Keywords
attitude - COVID-19 - dentistry - students
Introduction
The period of coronavirus disease 19 (COVID-19) is a significant period from various
aspects such as world health and socioeconomic considerations. Dentists who operate
with close proximity with the patient and are susceptible to infection via aerosols
had to revise the operating protocols to safeguard their team from the risk of infection.
Also, a large part of the population avoided dental treatment due to fear of contracting
infectious diseases.[1] Majority of the hospitals involved in dental education had previously limited their
clinical practices to dental emergencies, but now are geared up for nonemergent conditions.
As teaching modalities shifted to online platforms, students have reported to be anxious
with regard to accomplishment of required clinical skills, patient care and forthcoming
graduation. Fresh graduates have reported a delay in the drive, which they would have
been able to achieve in the initial stages of their profession. Students should be
encouraged and guided with timely communication with their respective mentors along
with accessibility of counselling sessions to get along this situation.[2] There was a need to assess the attitude and preventive awareness of the dental students
with the purpose of reinforcing prevention and measures to combat the disease in the
dental scenario. This survey was done with the objective of assessing the attitude
of the dental undergraduate students and interns toward dentistry post-COVID-19.
Materials and Methods
The present study was performed among undergraduate dental students (3rd BDS and 4th
BDS) and interns of a tertiary dental institution in South India. [Table 1] & [2] Ethics clearance was obtained from the Institutional Ethics Committee (Cert. No. ABSM/EC.43/2020). A structured online self-administered questionnaire comprising 10 close-ended questions
was formulated via Google forms for the purpose of data collection for this cross-sectional
survey. A pilot study was conducted among 15 subjects to check the flaws and feasibility
of the study.
Table 1
Distribution of study subjects based on the year of under graduation
|
Year
|
Frequency
|
Percentage
|
|
3rd BDS
|
71
|
31.3
|
|
4th BDS
|
69
|
30.4
|
|
Intern
|
87
|
38.3
|
Table 2
Distribution of study subjects based on gender
|
Gender
|
Frequency
|
Percentage
|
|
Male
|
51
|
22.5
|
|
Female
|
176
|
77.5
|
An online questionnaire was prepared by utilizing Google forms. This questionnaire's
online link was made available on social media platforms (Twitter and WhatsApp) and
email. The survey was conducted using a validated questionnaire, which was tested
for its content and face validity that was done by a group of expert evaluation. The
expert gave their concerns about the ease, relativity, and importance of the instrument.
The study instrument demonstrated adequate reliability, as indicated by Cronbach's
α (0.8). The questionnaire was divided into two parts. The first part comprised demographic
data and the second part explored about the attitude of the undergraduates and interns
toward dentistry post-COVID-19 pandemic. Their participation in this study was voluntary.
Digital informed consent was taken. Any details pertaining to identification was not
be mentioned anywhere on the questionnaire. Statistical analysis was done using IBM
SPSS Version 22.0. IBM Corp., Armonk, NY. Descriptive statistics were applied.
Results
A total number of 227 subjects responded to the questionnaire with a mean age of 21.10 ± 1.57
years. Also, 80.2% were prepared for the challenges lying ahead before beginning to
work on patients. In total, 89.4% of them were updating their knowledge regarding
the safety and use of adequate personal protective equipment (PPE) while administering
dental treatment. Also, 67.8% were scared of infecting themselves while performing
a dental procedure and 59% would be hesitant in administering dental treatment to
a patient who has just recovered from COVID-19. In total, 86.3% were positive that
this is a passing phase and within a matter of time things will be normalized, whereas
90.7% wished to pursue postgraduation, and 21.6% wished they chose an alternate profession.
