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 Table of Contents  
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 59-64

Attitude and response of indian dentists about corona (Covid-19) infection

Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India

Date of Submission13-Apr-2020
Date of Decision24-May-2020
Date of Acceptance04-Jun-2020
Date of Web Publication23-Sep-2020

Correspondence Address:
Faizal C Peedikayil
Department of Pediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/dmr.dmr_8_20

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Background: The coronavirus epidemic, which started in China, has become a worldwide pandemic. Despite global efforts to contain the disease spread, the outbreak is still on the rise, owing to the community spread pattern of this infection. Many countries have gone for a shut down for control of spread. Dental professionals can be infected as well as dental clinics can be a potential source of spread of infection. Therefore, a dental surgeon should be adequatly prepared regarding the spread of the disease. Materials and Methods: An online questionnaire was sent to dental surgeons through their professional and social groups. The questions were related to the source of corona (Covid-19) infection, the precautions to be taken by dentists, the work schedule during the lock down period, and also the response and precautions to be taken after the lockdown period. The results were tabulated, and statical analysis was performed. Results: 1235 responses were received.Above 84% of the participants were not practicing during the lockdown period in India. The participants have knowledge of COVID 19 infection mostly through TV and internet sites and social media platforms. There will be a statistically significant increase in the use of personal protective equipments during the postlockdown practice. Most of the participants prefer N95 masks (62%), disposable gowns (54%). Conclusion: The dentists were aware of the problems of the spread of corona COVID 19 and are in the process of having more stringent infection control measures in their practice.

Keywords: Corona, coronavirus disease 2019, infection control

How to cite this article:
Peedikayil FC, Kottayi S, Ismail S. Attitude and response of indian dentists about corona (Covid-19) infection. Dent Med Res 2020;8:59-64

How to cite this URL:
Peedikayil FC, Kottayi S, Ismail S. Attitude and response of indian dentists about corona (Covid-19) infection. Dent Med Res [serial online] 2020 [cited 2021 Apr 11];8:59-64. Available from: https://www.dmrjournal.org/text.asp?2020/8/2/59/295872

  Introduction Top

The coronavirus disease 2019 (COVID-19) epidemic Originated in Wuhan, China, has become a major public health challenge to >200 countries in the world.[1] The World Health Organization had announced that the outbreaks of the novel coronavirus have constituted a “public health emergency of international concern,” which is an extraordinary event to constitute a public health risk to other countries through the international spread of disease and to potentially require a coordinated international response, formulated when a situation arises that is serious, sudden, unusual or unexpected and require immediate international action.[2] With over 50 lakh confirmed cases of COVID 19 cases [Figure 1] the pandemic is a health emergency of indefinite propotions.
Figure 1: WHO data of total case on May 24, 2020 (source https://covid19.who.int/)

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The government of India has advised people for social distancing and the mitigation measures to combat the spread of the virus, The Prime Minister of India ordered Lock down of all 1.3 billion people in the country to stay inside their homes for 3 weeks starting on 25th of March to stop the spread of the coronavirus.[3] Social distancing and restrictions on population movement have been successful in a few countries in control of COVID 19.[4]

The coronavirus disease 2019 (COVID-19) is a zoonotic infection that, similar to other coronavirus infections, is believed to have been originated in bats and pangolins, and later transmitted to humans. The Corona virus (SARS-CoV-2) is present in nasopharyngeal and salivary secretions of affected humans and its spread is predominantly thought to be person-to-person transmission routes of 2019-nCoV included direct transmission, such as cough, sneeze, droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes. 2019-nCoV can also be transmitted through the saliva, and the fecal–oral routes may also be a potential person-to-person transmission route.[1],[5]

The dental professionals are exposed to high risk of 2019-nCoV infection due to the face-to-face communication and the exposure to saliva, blood, and other body fluids. Dental professionals can play important roles in preventing the transmission of 2019-nCoV by practicing infection control measures during dental treatment to block the person-to-person transmission routes in dental clinics.[6],[7]

Infection control procedures are actions taken in dental care settings to prevent the spread of disease. Due to the the widespread transmission of SARS-CoV-2 and reports of its spread to Health Care Providers (HCPs), dental professionals are at high risk for nosocomial infection and can become potential carriers of the disease.[7] Most procedures performed by the dental team have the potential for creating contaminated aerosols and splatter. Aerosols are tiny particles or droplets which remain suspended in air and represent an infection hazard due to their gross contamination with microorganisms and blood. A fourfold increase of airborne bacteria has been observed in areas where aerosol producing equipment was used. Aerosols can float in air for considerable time before being inhaled by dental staff and other patients. In addition, if adequate precautions are not taken, the dental office can potentially expose patients to cross-contamination.[8],[9],[10]

A study was therefore conducted to ascertain the attitude and response of Indian dentists about the Covid 19 infection and the precautions to be taken in the clinical practice.

