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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 121-123

Is dental practice in the current scenario in India safe or unsafe: A questionnaire study


1 Department of Oral and Maxillofacial Surgery, SGT University, Gurugram, Haryana, India
2 Department of Conservative Dentistry, PHC, Patna, Bihar, India
3 Department of Dentistry, Koppal Institute of Medical Sciences, Koppal, Karnataka, India
4 Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India
5 Dental Surgeon OM Dental Implant Center, Gurugram, Haryana, India

Date of Submission29-Apr-2020
Date of Decision11-May-2020
Date of Acceptance05-Nov-2020
Date of Web Publication08-Oct-2020

Correspondence Address:
Sunil Kumar Gulia
SGT University, Badli, Jhajjar, Gurugram, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_31_20

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  Abstract 


Aim: This study was intended to evaluate whether it is safe or unsafe for the clinician as well as the patient to carry out dental procedures in the current scenario of COVID-19 pandemic in India. Materials and Methods: This study was designed based on a cross-sectional survey. An self-administered questionnaire survey was used to evaluate whether it is safe or unsafe for the clinician as well as the patient to carry out dental procedures in the current scenario of COVID-19 pandemic in India. In this regard, a questionnaire study with a convenience sample of 124 dentists working in various clinics in India was conducted. This study, while limited in sample size, benefits the general practitioners as target readers to assess the awareness pertaining to safety of the dental practice. Results: The results of this study reveal that there exists a good knowledge among the dental health professionals pertaining to the COVID-19 virus and its oral manifestations in addition to the precautions to be taken for the prevention of COVID-19 in a clinical setup. Most of the dental professionals follow proper infection control biomedical waste disposal protocols, but their clinical areas are not properly ventilated. In addition to this, there exists an apprehension as well as an uncertainty pertaining to the current scenario to carry out their professional work. Conclusion: The results of this study suggest that it is relatively unsafe to carry out most of the dental procedures at this juncture in spite of taking all necessary precautions.

Keywords: COVID-19, dentists, oral manifestations


How to cite this article:
Gulia SK, Shekhar V, Maloth S, Kumar A, Singh M, Yadav D. Is dental practice in the current scenario in India safe or unsafe: A questionnaire study. J Dent Res Rev 2020;7:121-3

How to cite this URL:
Gulia SK, Shekhar V, Maloth S, Kumar A, Singh M, Yadav D. Is dental practice in the current scenario in India safe or unsafe: A questionnaire study. J Dent Res Rev [serial online] 2020 [cited 2020 Oct 28];7:121-3. Available from: https://www.jdrr.org/text.asp?2020/7/3/121/297520




  Introduction Top


Novel coronavirus is a unique virus affecting the human beings by causing severe respiratory disease and is responsible for a high-fatality rate globally.[1] It is a distinguished fact that the virus spreads through the airborne transmission. This predisposes the health-care workers, particularly the dentists to a bigger threat because the virus may be transmitted to the dentist from an infected patient through aerosols. Since hand pieces, air-water syringes, and ultrasonic scalers generate a significant volume of aerosols in the working area dentists are surely at a greater risk. Therefore, the likely chance for the spread of infection from patient to a dentist or dental assistant is high.[2] Hence, we intended to evaluate the knowledge and apprehension of dental health professionals pertaining to COVID-19.


  Materials and Methods Top


A cross-sectional survey was conducted to evaluate whether it is safe or unsafe for the clinician as well as the patient to carry out dental procedures in the current scenario in India. The study included 124 dentists performing clinical practice in various clinics belonging to the different parts of Southern India. Most of the participants had a postgraduate qualification and specialists in their field of clinical work while few were general dentists. Initially, a questionnaire with ten questions was designed, but two were eliminated to obtain a content validity ratio of one and pilot study was done for which a Corn back alpha of 0.9 was obtained. A self-administered questionnaire with eight questions was distributed through Google forms to the E-mails of these dental health professionals. The questionnaire was sent to approximately 200 consultants, but unfortunately, only 124 responded even after repeated reminders. The participants were instructed to answer the questionnaire very precisely without any descriptions. The dental health professionals were instructed to answer the questionnaire by using either the right or wrong options, as shown in [Table 1]. After collecting the filled questionnaires, participants were given instructions about COVID-19, precautions to be taken to prevent contamination and the type of procedures to be taken up for the patients and doubts if any were cleared. Survey questions were aimed to assess the facts whether it is safe or unsafe for the clinician as well as the patient to carry out dental procedures in the current scenario in India. The survey forms were evaluated and critically analyzed.
Table 1: The questionnaire used in the study

