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ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1650-1654  

Evaluation of knowledge, attitude, awareness, fear, and anxiety levels in pateints visisting the routine dental outpatient department during COVID 19 pandemic - A cross-sectional hospital-based observational research


1 Department of Oral Medicine and Radiology, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
2 Department of Pediatric and Preventive Dentistry, Kalinga Institute of Dental Sciences, Campus 5, KIIT University, Bhubaneswar, Odisha, India
3 BDS, Chandigarh Dental and Homeopathic Hospital, Sector 35, Chandigarh, India
4 Department of Oral Pathology and Microbiology, Government College of Dentistry, Indore, Madhya Pradesh, India
5 Department of Oral Pathology and Oral Microbiology, Index Institute of Dental Sciences, Indore, Madhya Pradesh, India
6 Department of Orthodontics and Dentofacial Orthopedic, Chandra Dental College, Barabanki, Uttar Pradesh, India
7 MPH Student, Parul Univeristy, Vadodara, Gujrat, India

Date of Submission10-May-2021
Date of Decision15-May-2021
Date of Acceptance21-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Puneeta Vohra
Department of Oral Medicine and Radiology, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_378_21

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   Abstract 


Background: Since the COVID 19 pandemic has hit worldwide wide being one of the biggest psychological menace that had an impact on all socioeconomic strata as well age group of society. Looking at the present scenario of confusion and anxiety a cross-sectional research was planned to see the level of fear and anxiety among a patient who is already having concern about his oral health and when he comes to a dental outpatient department (OPD) what are his main areas of concern and anxiety. Methodology: Cross-sectional study was planned in faculty of dental sciences, all the patients coming to dental OPD over a period of 3 months from November 2020 to March 2021 were asked to self-fill or fill with assistance a google form compromising of 10 multiple response questionnaire validated according to previous studies and surveys. Later on, the data was compiled and evaluated. Results: Out of 511 Patients enrolled in the study after taking their online consent. 28.2% of population did not know about COVID 19. 67.4% were aware about the pandemic whereas 4.4% were confused and did not know about the complete scenario. 36.9% of population were not in stress and 62.4% were in stress and had anxiety regarding their visit for dental check up and treatment. 30.4% had no fear of catching the infection from dental procedure, 62.4% had fear and 7.2% of population was ignorant regarding the same. About 70.7% had quarantined themselves before coming for dental treatment. 62.4% were willing for dental treatment post-vaccination and 26% were not willing for treatment 11.6% were not sure. After applying statistical analysis, it was found that P < 0.05 and people coming to dental OPD were in lot of stress and anxiety regarding the dental procedures during the COVID pandemic. Conclusion: Since the global pandemic has caused major worry among the populations but still there are many who are not so anxious. Knowledge and awareness regarding the disease and vaccination have led to a wave of calmness in some, but still many people have been impacted and are in major dilemma whether they should get a dental treatment or should delay it ??

Keywords: COVID 19, dental procedure, fear and anxiety, pandemic


How to cite this article:
Vohra P, Verma RK, Mongia JS, Kumar P, Sukhija H, Singh R, Tiwari H. Evaluation of knowledge, attitude, awareness, fear, and anxiety levels in pateints visisting the routine dental outpatient department during COVID 19 pandemic - A cross-sectional hospital-based observational research. J Pharm Bioall Sci 2021;13, Suppl S2:1650-4

How to cite this URL:
Vohra P, Verma RK, Mongia JS, Kumar P, Sukhija H, Singh R, Tiwari H. Evaluation of knowledge, attitude, awareness, fear, and anxiety levels in pateints visisting the routine dental outpatient department during COVID 19 pandemic - A cross-sectional hospital-based observational research. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Jun 25];13, Suppl S2:1650-4. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1650/330115




   Introduction Top


COVID-19 Infection was declared as a Pandemic by World health organization in March 2020 all over the world, the epicenter of the deadly disease was based in China, Wuhan it started there from Bats and was mutated in humans taking a deadly course and shape the invisible virus travelled across continents affecting the life of people. Once it was known that the virus is highly transmissible all efforts were made by all the governing bodies to decrease the spread by doing quarantines and major lockdowns, which almost caused a state of panic all over the world. As the time passed and people were dead, infected from mild to moderate to severe COVID infections the virologist and researchers all over the world wanted to curb the pandemic by increasing awareness in people about the COVID-19 Virus its mode of transmission early signs, symptoms and prevention. The information regarding the virus was spread and awareness drive was started by all countries including India by developing Applications likZe Arogya Setu, News Channels and social media. In this when so many people were talking about the deadly virus and so much information some fake and some true was reaching people through mass media the anxiety levels of people were noticeably raised.

