Journal of Dental Research and Review

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 8  |  Issue : 3  |  Page : 149--155

Dentist preparedness regarding novel coronavirus disease: An insight


Aniket Gid1, Roshani Thakur1, Motilal Jangid1, Vini Mehta2, Shreya Bagwe3, Ankita Mathur3,  
1 Department of Periodontology, Saraswati Dhanwantari Dental College and Hospital, Parbhani, Maharashtra, India
2 Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
3 Research Consultant, STAT SENSE, India, India

Correspondence Address:
Vini Mehta
Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre, Bhopal - 462 037, Madhya Pradesh
India

Abstract

Objective: This study aimed to assess the level of preparedness exhibited by Indian dentists regarding the novel coronavirus. Materials and Methods: The study included Indian dentists who worked in private clinics or hospitals, public healthcare centers, and government hospitals. The online questionnaire consisted of demographic details and questions on awareness of coronavirus disease 2019 (COVID-19) and the dentists' preparedness against it. Results: A total of 300 dentists participated in this study, with males in majority compared to females. The majority of the dentists were aware of the incubation period and symptoms of COVID-19. Ninety percent of dentists had received knowledge about COVID-19 from various health bodies. Most of the dentists were aware of the precautions to be taken in dental practice, and they enquired about the travel history of all the patients. Conclusion: There is a mounting need for protocols made by health bodies to reach every dentist to take the correct precautions.



How to cite this article:
Gid A, Thakur R, Jangid M, Mehta V, Bagwe S, Mathur A. Dentist preparedness regarding novel coronavirus disease: An insight.J Dent Res Rev 2021;8:149-155


How to cite this URL:
Gid A, Thakur R, Jangid M, Mehta V, Bagwe S, Mathur A. Dentist preparedness regarding novel coronavirus disease: An insight. J Dent Res Rev [serial online] 2021 [cited 2021 Nov 27 ];8:149-155
Available from: https://www.jdrr.org/text.asp?2021/8/3/149/324412


Full Text



 Introduction



The novel coronavirus disease 2019 (COVID-19) has spread its tentacles around every nook and corner of the world from the time it first started in Wuhan (China).[1] The World Health Organization (WHO), in March 2020, professed COVID-19 as a pandemic.[2] This virus is swiftly dispersing through human-to-human transmission via nasal droplets, touch, or when a healthy person comes in direct contact with an infected patient. The situation report by the WHO on August 7, 2020, stated that about 18,902,735 cases and 709,511 deaths were reported globally.[3]

Healthcare workers working for COVID-19–affected patients are succumbing to the disease despite the precautions taken. Dentists stand at a high risk of exposure to this disease due to their clinic setup and the instruments used such as ultrasonic scalers and handpieces, which produce aerosols.[4] The principal cause of contracting this disease is working in proximity to the patient's oral cavity. Although lockdown was enforced in India since March 2020 to curb the disease's spread, healthcare services were not halted. The dentists had to attend the dental emergencies of the patient.

Although coronavirus-positive patients can be deferred for dental treatments, asymptomatic carriers still are a danger for spreading the disease.[5] This poses a new challenge to the dentist and the dental team to recognize such patients. It is imperative that dentists need to display an increased level of attentiveness while treating patients in such times and help prevent the spread of COVID-19.

The protocols for the dentist and the dental team have been released by the Centers for Disease Control (CDC),[6] Ministry of Health and Family Welfare (MoHFW),[7] Indian Dental Association (IDA),[8] and American Dental Association.[9] These protocols include disinfection procedures for the dental clinic. These emergency dental procedures can be attended to donning and doffing of the Personal protective equipment (PPE), inquiring about the patient's medical and travel history, using a rubber dam and antiretraction devices, and proper handling of patient's impression. These protocols can enhance the knowledge of the dentist and help in preventing the spread of coronavirus through dental practice.