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  Results Top


The results of this study showed that 87.9% of the respondents were aware of the COVID-19, but only 77.77% of the respondents were totally aware of its oral manifestations. Nearly 80.6% of the respondents were aware that the dental health professionals are at the highest risk for COVID-19 infections than any other professionals. About 92.7% of the respondents were aware of the incubation period of the virus. One hundred percent of the respondents have not encountered any patient with suspected oral manifestations of COVID-19. However, only 32.25% of the respondents knew the laboratory test to be carried out in a patient suspected with COVID-19 infections.

It was observed that 90.32% of the respondents were totally aware of the difference between the emergency and nonemergency dental procedures to be carried out at this need of the hour. Almost all of the respondents follow a proper biomedical waste disposal in their clinical setup. Nearly 94.35% of the respondents were aware as to which dental procedure generates the maximum bioaerosol in a dental clinic, thereby increasing the risk of contamination. Unfortunately only 62.09% of the respondents were aware of how to manage contaminated air in the dental clinic and 42% of the respondents were aware of the ideal mouth rinse to be advised before any dental procedure for the prevention of contamination from COVID-19.

The results of this study reveal that there exists a good knowledge among the dental health professional pertaining to the COVID-19 virus and its oral manifestations in addition to the precautions to be taken for the prevention of COVID-19 in a clinical setup. However, there exists an apprehension as well as the lack of awareness pertaining to the laboratory test to be carried out in a patient suspected with COVID-19 infections as well as the role of a mouthwash and the management of contaminated air in the dental clinic. The results obtained for the study are depicted in [Table 2].
Table 2: Results of the questionnaire against appropriate questions

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  Discussion Top


Bioaerosols are considered to be biological particles suspended in gaseous media.[3] It is a well-known fact that a subgingival scaling using an ultrasonic scaler in the management of periodontally week teeth can produce aerosols.[4] Ultrasonic scalers and tips produced considerably more aerosol than handheld curette, irrespective of the kind of scaler used.[5] Repeated exposure to bioaerosols generated during these dental procedures and the small particle size of the bioaerosols increase the risk of infection for dentists.[6]

A recent study emphasized that equivalent priority should be given to following infection control protocols in a dental setup in addition to understanding the oral manifestations and the diagnosis of viral infections.[7] The results of this study revealed that 91.12% of the respondents follow complete infection control protocol in carrying out their clinical work. It is advisable to use extraoral radiographs such as orthopantomographs or oblique lateral views instead of intraoral radiographs for screening. In patients who are very sensitive for gagging, the oral mucosa may be anesthetized before taking impressions. In severe clinical scenarios, to control gag reflex sedation may be considered.[8],[9] The use of a rubber dams can considerably reduce the production of saliva and blood-contaminated aerosol or spatter.[10]

Considerable amount of debris and fluids are generated during a dental procedure. There exists a possible chance for a potential cross infection when the microbes contaminate the air and water tubes within the dental unit.[11] Anti-retraction high-speed dental hand piece can reduce the backflow of oral bacteria into the tubes of the hand piece and dental units.[12]

A well-ventilated dental clinic can reduce the amount of contaminated air by venting the exhaust air and also by avoiding the recirculation of contaminated air.[13] In order to continue their efficacy, it is essential to clean the filters in the suction apparatus every day. Personal protection in the form of washing hands regularly before and after treatment using complete disposable barriers and dispensing instruments in addition to sterilizing soiled instruments immediately is essential.[14] Disinfecting the surfaces following each patient visit is essential.[15] Personal protective equipment should be used as appropriate. The results of this study show that 62.09% of the respondents were unaware of how to manage contaminated air in their clinic. However, 91.12% of the respondents follow complete infection control protocol in carrying out their clinical work.

