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ORIGINAL ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 86-90

Knowledge, awareness, and attitude about novel corona virus disease among undergraduate, interns, and postgraduate dental students – A questionnaire-based survey


Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences Pondicherry, Puducherry, India

Date of Submission25-Feb-2020
Date of Decision20-May-2021
Date of Acceptance21-May-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. P Roland Prethipa
Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences Pondicherry, Puducherry
India
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DOI: 10.4103/srmjrds.srmjrds_17_21

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  Abstract 


Background: The extensive blowout of COVID-19 globally increases the probability that dental health care professionals will treat this subset of the patient population. If this virus follows the same pattern of other coronavirus infections it is anticipated to indisputably persists as a less virulent infection in our population with milder symptom. Hence, dental students are urged to have thorough knowledge, and keep themselves updated with the practice guidelines regarding this disease. Aims and Objectives: To assess the level of knowledge, awareness, and their influence on the attitude concerning the emergent pandemic COVID-19 among postgraduates (PGs), interns, and undergraduate (UG) dental students. Materials and Methods: A 21 closed-ended questionnaire was framed with three sections which included knowledge, awareness, and attitude which was face and content validated and circulated in Google form among study participants via various social media forums. Statistical analysis of the data was performed using SPSS (Statistical Package for the Social Sciences) version 20.0. Results: A total of 316 responses were obtained in which 11 unfilled or partially filled responses were excluded and 305 responses were included for analysis. PGs had more knowledge, awareness, and attitude than interns, followed by UGs. Conclusion: This survey not only recorded the knowledge, awareness, and attitude among the future dental professionals but also acts an indicator of the need for amendments to combat the lacunae especially in the learning dentist population to intensify upcoming dental practice in the post pandemic era.

Keywords: Attitude, awareness, COVID 19, dental students, knowledge


How to cite this article:
Boopathi D, Prethipa P R, Surenthar M, Ramanathan V, Vasudevan SS, Kumaran JV. Knowledge, awareness, and attitude about novel corona virus disease among undergraduate, interns, and postgraduate dental students – A questionnaire-based survey. SRM J Res Dent Sci 2021;12:86-90

How to cite this URL:
Boopathi D, Prethipa P R, Surenthar M, Ramanathan V, Vasudevan SS, Kumaran JV. Knowledge, awareness, and attitude about novel corona virus disease among undergraduate, interns, and postgraduate dental students – A questionnaire-based survey. SRM J Res Dent Sci [serial online] 2021 [cited 2021 Jul 31];12:86-90. Available from: https://www.srmjrds.in/text.asp?2021/12/2/86/319865




  Introduction Top


The up-and-coming pneumonia outburst began in Wuhan City, China in late December 2019.[1] The infectious agent of this viral pneumonia was finally identified as a novel coronavirus (2019-nCOV).[2] On January 30, 2020, the World Health Organization (WHO) announced the rampant spread of this virus as a public health emergency and declared a pandemic in March 2020. On February 11, 2020, WHO named the novel viral pneumonia as “Corona Virus Disease (COVID 19),” while the International committee on taxonomy of viruses suggested this nCOV name as “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”. It is the seventh member of the Coronaviridae family, encompassing large, single, plus-stranded ribonucleic acid as their genome. At present, there are four species of coronaviruses: α-CoV, β-CoV, γ-CoV, and δ-CoV. The α-CoV and β-CoV primarily infect the respiratory, gastrointestinal, and central nervous system of humans and mammals, while γ-CoV and δ-CoV mainly infect the birds. 2019-nCoV explored in Wuhan also belongs to the β-CoV.[3] The fleeting increase in the number of cases and evidence of human-to-human transmission advocated that the virus was more contagious than its two ancestors SARS-CoV and the Middle East respiratory syndrome-CoV.[4]

Dental procedures are extremely expected to expose both the patients as well as the professionals, due to the close contact between them during procedures.[5] The likely routes of spread of the infection include direct contact through inhalation of the respiratory droplets and indirect through fomite transmission.[6] The virus has high affinity to ACE2 (angiotensin-converting enzyme 2 receptors) which are present abundantly in salivary glands and also in the tongue. Thus, the saliva of infected patients can be a potential source for the spread of infection.[7] Although patients diagnosed with COVID-19 are not supposed to receive dental treatments, dental emergencies can occur, and close contact would be inevitable. In addition, the relatively protracted incubation period of the disease makes it burdensome for health professionals to identify the existence of COVID-19 infections, which could ease the transmission of the virus during the subclinical stages of the disease. Hence, patients who are asymptomatic, are of great menace to dentists and other associates of the dental team.[4] As the understanding of this novel disease is making headway, current knowledge of coronavirus infection should be shared without any boundaries. This survey is unique in the way that it was undertaken amongst undergraduates (UGs), interns and postgraduates (PGs) who are the learning dentist population and are obliged to play a noteworthy role in breaking the transmission chain and curbing this outbreak by entertaining a high level of awareness to pact with the disease by including necessary precautions so that provision of dental care will be continued along with the integrity of infection control.