Dentists have started implementing these protocols in their dental setup. However, there remains a doubt whether all the recommendations are being followed. This study aims to assess the level of preparedness exhibited by Indian dentists regarding the novel coronavirus.

 Materials and Methods



Study population

The study population included dentists in Maharashtra, India. These dentists had their private practice or worked in hospitals and public health centers. The study was a questionnaire-based survey and was conducted in June 2020. It was an online questionnaire that used Google Forms to accumulate data. 300 dentists were randomly selected. The questionnaire was made anonymous to maintain the confidentiality of the dentists. An approval from the ethics committee was obtained from the institution.

Study instrument

The questionnaire was designed in English language after reviewing the international guidelines.[6],[9] An epidemiologist was consulted for validating the content in the questionnaire. The questionnaire questions were related to the dentist's demographic location, knowledge about COVID-19, and their preparedness toward COVID-19. The survey was a multiple-choice questionnaire consisting of 18 questions and divided into the following sections: demographic information of the dentist, type of practice, and awareness regarding COVID-19 (incubation period, COVID-19 symptoms, and protocols followed in the clinic to prevent the spread of COVID-19). The questionnaire was sent to the subjects through an electronic mail and WhatsApp (Social Media Platform).[10] Descriptive statistical analysis was applied to give details of the questions in the survey.

 Results



Participants and demographic characteristics

The number of participants and their demographic details are presented in [Table 1]. A total of 300 dentists (161 males and 139 females) participated in this study. The male subjects (53.6%) were in the majority compared to female subjects (46.3%). For dental specialties, 36.67% were general dentists, 6.66% were prosthodontists, 33.33% were endodontists, 33.33% were pedodontists, 11.66% were periodontists, 7.66% were public health dentists, 2.33% were orthodontists, 8% were oral maxillofacial surgeons, 4% were oral radiologists, and 6.33% were oral pathologists. Regarding the type of dental practice, 35% owned a private practice, 17.6% worked in private hospitals, 15.6% worked in private hospitals, 12% worked in Primary Health Centre (PHCs), Community Health Centre (CHCs), and 19.66% worked in a government college. With respect to years of dental practice, it ranged from 1 to 30 years, with a majority (45%) having dental practice between 5 and 15 years.{Table 1}

Dentists' knowledge and their preparedness in dental clinic regarding COVID-19 [Table 2]{Table 2}

The dentists' response to knowledge about COVID-19 and their preparedness in the dental clinic are listed in [Table 2]. When asked about the incubation period, a majority (90%) of the dentists answered correctly, i.e., 7–14 days. With respect to information regarding protocols to be followed during dental procedures, 90.7% of the dentists reported that they had received information from websites of health bodies such as WHO, MoHFW, and other professional organizations. However, 7.5% of dentists received the information through webinars. When asked about the mode of transmission of COVID-19 in dental clinics, 90.2% reported the known transmission modes in a dental clinic.

Many dentists (86.9%) reported that they had modified their dental clinic by segregating it into different sections to prevent transmission of COVID-19. 68.7% of the dentists reported that they followed all important measures such as preprocedural mouthrinse and rubber dam use for endodontic and restorative procedures and reduced use of aerosol-producing instruments. When asked in which cases they would use rubber dams, 67.7% reported that they had used it in all endodontic and restorative cases, with 22.2% reporting that they would use rubber dam for selective cases. Routine cleaning of the dental clinic was done by a majority of dentists (70.7%). The majority reported that they had used atraumatic restorative techniques for restoring cavities and deferred the treatment for nonemergent cases such as treating incipient occlusal caries till pandemic subsides. 94.5% of the dentists performed hand hygiene by using alcohol rub or washing hands with soap and water between patients. In comparison, 91% of the dentists chose to wear the entire personal protective equipment (PPE) kit while examining the patient. 67.3% of the dentists confirmed that they had trained their staff in all fields necessary to prevent transmission of COVID-19. While coping with the financial burden, 91% of the dentists reported that they charged the PPE kit patients.