The biomedical wastes produced following the dental treatment, particularly in patients with suspected or confirmed infection should be considered as infectious medical waste.[10] The package bags need to be specifically marked and disposed according to the requirement for the management of medical waste. The results of this study show that 94.35% of the respondents follow proper biomedical waste disposal. However, 95.16% of the respondents felt that it is not advisable to start carrying out dental procedure at this juncture.


  Conclusion Top


Since it requires a close operator and patient contact to carry out a dental procedure in addition to the amount of bioaerosol produced during the procedure, the risk of COVID-19 transmissions from an infected patient is relatively higher for dentists when compared to other health professionals. If the number of confirmed COVID-19 cases increase in the near future with the current uncertainty that prevails pertaining to mutations that the virus can undergo and the unavailability of the vaccine required for it, dental professionals should follow stern infection control measures in the current scenarios. Hence, the results of this study suggest that it is relatively unsafe to carry out most of the dental procedures at this juncture in spite of taking all necessary precautions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, Al-Rabiah FA, Al-Hajjar S, Al-Barrak A, et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle east respiratory syndrome coronavirus disease from Saudi Arabia: A descriptive study. Lancet Infect Dis 2013;13:752-61.  Back to cited text no. 1
    
2.
Harrel SK, Molinari J. Aerosols and splatter in dentistry: A brief review of the literature and infection control implications. J Am Dent Assoc 2004;135:429-37.  Back to cited text no. 2
    
3.
Tanner RS. Cultivation of bacteria and fungi. In: Hurst CJ, Crawford RL, Garland KL, Lipson DA, Mills AL, Stetzenbach LD, editors. Manual of Environmental Microbiology. 3rd ed. Washington (DC): ASM Press; 2007.  Back to cited text no. 3
    
4.
Barnes JB, Harrel SK, Rivera-Hidalgo F. Blood contamination of the aerosols produced byin vivo use of ultrasonic scalers. J Periodontol 1998;69:434-8.  Back to cited text no. 4
    
5.
Harrel SK, Barnes JB, Rivera-Hidalgo F. Aerosol and splatter contamination from the operative site during ultrasonic scaling. J Am Dent Assoc 1998;129:1241-9.  Back to cited text no. 5
    
6.
Dutil S, Meriaux A, de Latremoille MC, Lazure L, Barbeau J, Duchaine C. Measurement of airborne bacteria and endotoxin generated during dental cleaning. J Occup Environ Hyg 2009;6:121-30.  Back to cited text no. 6
    
7.
Scully C, Samaranayake LP. Emerging and changing viral diseases in the new millennium. Oral Dis 2016;22:171-9.  Back to cited text no. 7
    
8.
Whaites E. Essentials of Dental Radiography and Radiography. 2nd ed. Edinburgh: Churchill-Livingstone; 1996. p. 107-13.  Back to cited text no. 8
    
9.
Robb ND, Crothers AJ. Sedation in dentistry. Part 2: Management of the gagging patient. Dent Update 1996;23:182-6.  Back to cited text no. 9
    
10.
Samaranayake LP, Reid J, Evans D. The efficacy of rubber dam isolation in reducing atmospheric bacterial contamination. ASDC J Dent Child 1989;56:442-4.  Back to cited text no. 10
    
11.
Hu T, Li G, Zuo Y, Zhou X. Risk of hepatitis B virus transmission via dental handpieces and evaluation of an anti-suction device for prevention of transmission. Infect Control Hosp Epidemiol 2007;28:80-2.  Back to cited text no. 11
    
12.
Al-Sehaibany FS. Middle East respiratory syndrome in children dental considerations. Saudi Med J 2017;38:339-43.  Back to cited text no. 12
    
13.
Li RW, Leung KW, Sun FC, Samaranayake LP. Severe acute respiratory syndrome (SARS) and the GDP. Part II: Implications for GDPs. Br Dent J 2004;197:130-4.  Back to cited text no. 13
    
14.
Thabet F, Chehab M, Bafaqih H, Al Mohaimeed S. Middle east respiratory syndrome coronavirus in children. Saudi Med J 2015;36:484-6.  Back to cited text no. 14
    
15.
Wenzel RP, Edmond MB. Managing SARS amidst uncertainty. N Engl J Med 2003;348:1947-8.  Back to cited text no. 15
    



 
 
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  [Table 1], [Table 2]



 

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Abstract
Introduction
Materials and Me...
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