|Ahead of print publication
Dentists' concerns about the control of coronavirus disease (COVID-19) in daily dental practice: A web-based cross-sectional study
Nikee Upadhyay, Monali Shah, Yesha Raval
Department of Periodontology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
|Date of Submission||22-Mar-2021|
|Date of Decision||05-Jun-2021|
|Date of Acceptance||19-Jul-2021|
|Date of Web Publication||19-Aug-2021|
Department of Periodontology, K.M.Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat
Source of Support: None, Conflict of Interest: None
Introduction: A newly identified viral infection, a global pandemic of coronavirus disease 2019, that began in Wuhan, China, and spread around the world, causing an epidemic of pneumonia (COVlD-19), has infected millions of population, causing social anxiety and panic amongst healthcare professionals and the general public. This study aimed to measure the dentists' anxiety and apprehension of being infected while operating during the latest coronavirus disease (COVlD-19) epidemic through a web-based questionnaire. Methodology: An online survey was used to perform a cross-sectional analysis. The well-constructed questionnaire, which consisted of closed-ended questions, was prepared and submitted to dentists of India. A total of 396 people from all over India took part in the survey. Results: The debilitating consequences of COVlD-19 caused anxiety and fear in a total of 55.8% of general dental practitioners in India. There were 373 dentists (94.2%) who were mindful of recent developments in care procedures. The majority of dentists, 316 (79.8%), are fearful of contracting COVID-19 from a patient or co-worker, and 309 (78%) dentists are nervous when treating a patient with COVID-19. Conclusion: Indian dentists revealed good information regarding COVID-19. However, dentists were comprehensive about the extra precautionary measures that protect them about the virus. A considerable percentage of dentists reflected their anxiety and worries about dental profession due to which they have either changed their services to comply with the rules or shut down their practices for an indefinite time.
Keywords: Anxiety, COVID-19, dentists
|How to cite this URL:|
Upadhyay N, Shah M, Raval Y. Dentists' concerns about the control of coronavirus disease (COVID-19) in daily dental practice: A web-based cross-sectional study. Adv Hum Biol [Epub ahead of print] [cited 2021 Oct 26]. Available from: https://www.aihbonline.com/preprintarticle.asp?id=324177
| Introduction|| |
In March 2003, a worldwide epidemic of severe acute respiratory syndrome (SARS) began. SARS had triggered international concern due to its communicability and rapid spread through jet travel, as well as the fact that it had disturbed a significant number of medical and nursing personnel. Similarly, since the COVID-19 epidemic is so rapid and deadly, many countries have declared a state of emergency to try to prevent the spread of the virus. Furthermore, several people went through self-quarantine in order to contribute to humanity by limiting disease transmission. People have also developed social anxiety and fear as a result of this.
A series of pneumonia cases have been reported in Wuhan, Hubei Province, China, since 8 December 2019. It is caused by the coronavirus 2 that causes SARS novel coronavirus (SARS-CoV-2), COVID-19 was declared a pandemic on 11 March 2020, and a national emergency on 13 March 2020 in the United States (Center for Disease Control & Prevention [CDC] 2020). This infectious disease is being monitored by international disease control and prevention centres.
Healthcare facilities are inherently important for any population and are rarely closed under such pandemic conditions. Healthcare staff are most likely to get sick as a result of their close contact with infected patients.
Dentists, in practice, perform their duties not only in close proximity to patients but also when exposed to aerosol and splashing droplets from the oral cavity. Dentists are therefore at a high risk of being infected by patients and then spreading the infection to their friends, relatives and other patients. In these circumstances, it is not uncommon for dentists to build an anxiety of being infected by their patients.
Healthcare professionals, on the other hand, are at a higher risk of becoming infected as a result of their exposure to infected patients, which makes them anxious.,
Fear and anxiety are intense emotions that can be linked to the overwhelming news of the COVID-19 pandemic through social, electronic and print media. Mild anxiety is normal and encourages protective and preventative action. While the American Dental Association (ADA) has released preventive recommendations, the majority of dentists are either unable or afraid of treating patients in such a condition (ADA-COVID-19 Resources for Dentists). As a result, we performed a questionnaire-based study to assess dental anxiety about the treatment of coronavirus disease (COVID-19) in daily dental practice.
| Methodology|| |
An online survey questionnaire was used to perform the research. As a result, a well-designed questionnaire was developed, and the online survey connection was distributed to dental professionals across India via E-mail and WhatsApp groups, and responses were obtained via an online survey submission. The questionnaire was adapted from a previous study by Ahmed MA et al., 2020, which consisted of 28 closed-ended questions primarily based on dentists' concerns about being infected with COVID-19 and collecting information in accordance with the CDC and ADA practice recommendations on practice modifications to tackle the COVID-19 spread. Statistical research was carried out using SPSS version 25. A Spearman correlation analysis and Chi-square were used to track confounders and assess the relationship between dental reaction and respect.
