The Level of Knowledge and Preparedness of Dental Professionals for COVID-19 among Public and Private Dental Sectors in Saudi Arabia: A Cross-Sectional Study

1.1. About COVID-19

Since the virus was first reported in Wuhan, China, in December 2019, it has turned into a significant health issue globally [1]. COVID-19 is caused by a novel virus called SARS-CoV-2, which results in pneumonia, with signs vary from mild to deadly. This virus’s infection can result in an acute inflammatory reaction and respiratory failure [6]. The World Health Organisation (WHO) announced COVID-19, a global pandemic, on 11th March 2020 [4]. By 6th July 2020, the virus had spread to 216 nations, causing 11,496,926 positive cases and claiming over 535,000 lives [4].

1.2. Dental Practice Prevention

In dental practice, prevention approaches are physical distancing. Service delivery in dental healthcare needs close physical touch between the sick and professionals. However, social distancing is a crucial strategy to prevent the transmission of the virus. A professional can limit the number of visitors entering the facility, encourage alternative means of communication between the visitors and patients, or fix appointments to reduce the number of patients in queues. Seats in the waiting area can also be arranged at least 1.5 meters apart. The Centre for Disease Control and Prevention (2020) recommends that all dental professionals should adopt the global source control approaches, referring to the use of masks to cover an individual’s mouth and nose to stop the spread of respiratory secretions [7].

Dental professionals are also advised to implement the use of personal protective equipment to protect them from any virus that might find its way out into the atmosphere or surface. Dental professionals should only provide services after they have evaluated the sick and weighed both the risk to the patient of postponing services and the risk to the professionals and patients of transmission of the virus in the process of healthcare provision [8].

1.3. World Health Organisation Precautions

Since close personal contact seems to be the leading cause of transmission, social distancing remains the main form of mitigating the spread. The WHO has recommended keeping a distance of close to 1.5 meters from each other in public places [9]. The distance avoids direct contact with respiratory droplets. The World Health Organisation also has recommended maintaining high hygienic standards. Regular handwashing with soap is -also suggested. Practising proper hygiene is a crucial habit that helps in the prevention of coronavirus transmission [10]. According to the WHO (2020), one should clean his/her hands often with soap and water for a minimum of 20 seconds, mainly after being in a public place or after coming in contact with their nose or mouth. If no soap or water is readily available, one must use a hand sanitiser with at least 60% alcohol [4]. The WHO also warns against touching one’s nose, eyes, and mouth with unwashed hands. According to Loey et al. (2020), face masks have become crucial tools in protecting individuals from contracting the coronavirus [2]. The World Health Organisation recommends that individuals wear face coverings in public contexts. Moreover, studies have indicated that individuals with the new coronavirus could be asymptomatic [11].

1.4. Protocols by the Saudi Ministry of Health

The Saudi Ministry of Health has put in place several protocols to ensure the virus does not spread in the country. The first strategy is early recognition of the virus and the application of source control measures. Secondly, the ministry applies standard precautions to all the patients and, later on, implements additional empirical safeguards. In the health facilities, the ministry has put in place mechanisms to control the virus’s exposure [12]. Environmental cleaning and disinfection take place as a form of environmental control [13].

1.5. COVID-19 Vaccines

With the world going through an unprecedented time due to the COVID-19 pandemic, economies and normal lives have come to a standstill, with many lives being lost. Due to these challenges, the COVID-19 vaccine was developed at a record speed [14]. Today, the world has many types of vaccines being administered to people, and dental professionals, being among the high-risk group, will be vaccinated to prevent the spread of the disease [15]. In Saudi Arabia, 2 vaccines have been approved by Saudi Food and Drug Authority (FDA), namely, (Pfizer BioNTech and Oxford-AstraZeneca) to be used on its population [16].

