during this panic time, such as using personal protection equipment (PPE), autoclaving handpiece after each patient, pre- procedural mouth rinse with 0.2% povidone-iodine, hand hygiene with alcohol sanitizers before and after each procedure, high-speed evacuation for treatment generating aerosols (e.g., endodontic, restorative and ultrasonic scaling procedures), social distancing inside the dental clinic by isolating patients in separate rooms, routine cleaning, and disinfection procedures that should include daily fumigation of the clinic.

Limitation

There is no comparative assessment between the different academic year students .Further research studies can be conducted on the comparative assessment of the KAP amongst the different academic year students.

Conclusion

The knowledge, attitude and practice of dental students is less when compared to the dental practitioner. Improvement on undergraduate training is absolutely necessary so as to mitigate the risk of transmission of disease among students, also they are the future health care workers and also act as role model for the community. Conducting periodic webinars/seminars for educational and medical intervention for all UG students could be a useful and a safe tool to prepare them for this pandemic.