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ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 5  |  Page : 747-752

Knowledge about coronavirus disease 2019: Implication for dentists in Saudi Arabia


Dental Public Health Division, Department of Preventive Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia

Date of Submission08-Jun-2020
Date of Acceptance28-Aug-2020
Date of Web Publication20-May-2021

Correspondence Address:
Dr. Afnan A Nassar
Department of Preventive Dentistry (Public Health), Faculty of Dentistry, Umm Al-Qura University, Makkah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_340_20

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   Abstract 


Background: The Saudi Ministry of Health (MOH) has published detailed guidelines and educational documents about Coronavirus disease 2019 (COVID-19) prevention and infection control. The knowledge of dentists of the reported guidelines is not yet assessed and lack of awareness of these guidelines may have negative implications on dental patients. Aims: The aim of this study is to assess the knowledge of dentists about COVID-19 and the MOH guidelines while treating dental patients in Saudi Arabia. Materials and Method: A cross-sectional study was conducted using an online survey which was sent to a sample of dentists in Saudi Arabia from March to May 2020. Results: A total of 294 dentists with a mean age of (36.9 ± 10.6) years completed the questionnaire. Participants included 157 females and 137 males with a range of professional classification and experience. All of the participants were aware of COVID-19, the nature of the disease, symptoms, modes of transmission and people at higher risk, except for 7.2% who did not report the correct incubation period. All participants agreed that patients and staff should wear a facial mask, use hydroalcoholic hand sanitizer upon arrival. Only 72.4% had knowledge about published guidelines. Infection control training was provided for 53% of the participants and those who had training were more confident to treat patients. Regarding personal protective equipment (PPE), putting on and taking off PPE, 64.6% and 78.6%, respectively, were aware of the guidelines. Conclusion: Dentists in Saudi Arabia had optimal knowledge about COVID-19. However, infection control training is recommended to increase readiness and confidence among dentists.

Keywords: COVID-19, Dentist, knowledge, PPE, Saudi Arabia


How to cite this article:
Nassar AA. Knowledge about coronavirus disease 2019: Implication for dentists in Saudi Arabia. Niger J Clin Pract 2021;24:747-52

How to cite this URL:
Nassar AA. Knowledge about coronavirus disease 2019: Implication for dentists in Saudi Arabia. Niger J Clin Pract [serial online] 2021 [cited 2022 Dec 3];24:747-52. Available from: https://www.njcponline.com/text.asp?2021/24/5/747/316464




   Introduction Top


Coronavirus disease 2019 (COVID-19) outbreak started in Wuhan, China. Patients infected presented with respiratory symptoms of fever, dry cough, and generalized fatigue. In addition, less common symptoms such as nausea, diarrhea, hyposmia, and abnormal dysgeusia were reported.[1] The present epidemiological data confirms that COVID-19 is more contagious and spreads faster than other forms of respiratory virus which transmit through direct contact by respiratory droplet inhalation and aerosol-generating procedures.[1],[2] The incubation period for this novel virus is between 2 and 14 days and it can also be transmitted through an asymptomatic carrier which imposes a great risk to dentists and dental staff.[3] Therefore, all cases managed during this pandemic should be handled with high level of awareness and professionalism.

To date, no specific treatment or vaccine is available, and the mortality rate is believed to be less than 1% (0.98%) in Saudi Arabia.[4] COVID-19 has become a major public health problem for all the countries around the world. The World Health Organization (WHO) reported that to date there are more than 14 million confirmed cases.[1] In Saudi Arabia, the first case was diagnosed on the 2nd of March 2020. The number of COVID-19 cases is increasing daily around the world and in Saudi Arabia, 248,416 cases on July 18, 2020 were confirmed.[4]

As a preventive measure to reduce the spread of the disease, The Ministry of Health (MOH) has instructed both public and private dental clinics to cancel all elective dental treatment and only accept emergency cases since the outbreak in February until the 3rd of May 2020.[5] The MOH in Saudi Arabia has published guidelines and provided multiple educational documents on how to maintain personal health and how to prevent the transmission of COVID-19 based on the best available scientific evidence and broad experiences.[5] Standard protocol and guidelines were made available, which cover all of the following information: types of dental care in emergency situations and how to manage each possible case, dental triage protocol, dental clinic considerations, infection prevention and control, proper personal protective equipment (PPE) usage and discard, proper hand hygiene, patient evaluation, which dental instrument/material should be used as such as 0.2% povidone mouth wash, rubber dam isolation and anti-retraction hand-piece, protocols for disinfection of the clinic and management of the dental waste were also included.[5]

Absence of proper knowledge and training of all these guidelines will negatively impact patient management in dental practice and will also contribute to fast spreading of the disease.