With the world facing a novel challenge in the name of the COVID-19 pandemic, a lot of caution has been taken, and several measures have been adopted in all aspects of life. In the medical sector, the pandemic has brought massive challenges and caused many losses, including the loss of lives. Among the most vulnerable individuals to this pandemic are medical practitioners, including dental professionals. Therefore, the level of preparedness among this group of individuals should be studied to determine if they are well prepared to tackle this deadly enemy. Information from the research can also be crucial to government institutions and other humanitarian entities willing to provide these professionals with financial or psychological support. It has been indicated that authorities have the responsibility to society members to implement environmentally sustainable practices to support their health and well-being, now and in the future.

2.1. Study Design and Setting

This study is a cross-sectional study with a non-probability sampling method. The target population comprised registered dentists in the Kingdom of Saudi Arabia.

2.2. Study Sample and Data Collection

This study was approved by the Ethics Committee of Prince Sultan Military College of Health Sciences (IRB-2021-DOH-021). The data was collected through online questionnaires between February 2021 and June 2021, where standardized close-ended questions were asked via Google forms among registered dentists in public and private dental sectors in five regions in Saudi Arabia. There were a total of 145 respondents to the questionnaire; three of them decided not to participate in the study, while 30 respondents failed to select the correct answer to the quality assurance question. The remaining 112 responses that were complete were included in the analysis. Informed consent was obtained on the first page of the online questionnaire.

2.3. The Instrument and Measurement

The researchers designed the structured online questionnaire according to the primary objective of the present study based on the Saudi Ministry of Health, World Health Organization (WHO) guidelines, and previous research. A total number of 38 questions, include 14 question assessing demographic and work related questions, 10 questions assess the knowledge level, 13 questions assess the preparedness and perception level of dentist toward COVID19. In addition, one question was inserted in the middle of the questionnaires with a specific answer to ensure the quality of responses and verify that the participants read the questions carefully. A panel of experts reviewed and validated the questions. Then, a pilot test was performed to measure the reliability of the questions with 30 participants whose data were not included in the final study sample. The reliability of the questionnaire was tested with the use of SPSS, which has a reliability coefficient (Cronbach’s alpha) of 0.89. The questionnaire completion time was estimated to be approximately 10 min. These questionnaires included the following domains: demographic questions and knowledge, preparedness, and perception of the dentists during the COVID-19 pandemic.

2.4. Statistical Analysis

The data collected from the dentists were analyzed and tested via Statistical Package for the Social Sciences (SPSS1) software (SPSS Inc., Chicago, IL, USA) version 26. Descriptive statistics were calculated as frequency, percentage, mean, and standard deviation (SD). The mean score of every question was calculated. The average of each domain was calculated out of the total point of each domain point. Knowledge score was calculated as one point for each correct answer and 0 for an incorrect answer, or “I do not know,” and the total score ranged from 0 to 10. The mean score, the minimum score, and the maximum score were calculated to generate three levels of knowledge: low knowledge for those who answered six or fewer correct answers from 10 (≥6), average knowledge, i.e., between 7 to 8 correct answers, and high knowledge with >8. Preparedness and perception were scored on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). A mean score was generated to determine the preparedness and perception score domains with five levels: “lowest prevention” for answers with a mean value between 1–1.79; “low prevention” for answers with a mean value between 1.8–2.59; “average prevention” for answers with a mean value between 2.6–3.39; “high prevention” for answers with a mean value between 3.4–4.19; and “highest prevention” for answers with a mean value between 4.2–5. We used an independent t-test and one-way ANOVA to test the significant differences in the mean score of the three domains with the demographic variable. The statistical significance was set at P < 0.05 for all analyses.

