Medical and Dental Consultantsí Association of Nigeria
Home - About us - Editorial board - Search - Ahead of print - Current issue - Archives - Submit article - Instructions - Subscribe - Advertise - Contacts - Login 
  Users Online: 1770   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
 

  Table of Contents 
ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 5  |  Page : 753-761

Evaluation of coronavirus disease (COVID-19) awareness of patients undergoing dental interventions in Turkey


1 Department of Oral and Maxillofacial Radiology, Dental Clinic of Baskent University, Adana Research and Practice Hospital, Adana, Turkey
2 Oral and Maxillofacial Surgery, Dental Clinic of Baskent University, Adana Research and Practice Hospital, Adana, Turkey

Date of Submission10-Jul-2020
Date of Acceptance28-Aug-2020
Date of Web Publication20-May-2021

Correspondence Address:
Dr. B Yilmaz
Department of Oral and Maxillofacial Radiology, Baskent University, Adana Research and Practice Hospital Dental Clinic, Adana
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_434_20

Rights and Permissions
   Abstract 


Aims: We aimed to objectively assess the COVID-19 awareness of the patients requiring dental interventions in our dental clinic by utilizing a newly generated questionnaire, which may serve helpfully in the hard battle against the pandemic in our country. Materials and Methods: This study included 306 volunteer adults who applied to our dental clinic for dental interventions during the early days of COVID-19 outbreak in Turkey. All patients responded to a newly created questionnaire composed of four sections with 19 questions those mostly assessing the social and demographic details; like the participant's age, gender, marital status, education status, medical history, basic dental hygiene habits, occupation, and general information about the COVID-19 infection and its protection methods. Results: The outcomes of 306 participants revealed that their gender, age, and education status showed significant distinctions about the dissemination of coronavirus via dental interventions. Higher education status was linked to a loftier level of social awareness about the COVID-19 infection and its potential associations with dental interventions. It was observed that the participants were unsatisfactorily cautious against the COVID-19 infection and its dissemination pathways in their social environment, particularly in the specific case of systematic diseases and preventive measures. The primary way of obtaining information about the COVID-19 infection was the electronic websites. Conclusion: Deplorably, accentuating the urgent need for further intensive training programs on the relationship between the systemic diseases and COVID-19 infection, and explicit daily care methods in the social environment.

Keywords: Awareness, COVID-19 infection, dental interventions, questionnaire


How to cite this article:
Yilmaz B, Somay E. Evaluation of coronavirus disease (COVID-19) awareness of patients undergoing dental interventions in Turkey. Niger J Clin Pract 2021;24:753-61

How to cite this URL:
Yilmaz B, Somay E. Evaluation of coronavirus disease (COVID-19) awareness of patients undergoing dental interventions in Turkey. Niger J Clin Pract [serial online] 2021 [cited 2022 Dec 3];24:753-61. Available from: https://www.njcponline.com/text.asp?2021/24/5/753/316471




   Introduction Top


First being reported in the Wuhan region of the People's Republic of China, the coronavirus disease 2019 (COVID-19) outbreaks were rapidly reported to be a globally life-threatening public health problem by the World Health Organization (WHO) on 30 January 2020.[1] Although the sickness was originally called coronavirus 2019-nCoV, or authoritatively the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), the COVID-19 terminology was acknowledged by 37 countries as of February 26, 2020, with a day-by-day growing incidence and disease-related deaths.[2] Although the Turkish government has announced the first COVID-19 case on March 11, 2020, with a total of 205,758 diagnosis and 5,225 deaths as of July 5, 2020.

It has been exhibited that the COVID-19 infection is typically disseminated among human beings through respiratory aerosols, salivary droplets or sputum, and fecal–oral contact.[3],[4],[5] Accordingly, as it is the case for the other common infections disseminated via respiratory aerosols or salivary droplets, the dental specialists represent one of the genuinely high-risk health laborers groups for COVID-19 infection because of the unique nature of dental interventions mandating close physical contact with the affected patients.[1],[6] Contingent upon this fundamental information, several nations deliberately delayed the routine dental care to guarantee the security of their local health workers and to reduce the terrific speed of COVID-19 dissemination.[7] For a notable example, currently, the emergency dental treatment interventions which cannot tolerate any deferral have been defined by the American Dental Association (ADA) to be practiced by the dental specialists during the pandemic period.[8] Albeit such maneuvers may serve valuably, yet the patients' awareness about the nature of the COVID-19 pandemic may additionally demonstrate estimable in limiting the quantity of the new COVID-19 cases and safeguard of the dental specialists and other laborers of the dentistry clinics. However, to our best information, no past inquiry from Turkey planned to decide the likely patients' awareness about this remorseful disease condition at a national ground. Consequently, we intended to objectively measure the COVID-19 outbreak awareness of Turkish patients who demanded emergency dental interventions in our institution by employing a newly created questionnaire which may suitably guide dental specialists in their standard daily practice during the period of COVID-19 outbreak.


