|Year : 2021 | Volume
| Issue : 2 | Page : 69-74
A pilot knowledge, attitude, and practice survey among pediatric dentists during COVID-19 pandemic
Department of Paediatric Dentistry, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India
|Date of Submission||08-Nov-2020|
|Date of Acceptance||10-Nov-2020|
|Date of Web Publication||16-Jul-2021|
C/O Dr Siddharth Mittal, C-104, MPMMCC Staff Quarters, Near Naria Gate, Sundar Bagiya Colony, BHU Campus, Varanasi - 221 005, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: COVID-19 pandemic has brought a drastic change in the way of practising dentistry. Adequate knowledge and training on prevention of this contagion will allow dental professionals to practise safely. The aim of the survey was to assess the knowledge, attitude, and practice of pediatric dentists during COVID-19 pandemic. Materials and Methods: This is a prospective pilot online survey among pediatric dentists in India. A self-explanatory, online questionnaire comprising 20 close-ended questions in English language was formulated via Google Forms. Results: We received a total of 55 responses. Overall knowledge was fair in 6/55 (10.9%) participants and majority (49/55; 89.1%) had good knowledge. Nearly all participants were changing gloves, performing temperature checks, and taking COVID-19-related history for each patient. However, only 75% (approx.) participants were sanitizing dental chair and surrounding surfaces after each patient visit. More than 90% of participants had received training for wearing personal protective equipment (PPE), but 27% (15/55) felt that they do not have adequate PPE. PPE most worn by respondents were gloves (52/55, 94.5%) and face shield or N95 mask (51/55; 92.7%), followed by surgical mask (46/55, 83.6%). Only 50% of respondents (approximately) were using goggles during routine dental practice. Nearly 96% of participants faced difficulties in communication and majority agreed that it interferes with patient management. About 98% of respondents felt that COVID-19 pandemic has reduced the frequency of patients. The most preferred mode of practice by pediatric dentists during COVID-19 pandemic was private practice as well as teledentistry. Conclusion: Majority of participants (89.1%) had a good level of knowledge about COVID-19 disease and were following adequate safety precautions to prevent its spread in their practice. We recommend all dental professionals to get proper training and follow guidelines by various agencies (CDC, WHO, and the American Dental Association) to prevent the spread of COVID-19 and ensure best dental practices.
Keywords: Attitude, COVID-19, dental practice, knowledge, knowledge, attitude, and practice survey, pediatric dentists
|How to cite this article:|
Kashyap P. A pilot knowledge, attitude, and practice survey among pediatric dentists during COVID-19 pandemic. J Dent Res Rev 2021;8:69-74
|How to cite this URL:|
Kashyap P. A pilot knowledge, attitude, and practice survey among pediatric dentists during COVID-19 pandemic. J Dent Res Rev [serial online] 2021 [cited 2021 Dec 8];8:69-74. Available from: https://www.jdrr.org/text.asp?2021/8/2/69/321533
| Introduction|| |
The outbreak of COVID-19 and its spread at the pandemic level has led to catastrophic implications in the whole world. The measures taken by governments to limit the spread of this highly infectious virus have changed the way we live. From online classes and webinars to online consultation, people have sought new ways to get their life back on track and live with the virus. Apart from increasing the risk of mortality and morbidity, the virus has also affected the economies all over the world. Many professions have borne the burden of the virus, including medical and dental.
The COVID-19 virus, i.e., SARS-CoV-2, is highly infectious in nature and it spreads through airborne droplets or aerosols, touching contaminated surfaces, and via close contact with an infected person. Due to the nature of dental practices and proximity with patients, dentists, in comparison to other health-care professionals, are at the highest risk of contracting COVID-19. Secondary to prolonged incubation period (2–14 days) of the disease, dentists and patients could be asymptomatic carriers at the time of examination leading to cross-contamination.,
In dentistry, pediatric dentistry requires special attention, as suspension of educational programs and sports activities in schools during the pandemic has led children to stay at home, thereby leading to increased intake of processed and calorie-rich food and drinks., This lifestyle change has caused increased rate of dental biofilm accumulation and development of caries. For pediatric dentists, the use of personal protective equipment (PPE) during examination has led to difficulties in behavior management and increased apprehension in children., Not to mention, the decrease in number of patients due to safety of dentist and patient has resulted in shift of practice towards teledentistry.,,
The purpose of this survey was to assess the knowledge, attitude, and practice (KAP) of pediatric dentists during COVID-19 pandemic.