There were constant updates just like a cricket match or game core regarding the data of incidence of newly infected cases, deaths due to COVID 19, and recoveries. Hence, other than attaining knowledge and awareness COVID-19 Pandemic has created panic, fears, anxiety, and worries among the general public. The mode of transmission of COVID-19 became very clear over a period of few weeks that it spreads from one person to other person through Droplet transmission within a range of 1-meter distance. Also, according to the World Health Organization, COVID-19 has a high probability of airborne transmission especially in specific circumstances and dental settings in which dental or medical procedures which generate aerosols and due to which virus stays in air leading to very high risk of transmission of virus along with probability of high viral load that can increase the risk of disease and also the severity. Various dental and medical treatment procedures involve the use of equipment that can generate aerosols. Aerosols will contain microorganisms and these microorganisms are so small amd totally invisible to the naked eye and will remain suspended in air in the work environment and sometimes the size of these microorganisms is so small that ven if we use high-efficiency particulate air (HEPA) filters in such work environment the filters are not able to remove the 100% of organisms from the sir. Keeping all this in mind we could understand that COVID 19 can potentially be transferred as infectious microorganisms to the health care workers and also to subsequent patients who might come for the dental treatment thus leading to chain of transmission. After the advent of this deadly virus COVID-19, there is a very quick and evident paradigm shift in how the Healthcare services have started operating differently all over the world. As the COVID 19 Pandemic transmission is easily transmitted through droplets and aerosols, concern regarding any Medical and Dental treatment has remained an issue of concern and anxiety for all.[1]

Several past cross-sectional observational studies have clearly established that all medical and Dental seeking behavior of patients coming for routine or emergency procedures is influenced by very high level of Fear and Anxiety.

As the world faces COVID-19 Pandemic in various waves, the Fear of COVID-19 infection and knowledge, awareness regarding COVID-19 infection, vaccination can majorly influence the Dental treatment-seeking behavior. General population awareness and knowledge regarding droplet transmission of COVID-19 plus how to maintain appropriate COVID appropriate behavior to break the chain of transmission by maintaining social distancing, wearing double mask, isolating self-moment any symptom of infection is felt and getting the testing done can potentially influence the fear, worry, and anxiety in Dental treatment-seeking patients. The research regarding the correlation of Fear of COVID-19 to Dental treatment Anxiety is very sparse especially still a lot of literature is still missing on how the general population will react to this pandemic postvaccination.[2],[3],[4]

Aims and objectives

The main aim and objectives of this study were to analyze the fear and anxiety levels in patients going for various dental treatments during the ongoing COVID 19 pandemic. We also evaluated the stress and anxiety levels in patients visiting the dental outpatient department (OPD) we also assessed whether the patient is coming for an emergency or a routine check-up. It was also assessed whether the patient is bothered about extra protective measures and wants to be shielded under cover of vaccination since the year 2021 came with a promise of various companies rolling the vaccine that can surely give a good level of protection against deadly virus and can help in the reduction of panic, fear, anxiety by acting as a primary shield against this deadly viral infection and reduction of mortality all over the world.


   Methodology Top


Materials

The study was conducted on the patients, who attended the OPD of Oral Medicine and Radiology, SGT Dental College and Research Institute, Shree GuruGobind Singh Tricentenary University, Gurugram. Over a period of 3 months from November 2020 to February 2021 patients were randomly enrolled for the study. Ethical clearance was taken from the ethical committee of SGT university Gurugram ethical clearance number is FODS/EC/FRP/OMR/2021/68A A questionnaire-based online Google survey, in the form of prospective, cross-sectional observational, and hospital-based study was performed. Statistical analysis was performed using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp and Chi-square test was applied to calculate the P (Pearsons) coefficient value.