There is limited published information regarding COVID-19 knowledge and training among dentists in Saudi Arabia. Information about the level of knowledge is necessary for future situations where similar crisis could be minimized.

Our study aims to assess dentist's knowledge about COVID-19 and the MOH guidelines regarding protection and prevention from this disease while treating dental patients in Saudi Arabia. This study will offer an insight and provide a baseline information which may help in implementing new guidelines for training and continuous educational programs for dentists and dental staff.


   Material and Methods Top


A cross-sectional study was conducted to investigate the knowledge of dentists about COVID-19 and the safety guidelines in Saudi Arabia while treating patients during this national crisis. This study was approved by the Biomedical Ethics Committee at Umm Al-Qura University in Saudi Arabia. The target population was dentists in Saudi Arabia of different ages, both males and females, with different levels of work experience, including newly graduated and more experienced consultants, from both public and private sectors.

Our study invited 500 dentists to complete the survey. Information was collected using an online survey (self-completion) sent via social media accounts such as WhatsApp groups, Twitter, and Facebook for different registered dental societies, University staff and Dental interns. Those interested had open access to a self-administered questionnaire which had a short introduction describing the aim of the study, the confidentiality of the responses and consent request. The questionnaires were collected immediately after completion.

The questionnaire was developed from a thorough review of available literature about COVID-19 and other infectious diseases,[6],[7],[8],[9] the WHO website and publications, MOH website, Saudi Commission of Health Specialties, and consultation and feedback from experts in questionnaire development. The questionnaire consisted of multiple-choice questions divided into three parts. The first part of the survey included participant's demographics: age, gender, educational achievements, work experience, and type of employment. The second part included questions regarding COVID-19 signs and symptoms, mode of transmission, nature of the virus, virus incubation period, people at risk, number of cases in Saudi Arabia, source of information, and updates about COVID-19. The third part consisted of questions related to the management of dental patients, history taking, applying and removing of PPE, infection control training during COVID-19 crisis, and knowledge about MOH published guidelines. The questionnaire was pilot tested on a convenience sample of 15 dentists to evaluate question format and sequence. Assessment for the reliability and validity of the questionnaire was done using Cronbach's alpha test and the score was 0.89.

Statistical analysis

All the responses were collected and coded. The data was then tabulated and analyzed by IBM SPSS Statistics version 23.0. Descriptive statistics were used to report frequency and percentages and Chi-square test was used to identify the correlation between independent and dependent variables. Mean and standard deviations were used to describe the continuous variables. P ≤ 0.05 was considered statistically significant.


   Results Top


The survey was completed by 294 dentists, which shows a response rate of 58.8%. Participants were 157 females and 137 males aged 26–60 years old with a mean of 36.9 and standard deviation of 10.6 years. The personal and professional backgrounds of the participants are presented in [Table 1]. The majority of participants were general dentists – 125 (42.5%), while the rest were specialists and consultants. Both governmental and private employees participated equally. Most of the dentists who completed the survey had less than five years work experience – 130 (44.2%), while those with more than 20 years' experience that participated were the least – 9 (3.1%) [Table 1].
Table 1: Participants personal and professional background

Click here to view


All the 294 (100%) dentists were aware of COVID-19, the nature of the disease, symptoms, mode of transmission, and people at risk. However, 22 (7.2%) did not show correct knowledge about the virus incubation period [Table 2]. Seventy two percent (n = 212) of the participants did follow updates about COVID-19 cases in Saudi Arabia via daily news while 82 (28%) were not interested. Furthermore, 189 (67.3%) dentists followed the MOH website and/or followed the Saudi Commission for Health Specialties for guidelines updates, while others depended on colleagues – 52 (17.6%) and published literature – 45 (15%).
Table 2: Knowledge about COVID-19

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Of those who participated in the survey, 213 (72.4%) had knowledge about the published COVID-19 guidelines for dental emergencies from the MOH. Pre-treatment patient preparation questions were also included in the survey. All 294 (100%) of participants were aware of all the proper safety measures needed to evaluate the patient before providing any treatment which were: checking the type of dental emergency before booking the patient, asking about travel history, checking patient temperature and any other respiratory symptoms, and checking if the patient had any contact with an ill person. Dentists were also asked if they were aware of what precautions should be taken to protect staff and visitors from transmission of any possible infection. All the 294 (100%) dentists agreed that patients and staff should wear a facial mask and use hydroalcoholic hand sanitizer upon arrival and before touching any item in the waiting room. Of the 294 participants 88 (29.9%) did not know the safe distance between patients in waiting areas as recommended by MOH (2 m away).