4.1. Dentists’ Level of Knowledge

In assessing the level of knowledge among the dentists, results showed that most dentists (58%) had high knowledge of COVID-19, which was followed closely by those who had average knowledge (34.8%), while the rest (7.1%) had low knowledge of COVID-19. The results imply that when COVID-19 emerged, there was significant awareness of this pandemic, owing to several organizations, such as the health sectors worldwide, that gave much attention to reducing its spread. Thus, there was a higher level of knowledge among the workers, for example, the dentists. In line with these results, Widyarman et al. (2020), in their study, examined dental professionals’ perceptions, attitudes, and knowledge regarding COVID-19 in Indonesia [5]. The results of this study showed that many materials had been made available to raise awareness and knowledge of coronavirus illness, including issues related to dentistry procedures. The results imply that the level of information that the government of Indonesia provided among the health sectors improved the knowledge of the workers. On a similar note, according to the Centers for Disease Control and Prevention (CDC), dental practitioners should utilise global source control techniques, which include wearing masks over one’s mouth and nose to prevent the transmission of respiratory secretions [7]. In addition, studies at the Centers for Disease Control and Prevention (CDC) noted that dental practitioners should also use personal protective equipment (PPE) to protect them from viruses that may be present in the atmosphere or on the surface. On the other hand, Turkistani and Turkistani (2020) indicated that dental practitioners should always offer services after evaluating the ill person and weighing the risks to the patient of delaying treatment as well as the potential of virus transmission to the professionals and patients throughout the healthcare delivery process [8]. The results indicate that there was higher knowledge gained when offering services to people with dental cases. In support of the results presented above, Mustafa et al. (2020) examined dentists’ early-outbreak-period knowledge, attitudes, and preparedness for COVID-19 in Saudi Arabia; they established that dentists in Saudi Arabian dental sectors were generally well-informed about COVID-19. This research concluded that dentists’ expertise could be improved by expanding their access to information offered by dental healthcare authorities, which details the most effective and secure methods for treating patients during and after an outbreak [17]. In line with the aforementioned research findings, Khader et al. (2020) explored Jordanian dentists’ knowledge, beliefs, and practices relating to the spread of the coronavirus (COVID-19) disease during the year 2020. They established that a majority of dentists had a good understanding or were knowledgeable about COVID-19, as seen by their ability to correctly identify patients at risk of being infected by the virus, report the known modes of transmission, and implement preventative measures within their practices [18]. Similarly, Alisofayan et al. (2020) indicated several measures that the Saudi Ministry of Health has implemented to prevent the virus from spreading throughout the kingdom [12]. According to the author, the first method is used to detect the infection early on to implement source control measures. The second method is that the ministry takes conventional measures with all patients and then adds further empirical protections afterwards. The government has put in place procedures to prevent the virus from spreading in healthcare institutions. The results of this study imply that the measures put in place to deter the spread of the said virus have enabled the acquisition of knowledge about COVID-19 by many health practitioners, for example, dentists, to grow significantly, which is consistent with the results of the current study [19].

4.2. Dentists’ Level of Preparedness

In addition, when evaluating the level of preparedness, which included the method of prevention and practice of dentists while dealing with COVID-19, results showed that most of the respondents (42.9%) indicated that they had the highest preparedness level. These results implied that during the COVID-19 outbreak, most health practitioners, such as dentists, were caught unaware. Therefore, their preparedness was not as significant as compared to their level of knowledge. However, due to their professionalism, dentists must be prepared for any pandemic that may affect their daily activities. In support of these results, a study by ILO (2020) established that the coronavirus outbreak had a significant impact on dental schools, as well as their linked health centres and research stations [3]. The results were due to many health centres not having enough preparations for curbing a severe pandemic. Therefore, according to this study, many practitioners have improved preparedness, but it is not sufficient, which is consistent with the results of the current study. In contrast, as per the World Health Organisation (2020), the risk of rapid infection is greatest among people who are close to or work with patients, such as family members or health care providers [4]. The results imply that when a pandemic outbreak occurs, in this case, COVID-19, most people who are close to or work with patients are at a higher risk of being infected. This may be a result of poor preparedness in handling such pandemics. Thus, results indicated that medical practitioners have low preparedness, which contradicts the results of the current study.

