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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 134-140

Parental knowledge and awareness about measures taken by the dentist and attitude of parents toward bringing their children to dental hospital during the COVID-19 pandemic: A cross-sectional study


Department of Pediatric and Preventive Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission16-Jul-2022
Date of Acceptance10-Aug-2022
Date of Web Publication2-Sep-2022

Correspondence Address:
Umapathy Thimmegowda
Department of Pediatric and Preventive Dentistry, Rajarajeswari Dental College and Hospital, #14 Ramohalli Cross, Kumbalgodu, Mysore Road, Bengaluru - 560 074, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jigims.jigims_37_22

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  Abstract 


Background: In the early 2020, the world witnessed an enormous spread of coronavirus disease 2019 (COVID-19) caused by a novel coronavirus (2019-nCoV or SARS-CoV-2). It is common for parents to be frightened and their attitudes toward dental visits to change, given COVID-19's high contagion and fast spread.
Aim: The aim of this study is to assess the parents' knowledge about coronavirus disease 2019 and measures taken by the dentist and to evaluate their attitudes/fears about bringing their children for dental visits during the pandemic.
Materials and Methods: A structured questionnaire was developed in English and local language Kannada, which was applied to a sample of 400 parents of children aged between 4 and 12 years, of different socioeconomic backgrounds.
Results: Regarding the knowledge about the COVID-19 pandemic among parents, 94% were aware about the present situation. 66% of parents perceived the dental hospital to be more dangerous when compared to public places. Regarding the attitude of parents in bringing their children to the dental clinic during the COVID-19 pandemic, 87.5% of the parents were comfortable in bringing their child to the hospital on following the COVID safety protocol.
Conclusion: Majority of the parents remained well aware of the current situation about the pandemic. Patients were unlikely to take their children to the dentist except for an emergency and perceived the dental clinic as a risky place for contracting the virus. However, on providing reassuring information about infection control measures taken at the dental hospital, they were more comfortable in bringing their child to the dental hospital.

Keywords: COVID-19, knowledge, measures, pandemic


How to cite this article:
Thimmegowda U, Pai K S, Krishnamurthy NH, Chikkanarasaiah N. Parental knowledge and awareness about measures taken by the dentist and attitude of parents toward bringing their children to dental hospital during the COVID-19 pandemic: A cross-sectional study. J Indira Gandhi Inst Med Sci 2022;8:134-40

How to cite this URL:
Thimmegowda U, Pai K S, Krishnamurthy NH, Chikkanarasaiah N. Parental knowledge and awareness about measures taken by the dentist and attitude of parents toward bringing their children to dental hospital during the COVID-19 pandemic: A cross-sectional study. J Indira Gandhi Inst Med Sci [serial online] 2022 [cited 2022 Nov 28];8:134-40. Available from: http://www.jigims.co.in/text.asp?2022/8/2/134/355322




  Introduction Top


In early 2020, the world witnessed the massive spread of coronavirus disease 2019 (COVID-19), believed to have originated in Wuhan, China.[1] It can cause severe acute respiratory symptoms, typical signs and symptoms being fever, cough, and fatigue, especially in adults.[2],[3] The World Health Organization categorized it as a pandemic, on March 11, 2020.[4]

COVID-19 is caused by a novel coronavirus (2019-nCoV or SARS-CoV-2) that retains high transmissibility capacity.[5] Common transmission routes are direct transmission through cough, sneeze, and droplet inhalation and contact transmission through oral, nasal, and eye mucous membranes.[6] In addition, 2019-nCoV can be transmitted directly or indirectly through saliva.[7] Studies have suggested that 2019-nCoV may be airborne through aerosols formed during medical procedures.[8]

The lack of knowledge about the disease, high degree of contagiousness, and healthy condition of the carriers of the virus (causing an increase in transmission) are some of the major difficulties among children. The public has received much information about COVID-19 through social media that could be incorrect and unnecessarily alarming, potentially leading to confusion and panic. It is common for parents to be frightened and their attitudes toward dental visits to change, given COVID-19's high contagion and fast spread.[9]