  Materials and Methods Top

An Online questionnaire prepared through Google forms was sent to Indian dentists by email and social media to dentists across the country. Apart from participants age, gender and nativity, the questionnaire ranged from questions related to source of Corona (Covid-19) infection, the precautions taken by dentists in routine dental practice, the work schedule during the lock down period, and also the response and precautions to be taken after the lockdown period, the respoces were tabulated automatically by google forms and exported to MS excel. Statistical analysis was done using WinPepi software. The qualitative variables were expressed in proportions. The Mid -P 95% confidence interval (CI) of the proportions were calculated. If the 95% CI of the proportion of its use before lockdown of a particular personal protective equipment (PPE) overlaps with 95% CI of proportion of its use after lock down of that PPE, we conclude that there is no statistically significant difference between these two proportions.

  Results Top

The participants of this study were dentists practicing in different parts of India. A total of 1235 responses were received through online. All responses were considered for the stusy as the submission of resosponses was possible on completion of all questions. The participants were 52.8% (652) females and 47.2% (583) males. Age range, Qualification and the Domicile status of the Participants are given in [Table 1]. The main source of Information about COVID infection was from TV, social media, and Internet sites; the details are given in [Figure 2].
Table 1: Demographic details of the participants

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Figure 2: Source of Information about covoid infection

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84.3% (1040) respondents were not working during the lockdown period whereas 15.7% (195) were working during the lockdown period. Out of the 195 doctors who were working during the lockdown period 83% (165) of them were giving only medications, 14% (29) only emergency treatment not involving aerosols whereas 3% (6) were carrying out treatment involving aerosols as shown in [Figure 3] and [Figure 4].
Figure 3: Percentage of dentists working during the lock down period

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Figure 4: Percentage of dentists working during the lock down period

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[Figure 5] shows a comparison of Use of PPE among Dentists before the lockdown period, and the attitude of its use in the postlockdown period whereas [Table 2] shows the statistical significance at 95% CI of the proportion of use of PPE's. Use of Masks and gloves before lockdown overlaps with the 95% CI of the proportion of use of Masks gloves after lockdown, concluding that there is no statistically significant difference regarding the use of gloves before and after the commencement of lockdown. When considering other PPE, there exists a statistically significant difference as there is no overlap in the 95% CI of the proportions of those PPEs before and after the commencement of lockdown, which significantly higher use after the commencement of lockdown.
Figure 5: Comparison of Use of personal protective equipment before lockdown and expected after lockdown

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Table 2: Proportion of Use of personal protective equipment before lockdown and expected after lockdown practice

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[Figure 6] shows the preference of types of gowns. Disposible gowns were the most preferred by 54% (655) of the participants, followed by reusable synthetic material gowns 27% (330). [Figure 7] shows the preference of types of masks. N95 maks were most preferred 62% (767), followed by surgical masks 36% (448). [Figure 8] shows the source of knowledge about infection control in the Corona infecyion period. The main sorces are WHO/ICMR websites 49% (601) and professional organizations 40% (499).
Figure 6: Types of gowns expected to use by participants after lock down

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Figure 7: Type of mask expected to use after lock down practice

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Figure 8: Professionals information of infection control neasures in relation to Covid 19 Infection

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  Discussion Top

COVID-19 has become a great public health concern in the world because of its high transmissibility. Ever since the first reported case in India in January 2020, the authorities are on alert to reduce the spread of COVID 19 infection.

The respondents in this study are dental surgeons practicing in India. The study shows that dental professionals obtained their information about COVID 19 through various media such as TV, websites, and social media apps. Similar to our findings, other studies reported that participants usually obtained their information about infectious diseases through the internet and watching TV.[11],[12] Mass media plays a central role in people's lives. The delivery of information through mass media is instant and available around the clock the widespread use of the internet and its availability have made it a major source of information for the professionals. Many social media can be used to improve or enhance professional networking and education.[13]

Dental clinics face a higher risk of disease transmission by the very nature of dental treatment operations, i.e., (1) formation of aerosols and diffusing into the surrounding air; (2) dental treatment is characterized by relatively long operation times, which results in the persistent existence of aerosols within a large area of the clinical office and introduces a potential risk of spreading disease, (3) conventional protective measures are not 100% effective, and patients have no protection during the treatment process, (4) the incubation period and possibility of patients concealing medical history could easily lead to the spread of disease and saliva, blood, and mixed water droplets carrying the virus would contaminate dental treatment equipment. Therefore dental workers and patients are likely to become infectors and transmitters of covoid 19 infection.[6],[7],[14] Based on the reasons above, the Dental Council of India and the Indian Dental Association have promptly given advisories to practicing dentists, which suggested them to protect themselves and should be cautious about spread of COVID 19 infection.[15],[16]

COVID 19 virus can persist on surfaces for a few hours or up to several days, depending on the type of surface, the temperature, or the humidity of the environment.[17] Therefore Hand hygiene has been considered the most critical measure for reducing the risk of transmitting microorganism to patients.[18] The 4-handed technique is beneficial for controlling infection. The use of saliva ejectors with high volume can reduce the production of droplets and aerosols.[19],[20]