Armamentarium

Google form questionnaire was prepared comprising of 10 multiple response questionnaire validated properly by team of the dentist by checking previous surveys and studies. This questionnaire uses the Guttmann scale with three response categories that can be selected, namely “Yes”, “No”, and an additional option that is “Don't Know or may be”. Answer Yes has a score of 1, and the answer No/Don't Know/maybe has a score of 0.

Methods

The patient will be informed completely of the ongoing survey and with the consent of the patient to participate in the survey his response will be recorded on the Google form by sharing the Google form with the participants electronically or by the dentist who is doing his checkup in OPD just in case the patient is not comfortable in using the electronic platform the dentist will ask him the questions verbally and his responses will be updated by the dentist in the Google form. There are 10 questions specially designed for this survey to evaluate the fear and anxiety levels in various patients visiting the dental OPD. Each question has a significance in evaluating the stress and anxiety due to which he might have postponed his dental visit in the last few months of the pandemic. In order to avoid any cross-contamination and chances of spread of COVID-19 infection the questionnaire was prepared on the electronic platform on Google forms so that disuse of paper and pen can avoid the chances of transmission of the COVID-19 infection.[6]


   Result and Observations Top


Five hundred and eleven patients were enrolled in the study after taking their online consent. 66.9% of the population was male and 29.8% were female. Maximum population were in the age group of 20–30 years (38.1%) 10.5% were in the age group of 10–20 years. Educational qualification of 39.8% were graduated, 15% were postgraduates and 6.6% were health care professionals. 28.2% of the population did not know about COVID 19. 67.4% were aware about the pandemic whereas 4.4% were confused and did not know about the complete scenario. 56.4% came for routine dental OPD and 43.6% had come for an emergency visit. 36.9% of population were not in stress and 62.4% were in stress and had anxiety regarding their visit for dental checkup and treatment [Figure 1]. The anxiety and stress regarding the pandemic and treatment were recorded on a Likert scale and P value was calculated which was <0.05 which is highly significant. 6.6% were not anxious as did not know much about the transmission of the disease and were ignorant and not so anxious. 30.4% had no fear of catching the infection from a dental procedure, 62.4% had fear and 7.2% of population was ignorant regarding the same. 24.9% were not bothered about sterilization/disinfection/personal protective equipment (PPE) etc., while undergoing checkup or treatment whereas 71.8% of the population wanted all COVID safety protocols to be followed diligently [Figure 2] 27% wanted to delay their dental treatment due to the ongoing Pandemic whereas 66.9% did not delay after proper counseling [Figure 3]. 86.7% were already COVID positive at some point of time before coming for treatment. [Figure 4] 70.7% had quarantined themselves before coming for dental treatment. 62.4% were willing for dental treatment postvaccination that meant vaccination drive will definitely have a positive impact on the mindset of people and 26% were not willing for treatment 11.6% were not sure because of ignorance and lack of knowledge [Figure 5].
Figure 1: Level of fear and anxiety (on basis of likert scale) of catching COVID 19 infection during dental procedure (P < 0.05)

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Figure 2: Level of fear and anxiety of catching COVID 19 infection and demand of PPE kit and safety measures by patients (P < 0.05)

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Figure 3: Level of fear and anxiety of catching COVID 19 infection and delay in dental treatment by patients (P < 0.05)

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Figure 4: Level of fear and anxiety of catching COVID 19 infection and patients who have already had COVID 19 Infection in past few months

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Figure 5: Level of fear and anxiety of catching COVID 19 infection and delay in dental treatment by patients who are waiting to get vaccinated (P < 0.05)

