Article Type : Research Article
Authors : Allaboon A, Shukri L, Alzareei S and Alotaibi NF
Keywords : COVID-19; REU dentistry; Airborne particles
Introduction: Corona Virus Disease 2019 (COVID-19) became a global pandemic disaster in early 2020, and it is currently wreaking havoc in many parts of the planet. Prosthodontics units have been forced to halt their clinical operations due to the pandemic. As a result, in the aftermath of the pandemic, several clinics and private practices substantially reduced the number of non-deferrable urgent care prosthodontics patients they treated during the initial wave of the epidemic. Method: This is cross-sectional research that was done via an online survey among REU dentistry students. This research involved 500 students from clinical levels 8 through 12. An online questionnaire was created that included demographic information, as well as questions about knowledge, attitude, and practice regarding the management of COVID-19 suspected patients in prosthodontic clinics. Results: Revealed that a significant proportion of the study was based on females comprising 56.9% and 6th level of dentistry. The majority of them thought that corona patients could be asymptomatic, and according to them, airborne is the main route of transmission. Using the rubber increases the airborne particles. Packets should be disposed of with hygiene and medical waste protocols. Dentists agree that gypsum must be treated as infectious clinical waste. The method for disinfecting dental casts can be immersed in sodium chlorite for 20 mins. Elderly people having denture wearers should be disinfected with 3% hydrogen peroxide for 30 mins. For those who can with temperature less than 37C and the patient should be instructed to self-quarantine for those with lesser temperature. Conclusion: In a prosthodontics clinic, over half of the dental students had a solid understanding of Covid-19 infection management. According to studies, students' practice experience with probable covid19 transmission channels in prosthodontics clinics is sufficient. During the Covid -19 epidemic, participants behaved well. We found non-significant differences across gender.
In early 2020, Corona Virus Disease
2019 (COVID-19) became a worldwide pandemic crisis and is still affecting
regions across the globe. Several countries have been affected by the COVID-19
outbreak, a public health crisis that has raised concerns about infection
control among health care workers, particularly dentists. This pandemic has
caused prosthodontics units to suspend their clinical activities. As a result,
many clinics and private practices in the wake of the pandemic drastically reduced
the number of prosthodontics patients they treated to non-deferrable urgent
care during the first wave of the pandemic [1].
Dentists, as well as dental students,
must maintain the safety of their staff and families when dealing with
prosthodontics patients. In some affected countries, dental care facilities
have been closed entirely or have only provided minimal treatment in
emergencies [2]. Nonetheless, several facilities in some of the affected
countries offer regular dental treatment. Moreover, this is partly due to the
absence of universal protocols or guidelines governing dental care during a
pandemic. COVID-19 outbreaks and limited knowledge about protective measures,
together with the need for safe dental treatments, pose a challenging situation
to dentists [3].
According to a report from Dong, Du
& Garnder [4], in China, where the first cases of COVID-19 were detected,
dental procedures carried out during the first wave of the pandemic mainly were
emergencies. As a result of international recommendations and actions of other
countries, several dental societies recommended suspending and delaying all
non-emergency and non-urgent dental treatments. It may be helpful to refer to
the American Dental Association's recommendations regarding dental emergencies,
which refer to uncontrolled bleeding, soft-tissue bacterial infection, swelling
in or around the mouth, and facial bone trauma. A tooth fracture, dental
trauma, and pulpal inflammation are the most common causes of urgent dental
care, which may require prompt treatment [5].
A study done in Austria included
questions that provided further insights into general knowledge and attitudes
about COVID-19 and dental care when a widespread pandemic. Dentistry students
described their clinical courses as having direct patient contact, which puts
them at a higher risk for COVID-19 infection due to work with rotating
instruments and aerosol build-up. Their confidence level in attending patients
with symptoms related to COVID-19 was found to be low [6].
Another study among dental students
reported that they maintain their clinics and ensure safety when providing
treatment. In some cases, you may need to discard plastic covers on handles and
the plastic tube to remove saliva from the patient's mouth. Between patients,
clean and disinfect equipment that has not been discarded. Dental staff and
dentists do require wearing personal protective equipment during treatment.
Equipment like disposable gloves, unique masks, protective eyewear, or a face
shield can be included. The use of specific tools is limited to one time. Clean
and sterilise non-disposable devices in an area dedicated to the purpose [7].
In Brazil, a study conducted among dental students during the COVID-19 outbreak period reported dental professionals using enhanced personal protection equipment (PPE) to provide dental care to patients in need of emergency treatment. However, other non-emergency treatments, including Prosthodontics treatment, were not performed [8,9].
Benefits of the study
The findings of this study may be
helpful in assisting the dentists willing to treat Prosthodontic patients
during the pandemic of COVID-19 with attaining knowledge on how they can
maintain infection control protocol when dealing with such patients.
Scope of the study
This study focused mainly on the
infection control knowledge and attitudes of students working in Prosthodontic
clinics, as it involves handling various materials being transported from
dentist to technician.
Aims of the study
·
To determine the
knowledge and practice of dental students regarding the treatment of
prosthodontic patients with COVID-19 related symptoms or history.
·
To compare the
responses on the basis of gender.
Materials and Methods
Study
Design: This is a
cross-sectional study conducted among the dental students of REU using an
online survey.
Study
Sample: 500 students from
clinical levels (8 to 12) were utilized in this study.
Study
Instrument: Online questionnaire was
constructed consisting of questions related to demographic data followed by
questions including knowledge, attitude and practice towards the treatment of
COVID-19 suspected patients in Prosthodontics clinics.
Instrument
Validity and Reliability: A pilot study was
conducted by sending the survey to 20 participants, and the data will be
inserted in SPSS version 22 to determine the reliability by using Chronbach’s
coefficient alpha (value: 0.711). The validity of the questionnaire will be
tested by sending it to experienced researchers in REU, but no changes were
made.