With their exclusive characteristics, dental settings warrant specific infection control considerations. Dental procedures generate aerosols that can contain saliva or blood particles and carry a risk of large-scale spread of the virus.[10] Although dental clinics typically perform strict infection control measures, even stricter measures have been called for since the beginning of the pandemic.[11] Detailed and frequently updated guidelines have been published by the Centers for Disease Control and Prevention, the American Academy of Pediatric Dentistry (AAPD), and the American Dental Association with recommendations to consider preceding the dental visit, at arrival, and during treatment to lessen exposure to the virus and protect staff and patients.[12],[13]

Very scarce studies have been conducted in India. Moreover, the knowledge regarding measures taken at the dental hospital among parents is questionable; hence, the aim of this study is to assess parents' knowledge about coronavirus disease 2019 and measures taken by the dentist and to evaluate their attitudes/fears about bringing their children for dental visits during the pandemic.


  Materials and Method Top


This cross-sectional study targeted parents of children of age 4–12 years, who reported to the Department of Pediatric and Preventive Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, India. A structured self-administered questionnaire was developed and modified.[14],[15] Of the 700 participants approached, 400 gave consent to take part in the study. The study was conducted for a duration of 6 months from September 2021 to February 2022. The parents who were willing to give consent to take part in the study were included and those with children above 4 years and below 12 years were excluded from the study. The questionnaire contained 21 questions that were divided into four sections (demographic data; COVID-19 knowledge; measures taken by the dentist; and attitudes toward visiting a dentist during the pandemic). The questionnaire was validated independently by 3 experts: a professor from the department of pediatric and preventive dentistry, head of the department of research, and a biostatistician. For face validity, each question was rated for its importance on a five-point scale (1 = very important, 2 = important, 3 = moderately important, 4 = of little importance, and 5 = not important) and whether it should be included in the survey on a three-point scale (0 = yes, 1 = no, and 2 = not sure). For content validity, each question was rated in four domains: relevance, clarity, simplicity, and ambiguity on a four-point scale (1 = needs major revision, 2 = needs some revision, 3 = needs minor revision, and 4 = no need for revision).[15]

The development of a bilingual survey was considered vital to cover most of the population of interest. The questionnaire was drafted in English and translated into the local language (Kannada).

To ensure privacy, it was assured that the names and contact information of the participants will not be publicly displayed or shared beyond the scope of the study. Furthermore, parental participation was voluntary, without any form of incentive or pressure.

The data collected were subjected to statistical analysis.

Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) for Windows, Version 22.0. Released 2013. Amonk, NY, USA, IBM Corp. The descriptive analysis includes the expression of responses for the study questionnaire in terms of frequency and proportions. The Chi-square test was used to compare the response for the study questionnaire between two study groups. The level of significance (P value) was set at P < 0.05.


  Results Top


Considering age-wise distribution of the study participants, 68% were around 31–40 years of age. Considering gender-wise distribution, 56% were female [Figure 1] and [Figure 2]. Among distribution of the parents' educational status, 44.5% were found to be graduates [Figure 3]. Among distribution of the parents' occupational status, 42.8% were found to be professionals [Figure 4].
Figure 1: The age-wise distribution of the study participants

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Figure 2: The gender-wise distribution of the study participants

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Figure 3: The parents educational status

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Figure 4: Distribution of the parents occupational status

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Regarding knowledge about the COVID-19 pandemic among the parents, 94% were aware of the current situation and only 6% remained unsure. 83.8% of parents were aware that COVID-19 is a viral infection and 91.3% were aware of all its symptoms. On options to control the spread of the disease such as social distancing, hand washing, wearing a mask, cough/sneeze etiquette, and wearing a face shield and disposable gloves, 96%% of parents seemed to be aware [Table 1].
Table 1: Knowledge among parents regarding the coronavirus disease 2019 pandemic

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Regarding importance of measures taken at the dental hospital, 97.3% of the parents were aware of the importance of measuring the temperature, oxygen saturation, and regarding COVID screening questions at the hospital entrance. 99.5% of parents were aware that social distancing in the waiting room is important. 86% were aware of the importance of a pretreatment antiseptic mouthwash and 11.8% were not sure regarding its importance. 97.5% of the parents would prefer the dental chair to be disinfected between each patient and 82.3% would prefer the use of disposable dental instruments. 98.8% of the parents were aware of the importance of PPE worn by the dentist during the treatment and prefer it [Table 2].
Table 2: Importance of measures taken by the dentist during the coronavirus disease 2019 pandemic

