Introduction

The newly emerged respiratory infection caused by coronavirus species COVID-19 (SARS-CoV-2, formely known as 2019-nCoV, has created massive panic and chaos worldwide [1, 2]. World Health Organization (WHO) on 30^th January 2020 announced public health emergency regarding a global pneumonia epidemic, and on 11th February 2020, WHO named  this disease as novel viral pneumonia coronavirus disease 2019 (COVID-19). The first few cases of COVID-19 were identified in Wuhan, Chinaon (December 2019), through genome sequencing in pneumonia patients with unknown etiology [3]. By 2^nd July  2020, approximately 4.91% of the mortality rate was reported worldwide. 194,225 cases were reported in Saudi Arabia with 1,698 deaths, which led the MOH to announce general health guidelines to combat the pandemic, and health care was limited to emergency cases, including dental care [4-6]. 

SARS-CoV-2 shares the same host receptor, with SARS-CoV. The natural host of SARS-CoV-2 shows 96.2% whole-genome identity to BatCoV RaTG13 [7]. This virus spreads through respiratory droplets, direct contact, and through aerosol-generating procedures [8]. COVID-19symptoms include, fever, dry cough, myalgia loss of smell and taste, irregular chest computed tomography scan. [9]. 

In the advent of symptoms like loss of smell and taste, patients tend to  approach a dentist for consultation and care [10]. This paves a path of concern regarding the health of the dental practitioner who can likely become infected from the patient, through direct contact with the mucous membrane, inhalation of aerosol/droplets, oral fluids, contaminated instruments, and surfaces. Thus, it is  advised that during dental procedures, certain precautionary protocols must be observed for the safety of the practitioner, dental personnel, and patients. Good hand hygiene with a cleansing time of the 40s, clinical disinfection protocol, use of personal protective equipment (PPE), N-95 masks, gloves, gowns, face shields, ensuring adequately ventilated space and cautious use of aerosol-generating procedures became mandatory [8, 11-13].

By 28th January 2022, COVID vaccines produced with the collaboration of scientists across the world, gave a headstart to combat the spread of COVID-19. These vaccines have proved to be an innovative and successful tool, by reducing  severity and complications caused by the virus [14].

Materials and Methods

Study design

This cross-sectional research was conducted from 13 February to 10 April 2021, using a web based questionnaire  involving dental professionals working in government hospitals, private clinics and academic universities, in Saudi Arabia. The questionnaire was prepared in English and reviewed for face validation by two independent local reviewers. The questionnaire was distributed through emails, text messages, and social media outlets. Undergraduate dental students were excluded from the study. The questionnaire was categorized into parts, out of which, the first part comprised of demographic information about the participants. The second part assessed the participants’ awareness  and basic knowledge  about SARS-CoV-2 and COVID-19, emphasizing on the signs, symptoms, route of transmission, incubation period, and viability outside the human body. The last part of the questionnaire  focused on the methods of prevention and  attitude towards treating SARS-CoV2-infected patients.

A pilot study was conducted to ensure the certainty of the questionnaire,  by sending the survey to 20 participants and the data were inserted in SPSS version 22 to determine the reliability using Chronbach’s coefficient alpha (value: 0.712). Experienced researchers in REU reviewed the validity of the questionnaire and changes were made accordingly.

Ethical approval and consent

Informed consent and ethical approval (Institutional Review Board) IRB# ("FUGRP/2021/225/398/390) was obtained from the Scientific Research Unit of Riyadh Elm University. Participants were informed about the purpose of the study, voluntary nature of participation, their right to refuse or withdraw at any point from the study, and the potential benefits of the involvement in the study. Consent form was attached along with the online questionnaire, and  participants were redirected to the questionnaire after the completion of the consent, to ensure approved participation of the participants.

Analysis methods

Analysis of the collected data was done using SPSS version 22, which included descriptive as well as inferential statistics. Comparisons between groups were done with the significance value kept under 0.05 using the Chi-square test. The results of all categorical variables are presented in terms of frequencies and percentages. A Chi-square test was performed to compare work sectors, work settings, and professionals. All tests were performed at a significance level of α=0.05.

Results and Discussion

355 dentists from all over Saudi Arabia filled the survey, with the power of the sample being 0.85, which shows that there is an 85% chance of achieving a statistically significant association in the acquired data (Table 1).