| Materials and Methods|| |
This is a prospect, pilot survey which was conducted between September 21, 2020, and September 27, 2020, among pediatric dentists in India. Selection of samples for survey was done randomly through exclusive pediatric dentists' group (s) on social network platform (WhatsApp groups). Participants included those practicing pediatric dentistry in private, government, or other health sectors as well as those pursuing postgraduation studies in pediatric dentistry. A self-explanatory, online questionnaire comprising 20 close-ended questions in the English language was formulated via Google Forms to assess KAP among pediatric dentists during COVID-19 pandemic. The questionnaire was distributed through a link using a social media platform (WhatsApp).
The questionnaire was formulated in such a manner that 25% (4/20) of questions tested knowledge regarding COVID-19 (part 1), while the rest, 75% (15/20), determined attitudes, practical aspects, perceived ability, safety precautions, and practices, followed by pediatric dentists during COVID-19 pandemic (part 2). The questions in part 1 of the study were assigned score 1 for each correct response and 0 for each incorrect response. The total score was calculated by adding individual score of all five knowledge-based questions followed by calculation of percentage. The score was divided into three categories based on percentage: poor (0%–40%), fair (41 <80%), and good (>80%) knowledge.
The survey was designed to maintain the anonymity of participants while ensuring privacy and confidentiality of all the information collected. Consent was obtained from all participants. The only personal information collected was e-mail address of respective participants for future follow-up.
Statistical analysis was done using SPSS version 20 (SPSS Inc., Chicago, IL, USA). Continuous variables were expressed as means and standard deviations. Categorical variables were summarized as frequencies and percentages. Comparison between distributions of categorical variables, if any, was done using Pearson's Chi-square test. The significance levels were set at P < 0.05.
| Results|| |
The survey was taken by 55 participants, of which 40 (72.7%) were female and the rest (15, 27.3%) were male. The age of participants ranged from 25 to 44 years old (mean age: 34.21 ± 7.2).
Distribution of knowledge among participants
[Table 1] shows the distribution of participants who selected the correct answer to knowledge-based questions. Distribution of overall knowledge showed that 6 (10.9%) had fair knowledge and the rest 49 (89.1%) had good knowledge. No participant had poor knowledge.
|Table 1: Distribution of participants who selected the correct answer to knowledge-based questions|
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Distribution of attitude and safety precautions followed during COVID-19 pandemic
In the present survey, questions six to nine were designed to determine the safety precautions followed by pediatric dentists during COVID-19 pandemic. The results are tabulated in [Table 2].
|Table 2: Distribution of attitude and safety precautions followed during Coronavirus Disease-2019 pandemic|
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Distribution of attitude, perceived ability, and practical aspects regarding the use of personal protective equipment
Questions ten to fifteen addressed the preference, opinion, and practical aspects of using PPE among pediatric dentists. When asked about training received in the use of PPE (question 10), majority (50/55; 90.9%) responded yes. However, the next question (question 11) asked whether they feel they have adequate PPE, to which 15/55 (27.3%) participants responded no. Distribution of type of PPE worn routinely is given in [Figure 1].
|Figure 1: Distribution of type of personal protective equipment worn routinely by pediatric dentists|
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Majority of participants (47/55; 85.5%) preferred N-95 mask while examining the patient (question 13), while only small proportion chose surgical (7/55; 12.7%) and N-99 mask (1/55; 1.8%). When asked whether they face difficulties in communication with patients while wearing PPE (question 14), 53/55 (96.4%) participants responded yes. Question 15 asked participants their opinion regarding the routing use of PPE and their response is shown in [Figure 2].
|Figure 2: Pie chart showing opinion of participants regarding routine use of personal protective equipment|
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Distribution of attitude and dental practices during COVID-19 pandemic
Questions 16–20 judged the impact of COVID-19 on nature of dental practice among pediatric dentists. Nearly all participants (54/55; 98.2%) agreed that COVID-19 pandemic has led to a decreased number of patients in daily practice (question 16). Response to questions 17–20 is displayed in [Table 3].