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Regarding the attitude of the parents in bringing the child to the dental hospital during the COVID-19 pandemic, only 59.3 of parents would prefer a hospital consultation during the pandemic and 27.3% and 13.5% would prefer an online consultation and home visit respectively. 84.3% of the parents preferred a pediatric dentist for their child's dental treatment during the pandemic over a general dentist or physician. 71.5% of the parents preferred to bring their child to the dental hospital only in cases of pain. 66% of the parents perceived the dental hospital to be more dangerous when compared to public places, 21.3% perceived it as less dangerous, and 9% perceived it as not dangerous at all. 54% of the parents were willing to take their child to the dental hospital during the pandemic, only in cases of emergency. 47.8% of parents were worried about contacting the virus from the dental clinic, 39.5% were somewhat worried, 10.3% were not worried at all, and 2.5% of the parents remained unsure. However, 87.5% of the parents were comfortable in bringing their children to the dental hospital during the pandemic, on following the COVID safety protocol [Table 3].
Table 3: Attitude of parents in bringing their child to the dentist during coronavirus disease 2019 pandemic

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  Discussion Top


In India, parents are usually children's primary caregivers, spending the most time with them and often accompanying them to medical or dental visits. The school shutdown was distressing to many parents and demonstrated the magnitude of the pandemic. Like most people in the country, parents in India are concerned with the pandemic and follow the news regularly. The study targeted this population because parents would be making most decisions about pediatric dental visits during the pandemic.

In April 2020, a World Economic Forum publication leveraged infographic data to determine which occupations face the highest risk of exposure to 2019-nCoV. The study assessed three parameters for each occupation: contact with others, physical proximity, and exposure to disease and infection. Not unpredictably, dental hygienists, dental assistants, and dentists were three of the top four occupations for the highest COVID-19 risk scores.[9] The distance that separates the dentist from the operating field is only about 35–40 cm; moreover, certain procedures can be time-consuming, particularly with an uncooperative child, makes the risk of cross-infection between dentist and patient even complex.[16]

In our study, regarding the knowledge about COVID-19 pandemic among parents, majority of them were aware of the situation. Most of the parents were aware that COVID-19 is a viral infection and were aware of all its symptoms. In accordance with our study, a study stated that the parents were well aware of the current situation regarding the COVID-19 pandemic and had explained it to their children as well.[14] According to a study, the findings indicate that the parents had a good understanding of the clinical signs, mode of transmission, and protection measures and were satisfied with governmental measures.[17] In contrast to our study, a study suggested that with respect to knowledge among parents, 90.6% of parents were unaware that disease may show no symptoms; 61.1% and 32.6% did not know roles of “close contact with asymptomatic patients and dentistry practices in transmission, respectively.[18]

Despite the high risk of dentistry, few reports are available about 2019-nCoV infection between the dental team and their patients so far. A study on COVID-19 infection in the dental setting reported nine confirmed cases among the dental team in the School and Hospital of Stomatology, Wuhan University, Wuhan, China.[12] It was suggested that the transmission of COVID-19 in the dental clinic that there is a probability for transmission, through saliva, bodily fluids, aerosols, contaminated instruments, and surfaces.[19] Nonetheless, one cannot underestimate infection control measures being second nature to most dentists, who routinely wear gloves and a mask, often with eye protection, when treating patients.[20] Hence, it is important to follow the recommended safety protocols. The awareness of the importance of these measures among was assessed in our survey.

In accordance with AAPD's re-emergence practice checklist, participants in our study were asked about their perceived importance of measures taken at dental clinics.[12] Majority of parents felt that asking COVID-19-related screening questions at the clinic entrance were very important. On the other hand, the three highest extremely important measures were dentist/assistant wearing PPE, dentist changing gloves frequently, and dentist washing hands frequently, suggesting that parents were well aware of the various measures. In a study, majority of the parents expressed confidence about the preventive measures taken in the dental department to ensure safe treatment for their children.[18]