Aims and objectives

To assess the level of knowledge, awareness, and their influence on the attitude concerning the emergent pandemic COVID-19 amongst PG, Interns, UG dental students.


  Materials and Methods Top


Our survey population consisted of UGs, Interns and PGs from various dental colleges across India. Practicing dental professionals were not considered since the survey was performed during the initial outbreak of the disease and majority of dental practice was withheld due to their potential risk involved in the transmission of virus.

A well-framed online survey questionnaire using Google forms were used to collect data from the subjects in the month of May 2020. The online survey link was circulated through diverse social media forums and responses were received through an online survey submission. The questionnaire comprised a total of 21 closed-ended questions [given in [Figure 1]], which were divided into three sections. The first section focused on the knowledge among subjects about COVID-19 and the second section was designed to gather information about their awareness and the last section was related to the attitude of the subjects during this COVID-19 pandemic.
Figure 1: Questionnaire used in the current study

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The questionnaire was expertized to evaluate problems, ambiguity, relativity, proper terms and grammar, and understandability to ensure face validity and content validity. A total of 316 participants participated and submitted the questionnaire, of which 11 unfilled or partially filled forms were excluded as shown in the study protocol flowchart [Figure 2]. Sample size (convenient sampling method) was calculated based on the data obtained from the pilot study consisted of the same questionnaire that was given to 30 participants (10 in each group) with the power of study 95%.
Figure 2: Study protocol flowchart

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Statistical analysis

Data were analyzed using IBM SPSS (IBM Corp. Released 2011.IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA: IBM Corp.). One-way (analysis of variance) was used to compare the scores between the three groups of participants. Scheffe's post-hoc test was done for multiple pairwise comparisons after a significant difference in knowledge, attitude, and awareness scores observed among the groups. The latter was done since there are unequal samples among the main groups. P < 0.001 was considered to be significant.


  Results Top


This survey included a total of 305 subjects with 228 females and 77 males [Table 1]. With respect to gender distribution, females were in greater proportion in our survey. The mean age of our participants was 26 years in PGs, 23 years in Interns and 21 years in UGs, respectively. The descriptive data also suggests that this survey involved more UGs among the various groups.
Table 1: Descriptive statistics of participants

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The individual scores secured by each group in knowledge, awareness, and attitude categories respectively are shown in [Figure 3]. The maximum score was obtained by the PGs in all three categories followed by the Interns and UGs. The question with the correct response by most individuals was Question (Q) 2, chosen wrongly by only 7.9%, 4.1%, 6.3% of the PGs, interns, and UG, s respectively. The incorrect answer opted most among the knowledge group is Q1, chosen wrongly by 88.8%, 95.1%, 91.6% of the PGs, interns, and UGs respectively.
Figure 3: Score secured by 3 groups in knowledge, awareness and attitude

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The three different variables of the questionnaire are individually compared between the groups using statistical analysis as shown in [Table 2]. The PGs scored the highest (4.382 ± 0.971) followed by interns (4.356 ± 1.11), in the knowledge-related questions. To awareness scores among the study group are, PGs (5.011 ± 1.42), interns (4.671 ± 1.42) and UGs (4.685 ± 1.23), respectively. Scheffe's post-hoc test results show that there is a significant difference in knowledge and attitude scores among the three groups PGs, UGs, and interns. Moreover, the knowledge and attitude scores were significantly higher in PGs [Table 3].
Table 2: Comparison of scores between the groups

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Table 3: Multiple pairwise comparison using Scheffe's post-hoc test

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  Discussion Top


COVID-19 pandemic has destructively altered the living aspects, mental and social well-being, and economical upfronts. It is of no denying that dentists are at greater risk and trying to find a way to continue providing dental care for society with manageable cons. It goes unsaid that the fear of future, trepidation and the mental chaos that is present in the people of our profession, due to the unclear situation that is persisting. We can say that the whole dentistry practice may be needing alterations in certain aspects. The mental state, awareness, and the approach that will be opted by the future dental professionals such as UGs, interns, and PG is to be sober-sided.