Discussion
The continuance of education has been heavily impacted globally due to COVID-19. Though
online learning modules were going on, it could not compensate the practical experience
gained during personal interaction with patients. Globally, colleges have faced the
disastrous effects of the pandemic outbreak. Lockdowns in clinical scenarios, restrictions
in access to clinical training for students along with nonavailability of patients
for treatment are just to name a few. Furthermore there have been crumbing of research
programs, grants, losses of income, cancellation of academic conferences along with
convocation ceremonies. The psychological impact on this has had detrimental effects
on the faculty as well as students.[3]
Despite the scenario, the majority (80.2%) were prepared for the challenges lying
ahead before beginning to work on patients. This was in contrast to the study conducted
by Almulhim et al, where only 16% were willing to treat patients and 28% did not want
to treat patients and preferred teledentistry, while 44% were willing to handle emergency
cases [Table 3].[4]
Table 3
Attitude and preparedness toward dentistry amidst COVID-19 pandemic
|
Questions
|
Yes
n (%)
|
No
n (%)
|
|
Are you prepared for the challenges lying ahead before you begin working on patients?
|
182 (80.2)
|
45(19.8)
|
|
Are you updating your knowledge regarding the safety and use of adequate personal
protective equipment (PPE) while administering dental treatment?
|
203 (89.4)
|
24 (10.6)
|
|
Are you eager to join back and resume your course?
|
192 (84.6)
|
35 (15.4)
|
|
Are you scared of infecting yourself while you are performing a dental procedure?
|
154 (67.8)
|
73 (32.2)
|
|
Will you be hesitant in administering dental treatment to a patient who has just recovered
from COVID 19?
|
59 (26.0)
|
168 (74.0)
|
|
Are you positive that this is a passing phase and within a matter of time things will
be normalized?
|
196 (86.3)
|
31 (13.7)
|
|
Do you wish to pursue postgraduation?
|
206 (90.7)
|
21 (9.3)
|
|
Did you wish that you chose an alternate profession?
|
49 (21.6)
|
178 (78.4)
|
Also, 84.6% were eager to join back their course. This indicated that they were familiar
with PPE (personal protective equipment) usage and the protocol followed during treatment,
as 89.4% responded positively to updating their knowledge regarding the same [Table 3].
However, 67.8% were scared of infecting themselves while administering dental treatment
[Table 3]. This is in agreement to a study conducted by Alwaiaet al, where 89% admitted the
fear of transmitting virus to their families.[5] This could be attributed to the fact that it could be uncomfortable and physically
challenging to perform certain procedures in the required PPE. Dental treatments generate
large volumes of aerosols which land on the treating clinician's face, head and neck.
Nonspecific clinical manifestations, the uncertainties of viral transmission, indecipherable
range of mortality rate were responsible for creating knowledge voids. Since its inception,
COVID-19 has been trending on social media platforms as the posts on its transmission
and pathogenesis have created a phenomenon called “infodemic.”[6]
[7] This was evident in the fact that 78.9% were concerned that there could be more
such pandemics
There have been adverse effects on the psychological well-being of dental health care
professionals.[8] Also, the unpredictability of the pandemic creates an uncertainty regarding when
the dental institutions will fully resume back to normal.
This situation has been an obstacle to the hands-on learning experience of dental
students owing to University lockdowns.2 Hence this could be the reason behind 21.6% of the respondents who wished that they
chose an alternate profession.
Also, 70.5% of the participants felt that the scope of dentistry has not diminished.
This was in accordance to the study conducted by Guo et al concluded that despite
the large scale transmission, the demand for urgent dental treatment decreased by
only 38%.[9]
In total, 90.7% were also interested to pursue postgraduation and 86.3% felt that
this was a passing phase and things would be normalized soon. This indicates that
the need for urgent dental care despite the pandemic will always be essential.
Conclusion
With second and third waves being rampant, novel coronavirus has become a public health
crisis. Since dental services cannot be stopped for a long time, it is essential for
dental students to be well trained to limit the spread of the disease. Because the
attitude of the students was positive, it is a constructive sign that participants
may significantly contribute even in patient screening programes if trained adequately.
The study concluded that majority of the students had a positive attitude toward dentistry
post COVID-19.
Owing to the present scenario, appropriate donning and doffing of PPE (personal protective
equipment) is a pivotal step in direct patient care, and simulation-based training
may help ensure that these skills are acquired by them. Dental professionals were
always vulnerable to infections even before the novel corona virus. Hence appropriate
measures must be taken to restart and resume the learning and training in dental institutions.