Regarding the attitude of the parents, in our study, parents were generally afraid to visit the dentist during the pandemic. More than one-third viewed dental clinics as being a more dangerous place to contract the virus than public places were. The fear was reflected in their practices as well, as majority stated they would do so for an emergency only. However, on providing reassuring information, majority of the parents were more comfortable in bringing their children to the dental hospital. Supporting our findings, a study reported that 86% of children who endured dental trauma during the pandemic did not seek dental care and also found that parents with higher fear levels and that when the number of COVID-19 cases increases; parents are less likely to take their children to dental appointments.[21]

One of the major challenges after the pandemic will be dealing with its sequelae. Dental health care has tolerated changes on many levels. Access to routine dental care has been more limited, as dentists have rightfully taken a backseat to avoid unwanted risk of infection transmission and to preserve PPE for other professionals who are dealing with COVID-19 patients. Parents may also have opted not to visit the dentist. Furthermore, many parents had to support their children with home-schooling when working from home. This put a massive pressure on parents and also drastically cut the time available to attend to other duties, such as supervising oral hygiene practices and providing healthy low-sugar meals. These factors may have led to the development of new carious lesions in high-risk children and/or the progression of already established lesions. Unexpected life events that limit access to dental care, as seen with the COVID-19 pandemic, are a good example of why prevention of oral disease and raising public oral health awareness are of pivotal importance. Dental health-care providers should take this opportunity to assess their efforts in public oral health care and must be ready to play a more active role in the fight against emerging diseases by being available for emergency treatment and volunteering as needed in their communities in the fight against COVID-19.[16]

Despite the comprehensiveness of the study, it has limitations. The study recruited parents from different socio-economic and educational backgrounds and since they were all from Bangalore, this prevented us from generalizing the results on a higher level. Second, future studies could aim at a larger sample size in order to generalize the results.


  Conclusion Top


Majority of the parents remained well aware of the current situation about the pandemic. Patients were unlikely to take their children to the dentist except for an emergency and perceived the dental clinic as a risky place for contracting the virus. However, on providing reassuring information about infection control measures taken at the dental hospital, they were more comfortable in bringing their child to the dental hospital.

Acknowledgment

We sincerely thank Dr. Nagarathna C, Head of the Department, for her constant support in conducting the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Farsi D, Farsi N. Mothers' knowledge, attitudes, and fears about dental visits during the COVID-19 pandemic: A cross-sectional study. J Int Soc Prev Community Dent 2021;11:83-91.  Back to cited text no. 9
    
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Harrel SK, Molinari J. Aerosols and splatter in dentistry: A brief review of the literature and infection control implications. J Am Dent Assoc 2004;135:429-37.  Back to cited text no. 10
    
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Center for Disease Control and Prevention. Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response; 2020.  Back to cited text no. 11
    
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American Academy of Pediatric Dentistry. Re-emergence Pediatric Dentistry Practice Checklist. 2020.  Back to cited text no. 12
    
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American Dental Association. ADA Develops Guidance on Dental Emergency, Nonemergency Care. 2020.  Back to cited text no. 13
    
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Sun J, Xu Y, Qu Q, Luo W. Knowledge of and attitudes toward COVID-19 among parents of child dental patients during the outbreak. Braz Oral Res 2020;34:e066.  Back to cited text no. 14
    
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Yip HK, Tsang PC, Samaranayake LP, Li AH. Knowledge of and attitudes toward severe acute respiratory syndrome among a cohort of dental patients in Hong Kong following a major local outbreak. Community Dent Health 2007;24:43-8.  Back to cited text no. 15
    
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Kamate SK, Sharma S, Thakar S, Srivastava D, Sengupta K, Hadi AJ, et al. Assessing knowledge, attitudes and practices of dental practitioners regarding the COVID-19 pandemic: A multinational study. Dent Med Probl 2020;57:11-7.  Back to cited text no. 16
    
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Ceyhan D, Kirzioglu Z, Yildirim F. An evaluation of knowledge, awareness, attitudes, and behaviors regarding COVID-19 among parents of pediatric dental patients. Clin Pediatr 2022;61:168-76.  Back to cited text no. 18
    
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Campagnaro R, Collet GO, Andrade MP, Salles JP, Calvo Fracasso ML, Scheffel DL, et al. COVID-19 pandemic and pediatric dentistry: Fear, eating habits and parent's oral health perceptions. Child Youth Serv Rev 2020;118:105469.  Back to cited text no. 21
    


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