Infection control training for the prevention against COVID-19 was provided for 156 (53.1%) of the participants. The most common form of training was online via webinars for 134 (45.6%) compared to 22 (7.5%) who received on-site training at their workplace. Regarding PPE availability and correct utilization, 180 (61.2%) reported that their workplace provided all the recommended PPE for COVID-19 infection control while others did not believe that all PPE were available or were not sure. The published guidelines illustrated the correct way for putting on (donning) and taking off (doffing) PPE [Figure 1]. Of those who completed the survey, 190 (64.6%) and 231 (78.6%), respectively, could identify the correct order of putting on and taking off PPE. In line with recommended guidelines, N95 or higher respirators should be used when performing aerosol generation and in case of the need for a replacement, a combination of surgical mask and full-face shield should be used. Only 204 (69.4%) of the participants knew about the correct approved replacement for the N95 mask. Seventy percent (n = 207) of the dentists felt confident to treat patients during this pandemic with their currant knowledge and training. All the dentists knew about the need to use a dental rubber dam, high volume suction, hand instrumentation, and extraoral radiographs. Also, the majority of the dentists – 258 (87.7%) were aware about the recommendation to use anti retraction function of handpieces to provide additional protection.
Figure 1: Personal Protective Equipment (PPE) for Healthcare Workers

Click here to view


Dentists who reported to be confident in providing treatment during this pandemic were the ones with qualifications higher than general dentistry (P = 0.004), who received COVID-19 infection control training, compared to those who did not (P = 0.013) and those with more work experience (more than 5 years) (P = 0.003). No significant difference was found between feeling confident to provide treatment and the type of training received; online or physical (P = 0.68).


   Discussion Top


Workers in the healthcare system were exposed to knowledge that was crucial for their personal protection and the people around them when performing any medical or dental procedures during the COVID-19 outbreak. Dentists are always involved in the treatment and management of patients with different diseases and medical histories, therefore, making sure that they are up to date with this new disease and its management protocol is vital. This study provides an insight on the level of knowledge and the implication of the awareness of dentists in Saudi Arabia about COVID-19 and its management protocol. Dentists both male and female from different educational and employment backgrounds participated.

Our study response rate was 58.8% which is considered acceptable and shows a better response rate compared to a similar study which investigated Middle East Respiratory Syndrome (MERS) awareness among dentists.[7] The peer study had a response rate of only 33% from their online survey compared to 77% of their paper-based surveys.[7] Hence, paper-based surveys may result in better findings, which was not applicable in our situation due to total lockdown for health quarantine. The majority of participants, 125 (42.5%), were general dentists while the rest were specialists and consultants. This could be due to inviting all new graduates and dental interns from dental school. Both governmental and private employees participated equally. Most of the dentists who completed the survey had less than 5 years work experience – 130 (44.2%), while those with more than 20 years' experience participated the least – 9 (3.1%).

Knowledge of how to identify possibly infected patients by history-taking and practicing safe precautions relevant to the disease was optimal. This part of the survey showed that dentists in Saudi Arabia had all the correct basic information about COVID-19 except for some (7.2%) who reported an incubation period other than 2–14 days. This could be due to a lack of knowledge or due to the variability of the reported incubation period in published literature. Backer, Klinkenberg, and Wallinga (2020)[3] reported that the incubation period ranged from zero to 14 days as stated by the WHO (2020),[1] while the European Centre for Disease Prevention and Control (2020)[10] announced that 2–12 days is the incubation period with a mean incubation period of 5.2 days. Still, it is important for dentists to be aware of the correct incubation period in order to decide the safest time to treat any possible suspected person. The participants of this survey showed a similar level of knowledge about the nature, signs and symptoms, transmission and incubation of COVID-19 compared to Jordanian dentists.[9] Our sample showed a higher level of awareness compared to the study by Gaffar et al. (2019)[7] where 78% of the dentists were aware of disease transmission and patient recognition. Understanding the most basic information about this disease implies that dentists can identify the threat and provide all the required procedures to ensure their own safety and that of their patients. Optimal dentist knowledge while managing cases in this pandemic is considered the first step in disease prevention.[7],[9] Some participants (29.9%) were not aware of the required safe distance of 2 m between patients as recommended by MOH. This confusion may be caused by reading other international guidelines which recommended a distance of at least 1 m.[1]

Only 60–70% of the participants followed COVID-19 updates and the changes in the guidelines through the official MOH channel while others depended on their colleagues or social media. Dentists need to be encouraged and advised to enrich their knowledge through the official and accurate sources which are the MOH and Saudi Health Commission, otherwise improper patient management or other medicolegal problems can arise. Similarly, 72.4% of the participants have read the published COVID-19 guidelines for dental emergencies from MOH. Ideally, every institution should aim for a 100% update in knowledge and training among their operating dentists to provide maximum disease prevention. However, similar findings to ours were reported in other studies that investigated the level of awareness among dentists about patient management during such a pandemic which ranged between 68 and 73%.[7],[8],[9]

