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ORIGINAL ARTICLE
Year : 2022  |  Volume : 49  |  Issue : 2  |  Page : 180-185

Assessment of knowledge, attitude, awareness, and opinion of patients on routine dental services during COVID-19 pandemic: A cross-sectional study


Department of Periodontics, KAHER KLE Vishwanath Katti Institute of Dental Sciences, Belgaum, Karnataka, India

Date of Submission09-Oct-2021
Date of Acceptance01-Mar-2022
Date of Web Publication23-Aug-2022

Correspondence Address:
Shaila V Kothiwale
Department of Periodontics, KAHER KLE Vishwanath Katti Institute of Dental Sciences, Belgaum, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_145_21

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  Abstract 


Background: The novel severe acute respiratory syndrome-coronavirus-2 virus has undoubtedly disrupted the life of every individual and created a global health and economic crisis. Health-care systems, including dental clinics, were affected and patients with dental pain suffered since they were unable to seek dental care at the right time. It has since become relevant to examine and understand the outlook and views of patients toward seeking routine dental services and their acceptance of alternative methods of dental practice through the COVID-19 pandemic. Hence, this cross-sectional questionnaire study was conducted to assess the knowledge, attitude, and opinion of patients visiting a dentist for routine dental services during the COVID-19 pandemic Methodology: A cross-sectional questionnaire-based survey was conducted among 200 patients who visited the dental college for their treatment. Their responses were recorded and descriptive analysis, Chi-square test, and multiple logistic regression analysis were carried out to evaluate their responses. Results: The participants were aware of the transmission of COVID-19 (91%), 64% believed it was safe to visit a dentist and 99.5% believed it necessary to take proper precautions before visiting the dentist. Participants (84%) preferred having dental consultations over phone/email/video calls compared to regular in-person consultations during the pandemic. Conclusion: Teledentistry has the potential to emerge as an effective mode of managing patients with dental needs to reduce the burden on dental clinics and hospitals. It can ensure the accessibility to dental care even in the remotest area by allowing patients to connect with dentists through appropriate digital and social media.

Keywords: Aerosol, COVID-19, dental care, teledentistry


How to cite this article:
Kothiwale SV, Andrews A, Mehta K, Hugar SS. Assessment of knowledge, attitude, awareness, and opinion of patients on routine dental services during COVID-19 pandemic: A cross-sectional study. J Sci Soc 2022;49:180-5

How to cite this URL:
Kothiwale SV, Andrews A, Mehta K, Hugar SS. Assessment of knowledge, attitude, awareness, and opinion of patients on routine dental services during COVID-19 pandemic: A cross-sectional study. J Sci Soc [serial online] 2022 [cited 2022 Oct 3];49:180-5. Available from: https://www.jscisociety.com/text.asp?2022/49/2/180/354262




  Introduction Top


Since the World Health Organization officially declared COVID-19 a pandemic in March 2020, the novel severe acute respiratory syndrome-coronavirus-2 (SARS COV-2) virus has undoubtedly disrupted the life of every individual and created a global health and economic crisis. Many countries adopted the draconian measures of lockdowns to contain the spread of COVID-19 bringing all economic activity to a standstill.[1] Health-care services were also affected as only emergency health services were being provided. Dental clinics and offices were also closed down and very few offered dental emergency services as directed by their dental associations.[2] These left patients having severe orodental pain in the lurch because they could not seek appropriate dental care during their time of need. There was additionally very little information available regarding how exactly the virus transmits and what possible effect it could have on the dental industry. People despite having severe dental pain avoided seeking proper dental treatment during a lockdown largely due to the fear of contracting the virus.

Health-care workers are at the highest risk of contracting and transmitting several infectious diseases such as coronavirus due to their proximity with affected patients while providing health care. Besides doctors and nurses, dentists too are placed in this high-risk category because they are exposed to aerosol-generating procedures. Several dental clinics adapted to the situation by innovating and practicing several safety measures such as the use of personal protective equipment, preprocedural rinses, and noninvasive dentistry to minimize the risk of cross-infection during dental procedures.[1] This allowed them to continue safe dental practice in the midst of a pandemic. It has been established that several infectious diseases including COVID-19 spread through direct or indirect human-to-human contact of infected secretions and working in close proximity to a person's oral cavity leaves a dentist in a vulnerable position. Infection control has always been a part of regular dental work routine and COVID-19 ensured that all proper protocols of cleaning and disinfection were adopted in dental clinics.[3]

As the pandemic is still ongoing and countries are slowly easing lockdown measures to restart their economy, it has become pertinent to understand the outlook and views of patients toward seeking routine dental services and their acceptance of alternative methods of dental practice through the COVID-19 pandemic. Hence, this cross-sectional study was conducted to assess the knowledge, attitude, and opinion of patients visiting a dentist for routine dental services during the COVID-19 pandemic.