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   Discussion Top


The psychological aspects of COVID-19 Fear and Dental anxiety have to be considered and researched properly the world over just in case we want to prevent the spread of transmission of this infection to the dentist and through the dentist. Our research mainly focused about the psychological aspect of this pandemic on a small set of population coming to Dental OPD in a dental hospital for their treatment also in previous studies conducted worldwide our results were congruent with the study of Dr Shiva Shankar Bugude, Assistant Professor, Qassim University-Clinical trials. Gov US library-Cross Sectional study using scientifically validated psychometric Scales and found Correlation fear of COVID-19 and dental treatment anxiety P < 0.05. In our study, more number of male participants were enrolled 66.9% and about 50% of the population enrolled in the study were well educated. 62.4% of the participants had severe anxiety regarding the treatment and were suffering from COVID 19 anxiety although they had knowledge and awareness of the disease which clearly stated that the COVID anxiety and fear cannot be directly related to the educational status and knowledge regarding the current pandemic situation as also we found that 6.6% of the population living in suburbs and uneducated who were unaware about the pandemic situation were not at all anxious and were not in fear but this does not mean that being unaware/ignorant about the disease is the way of prevention from COVID 19 anxiety or stress. Rather population who is unaware or uneducated are the potential carriers high-risk group and spreaders of this deadly virus who do not follow COVID appropriate behaviors and are eventually increasing the load of infection at all levels.[7] Hence, it can be clearly stated and when compared with previous studies' knowledge, awareness is must so that the health care workers and also the patients must follow the proper sanitization, double mask, 1-m distance and proper COVID protocols while going for treatment. 71.8% population wanted to get the treatment and check erilization, PPE kits, face shields, HEPA Filters to curb this infection. Hence, it can be stated that if we do proper counseling and follow the appropriate COVID protocols and behaviors we can actually decrease the psychological impact of this disease on the general population and health care workers. Also, since 86.7% were tested COVID positive before they came in for treatment also meant that they were also anxious because of fear of COVID reinfection and also looking at the positive aspect of same since they were infected we are also going to develop some herd immunity sooner or latter against the deadly virus which can be told to individuals as reinfections are less deadly according to current data and research.[8],[9] There are various observational studies carried on participants for assessing the symptoms/signs, protective measures, awareness, and perception levels regarding COVID-19 among dentists in various countries like northern Italy LOMBARD, Pakistan, Saudi Arabia, Indonesia, and various European countires whose results support our present data.[5],[6],[7] This survey demonstrated that as a dentists and health care worker it should be our duty to increase the awareness and knowledge among the general population regarding the disease rather than creating a wave of fear we must spread a wave of hope and also educate them at all levels by counseling and motivating them to get the vaccination as early as possible so that they can get their treatment done without stress and anxiety.[10] Anxiety and stress in any form will also effect the healing and might create posttreatment complications in population. In the COVID-19 scenario, social distancing COVID appropriate behavior and becoming COVID guides can definitely help us all to come out of this deadly pandemic.[11]


   Conclusion Top


Hence, more studies with a bigger sample size covering more number of patients walking to dental OPD in the present scenario should be done to find out their main areas of concern, anxiety, fear and also the safest COVID protocols and postvaccination advantage that can be followed during the time of pandemic for patients as well as dentist. We should be able to treat the fear associated with the virus to increase awareness and decrease the anxiety related to dental procedures during this COVID scenario as there is no bigger virus then fear and no bigger vaccine then knowledge and awareness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Consolo U, Bellini P, Bencivenni D, Iani C, Checchi V. Epidemiological aspects and psychological reactions to COVID-19 of dental practitioners in the northern Italy districts of Modena and Reggio Emilia. Int J Environ Res Public Health 2020;17:3459.  Back to cited text no. 3
    
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Cagetti MG, Cairoli JL, Senna A, Campus G. COVID-19 Outbreak in North Italy: An overview on dentistry. A questionnaire survey. Int J Environ Res Public Health 2020;17:3835.  Back to cited text no. 5
    
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Pasiga BD. Relationship knowledge transmission of COVID-19 and fear of dental care during pandemic in South Sulawesi, Indonesia. Pesqui Bras Odontopediatria Clín Integr 2021;21:e0148.  Back to cited text no. 7
    
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Bizzoca ME, Campisi G, Muzio LL. Covid-19 pandemic: What changes for dentists and oral medicine experts? A narrative review and novel approaches to infection containment. Int J Environ Res Public Health 2020;17:3793.  Back to cited text no. 8
    
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Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: Development and initial validation. Int J Ment Health Addict 2020:1-9. [Online ahead of print]  Back to cited text no. 9
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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