All the dentists in our sample were aware of the dental measures required to reduce the spread of the disease compared to 97.8% of Jordanian dentists.[9] However, our study sample made some errors in donning and doffing of PPE and in choosing the correct mask and shield, which need further attention and practice to prevent disease spreading. Infection control training for prevention against COVID-19 was provided for only 53.1% of our sample. Although all dentists in Saudi Arabia have received an infection control training during their undergraduate years, it may be advised to plan a mandatory infection control training for special circumstances such as COVID-19. Our sample showed that those who received training reported more confidence to treat patients during this pandemic compared to the ones that didn't. Therefore, it is crucial that all working dentists are up to date with the recommended guidelines and ready to treat patients with confidence. Training courses can be emailed to all registered dentists via the Saudi Commission of Dental Specialties and followed by a quick knowledge test. Only 70% of the participants felt ready to manage dental cases compared to 82.6% of Jordanian dentists who preferred to avoid suspected of COVID-19 cases.[9]

Our findings of this study provide an insight about the knowledge of COVID-19 among dentists in Saudi Arabia, which can be used for teaching and training purposes for dentists and dental students, and yet, our study had limitations in regard to the sample size due to the low response rate. Low replies are expected for in such limited time frame for data collection and because of the overwhelming number of questionnaires sent from many researchers during this pandemic. Such factors may cause selection bias and sampling error which may prevent the ability to generalize our results. Using of closed-ended questionnaires also has other limitation such as the absence of flexibility for adding comments or explanations for the answers, and for the responses to be assessed at a single point of time which might differ latter. These limitations are to be considered in future research.


   Conclusion Top


Dentists in Saudi Arabia had optimal knowledge about COVID-19 symptoms, modes of transmission, people at risk, and infection control measures in dental clinics. However, mandatory infection control training with any form is recommended for all registered dentists.

Acknowledgements

The author is very thankful to all the associated personnel that contributed in/for the purpose of this research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
The World Health Organization [homepage on the Internet]. Q&A on coronaviruses (COVID-19). [cited 2020 May 10]. Available from: https://www.who.int/news-room/q-a-detail/q-a-coronaviruses.  Back to cited text no. 1
    
2.
To KK, Tsang OT, Yip CC, Chan KH, Wu TC, Chan JM, et al. Consistent detection of 2019 novel coronavirus in saliva: Clinical Infectious Diseases. [Serial on the Internet]. 2020 Feb [cited 2020 May 12]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108139/.  Back to cited text no. 2
    
3.
Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travelers from Wuhan, China. Euro surveillance 2020;6:25-7.  Back to cited text no. 3
    
4.
Saudi Arabia Ministry of Health [homepage on the Internet]. Updated number of cases affected by COVID-19 [cited 2020 Jul 18]. Available from: https://covid19.moh.gov.sa.  Back to cited text no. 4
    
5.
Saudi Arabia Ministry of Health [homepage on the Internet]. Dental emergency protocol during COVID-19 pandemic [cited 2020 May 14]. Available from: https://www.moh.gov.sa/Ministry/MediaCenter/Publications/Documents/MOH-Dental-emergency-guidline.pdf.  Back to cited text no. 5
    
6.
Javed M, Khan A, Nawabi S. Dental Faculty's Knowledge and Attitude regarding COVID-19 disease in Qassim, Saudi Arabia: BMC Oral Health. [Serial on the Internet]. 2020 May [cited 2020 May 10]. Available from: https://www.researchsquare.com/article/rs-25805/v1.  Back to cited text no. 6
    
7.
Gaffar BO, El Tantawi M, Al-Ansari AA, AlAgl AS, Farooqi FA, Almas KM. Knowledge and practices of dentists regarding MERS-CoV. Saudi Med J 2019;40:714-20.  Back to cited text no. 7
    
8.
Alqahtani AS. Knowledge and attitude toward Middle East respiratory syndrome coronavirus among heath colleges' students in Najran, Saudi Arabia. Int J Community Med Public Health 2017;4:2641-7.  Back to cited text no. 8
    
9.
Khader Y, Al Nsour M, Al-Batayneh OB, Saadeh R, Bashier H, Alfaqih M, et al. Dentists' awareness, perception, and attitude regarding covid-19 and infection control: Cross-sectional study among Jordanian dentists. JMIR Public Health Surveill 2020;6:e18798.  Back to cited text no. 9
    
10.
European Centre for Disease Prevention and Control [homepage on the Internet]. Disease Background of COVID-19 [cited 2020 May 14]. Available from: https://www.ecdc.europa.eu/en/2019-ncov-background-disease.  Back to cited text no. 10
    


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