Dentist preparedness to prevent the spread of COVID-19 among patients [Table 3]{Table 3}

The response of dentists' preparedness to prevent the spread of COVID-19 among patients is presented in [Table 3]. 80.7% of dentists opted to treat only emergency cases. In comparison, 12% chose to keep their clinic closed until cases of COVID-19 declined. The majority of the dentists preferred to ask whether the patients had visited any high-risk areas, while 18.9% enquired about their recent visit to any (COVID-19) affected country. 97.9% of the dentists emphasized that patients should follow the instruction protocols on entering the clinic before treatment and 41.2% of the dentists opted for educating the patients about coronavirus by displaying visual posters in their clinic. 53.26% of the dentists preferred to use 1% hydrogen peroxide as preprocedural mouthrinse, while 36% chose 0.2% povidone-iodine for the same.

 Discussion



The COVID-19 pandemic that began in March 2020 will continue to claim many lives until a vaccine is discovered. The present study reflects the awareness and preparedness of dentists regarding novel coronavirus disease. A total of 300 dentists had participated in this multiple-choice questionnaire study.

It has been reported that the incubation period of COVID-19 ranges from an average of 5–6 days to 14 days.[11] Most dentists in this study were aware of the incubation period as it determines the safe period when suspected patients can be treated. Dentists have received knowledge about preventing the spread of COVID-19 in dental practices through websites of various health bodies such as the CDC, MoHFW, and IDA.[6],[7],[8]

To prevent the spread of COVID-19 in dental clinics, most dentists in this study opted to modify their dental clinics by dividing their clinics into various sections and segregating their staff to prevent cross-infections and have a well-ventilated clinic.[12] Due to the pandemic, dental treatments were classified under-emergent, urgent, and nonemergent dental care. Further, care needs to be taken to make minimum use of high-speed handpieces as the presence has been found of the virus in secretions, saliva, etc. In this study, most of the dentists preferred only to treat emergency cases during this pandemic. Guo et al. reported that 94.6% of the dental visits were for emergency treatments in light of the pandemic.[13] Most dentists deferred to treat nonemergency cases during lockdown and preferred to use atraumatic restorative techniques for restoring cavities to reduce the aerosol production from high-speed handpieces.[14]

In this study, most dentists opted to use rubber dams and preprocedural mouthrinses and reduce the use of instruments that produce aerosols. 67.7% of the dentists opted for the use of a rubber dam for all restorative and endodontic cases. It has been reported by Meng et al. and Samaranayake et al. that the use of a rubber dam significantly helps in minimizing the inhalation of infective aerosols by dentists and aids in preventing cross-transmission via saliva.[14],[15] 53.26% of the dentists in this study opted to use 1% hydrogen peroxide, while 36% opted to use 0.2% povidone-iodine as preprocedural mouthrinses. These mouthrinses are known for their nonspecific virucidal activity in the saliva and reduce coronavirus's load in the saliva.[16],[17]

It has been reported that the coronavirus can survive on inanimate surfaces such as metals and glasses for up to 9 days.[18] However, they are proficiently inactivated by surface disinfection procedures with 62%–71% ethanol, 0.5% hydrogen peroxide, or 0.1% sodium hypochlorite within 1 min.[18] In this study, most dentists opted for routine disinfection of their dental clinics every day before and after every procedure and at the end of the day before closing the clinic. Zhang et al. have recommended the use of ultraviolet radiation for disinfection of the operatory room.[19]

When dentists are in the working environment, they must wear the entire personal protective equipment (PPE) kit as they are at high risk of getting infected. In the present study, the majority of the dentists preferred to wear the entire PPE kit. The second most crucial professional measure followed this: performing good hand hygiene using alcohol rub or soap and water before examining each patient (94.5%). It is essential to maintain good hand hygiene as it is the most important measure for reducing the risk of transmission of microorganisms to patients.[20] The other measures followed by dentists were wearing N-95 masks (68.7%), using goggles (63.57%), use of gloves (67.7%), and use of face shields (34.36%). When treating COVID-19–positive patients, it is recommended to use a high-level respirator like a higher-level respirator such as EU FFP3 conforming to the European Standard 149.[14],[21],[22] Tang et al. have recommended using goggles and face shields for eye protection.[23]