   Materials and Methods Top


Study population

This study was approved by Baskent University Institutional Review Board (Project no: D-KA 20/12) on 27 March 2020 and was supported by Baskent University Research Fund. Informed consent was procured from all participants. All interventions that involved human participants were following the ethical standards of the institutional research committee and with the Declaration of Helsinki (revised 2013) and its more recent amendments or comparable ethical standards.

A total of 306 patients participated in this study, who applied to Baskent University, Adana Treatment and Research Center, Dental Clinic, requiring emergency dental interventions between March 28 and May 31, 2020, namely during the period of COVID-19 outbreak in our country. The sample group of the study comprised of an aggregate of 306 participants selected by a straightforward random sampling method (survey technique, one of the qualitative research methods, was used). The questionnaire method was utilized for the acquisition of necessary research information by seeking the likely patients whether they were volunteers to participate in the survey. To be qualified, patients had to accept to complete a survey created by our team which consolidated the patients' age, gender, marital status, education status, medical history, basic dental hygiene habits, occupation, and general information about COVID-19 virus. The additional qualification criteria were as per the following: age ≥18 years, judged to be mentally and cognitively capacitated to assess and respond to the questions, and full completion of the questionnaire forms.

The questionnaire

We collaboratively developed a new questionnaire with 19 inquiries on COVID-19 by typically using some modified questions utilized in past studies,[9],[10],[11] with the primary purpose of exploring the general information and conscious awareness of likely patients on the COVID-19 pandemic who applied to our oral and dental clinic for dental interventions [Table 1]. The validation tests and per patient administration of the developed questionnaire was performed by the active cooperation of an oral and maxillofacial radiologist and an oral and maxillofacial surgeon.
Table 1: Questionnaire form

Click here to view


To reveal the threat posed by coronavirus disease 2019 (COVID-19) in terms of dental interventions, the study was first pretested with a sample of 80 to represent the planned universe. After the feedback received by individuals, questionnaire form questions were prepared. The pretest was conducted face-to-face with 40 female and 40 male participants, who are considered to represent the sample and have similar sociodemographic characteristics (education, age). The questionnaire was revised with the feedback of 80 patients and the last form was revised. The pretest data obtained were evaluated before analysis and it was determined whether there were missing or incorrect filled questionnaire forms.

Our questionnaire had four parts: Part-1 consisted of seven inquiries concerning the participant's demographic characteristics including age, gender, marital and education status, occupation, presence of systemic diseases, the diagnosis of COVID-19 infection in relatives or friends. Part-2 consolidated six inquiries to assess the participant's general information on the COVID-19 infection, including their familiarity with the cause of the disease, contamination sources, fatality, accessibility of a vaccine, and disease symptoms. Part-3 had four questions about the participant's awareness about the methods of reaching the information on COVID-19 infection, specific protection methods, and high-risk factors. What's more, Part-4 included four inquiries to test the participant's awareness about basic dental hygiene attitudes and the COVID-19 infection risks during the dental interventions [Table 1].

Statistical analysis

Independent Samples t-test, which is one of the parametric test statistics in binary comparisons based on the questions prepared for determining the level of consciousness and information of the public in dental interventions, and the participants' gender, marital status, presence of systemic disease, and the state of worrying when coming to the dentist, were used during the days when the coronavirus was intense. In multiple comparisons such as the age variable, the one-way ANOVA test was used.

Post-hoc tests and LSD tests were used to determine which groups originated from the differences analysis. In addition, the Kruskal–Wallis H test, one of the non-parametric test statistics, was used to determine the differences in the level of education and occupational variables. Tamhane's T2 test, which is one of the non-parametric post-hoc tests, was used to determine which groups originated from the differences analysis resulting from the analysis used. The significance level was accepted as 0.05 in the study (P = 0.05).


   Results Top


We incorporated a total of 306 (120 male and 186 female) patients who applied for emergency dental interventions to our dental clinic in this survey analysis with the primary aim of objectively measuring the COVID-19 awareness of them by typically using a newly generated questionnaire [Table 1] and [Table 2].
Table 2: Participants' demographics

Click here to view


Majority of participants were in the age group between 30 and 39 years (35.3%), and those with undergraduate degree (52.9%) and without systemic disease (82.7%). The replies to the questions about infectious disease (77.8%), protection methods (98.7%), dental interventions (76.1%) were mostly “Yes” [Table 2].