  Methodology Top


This was a cross-sectional questionnaire-based survey. The study was conducted among the patients treated at the outpatient department at a dental college in South India. Ethical approval was obtained from the Institutional Review Board. The study was conducted over a period of 3 months and written informed consent was taken from all participants prior to their participation in the study. Patients who were not willing to sign consent and patients who were children were excluded from the study.

Sample size estimation

The sample size was calculated at confidence level of 99% with 5% margin of error using the formula.

Sample size = Z α2 × (P) × (1-P)/C2.

where Z = Z value (2.576 for 99% confidence level).

P = percentage of picking a choice expressed as a decimal (0.5).

C = confidence interval or margin of error expressed as decimal (.05).

Sample size = (2.576) 2 × (0.5) × (1-0.5)/(.05) 2 = 663.5776.

Assuming the population size as 200.

n = N × X/(X + N– 1), where 'n' is required sample size and 'N' is the population size.

n = 200 × (663.5776)/(663.5776 + 200-1).

n = 154.

The sample size for the study was calculated as 154. Therefore, in the cross-sectional questionnaire study, 200 participants were selected based on the convenience sampling method.

Details of the questionnaire

The questionnaire consisted of 11 self-prepared questions and it took 2 min to complete. Participants' personal details such as age, education, occupation, and address were recorded. The questionnaire consisted of three parts. The first part tested the participants' general knowledge about COVID-19 and dental treatments options available during the COVID-19 pandemic. The second part assessed their attitude and awareness toward seeking dental treatment during COVID-19. The third part provided their personal opinions and inputs regarding visiting a dentist during a pandemic. The questionnaire was answered by the participants by giving YES/NO options [Annexure 1].

Statistical analysis

  • The data obtained from the study were analyzed using descriptive analysis for each question
  • Chi-square test and multiple logistic regression analysis were applied to determine the associations between various factors. The obtained data were then entered into Microsoft Excel sheets and IBM SPSS software (version 20.0 Chicago IL, USA) was used for the statistical analysis.



  Results Top


Ninety-one percent of the study participants stated they were aware of the mode of transmission of COVID-19 [Figure 1]. 81.5% of the participants strongly believed that a testing for COVID-19 before undergoing any routine dental procedure should be mandatory [Figure 2]. Three-fourth (74.5%) of the participants agreed that dental procedures can contribute to the transmission of COVID-19 infection [Figure 3] and only 64% believed it was safe to visit a dentist during the COVID-19 pandemic [Figure 4]. More than half (55.5%) of the participants did not think it safe for children, pregnant women, and elderly individuals to undergo any routine dental procedures [Figure 5]. Participants' opinion regarding the availability of emergency dental procedures was left divided equally [Figure 6]. A dismaying 40.5% of the participants stated they would visit the dentist for routine treatments during the COVID-19 pandemic [Figure 7]. An overwhelming 99.5% of participants agreed it was necessary to take proper precautions before visiting a dentist during the COVID-19 pandemic [Figure 8]. Only 29.5% of the study participants experienced any dental pain during the COVID-19 pandemic [Figure 9]. The procedures the study participants deemed necessary to visit a dentist during the COVID-19 pandemic are: for severe dental pain, for swelling, or abscess, followed by for extraction of teeth, fillings, cleaning of teeth, and fabrication of denture [Figure 10]. Eighty-four percent of participants preferred having dental consultations over phone/email/video calls compared to regular in-person consultations [Figure 11].
Figure 1: Are you aware of the mode of transmission of COVID-19?

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Figure 2: Do you think testing for COVID-19 should be mandatory for undergoing any routine dental procedure?

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Figure 3: Do you think dental procedures can contribute to the transmission of COVID-19 infection?

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Figure 4: Do you think it is safe to visit a dentist during the COVID-19 pandemic?

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Figure 5: Do you think it is safe for children, pregnant women, or elderly to undergo any routine dental procedures?

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Figure 6: Do you think only emergency dental procedures should be functional during the COVID-19 pandemic?

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Figure 7: Would you visit dentist for routine treatment during the COVID-19 pandemic?

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Figure 8: Do you think it is necessary to take proper precautions before visiting a dentist during the COVID-19 pandemic?

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Figure 9: Have you experienced any dental pain during the COVID-19 pandemic?

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Figure 10: For which of the following procedures would you visit dentist COVID-19 pandemic?

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Figure 11: Would you prefer dental consultation of phone/email/video calls compared to in-person consultation?

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  Discussion Top


COVID-19 or the novel coronavirus infection has shown no signs of abating since it wrecked Global Havoc in 2020. The current evidence points to a possibility of the COVID-19 infection becoming endemic to certain communities in the world. The current pandemic has forced medical and dental health professionals to seek, adopt, and adapt newer methods of keeping in touch with patients and dispensing health care with minimal risk of cross-infection.[4]

The extent of the impact of COVID-19 on health-care systems around the world is not yet determined. Hospitals and emergency rooms have been overwhelmed with COVID-19 cases for a little over a year now. Development of vaccines and better treatment protocols has to a large extent helped control the spread of infection. This has definitely eased the burden on already overstretched health-care systems. There is a need to innovate and develop a robust system of health care that can completely eliminate the need for an in-person consultation for every symptom. This will help triage patients according to priority and ensure better utilization of resources and address a larger population's medical and dental needs.