The dentist must train the dental staff for protection against coronavirus to prevent the spread of the same. In this study, 67.3% of the dentists had trained their dental staff for teledentistry, donning and doffing of PPE kit, proper sterilization, and disinfection of the instruments and dental clinic. Proper disposal of biomedical waste prevents infection. Due to various restrictions imposed and lockdown in cities, the patient flow was relatively low. An additional expense of the PPE kits and other equipment such as thermal scan and pulse oximeter has been added to dentists' financial burden. In this study, most dentists opted to cope with this financial burden by charging the patients with the PPE kit cost and revising the treatment charges. Other measures to cope with this financial burden were to reduce the number of staff or their salary.

The symptoms of COVID-19 are fever, cough, breathlessness, fatigue, or muscle pain, and the less common being diarrhea, sputum production, headache.[24] In this study, most dentists asked the patient during teledentistry, whether they had any symptoms pertaining to COVID-19. Furthermore, most dentists preferred to ask about the patient's travel history, the main question being whether they had visited any COVID-19–infected country or come in contact with a COVID-infected patient or if they had been to any high-risk areas or visited any social gathering. However, a few dentists still did not ask these questions.

After triaging a patient for dental treatment, the patient needed to follow a certain set of protocols when appointed for dental treatment to prevent transmission of COVID-19.[12] In this study, 97% of the dentists stressed that patients need to follow protocols such as leaving footwear outside the clinic, getting checked for temperature, and use of hand sanitizer on entering the clinic.

It has been shown that COVID-19 spreads via human-to-human transmission by droplets or saliva.[25],[26] It is essential to educate the patient about the mode of transmission and the precautions to be taken to prevent the spread of COVID-19. 51% of the dentists chose to place visual posters in the waiting area to educate the patient about COVID-19, whereas a few dentists opted for a health education talk.

A recent systematic review highlighting the risks and precautions taken to prevent cross-transmission of COVID-19 in a dental setting has emphasized that the dental team should reinforce a strict infection prevention measures in the clinic and minimize aerosol and decrease use person-to-person contact.[27] It has also accentuated that dental care workers should keep themselves well informed about this disease.[27]

Dentists can play an important role as frontline workers in managing COVID-19 patients. As they have knowledge about the oral and nasal cavity, they can take oral and nasal swabs of suspected COVID-19 patients atraumatically.[28] Dentists can also assist their medical counterparts during patient triage and help in monitoring vital signs, administering injections, and writing prescriptions.[29] Due to lockdown enforced in almost all places around the world, it has become impossible for the patients to visit their local dentists unless for emergency procedures. There is a need for dentists to develop online platforms to educate people on maintaining their oral health while staying indoors.[28] This pandemic has highlighted the importance of infection protocols. It thus becomes imperative to include courses on stringent infection control protocols for dental students as well as practicing dentists to help evade the anxiety of patients post-COVID.[28] This pandemic also brought in to focus the importance of voluntary work in medical centers.[28] This suggests the importance for dental students to work at primary healthcare centers as they will interact with people from various strata of the society as well as help them to set a career as a public healthcare worker.[30]

This study had a few limitations. The main limitation is a small sample size, so the response rate was less. It can be attributed to the short period of data collection. Furthermore, only those dentists who were active on social media participated in this study.

 Conclusion



The participants in this study were aware of the incubation period, modes of transmission of COVID-19 in dental clinics, and the precautions needed to prevent the spread of the disease. There is a mounting need for health bodies' protocols to reach every dentist to take the correct precautions.

Ethical clearance

The study was approved by the Institutional Ethics Committee of Saraswati Dhanwantari Dental College and Hospital, Parbhani, Maharashtra.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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