[Table 3] was designed according to the sociodemographic features and diseases, protection methods, and dental interventions about COVID-19 the patients whose answers were “yes” to the questions. Considering the replies to the questions about the infectious disease caused by the COVID-19 virus revealed that uniquely the participants' occupational (P < 0.001) and educational status (P < 0.001) were linked with better disease awareness status. Accordingly, private-sector workers and those with undergraduate degree education had more detailed information on the COVID-19 than other expert work gatherings and advanced education levels, respectively [Table 3].
Table 3: Relationship between socio-demographic features and diseases, protection methods and dental interventions about COVID-19

Click here to view


Participants' replies to the questions related to COVID-19 protection methods demonstrated that 98.7% of them were using at least one protective method [Table 2]. Additionally, the female gender had all the earmarks of being associated with the use of defensive measures contrasted with the male gender (P < 0.05), which suggested that the women participants were more curious about the ways of protection against COVID-19 infection and their ordinary usage [Table 3].

The answers to the inquiries regarding the dissemination routes of COVID-19 infection and their relationship with the dental interventions showed statistically significant relations between the participant's gender (P < 0.05), age group (P < 0.001), and educational status (P < 0.001) [Table 3]. A total of 85.3% of the participants, who had the information that COVID-19 would be disseminated by dental interventions, consisted of groups under the age of 50, while the proportion of those aged 50 years and above was 14.7% [Table 2].

Participants' with systemic disease replies revealed that 83.2% of them did not have information about the infectious disease caused by the COVID-19 virus, and 83.8% did not use COVID-19 protection methods. Nonetheless, 85.0% of these participants were aware that COVID-19 infection can be disseminated by dental interventions [Table 3].

All participants were aware of the fact that the COVID-19 infection was disseminated from individual to individual. As depicted in [Figure 1], answers to the inquiries concerning the COVID-19-related symptoms demonstrated that the 131 of all participants stated that all patients might probably manifest all specified symptoms, with fever, respiratory failure, and cough being the commonest single symptoms. Considering the dental hygiene habits, we encountered that 51.3% of them were brushing their teeth twice a day, while just 7.8% of them were utilizing antimicrobial mouthwashes twice a day routinely [Table 4].
Figure 1: Familarity of the clinical symptoms of COVID-19 infection

Click here to view
Table 4: Patients' general familarity to COVID-19 and dental care status

Click here to view


Participants replied that they obtained the COVID-19 related information firstly (33.3%) and most commonly from the web sources. Among all participants, 27.2% were informed about and were utilizing all protection methods to the extent they are informed. As per 48.69% of the participants' information, the medical staff, elderlies, children, frequent travelers, immune-deficient patients, and those with systemic chronic diseases were representing the most hazardous gathering for being contaminated with COVID-19 infection [Table 5]. As shown in [Table 5], every single dental intervention was expressed by 47.4% of all participants to be firmly associated with COVID-19 dissemination among the population.
Table 5: Participiants' preferences of getting COVID-19 related information, protection methods, risk groups, and their relationships with dental interventions

Click here to view



   Discussion Top


The results of this first survey from Turkey exhibited that the patients requiring dental interventions during the COVID-19 pandemic were, in general, devoid of sufficient awareness of COVID-19 infection in our country. Therefore, this finding accentuates the solid requirement for nationwide education on the causes, dissemination routes, consequences, and the prevention strategies of COVID-19 pandemic, which mankind meets for the first time in his history.

Studies on the virus dissemination routes of the COVID-19 infection undoubtedly displayed that the likelihood of being infected during the dental interventions was notably high due to the inability of the dental specialists to maintain the social distance that is related to the nature of the interventions necessitating close contact with the patients.[1],[2] Therefore, high awareness of the severity of the COVID-19 outbreak and its consequences is of critical importance which may prevent unnecessary requests for safely delayable dental interventions, which will reduce the COVID-19 infection risk for both the physicians and the patients. Relying upon this basic information, we planned to test the feasibility of a newly generated questionnaire in the objective assessment of the COVID-19 awareness in patients requiring dental interventions during the fatal COVID-19 pandemic.