Statistical Analysis
Collected data was analyzed using SPSS version 22, where descriptive as well as inferential statistics were conducted. Comparisons between groups were made with the value of significance kept under 0.05. Chi-square test was done to compare the responses among sub-groups.
Results
The present study about the knowledge
and awareness about the COVID-19 in dental students revealed that a significant
proportion of the study was based on females comprising 56.9% and 6th level of
dentistry. The majority of them thought that corona patients could be
asymptomatic, and according to them, airborne is the main route of
transmission. Packets should be disposed of with hygiene and medical waste
protocols. Dentists agree that gypsum must be treated as infectious clinical
waste, and the lathe machine should be cleaned and heat sterilized between each
patient. Method for disinfecting dental casts can be immersed in sodium
chlorite for 20 mins, and for Zinc-oxide Iodophors is used. Older people having
denture wearer should be disinfected with 3% hydrogen peroxide for 30 mins.
Those who can with temperature less
than 37C and the patient should be instructed to self-quarantine, for those
with lesser temperature. In table 3, we examined the differences across gender,
and the finding reported non-significant differences in both. Females think
corona patients could be asymptomatic and the main route of transmission is
airborne droplets for females while coughing for males. On how Covid-19 spreads
in the prosthodontics department, mostly said they do not know about it. It can
be prevented via protection equipment for females while males think all answers
are correct. Usage of rubber can increase airborne drops for both groups and
should be disposed of with hygiene protocols for a male while with bio-medical
waste protocols. In case of contamination, gypsum must be treated as an
infectious disease, while for females; this should be disposed of in a sharps
bin. The lathe machine should be cleaned and heat sterilized for females, while
for males, it should be disinfected at the start and the end of the year.
Females did not know methods of disinfection, while males considered immersing
Sodium hypochlorite as the best option. Iodophors is the method of disinfecting
Zinc-oxide pastes for both male and female samples. For denture wearing elderly
people, both groups agree on discarding wearer. People with higher temperatures
should be self-quarantined.
Discussion
The present study was carried out in
KSA on awareness and knowledge about corona prevention. Data was collected
through cross-sectional research design, chi-square and descriptive analysis
were also used through SPSS. In the first frequency table, findings revealed
that a significant proportion of the study was based on females comprising
56.9% and 6th level of dentistry. The majority of them thought that corona
patients could be asymptomatic, and according to them, airborne is the main
route of transmission. In prosthodontics, Covid-19 is caused by all the reasons
mentioned in the table, also supported by literature that Covid-19 has been
found in aerosols generated during medical operations, according to studies.
The primary mode of transmission and dissemination of illness is currently
regarded to be airborne droplets, according to respondents [10].
Again in preventing Covid-19 in
prosthodontics, the majority of individuals agreed on all the options given to
them, and literature also reported that dental staff and dentists do require
wearing personal protective equipment during treatment. Equipment like
disposable gloves, unique masks, protective eyewear, or a face shield can be
included. The use of specific tools is limited to one time. Clean and sterilise
non-disposable devices in an area dedicated to the purpose [7].
Using the rubber increases the
airborne particles, but literature reported opposite to this and said that
rubber dams might significantly limit the creation of saliva- and blood-defiled
aerosol or spatter, according to studies. Rubber dams can also dramatically
reduce particles in the air in a 3-foot circumference operating region. Packets
should be disposed of with hygiene and medical waste protocols. Dentists agree
that gypsum must be treated as infectious clinical waste, and the lathe machine
should be cleaned and heat sterilized between each patient. Method for
disinfecting dental casts can be immersed in sodium chlorite for 20 mins, and
for Zinc-oxide Iodophors is used. Elderly people having denture wearers should
be disinfected with 3% hydrogen peroxide for 30 mins. Those who can with
temperature less than 37C and the patient should be instructed to
self-quarantine for those with lesser temperature [10].
In the subsequent analysis, we examine
the differences across gender, and the finding reported non-significant
differences in both. Female think corona patients could be asymptomatic and a
previous study reported that in a German investigation, the covid-19
coronavirus can potentially be mainly transmitted with asymptomatic people. The
main route of transmission is airborne droplets for females while cough for
males, and literature also supports the notion of female participants. Using
rubber can increase airborne drops for both groups and should be disposed of
with hygiene protocols for a male while with bio-medical waste protocols [10].
In case of contamination, gypsum must
be treated as an infectious disease, while for females; this should be disposed
of in a sharps bin. The lathe machine should be cleaned and heat sterilized for
females, while for males, it should be disinfected at the start and the end of
the year. Females did not know methods of disinfection while males considered
immersion Sodium hypochlorite the best option while literature reported that
there are techniques for washing and disinfecting dentures. To disinfect
dentures, immerse them in 3 per cent hydrogen peroxide for 30 minutes.
Iodophors is the method of disinfecting Zinc-oxide pastes for both male and
female samples. For denture wearing elderly people, both groups agree on
discarding wearer. People with higher temperatures should be self-quarantined [10].
Conclusion
In a prosthodontics clinic, over half
of the dental students had a solid understanding of Covid-19 infection
management. Students' practice experience with probable covid19 transmission
channels in prosthodontics clinics is sufficient. During the Covid -19
epidemic, participants behaved well. We found non-significant differences
across gender.
Limitations
The study was conducted on a small
sample and only from one area. Corona conditions differ in every region around
the globe, so there are some generalizability issues, internal consistency and
social desirability as it was an online self-report survey.
Acknowledgement
We would like to acknowledge the
supervision and guidance of Shazeb H Ansari, Faculty of Dentistry, Riyadh Elm
University, and Riyadh, Saudi Arabia.
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