Corona Virus Disease 19 (COVID-19) is a recently identified viral infection that originated in Wuhan, China, and triggered a pneumonia epidemic in the rest of the world.1 It seems that the quickly circulating virus is more infectious than Severe Acute Respiratory Syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV).2 The disorder is triggered by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2)3 and is believed to be transmitted from human to human in various ways, including droplets, aerosols, and fomites.4 Globally, as of April 20, 2021, there have been 141,754,944 confirmed cases of COVID-19, including 3,025,835 deaths, reported to World Health Organization (WHO). A survey conducted among 2195 licensed dentists in United States of America in June-2020 found that 20 dentists had contracted COVID-19.4
COVID-19 infection induces severe respiratory disease, with fever, cough, myalgia, and exhaustion as typical signs at the start of the disease.5,6 Organisms causing infection, can spread from their particular habitat to a susceptible host in various pathways. Viral spread may occur by human-human transmission, airborne transmission, and other forms of dissemination, such as endogenic virus, and vector spread.7 However, certain respiratory viruses are known to be spread through several channels, in which the transmission mechanisms in droplets and aerosols are of primary importance, but their role in the transmission of the disease remains uncertain.7,8
Respiratory particles may be classified as droplets or aerosols depending on particle size and aerodynamic diameter.9 There is no evidence of the least infectious viral load for the COVID-19 pandemic, although several researchers suspect that a few hundred SARS-CoV-2 viruses would enough to induce disease among susceptible hosts.10 People infected with COVID-19 can transmit viral particles anytime they speak, smoke, cough, or sneeze. Such viral particles are likely to be encapsulated in globs of mucus, saliva, and water, and globs behavior in the atmosphere depends on its size. Big-sized globs sink quicker than they evaporate, splashing in droplets nearby.11
Many medical workers contracted the disease while working with COVID-19 infected patients.12 The dental clinic is no exception to a relative probability of sharing and contracting the infection between dental staff or patients, although the dental clinic may be a more dangerous place for the spread of the virus due to close interaction with patients and the type of dental care.13 Often, extended disease incubation up to 14 days before any symptoms are identified, and the post-infection phase challenges medical staff to identify the COVID-19 patients.12
Hence, COVID-19 infected patients without showing symptoms are a significant threat to dentists and other dental team members. Therefore, dentists should exercise a high level of awareness and integrity to deal with the disease and control and manage its spread.14 Because of this, the ministry of health issued a dental emergency protocol during the COVID-19 pandemic that recommended only urgent/emergency dental care of the patients with a high infection control level in dental treatment. The recommendation included postponing all the elective dental treatment until further notification.13
Like any other contagious infection prevention guidelines, COVID-19 prevention recommendations included personal protective equipment, hand wash, detailed patient evaluation, rubber dam isolation, anti-retraction handpiece, mouth rinsing before dental procedures, and disinfection of the clinic. Besides, some guidelines and reports had provided useful information about the signs and symptoms of the disease, ways of transmission, and referral mechanisms, to increase dentists’ knowledge and prevention practices so they could contribute at a population level to disease control and prevention.15,16
Recent studies have indicated adequate knowledge, attitude, and practices towards COVID-19 prevention and control among dentists. In contrast, gaps in taking extra precautions of specific dental procedures in the context of the current outbreak and disinfection protocols have been identified.14–16 The Ministry of Health (MOH) in Saudi Arabia reacted promptly to this pandemic by following World Health Organisation (WHO) guidance and issuing dental practice guidelines, which were widely circulated and published on the ministry website.13 Given these guidelines, it is necessary to assess the dentist’s knowledge, preventive awareness, and attitude towards COVID-19 to strengthen prevention and control measures within the dental practice.
Therefore, this cross-sectional study aimed to assess dental professionals’ knowledge, preventive awareness, and attitude towards dental care during the COVID-19 pandemic in Saudi Arabia.
Materials and Methods
Study Design and Participants
This cross-sectional survey was conducted in July 2020. Study participants consisted of dental students and dentists working in Saudi Arabia regardless of their nationality or workplace. Dentists and dental students registered under the Saudi Dental Society were accessed through social media platforms (Twitter and WhatsApp).
The research proposal submitted to the Riyadh Elm University Research Centre, with registration number FPGRP/2020/473/223 and approved by the Institutional Review Board FPGRP/2020/473/223/219. All the participants were informed about the purpose and scope of the study. Online written consent was obtained before completing the survey and respondents were informed that their participation in the study was completely voluntary. Those who agreed to participate were included in the study. The questionnaire was anonymous to protect the integrity and confidentiality of the information. This study was conducted in accordance with the Declaration of Helsinki.
Sample Size Calculation
A minimum sample size of 356 dental professionals were calculated by considering the margin of error 5%, confidence interval of 95%, and a total of 16,887 licensed dental professionals in Saudi Arabia as was reported by Al Baker et al (2017)17 with expected 64% response distribution from active members on social media.18 A convenience sampling methodology was utilized to recruit dental professionals in Saudi Arabia based on ease of availability during the survey period. RaoSoft online sample size calculator was used to estimate the required sample.
Questionnaire Development, Design, and Administration
A structured, closed-ended, and self-administered questionnaire consisting of 25 items and demographic information was prepared and administered to the study participants. Questions of the survey were developed after reviewing published literature and the guidelines issued by the Centre for Disease Control and health ministry, Saudi Arabia, towards COVID-19. The validity of the questionnaire was established by obtaining an expert opinion from the dental public health faculty. The expert gave their concerns about the ease, relativity, and importance of the instrument. The questionnaire was pretested by recruiting ten dentists, who gave their feedback on the questionnaire. The study instrument demonstrated adequate reliability, as indicated by Cronbach’s alpha (0.798).
An online questionnaire was prepared by utilizing google forms. This questionnaire’s online link was made available on social media platforms (Twitter and WhatsApp) associated with the dental professional groups in Saudi Arabia. The questionnaire was divided into four parts. The first part included the respondents’ demographic information (gender, experience, health sector, nationality, qualification, and marital status).
The second part consisted of 11 items that explored the study participants’ knowledge about the symptoms and spread of the COVID-19. The questionnaire included items on the development of severe acute respiratory illness,…