Table 1. Power of sample

Table 2 demonstrates demographic information of the study participants. Obtained data showed, (59.7%) were women, and 144(40.3%) were men. The majority of the participants were postgraduate practitioners (24.5%) working in the academic working sector (39.2%). Majority were from the central region (58.9%). In terms of the specialties, 18.6% were general practitioners, 12.7% orthodontist, operative dentistry 41%, 9.3% prosthodontics, 8.5% endodontists and periodontists. 49% of the participants treated COVID patients in their clinics, which showed similarity to the study done by Nasser [15], where it was stated that if an emergency dental treatment was to be provided to a Covid-19 suspected patient, separate appointments should be arranged in a ventilated waiting area, at least one hour apart  from regular patients.

Table 2. Demographical distribution of study participants

Awareness of COVID 19

Table 3 shows participants’ awareness regarding the common symptoms, incubation period, and transmission of COVID-19 viruses; and about personal protective measures to be adopted by dentists during use of aerosol-generating procedures. 96.9%  to 89%, of the participants were aware of COVID symptoms like fever and shortness of breath. According to Table 5, 88.2% agreed that the disease is transmitted through direct contact with respiratory tract secretions, and 49% of the participants believed that the disease cannot be transmitted from asymptomatic patients. 15.8% of the participants were not aware that surfaces contaminated by COVID patients should be cleaned with a bleaching solution. According to the data, only 87% of the participants were aware of personal protection against COVID. Majority of the respondents were aware of the protocols issued by CDC, ADA for the prevention of disease transmission. But scant knowledge has led the participants to rely on clinical indicators to diagnose COVID19. These findings were in accordance with previous studies by Ahmed MA, carried out among dental practitioners [16]. Updated informations regarding  COVID viruses  are being  followed every second; as we are still in the learning phase and yet to know about the nature of these viruses and their variants.

Table 3. Awareness of participating dentists of COVID-19

Preparedness and source of awareness about the disease

Table 4 depicts perception and preparedness for the disease among participants. 85.1% believed COVID will resolve with time and doesn’t require any special treatment, while 14.9% doesn’t. 87% of the participants prefer to avoid working with COVID patients, and 42% refused to treat the patient and asked them to leave the clinic. This is similar to the findings in a study done by Bakken et al., which noted that the majority of dental professionals were not comfortable providing even elective or emergency treatment to their Covid-19 suspected patients. Another similar study showed that only 41.8% of the dentists were willing to provide emergency services to their patients [17]. About 4% of the participants conveyed  that it might cause panic  if a patient is asked  to sit at a distance. About 15% of the participants believed that their role in educating others are moderate to mildly significant (15.5%-7%); this attitude was similar to a study that stated  the primary oral care physician is responsible to clear  misconceptions about this disease and inculcate positive attitude,by educating and encouraging infection control measures among the patients [18]. Table 6 shows that 11.5% of the participants were unaware of whom to contact in case of unprotected exposure to the COVID 19 virus. It was also observed that 12.7% of participants did not encourage their patients to be vaccinated before appointments, as 7% of the dentists were not convinced that vaccination decreases the severity and chance of getting COVID.

43% of the dentists did not allow their staff members to work on patients who showed flu-like symptoms and 22.8% of dentists referred such patients to hospitals without giving treatment. This was in accordance with another study  that due to short chair-side distance between the practitioner and patient during aerosol-generating procedures, dental staff can be prone to contract COVID-19  and it is undeniable [19].

Information about COVID-19 vaccines  were mostly from health care professionals (45.1%) and 14.9% gathered information, from family and friends, and 11.3% through  television and newspapers. Another study which was similar to our study, highlighted that mostly young dentists who were open to web learning resources, received higher level of knowledge in their field of practice and thus played a major  role in educating others about COVID-19, precautionary measures to be taken and the benefits of taking vaccines [20]. Figure 1 illustrates the frequency of the source of information used.

Table 4. Perception and preparedness for the disease among study participants

Table 5 demonstrates that specialty had the most statistically significant association and qualification had the least number of statistically significant associations (Chi-square test).

Table 5. Awareness among participants and demographic variables

*Statistically significant association

Table 6 shows the most number of statistically significant associations with specialty and the working sector had the least number of significant associations (Chi-square test).

Table 6. Perception and preparedness of COVID 19 among participants and demographic variables

*Statistically significant association