One significant finding of our research was that there was not the exhibit of a direct connection between the COVID-19 pandemic and the participants' age and education status. Before the statistical analyses, we sensibly hoped that the patients' awareness status should increase with an advanced age and education status, but the results indicated that the awareness was independent of age and education status. Nonetheless, the patients' social awareness about the enhanced COVID-19 dissemination and direct exposure to dental interventions has not increased by aging as expected, and distinctly standing out from our expectations, we found that an advanced education status was related to a lesser awareness level regarding these two facts (52.9% for undergraduate, 17.0% for master degree). Though the exact cause of the latter finding is difficult to be properly assigned to a well-known cause, still, it might be speculated that the patients who were associate degree graduates were less curios on searching for and comprehending less information on the COVID-19 virus infection, its consequences and prevention strategies than other education counterparts. Further studies on this fascinating finding may serve helpfully in the fierce determination of its exact cause (s), which may guide fitly in the instructive endeavors against the COVID-19 pandemic battle.

Our present results revealed that women were doing better in terms of being aware of and obeying the protective meaures against the COVID-19 infection, which was unlike Machida et al. larger study incorporating a total of 2,400 Japanese people.[12] The through relationship between the gender and such an observation remains to be elucidated on the particular grounds of COVID-19 infection. Although women are more resistant to infections due to steroid hormones and sex chromosomes, it is promising that they were protected from the COVID-19 virus, but unfortunately this is not the case for men.[13],[14]

It was worrying for us not to apprehend an indistinguishable COVID-19 infection awareness status between the patients with chronic illnesses which render them less predisposed to this dreadful viral disease condition opposed to their so-called healthy counterparts in all terms of self-protection methods and the potential relationship between an expanded hazard for COVID-19 infection and dental interventions. In this respect, the results of the nationwide Chinese Cardiometabolic and Cancer Cohort (4C) study uncovered that the individuals with one of the glucose intolerance or diabetes mellitus diagnoses had a 50–60% higher risk for lung infections, and diabetes mellitus prevalence was reported to be significantly higher in established COVID-19 cases, particularly in the critically ill patients' population.[15] Similarly, Schriffirin et al. underlined the importance of keeping the blood pressure in normal limits for the wellbeing of the hypertensive cases.[16] Therefore, our above-mentioned finding appeared to strongly underscore the urgent need for more intensive education programs in this particularly high-risk group on the COVID-19 infection risk factors, prevention methods, and its potentially lethal consequences. Supporting furtherly our intensive population-based training proposal, the effective use of face masks, frequent hand washing, and deliberate avoidance of close contact with others personally or through the entrance into the populous places had been previously unequivocally recommended for a compelling control of the pandemic.[2],[17] But deplorably, the present survey's direct results demonstrated an insufficient social awareness level about the protection methods against the COVID-19 infection and prompt obedience to the specified tools.

Participants' replies to the questions testing their information on the clinical symptoms of an established COVID-19 infection showed that only 131 of them were familiar with all widely accepted symptoms,[18] which again accentuate the requirement for intensive population-based education programs on the subject. Additionally, we discovered that the web was the most preferred method (33.3% overall) to access information on COVID-19 infection, which may be related to altogether the population's overt enthusiasm on the web as an easy source of accessing any information. Notwithstanding, though this finding stresses the significance of utilizing the web as a viable arbitrator of dispersal of information on COVID-19 infection for the governments, yet it additionally cautions about the hazard for some web destinations as the disinformation sources for the overall population and the requirement for their stringent control.

The present study has certain limitations. First, because our present survey was generated and applied during the very early phase of the COVID-19 outbreak, the factual distributions of the replies may have been altered in anyways during the passed timeframe. Second, our current results are pertinent just to the Turkish population as cultural, ethnic geographic, social, and economic factors may alter them in significant manners among different nations. And, third, as this is the first study in Turkey, further periodical surveys that are conducted by the dental specialists may serve usefully in a thorough interpretation of our results and the exhibit of the time-dependent adjustments in the population's awareness and attitudes against the COVID-19 pandemic.


   Conclusion Top


The present first endeavor survey examination conducted in an academic dentistry clinic in Turkey during the early days of the COVID-19 pandemic demonstrated that the Turkish population, in prominent general, possessed the essential information about the causative virus, predisposing factors, disease severity and related symptoms, and the prevention methods. However, sadly, we observed that the participants did not take the necessary cautions against the possible COVID-19 infection and its dissemination pathways in their social environment, particularly in the specific case of systematic diseases and preventive measures. Accordingly, we strongly advocate the urgent engagement of nationwide training programs to gently raise the COVID-19 related social awareness as high as conceivable in all specific fields of health, including dentistry, to promptly get the pandemic under precise control at the earliest opportunity.

Declaration of patient consent

The institutional review board of Baskent University Medical Faculty approved the study design before collection of any patient data and written informed consent was provided by each participant either themselves or legally authorized representatives for collection and publication.