|Table 3: Distribution of dental practices during Coronavirus Disease-2019 pandemic|
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Finally, the participants were asked about their preference regarding the type of practice during COVID-19 pandemic. Their response is shown in [Figure 3].
|Figure 3: Distribution of type of practice preferred by pediatric dentists during COVID-19|
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| Discussion|| |
The spread of the COVID-19 virus worldwide has altered the outlook of all dental practitioners in providing routine care in the present situation. As per the CDC guidelines, dentists should only treat emergency cases, the rest should be deferred by prescribing appropriate drugs to reduce local infections. This practice is advised due to the fear of asymptomatic carriers of COVID-19. Due to this, frequency of patients has drastically reduced, followed by a decline in the economy in the field. The whole lifestyle of dental practitioners has been influenced by this pandemic. Dental practitioners and staff are at the highest risk of getting infected with COVID-19. The cost of PPE, above everything, makes the dentist to close his practice. ADA Health Policy Institute evaluated that around 76% of dentists in the United States have closed their clinics for routine treatment except dental emergencies, while 19% of them have completely ceased their services.
To continue the practice in such a difficult situation, one needs to have proper knowledge about the contagion and its incubation period which is reflected in the first five questions of the survey. As per the responses, overall knowledge was fair in 6/55 (10.9%) participants and the rest, 49/55 (89.1%), had good knowledge. This percentage is better than the study by Kamate et al., in which majority of participants (92.7%) had a fair level of knowledge. However, their study had a higher number of knowledge-based questions, i.e., 11 in comparison to 5 in our study.
In the present study, 92.7% of the respondents knew that COVID-19 is caused by SARS-CoV-2. Our result is consistent with Arora et al. where 84.5% of the respondents knew the same. Similarly, 87.3% of participants knew incubation period (2–14 days) of COVID-19 disease. However, only 54.5% of participants perceived that COVID-19 disease is more infectious in comparison to severe acute respiratory distress syndrome (SARS) and Middle East respiratory distress syndrome (MERS).
This contrasts with 84.2% of respondents knowing that COVID-19 is most infectious in the study by Arora et al. As our study has only focused on pediatric dentists, this finding suggests that there is a lack of knowledge in this group.
Approximately 96% of respondents believed that mode of transmission of COVID-19 in dentistry can be droplets, aerosols from an infected patient, and touching contaminated surfaces. Furthermore, majority (94.5%) deemed that real-time polymerase chain reaction is commonly employed diagnostic test for COVID-19.
With regard to safety precautions followed by pediatric dentists during COVID-19 pandemic, all participants agree that they change gloves after examination of each patient and check temperature of each person entering their facility. However, only 75% (approx.) of participants were sanitizing dental chair and surrounding surfaces after each patient visit, with 22% doing it often but not every time. This practice might be due to a lack of staff or to reduce cost secondary to already increased expenditure on PPE and less income. Most of the participants (98.2%) were taking history regarding COVID-19 symptoms from their patients.
In the present survey, only <10% of participants did not receive training for properly wearing PPE. However, 27% (15/55) felt that they do not have adequate PPE. The availability of appropriate number of PPE is an important issue in the present economic condition. Furthermore, the shortage of good-quality PPE might also be a contributing factor.
PPE most worn by respondents were gloves (52/55, 94.5%) and face shield or N95 mask (51/55; 92.7%), followed by surgical mask (46/55, 83.6%). Apron was used routinely by 72.7% (40/55) participants. Only 50% of respondents (approximately) were using goggles during routine dental practice. This is a cause for concern as during routine consultation with an infected patient, aerosols might be released which might come in contact with the conjunctiva. It has been reported that virus can be transmitted through aerosol contact with conjunctiva and cause conjunctivitis. Although it is a minor route of infection, it should not be ignored among dentists. Especially among pediatric dentists, social distancing with a child might not always be possible and can increase the transmission rate. Majority of participants (47/55; 85.5%) preferred N-95 mask while examining patients.