In our study, the participants had good knowledge of transmission of COVID-19 [Figure 1] and majority of them agreed that COVID-19 testing is mandatory before undergoing any routine dental procedure [Figure 2]. Currently, the gold standard for testing COVID-19 is the real-time reverse transcription-polymerase chain reaction (rRT-PCR) test which requires naso/oropharyngeal swabs to qualitatively detect nucleic acid of SARS-CoV-2.[5]

Given the novelty of the disease, no cases of SARS-CoV-2 transmission in a dental setting are identified yet. It is well known now that COVID-19 is highly transmissible and considering that routine dental procedures usually generate aerosols; during the course of this pandemic, alterations to dental treatment should be considered to maintain a healthy environment for the patients and the dental team.[6] Armed with the knowledge [Figure 3] of how COVID-19 transmits and awareness of aerosol-generating dental procedures, participants felt safe to visit a dentist after taking due precautions according to the health advisory [Figure 4] and [Figure 8]. However, for specific group of population, namely children, pregnant women, and elderly adults, the participants believed it was unsafe for them to undergo even routine dental procedures. This shows that the participants believed this group of people to be more vulnerable to acquiring the COVID-19 infection [Figure 5]. When the participants were questioned about their attitude toward routine and emergency dental treatments, the results were divided. Majority stated that they would not visit the dentist for routine dental procedures but they would seek treatment for dental emergencies [Figure 6] and [Figure 7].

During the pandemic, only a small number of the study participants experienced dental pain [Figure 9]. The procedures they deemed necessary to visit a dentist during the COVID-19 pandemic are: for severe dental pain (91%), for swelling (76.5%) followed by for extraction of teeth (51%). A small minority of participants would visit the dentist for fillings (35.5%), cleaning of teeth (8%), and fabrication of denture (3.5%) [Figure 10].


  Conclusion Top


The present study shows that patients are willing to adopt newer, safer means of seeking dental care during adverse circumstances. Eighty-four percent of our study participants opted for teledentistry when asked about their perceptions on consultations via email/phone/video. With increasing advancements in the digital world, video consultations or teledentistry has the potential to emerge as an effective mode of managing patients with dental needs to reduce the burden on dental clinics and hospitals. As smartphones are widely used even in rural communities, they can be used as point-of-care aids in delivering patient-centered care.[7] Video consults can reach patients in the remotest areas and help alleviate their symptoms by advising at home care, appropriate medications, and direct the patient to the nearest available dental care center. Thus, teledentistry can help patients seek dental care by connecting them to dentists through appropriate digital and social media through a pandemic and otherwise.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Annexure Top



  Annexure 1: Details of the questionnaire with consent form Top


Questionnaire

Title: Assessment of Knowledge, Attitude, Awareness, and opinion of outpatients on routine dental services during COVID-19 pandemic – A cross-sectional survey

Thank you for participating in the survey. Filling the form provides your consent for the study. All responses will be kept confidential for research purposes only.

A. Patient details

Age: Address:

Occupation: Education:

B. Questions – Please tick the most suitable option

Part 1 – Assessment of knowledge of patients regarding COVID-19 pandemic

Part 2 – Attitude and awareness of patients toward COVID-19

Part 3 – Opinion of patients regarding visit to the dental clinic during the COVID-19

I am willing to participate in this survey and give my consent for the same.



 
  References Top

1.
Bhanushali P, Katge F, Deshpande S, Chimata VK, Shetty S, Pradhan D. COVID-19: Changing trends and its impact on future of dentistry. International journal of dentistry. 2020;2020.  Back to cited text no. 1
    
2.
Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J 2020;32:181-6.  Back to cited text no. 2
    
3.
Faccini M, Ferruzzi F, Mori AA, Santin GC, Oliveira RC, Oliveira RCG, et al. Dental Care during COVID-19 Outbreak: A Web-Based Survey. Eur J Dent 2020;14:S14-9.  Back to cited text no. 3
    
4.
Ghai S. Teledentistry during COVID-19 pandemic. Diabetes Metab Syndr 2020;14:933-5.  Back to cited text no. 4
    
5.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 5
    
6.
Epstein JB, Chow K, Mathias R. Dental procedure aerosols and COVID-19. Lancet Infect Dis 2021;21:e73.  Back to cited text no. 6
    
7.
Estai M, Kanagasingam Y, Mehdizadeh M, Vignarajan J, Norman R, Huang B, et al. Teledentistry as a novel pathway to improve dental health in school children: A research protocol for a randomised controlled trial. BMC Oral Health 2020;20:11.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]



 

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Abstract
Introduction
Methodology
Results
Discussion
Conclusion
Annexure
Annexure 1: Deta...
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