Questionnaire-based studies are well-established method for gathering data concerning preferences, attitudes, opinions, and experiences of participants; however, careful data collection and interpretation is required.[8] Our questionnaire consisted of total 21 closed-ended questions and responses collected objectively.

The PGs scored the highest followed by interns in the knowledge-related questions that included the nCOV origin, pathogenesis, investigations, and treatment, as of current time. This major difference in knowledge may be attributed to the source of information (Internet, social media, or news) or simply the ignorance to an unfamiliar infectious disease. The PG group was also exceeding the other groups in the awareness scores. It is to be noted that the overall awareness is relatively less than predicted which could be probably attributed to the day-by-day changing scientific updates regarding COVID-19's etiology, prevention and treatment measures.[9],[10],[11] Predominantly, all groups have responded that the risk of COVID-19 transmission during a dental procedure is very high as previously documented by Fallahi et al. in 2020.[12]

The most crucial question was regarding the correct time of providing dental treatment for a coronavirus positive patient, for which about 79.8% of PGs, 87.7% of interns, and 82.5% of UGs chose the most favored option of doing dental procedures for COVID recovered patients, after one molecular test negative for COVID-19. This is persuasive because even after patient recovery, the presence of the virus in saliva and recusancy during the convalescence period was reported by Chen et al. in 2020.[13] 1.5% hydrogen peroxide or 0.2% povidone-iodine can be used to eliminate the virus and effectively manage the patients during dental procedures.[14] The awareness concerning the use of preprocedural mouth rinse, was still low in all three groups. Regarding oral manifestations of the disease, the awareness score was very minimal in all three groups, only 38.2% of PGs, 46.6% of interns, and 39.9% of UGs were aware of irregular ulcer as documented by Anne-Ga&#s235;lle et al. in 2020.[15]

In terms of attitude which included dental triaging, need for nonemergency procedures, fear of infection and a suitable method to spread awareness and an overall highest score of 4.764 was obtained by PGs. Predominantly the idea among them was acceptable and in the basis of the current situation, such as dental triaging to find out emergency cases and to give appropriate care, spread of awareness through all available methods. As a whole, PGs had more knowledge, awareness, and attitude than interns, followed by UGs but awareness of all three groups was not exceptionally notable. This could be due to the hindrance in communication, pooling of nonspecific unreliable information in various social media.

The findings of a study by Shivalingesh et al. in 2020[16] also assessed the knowledge, attitude, and practices of dentists and it was found that the High/Good knowledge and practice scores were seen in 92.7% and 79.5% of the 860 participating dentists, respectively. When compared to general dentists, it was observed that the dentists with higher qualifications (PGs) reported better and significant knowledge scores as compared to graduates. Another study which assessed the awareness toward COVID-19 precautions among different levels of dental students in a university located in Saudi Arabia, depicted statistically significant differences in knowledge, with PG students having the highest mean scores, followed by interns and UG students[17] which was in accordance with our present study.

Drawing concluding remarks, the PGs had more knowledge and awareness about COVID-19 when compared to interns and UGs, as assumed in the null hypothesis. This difference might be predicted by their higher experience in the clinical setting and more advanced skills in information search, critical reading, as well as problem-focused observation.[18]

The biggest scope and advantage of this survey is that it targeted the future members of the dental profession and based on results, the additional focus should be given for UGs. Limitations are, being a cross-sectional study, which was carried out in the early stages of pandemic, when the disease process and management strategies were unclear, it documented only the data at that particular time and more development in knowledge, awareness, and attitude is possible and expected in the near future.

This research survey can be performed in future with more variable cohort involving the whole nation and can be utilized for planning and improving the knowledge and awareness towards this pandemic through implementing public health awareness models and health education.


  Conclusion Top


This survey gives us an insight into the future aspects involving upcoming dental professionals which is the need of the hour. These results pave way to increase the interaction and knowledge provision for UGs, through webinars, online classes, and inducing the urge to review the literature. An effort to combat the negligence in awareness, we recommend that the PGs, interns, and UGs are advised to be updated about the guidelines from the Centers of Disease Control and Prevention, WHO and Dental Council of India and as science is evolving day by day, the process of learning must be dynamic and continuous.

Author contributions

Designed the study, formulation of Survey questionnaire, Collection and data analysis, and drafted the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Fallahi HR, Keyhan SO, Zandian D, Kim SG, Cheshmi B. Being a front-line dentist during the Covid-19 pandemic: A literature review. Maxillofac Plast Reconstr Surg 2020;42:12.  Back to cited text no. 12
    
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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. 14
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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