Nearly 96% of participants faced difficulties in communication while wearing PPE in our study. Majority of them (39/55; 70.9%) felt that PPE interferes with behavior management in children and leads to reduced productivity at work and tiredness. When we talk particularly about pediatric dentistry, we cannot deny that it is difficult to apply behavior management techniques like non-verbal communication, as our expressions hide behind the mask and the face shield. Live modeling is also avoided, as this technique tends to increase the crowd in the facility, thus again posing a risk to the dentist as well as patients and their accompanied person. Child patient also seems to be more apprehensive of PPE. Child-friendly PPE is a much better alternative for pediatric dentists.
Nearly all participants (98.2%) agreed that COVID-19 pandemic has reduced the frequency of patients in their practice. This finding is in accordance with the current state of economy and change in attitude of patients due to the contagion. However, it is important to note that COVID-19 has also led to increased consumption of calories and fatty food among children due to prolonged stay at home, secondary to suspension of schools., This can further lead to carious lesions. Therefore, pediatric dentists might get increased patients presenting with caries soon.
Participants were questioned regarding dental practices during COVID-19 pandemic to judge whether they are aware of recent guidelines. Around 45% of participants used both rubber dam and high-speed saliva ejectors for isolation of teeth during a procedure, while 31% used only rubber dam and the rest, 23.6%, used only high-speed saliva ejectors. As per the CDC guidelines, high-speed saliva ejectors and rubber dam should be used in any aerosol generating procedure to minimize droplet spatter and aerosols.
Voice control was the most common (40%; 22/55) behavior modification technique preferred by respondents followed by modeling (23.6%; 13/55). Voice control carries minimal risk of infection, as it does not involve touching of surfaces and avoids overcrowding in comparison to other techniques like audio–visual modeling and parent's presence. Nonverbal communication was chosen by 14.5% of participants; however, it is not feasible while wearing PPE. Tell-show-do is an alternate technique which can be used in current scenario.
In a definitely negative child with multiple carious lesions like early childhood caries (ECC), Royal College of Surgeons' (RCS) UK guidelines suggest conducting the treatment under general anesthesia (GA) to limit the number of visits, thus reducing the risk of COVID-19 infection. In the present scenario, 8-handed dentistry also increases the risk of infection. Thus, conscious sedation or GA is a better option. However, in the present survey, maximum number of participants, i.e., 56.4%, responded being able to manage a definitely negative child even with a smaller number of staff.
Finally, we wanted to see the preferred mode of practice by pediatric dentists during COVID-19 pandemic. To our surprise, more than 50% (28/55) of participants preferred private practice and teledentistry both equally in our survey. Teledentistry has been approved by Brazil Council (2020), as it allows parents and children to have video or phone appointments, with dentists providing a safe triage and sharing information on oral hygiene and health., Private practice is usually preferred by pediatric dentists, as it allows them to practice with their safety standards and precautions. Working in a government hospital/institute was the least preferred choice among the respondents. This could be due to the increased risk of contracting COVID-19 infection.
We did this study as a pilot survey to assess its feasibility on a larger scale. One of the limitations of the study was the short duration of data collection considering the changing dynamics of the pandemic on dental practitioners which led to smaller than expected sample size. Furthermore, we could not cover those pediatric dentists who were not on social media platforms. We also did not include questions regarding the management of COVID-19-positive patients. We plan to conduct this study on a larger scale among pediatric dentists from all over the country to get a more detailed insight into dental practices currently followed by pediatric dentists and influence of COVID-19 on them.
| Conclusion|| |
This survey has revealed some interesting findings. Majority of participants (89.1%) had good level of knowledge about COVID-19 disease. The participants were following adequate safety precautions like changing gloves, sanitization, temperature checks, and history taking during their routine practice. Majority were trained in the use of PPE, but a small proportion felt that they have inadequate PPE. Most of the respondents were wearing gloves, face shields, and N95 masks routinely during practice, but only half of them were using protective eye goggles which is risky. Most of the respondents faced difficulties in communication while wearing PPE which interfered with behavior management and led to decreased efficiency. COVID-19 pandemic has decreased the daily workload in dental practice of nearly all participants and more than half of them prefer private practice as well as teledentistry in the current scenario. We recommend all dental professionals to get proper training and follow guidelines by various agencies (CDC, WHO, and the American Dental Association) to prevent the spread of COVID-19 and ensure best dental practices.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]