At the 95% confidence interval, the sample size for this analysis was calculated to be 384. The dentists in the study were chosen at random from E-mail or WhatsApp lists. The number of people who were asked to fill out the form was more than double the sample size calculated. Each participant was approached individually to ensure that they are a dentist who works in India.
The current research included descriptive and inferential statistical studies. Continuous measurement results were presented as mean and standard deviation, while categorical measurement results were presented as a percentage (%). Any value ≤0.05 was considered statistically important. The importance of research parameters on a categorical scale was determined using Chi-square analysis. The data were analysed using the statistical programme IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA), and diagrams, charts and other graphics were created using Microsoft Word and Excel.
| Results|| |
A total of 396 participants across India completed the questionnaire, which included 28 closed-ended questions about apprehension or anxiety levels and practice adjustment as a result of COVID-19. [Table 1] shows the demographic statistics of the participants. The dentists who took part in the study came from various parts of India.
[Table 2] shows the uncertainty and anxiety rate of dental care workers as it comes to COVID-19. A total of 79.8% of participants were concerned about being contaminated with COVID-19 by a patient or co-worker. As compared to the postgraduate group (56.1%), the undergraduate group (69.0%) was more nervous when communicating to patients in close proximity, which is statistically important (P = 0.016).
[Table 3] shows the results of their knowledge and experience. COVID-19 was transmitted in one of two ways, according to 99.2% of dental practitioners. The new CDC or World Health Organization (WHO) recommendations for cross-infection prevention are revised in 94.2% of the cases. When it comes to personal defence, 59.8% of respondents agree that a surgical mask is insufficient to avoid COVID-19 cross-infection. In comparison to dentists who practice in clinics (26.1%), 39.8% of hospital dentists agree that surgical masks are necessary to eliminate COVID-19 cross-contamination(P = 0.013). During the latest outbreak, 90.9% of respondents preferred the use of N95 masks for normal dental operations. However, 17.7% said that they would not use an N95 mask when treating a patient.
For each patient, 58.8% of participants used high-volume suction. However, 40% of dentists did not require patients to clean their mouths with antibacterial mouthwash prior to receiving treatment. While following the universal infection control precautions for all the patients the data yielded a statistically important finding in the undergraduate group (90.3%) relative to the postgraduate group (86.1%) (P = 0.005). Dentists who work in clinics (90.9%) practised universal infection prevention precautions for all patients, while dentists who work in hospitals (84.9%) did not, indicating a highly significant finding (P < 0.001). Rubber dam isolation is not needed for all patients, according to 66.1% of dentists working in clinics (51.8%) (P = 0.015). 98.2% of participants washed their hands with soap and water or sanitiser before and after treating patients, and 90.9% knew how to contact if they came across a patient with a possible COVID-19 infection.
| Discussion|| |
The aim of this cross-sectional analysis was to document the stress and worry experienced by dentists who became infected while operating during the current viral epidemic. To do so, a closed-ended questionnaire was developed, which elicited information about dentists' fears and any practice changes made in response to the COVID-19 outbreak epidemic. Any questionnaires that were not completed were not included. In pandemics, psychological effects such as fear and anxiety are natural, particularly as the number of infected individuals and mortality rates rise.
Previous outbreaks of related infectious diseases, such as SARS, reported a number of causes that contributed to psychological distress amongst healthcare personnel, including the fear of being infected while handling an infected patient or infecting a family member.
According to the survey, 79.8% of dentists are fearful of contracting an infection from a patient or co-worker, 15.7% are not and 4.5% are unsure that it can happen. According to Ahmed et al.'s report, 87% of dentists are fearful of contracting an infection from a patient or co-worker, 10% are not and 3% are ignorant.