Acknowledgements

This research was approved by The Ministry of Health, Republic of Turkey Scientific Research Platform – No: 12_12_47.

Financial support and sponsorship

This study was supported by Baskent University Research Fund, project number: D-KA 20/12.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ 2020;368:m408. doi: 10.1136/bmj.m408.  Back to cited text no. 1
    
2.
World Health Organization. Coronavirus disease 2019 (COVID-19): Situation report-37. [Last updated on 2020 Feb 26; Last cited on 2020 July 05 ]. Available from: https://www.who.int/dg/speeches/detailwho- director-general-s-opening-remarks-at-the-mission- briefing-on-covid-19---26-february-2020.  Back to cited text no. 2
    
3.
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet 2020;395:514-23.  Back to cited text no. 3
    
4.
Special Expert Group for Control of the Epidemic of Novel Coronavirus Pneumonia of the Chinese Preventive Medicine Association. An update on the epidemiological characteristics of novel coronavirus pneumonia (COVID-19). Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41:139-44.  Back to cited text no. 4
    
5.
Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020;382:929-36.  Back to cited text no. 5
    
6.
Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, et al. Guidelines for infection control in dental health-care settings-2003. MMWR Recomm Rep 2003;52:1-61.  Back to cited text no. 6
    
7.
Dave M, Seoudi N, Coulthard P. Urgent dental care for patients during the COVID-19 pandemic. Lancet 2020;395:1257.  Back to cited text no. 7
    
8.
American Dental Association. ADA develops guidance on dental emergency, nonemergency care. Recommendations part of dentists' response over COVID-19 concerns. [Last updated on 2020 Mar 18; Last cited on 2020 Jul 05 ]. Available from: https://www.ada.org/en/publications/ada-news/2020-archive/march/ada-develops-guidance-on-dental-emergency-nonemergency-care.  Back to cited text no. 8
    
9.
Elrggal ME, Karami NA, Rafea B, Alahmadi L, Al Shehri A, Alamoudi R, et al. Evaluation of preparedness of healthcare student volunteers against Middle East respiratory syndrome coronavirus (MERS-CoV) in Makkah, Saudi Arabia: A cross-sectional study. Z Gesundh Wiss 2018;26:607-12.  Back to cited text no. 9
    
10.
Kharma MY, Alalwani MS, Amer MF, Tarakji B, Aws G. Assessment of the awareness level of dental students toward Middle East respiratory syndrome-coronavirus. J Int Soc Prev Community Dent 2015;5:163-9.  Back to cited text no. 10
    
11.
Khan MU, Shah S, Ahmad A, Fatokun O. Knowledge and attitude of healthcare workers about Middle East respiratory syndrome in multispecialty hospitals of Qassim, Saudi Arabia. BMC Public Health 2014;14:1281.  Back to cited text no. 11
    
12.
Machida M, Nakamura I, Saito R, Nakaya T, Hanibuchi T, Takamiya T, et al. Adoption of personal protective measures by ordinary citizens during the COVID-19 outbreak in Japan. Int J Infect Dis 2020;94:139-44.  Back to cited text no. 12
    
13.
Conti P, Younes A. Coronavirus COV-19/SARS-CoV-2 affects women less than men: Clinical response to viral infection. J Biol Regul Homeost Agents 2020;34:339-43.  Back to cited text no. 13
    
14.
Korean Society of Infectious Diseases and Korea Centers for Disease Control and Prevention. Analysis on 54 mortality cases of Coronavirus Disease 2019 in the Republic of Korea From January 19 to March 10, 2020. J Korean Med Sci 2020;35:e132.  Back to cited text no. 14
    
15.
Wang W, Lu J, Gu W, Zhang Y, Liu J, Ning G. Care for diabetes with COVID-19: Advice from China. J Diabetes 2020:12:417-9.  Back to cited text no. 15
    
16.
Schiffrin EL, Flack JM, Ito S, Muntner P, Webb RC. Hypertension and COVID-19. Am J Hypertens 2020;33:373-74.  Back to cited text no. 16
    
17.
Centers for Disease Control and Prevention. [Last updated on 2020 Mar 13; Last cited on 2020 July 05 ]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/index.html.  Back to cited text no. 17
    
18.
Centers for Disease Control and Prevention [Last updated on 2020 Apr 24; Last cited on 2020 Jul 05]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.  Back to cited text no. 18
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed625    
    Printed16    
    Emailed0    
    PDF Downloaded100    
    Comments [Add]    

Recommend this journal