Due to its high mortality rate, SARS-CoV-2 and the associated debilitating COVID-19 are an emerging topic that has recently received great attention and underwent intense investigation. The pandemic is highly infectious as the number of infected patients exceeds 2 million worldwide in < 6 months, as reported by the WHO.14
This survey assessed the degree of awareness of dental professionals as they are typically in close contact with patients when delivering oral healthcare services.
Based on our results, the overall knowledge about the means of transmission, associated symptoms, and prevention of SARS-CoV-2 was satisfactory. The overall knowledge about the incubation period, route of transmission, and recommended hand-soap cleaning time to prevent SARS-CoV-2 was adequate across all dental professions, except for dental assistants, where only 25% of them believed the recommended hand-soap cleaning time was 40 seconds. This clearly emphasizes the significance of the adequacy of viral prevention knowledge across all dental professionals and auxiliaries during pandemic periods. Overall, these results show an improvement in knowledge compared with the results found in a previous survey of dentists in Saudi Arabia about SARS-CoV.15 Although modestly answered among all professionals, the highest response was among dental specialists/consultants, with only 48.3% believing that the survivability of SARS-CoV-2 outside the host was a couple of days. There seemed to be a significant disagreement among the dental professionals regarding the question of SARS-CoV-2 survivability (p < 0.001). Regarding general knowledge about SARS-CoV-2, our study showed a relatively lower percentage of individuals who answered “I do not know” in questions regarding the incubation period and recommended hand-soap cleaning time (0.69% and 1.69%, respectively) compared with virus survival outside the host (10.04%). This may be due to the fact that local health authorities have utilized all media outlets toward a community-wide awareness campaign covering the pandemic, which had hand-soap cleaning time being one of the most shared preventive methods promoted. In contrast, the survival of the virus outside the host may be confusing due to various survival times related to different surfaces.8,16 This further emphasizes the significance of knowledge on virus survival to ensure adequate preventive measures in the working environment while treating suspected COVID-19 patients.
The majority of respondents, regardless of professional category, were reluctant to treat a patient under suspicion of having COVID-19, which indicated a certain level of apprehension. This is thought to be due to the general guidelines conveyed to caregivers by local authorities, that is, to limit dental procedures to urgent or emergency cases only and refrain from elective procedures. When it came to willingness to treat suspected patients with COVID-19, dental hygienists (38.89%) were most willing to treat suspected patients. In contrast, postgraduate dental residents (17.39%) were least willing compared with the remaining groups. This is an interesting outcome as dental hygiene is considered to have mostly elective procedures compared with general or specialized dentistry. Future studies addressing the level of apprehension among dental professionals are warranted.
Regarding the question about modes of transmission, the majority of the participants (92%) believed that the mode of transmission was droplet infection, followed by direct fluid transmission (54.1%) and direct skin-to-skin contact (30.8%). However, 30.1% of the participants also believed that the virus was airborne transmittable, which is clearly a misconception, as the disease is transmitted by aerosols.3 The present study showed that the majority of the participants identified fever, coughing, and shortness of breath as the most common symptoms related to COVID-19 (98.7%, 93.2%, and 92.8%, respectively), which indicated a high degree of knowledge pertinent to this area. This is an intuitive finding considering that fever screenings have been increasingly prevalent at establishment entrances throughout the pandemic. Furthermore, previous epidemics of SARS-CoV and Middle East respiratory syndrome-related coronavirus (MERS-CoV) may explain the degree of knowledge regarding common respiratory symptoms of coronaviruses.
To prevent SARS-CoV-2 infection in dental clinics, dental professionals should follow standard precautions, which include appropriate hand hygiene, personal protective barriers (gloves, masks, face shields), use of preoperative mouthwash (1% hydrogen peroxide), rubber dam isolation, and implementation of effective and strict disinfection measures.17 It is worth highlighting that 54.6% and 51.6% of dental assistants and hygienists, respectively, believed that the use of preoperative chlorhexidine mouthwash (0.12%), which is antibacterial, was a preventative measure against SARS-CoV-2. On the other hand, 84.9% and 93.5% of dental assistants and hygienists did not believe that rubber dam isolation was a significant measure of SARS-CoV-2 prevention. This implies the presence of a gap in knowledge regarding preventive measures among the dental team.
The representative sample of 1,013 dental professionals covering all regions of Saudi Arabia is a strength of this study as it is consistent with the distribution of the population within each region.18 Furthermore, a thorough distribution among all the dental professionals and dental work settings was achieved to act as a realistic representation of the country’s dental work force. To the best of our knowledge, this is the first representative survey to provide insight on the knowledge and perception of dentists and dental auxiliaries and students on SARS-CoV-2 in Saudi Arabia. Furthermore, the distribution of male and female participants was balanced (46.5% and 53.5%, respectively). However, this study has several limitations. In addition to the general limitations of a cross-sectional study and online surveys, one of our limitations was the dichotomous nature of the question as to whether the practitioner was willing to treat a SARS-CoV-2 patient. Information pertaining participants who answered “No” but who would otherwise be willing to treat emergency patients only may have been lost as the options were only “Yes” or “No,” especially with a considerable number of dental procedures being elective or at least of a nonurgent nature. In addition, with the high volume of information influx from media outlets in combination with a higher than average viewership due to curfews and lockdowns, the status quo of general perceptions may shift on a weekly or even daily basis, rendering this survey limited to a specific snapshot of time. This study can be used as a benchmark for general knowledge and attitude toward pandemics in developing countries with an established dental healthcare system.