Since SARS-CoV-2 can be transmitted from person to person by droplets, contact and through saliva, dental patients and dentists and their coworkers can be easily exposed to novel coronavirus infections [19, 27]. In the period of contagion outbreak from the new coronavirus, information about the virus has become increasingly the subject of attention of the media, such as television, the internet, and social channels. However, it was only when the first cases began to register in Italy that professional associations and dental professionals began to take a deeper interest in the problem. Dental professionals had to refer only to the official communication of the ministry, whose law decrees lacked specific references to the dental profession.
Male dentists believed to be very well informed about Coronavirus unlike female colleagues who had a more cautious opinion on their knowledge of the subject (Pearson χ2 test 9.6496- p 0.047; LR χ2 test 9.8368- p 0.043). Dentists between the ages of 46-60 believe they were well informed compared to younger colleagues who judged sufficient their knowledge (Pearson χ2 test 39.3684- p 0.000; LR χ2 test, 38.2612 –p 0.000). Male dentists showed to have a significantly clearer idea of the taxonomic characteristics of the virus (Pearson χ2 test 9.2567- p 0.010; LR χ2 test 9.3697- p 0.009). Most were aware of the main features of coronaviruses but confused the term COVID-19 with the virus itself (68.4%). The definition of COVID-19 was provided more correctly by the dentists of Lazio, Lombardy, Emilia-Romagna and Sicily but the same regions, with the exception of Sicily, reported the greatest number of incorrect answers (which overall exceeded the correct ones) and attributed to this term the meaning of “virus that causes the disease”(Pearson χ2 test 77.3373- p 0.065). The question containing the request to identify the correct definition of COVID-19 was absolutely, among all the questions in the questionnaire provided with the aim of assessing scientific knowledge on the subject, the one for which the largest number of wrong answers were recorded.
In addition, most believed that the term SARS-CoV 2 is not related to the new coronavirus but is rather the name of the SARS virus that caused an epidemic in 2002-2003 (22.4%). Dentists aged between 36 and 45 have identified the correct answer in a significantly higher percentage than younger and older colleagues (Pearson χ2 test 20.0687 - p 0.066; LR χ2 test, 19.5222 -p 0.077). Also on this definition, the dentists of Lazio and Lombardy were those significantly better informed, followed by their colleagues from Emilia-Romagna and Campania (Pearson χ2 114.5570- p 0.007; LR χ2 test 104.4948- p 0.034).
The most informed dentists on the possibility to access a free online course on the new Coronavirus promoted by the FNOMCEO (National Federation of Surgeons and Dentists) were those from Lazio, followed by those from Lombardy, Sicily and Tuscany (LR χ2 test 99.0171- p 0.073).
Quite important for the population and for the spread of epidemics is the preventive approach of dentists. For the possibilities of transmission from person to person, most are properly informed (60.9%). Female dentists were better informed on this aspect (Pearson χ2 test 10.5200- p 0.033; LR χ2 test 10.9648- p 0.027). Compared to age, younger dentists were significantly better informed about the transmission routes of the virus than other age groups (Pearson χ2 test, 19.3533- p 0.080; LR χ2 test 19.2796- p 0.082).
More than 87% of respondents to the survey were aware of the wide variety of symptoms with which the infection can occur, which is encouraging because it means that a diagnostic suspicion and a report to the authorities regulating the execution of swab tests of potentially infected individuals can also be appropriately carried out by a dentist. It is important to consider that transmission may occur through asymptomatic patients and that symptoms when COVID-19 is present can also be mild and confused with a simple cold or flu . Its manifestation does not always culminate with severe symptomatology accompanied by respiratory failure up to interstitial pneumonia. The asymptomatic incubation period takes approximately 1-14 days, and in these days, persons without symptoms can spread the virus. For this reason, it is important to add to the information required of the patient in the medical history, the report of a possible contact with infected or potentially infected people or of trips to the areas where the infection has spread. Many dentists (10%) who responded to the survey chose to ask this question of their patients, judging it to be important. At the time of the virus's main spread, it was recommended to perform a telephone triage even before seeing the patient to assess whether to visit or to postpone the appointment.