Most of dentists (78%) are hesitant to treat any patient that presents with suspicious symptoms. COVID-19 has affected such a vast number of people in such a short period of time in virtually every country that the risk of being infected by a patient is tolerable. Due to the high degree of fear, a substantial number of dentists (47%) expressed a desire to close their practices, which may have major financial consequences for dentists and dental healthcare staff.
Patients with dental pain and/or who are completing a multi-visit treatment schedule can face delays in dental care as a result of this situation. According to the most current COVID-19 epidemic recommendations, all non-essential dental care should be avoided, and only patients suffering from discomfort, swelling, bleeding or injuries should seek treatment. In the current condition, all non-essential or discretionary dental care for all patients should be postponed until the situation is stabilised. 43.9% of dentists are worried about being quarantined as a result of a potential disease or actual virus, which is a legitimate concern as one considers how the majority of the family will suffer as a result of various factors. Since being sick, 63.4% of dentists were concerned about the medical burden. Health services could not be supported by the government anywhere, resulting in a substantial financial cost. In certain countries around the world, government bodies have heavily funded COVID-19 screening and monitoring, which is inspiring people to get screened. Similarly, it was reassuring to see that a large number of dentists were aware of the new CDC and WHO recommendations for cross-infection control in dental practises, which include telling patients about their travel records and taking their body temperature. Despite the fact that the majority of dentists agreed that these precautions should be used for any patient, a substantial percentage of participants said that they would not use simple cross-infection steps like the rubber dam for any patient. The use of a rubber dam to control cross-infection by limiting the transmission of aerosols is an effective way to control cross-infection with strong patient acceptance for dental procedures. As opposed to dentists who work in hospitals (51.8%), 66.1% of dentists who work in clinics believe that rubber dam separation is not needed for all patients (P = 0.015). High-volume suction is also seen as an important tool for controlling aerosols during dental operations and can be used for the vast majority of patients. While 89.6% of dentists observe the procedure of rinsing with antimicrobial mouthwash, which has been recommended in the latest pandemic, 10.2% of dentists said that they do not. As a result, this suggestion may be based on the fact that gargling has been shown to reduce viral load and spread by eliminating oropharyngeal protease and viral replication associated with it.
Mouthwashes containing antiviral compounds, such as povidone-iodine, have also been shown to be effective against a variety of respiratory viruses.
During the COVID-19 epidemic, the importance of hand hygiene was constantly emphasised, and this is particularly true for dental professionals. In this survey, 98.2% of dentists concluded that good hand hygiene, such as handwashing with soap and water and brushing with alcohol-based sanitisers, is an important step in preventing the spread of respiratory illnesses like SARS. As a result, the WHO advises that dentists wash their hands often or use an alcohol-based hand sanitiser. The use of a particulate respirator, such as the N95 mask, has been recommended for COVID-19 patients. Otherwise, where the space between the dental healthcare worker and the patient is <1 m, at least a surgical mask should be worn while treating all patients.
The guidelines are currently based on practise and practical advice, in addition to the basic protections applicable to all dental patients. Extra-oral radiographs, such as orthopantomogram and cone-beam computed tomography, can be recommended in favour of intra-oral radiographs wherever possible. Hand dealers can be used instead of ultrasonic dealers in periodontal procedures to reduce the output and spread of aerosol and splatter.
Dental enforcement bodies around the world, such as the ADA, are now advising dentists to only perform emergency dental procedures. Other related materials include additional dental care guidelines. Given the dental group's fear and anxiety against COVID-19, it is important to exercise relational coping strategies and interventions in order to remain calm and function efficiently. The fear that dentists have about being contaminated with COVID-19 will be dramatically minimised if dentists and dental healthcare staff carefully follow the regulatory authorities' guidelines. This includes universal cross-infection prevention procedures, as well as some extra measures in cases where patients present with some unusual signs.
| Conclusion|| |
Despite possessing a high level of awareness and experience, dental practitioners across India are experiencing distress and terror while employed in their fields as a result of COVID's effect on humanity. Dentists have either limited their services to emergency care only, or closed their practices for an unknown time, in accordance with the prescribed guidelines.
We thank Dr. Ahmed and co-authors for enabling us to employ their questionnaire in our research. We are grateful to the dentists in India for taking time to participate in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]