4.3. Dentists’ Level of Perception

Finally, when examining the level of perception of dentists toward COVID-19, the results showed that the majority (48.2%) of the dentists had the highest perception. However, the perception level was higher compared to their level of preparedness but lower compared to their level of knowledge. The results implied that since the coronavirus was a new pandemic, the only known thing was that it originated from Wuhan, China. In contrast, the perception of its source, its influence, the rate of spread, and the most affected personnel was initially not known among the people and other health workers, causing the perception level to be lower [20]. However, due to instant research that started after the outbreak, the knowledge of preventing the fast spread was shared, which also affected the perception level among dentists. The results of this study lacked direct support from the work of literature, which indicates that identifying the dentists’ perception level toward COVID-19 fills a gap in the work of literature and will act as guidance or reference to other researchers who may conduct a similar study in the future. In addition, while determining the difference between the level of knowledge and preparedness and perception toward COVID-19 among dentists concerning various factors, results showed a statistically significant difference in participants’ responses regarding the knowledge in education level, position, and region of practice in KSA. On the other hand, results illustrated that the difference in participants’ responses to the preparedness was statistically significant for the current workplace. Nonetheless, factors such as gender, age, marital status, main sources of clinical information on COVID-19, working hours per week, and nationality had no statistically significant difference in either level of knowledge, preparedness, and perception toward COVID-19 among dentists. However, no earlier research has identified a difference between the given factors in the level of knowledge and preparedness, and perception of COVID-19, given that the various factors had shown either statistically significant or insignificant differences in the level of knowledge, preparedness, and perception of COVID-19.

The current study has some practical and theoretical implications. For instance, the results from this study give a glimpse into the knowledge, preparedness, and perception of dentists working in health sectors about infection management in general and COVID-19 in particular during the period of its occurrence in 2020. In addition, these results imply that it would be advantageous when assessing the requirement for educational and clinical training for dentists if there were a scale to measure their level of preparedness and understanding of COVID-19. Therefore, for dental workers to get the most out of the COVID-19 training, it should be tailored to their specific needs. These results imply that dentists with higher levels of knowledge were better able or were more prepared to treat patients during the pandemic and that level of education had a beneficial effect on the dentists’ degree of COVID-19 knowledge. In addition, the results of this study can assist in pinpointing any knowledge gaps, which may then be used to guide future interventions aimed at enhancing the knowledge and preparedness of dentists while attending to their patients during the COVID-19 period.

Several limitations of this study that could guide the future must be kept in mind when interpreting the data. This study's participants had to have access to the Internet and specifically social media. When not available, the generalizability of study findings could be threatened. Using social media may have limited the opportunity to participate in this study affecting the sample size. In addition, overall mean scores were the focus of this investigation. The individual results were not considered in the analyses, which is a drawback of the current research. In addition, there is limited literature on dental specialists’ knowledge, preparedness, and perception scores on COVID-19, which affected the comparison of the results to have a broader understanding. Nonetheless, the current study was conducted during the pandemic’s peak period, and since COVID-19 is considered a fresh and unexplored topic, the updates and recommendations may be revised, amended, or added daily. As a result, these new changes due to revising and amending practices and recommendations to curb the spread of COVID-19 were a major limitation to the current situation since they could not be generalised. Another limitation of our study was the possibility of recall bias among our respondents.

Researchers in the future should increase the sample size to cover a larger population and increase the reliability of results. In addition, researchers should undertake the same research when the spread of this pandemic is contained to involve face-to-face interviews and reduce the possibility of respondents making mistakes when giving out feedback, and thus reducing the bias when reporting. Finally, future research should involve a scale measuring dentists' COVID-19 preparedness and knowledge that would effectively evaluate the need for educational and clinical training. To ensure the optimum gain of knowledge and preparedness, the COVID-19 training should be customised for dental professionals.