At the time of the survey, performed between February 23rd and March 15th, just over 50% of dentists did not notice a reduction in the number of visits despite the spread of the virus. It must be specified that after two weeks from the start of this research many work activities were suspended by the government by extraordinary decree, but the clinical dental activity was allowed only for the management of emergencies provided by dentists equipped with adequate personal protective equipment (PPE). The definition of “adequate PPE” for dentists is a matter of debate because above all the surgical masks used routinely by dentists would not have sufficient filters to protect from infection. The use of facemasks with ffp2 or ffp3 filters, highly protective than the surgical ones, does not seem to be considered necessary for routine dental activity, even if this has not been clearly said nor denied.
The absence of a sample calculation and the methodology used in the dissemination of the survey represent limitations in this research. Anyway the distribution of the respondents in the national territory was quite homogenous (proportionate to the extension of the individual regional territories) and the greatest proportion came from medium-large cities. Although 65.2% of dentists said that patients have asked questions about coronavirus, they agree that patients feeling worried about contracting the infection through dental care has not emerged (61.3%). Most of the dentists (69%) adopted additional preventive practical measures, a sign of a growing and widespread awareness (87.5%) of the risk of contributing to the spread of contagion through dental activity. There were regions where the number of dentists who claimed to have taken additional contagion prevention measures during their clinical activity was significantly higher than others. This was especially true for regions such as Lazio, Lombardy, Emilia Romagna and Campania. It is interesting to note that regions such as Veneto which since the beginning of the spread of the virus in Italy has been one of the first regions and among the most affected had not the same attitude (Pearson χ2 test, 42.1485- p 0.003; LR χ2 test 44.5656- p 0.001).
The female gender appeared significantly more concerned than the male gender about the spread of Coronavirus infection (Pearson χ2 test 24.9374- p 0.000; LR χ2 test 25.7561, p 0.000). Dentists belonging to the younger age groups were found to be much more convinced than their older colleagues that this epidemic has future repercussions on the dental profession as it is not without risk (Pearson χ2 test, 6.8839- p 0.076).
Dental treatment procedures always involve close contact with the patient, and this setup does not allow the maintenance of an adequate safe distance. It is extremely important that dentists equip themselves with appropriate individual safety devices (masks, gloves, protective goggles, hair caps and shirts). A recent article in the New York Times, referring to the database "O'NET" used by the Department of Labor to describe the various physical aspects of different professions, highlighted that the occupational categories in which you come into physical contact with others are those where the risk of COVID-19 is highest. Dentists are at the top of the ranking for work-related risk . In this survey, dentists affirmed the constant use of these safety devices as prescribed by the Italian medical guidelines of safety in workplaces . When aerosol procedures are carried out, the presence of saliva and blood increases the spread of germs, bacteria and viruses. Ensuring a change of air in the workplace and in the waiting room is a simple but important measure chosen by 14.9% of dentists in this survey. This measure should always be adopted by dentists and not only in this situation. Equally essential is to wash hands more frequently and disinfect them with alcohol-based solutions. This provision should also be encouraged for patients before entering the operating dental unit. These recommendations, together with those of not shaking hands with anyone, were accepted by 9.7% and 19.7% of respondents, respectively. The data that emerged on the cleansing measures also include the cleaning of the clinical contact surfaces, such as buttons, handles and work surfaces. Thorough cleaning has proven to be a mandatory and indispensable choice for prevention, as it is proven that the coronavirus family, including SARS-CoV-2, can survive on plastic, metal and glass surfaces for up to 9 days and can be efficiently deactivated through disinfection procedures with 62-71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. The use of 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate does not have the same effectiveness . It must be said that the majority of dentists paid great attention to the measures to be taken; indeed, 25.3% of them said they had adopted all the preventive measures listed so far.