The present study shows that the use of personnal protective equipments is going for an exponential rise in the postcorona period, (i.e., after the postlock down practice starts). Masks are examples of personal protective equipment that are used to protect the wearer from airborne particles and from liquid contaminating the face. In a significant study[21] comparing cloth masks with other masks, it was found that the physical properties of a cloth mask, reuse, the frequency and effectiveness of cleaning, and increased moisture retention, may potentially increase the infection risk for health care workers. Contaminated cloth mask may transfer pathogen from the mask to the bare hands of the wearer and filtration was extremely poor for the cloth mask.[22]

The surgical mask may be effective in blocking splashes and large-particle droplets. Their efficacy must be re-examined because aerosols contain particles many times smaller than 5 microns. Surgical masks also do not provide complete protection from microorganisms and other contaminants because of the loose fit between the surface of the face mask.[23] Oberg and Brousseau[24] demonstrated that surgical masks did not exhibit adequate filter performance against aerosols measuring 0.9, 2.0, and 3.1 μm in diameter. Lee et al.[25] showed that particles 0.04 to 0.2 μm can penetrate surgical masks. The size of the SARS–CoV particle from the 2002–2004 outbreak was estimated as 0.08 to 0.14 μm assuming that SARS-CoV-2 has a similar size, surgical masks are unlikely to effectively filter this virus.[22],[26]

N95 and FFP2 masks are respiratory protectors which filters out at least 95% of airborne particles, including large and small particles device designed to achieve a very close facial fit and very efficient filtration of airborne particles. The edges of the respirator are designed to form a seal around the nose and mouth. N95 and FFP2 are commonly used in healthcare settings for people who work in close proximity with the patients and are recommended for aerosol-generating procedures.[25],[26],[27]

Protection of the mucous membranes of the eyes/nose/mouth by using face shields/goggles is an integral part of standard and contact precautions. The flexible frame of goggles should provide a good seal with the skin of the face, covering the eyes and the surrounding areas and even accommodating for prescription glasses. Face Shield made of clear plastic and provides good visibility and Adjustable band to attach firmly around the head and fits snuggly against the forehead are advised. It is preferable to have Fog resistant and those completely covers the sides and length of the face. Both re-usable or disposable can be considered. Shoe Covers are advised which the entire shoe and reach above ankles and should be made up of impermeable fabric to be used overshoes to facilitate personal protection and decontamination.[28]

Nitrile gloves are preferred over latex gloves because they resist chemicals, including certain disinfectants such as chlorine. There is a high rate of allergies to latex and contact allergic dermatitis among health workers. However, if nitrile gloves are not available, latex gloves can be used. Nonpowdered gloves are preferred to powdered gloves.[29]

Coverall/gowns are designed to protect the torso of healthcare providers from exposure to the virus. Although coveralls typically provide 360-degree protection because they are designed to cover the whole body, including back and lower legs and sometimes head and feet as well, the design of medical/isolation gowns do not provide continuous whole-body protection. Coveralls and gowns are deemed equally acceptable as there is a lack of comparative evidence to show whether one is more effective than the other in reducing transmission to the health worker. Disposable (single-use) isolation gowns are designed to be discarded after a single use and are typically constructed of nonwoven materials alone or in combination with materials that offer increased protection from liquid penetration, such as plastic films such as polypropylene, polyester, polyethylene. Reusable isolation gowns are typically made of 100% cotton, 100% polyester (synthetic), or polyester/cotton blends. These fabrics are tightly woven plain weave fabrics that are chemically finished and maybe pressed through rollers to enhance the liquid barrier properties. Several studies have identified that the fabric properties, such as repellency, pore size, fabric thickness, and wicking, have an impact on the barrier effectiveness,[29] Leonas and Jinkins[30] showed that fabrics with smaller pore sizes have improved barrier effectiveness to bacterial transmission. fluorocarbon-based finishes are most commonly used in hospital gowns that repel both water and oil-based liquids. Flourocarbon-based finishes provide a fabric that is water resistant.[31] Based on an evaluation of the functional requirements, environmental impact, and economics of gowns, clear superiority of either reusable or single-use gowns and drapes cannot be demonstrated.[32] Headcover that covers the head and neck while providing clinical care for patients is better. Hair and hair extensions should fit inside the headcover.[33]

This study also shows that dental professionals are more aware of the infection control procedures because of the threat of coronavirus through various means. Most of them have accessed to information and learning sites and journals. Various websites such as WHO,[34] CDC[35] and professional bodies provide information regarding the threat of corona virus and the precautions to be taken., Professional associations such as Indian Dental Association and other specialty organizations are sending advisories to their members regarding the information about Infection Control during and after the corona infection period. It is up to each practitioner to adhere to the protocols, which can make the dental practice safe for them and their patients.

  Conclusion Top

This study shows that Dentists are aware of the spread of Corona- COVID 19 infection and the need for more stringent infection control measures. The study also shows that dentists are looking forward to acquiring and use personal protection equipments in their practice. The emergence of COVID 19 infection is a learning process for the dental professional, and the dental practice is going to change for the better.

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Conflicts of interest

There are no conflicts of interest.

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

  [Table 1], [Table 2]


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