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Despite the availability of prevention guidelines and recommendations on infection control, many dental practices lack the minimum requirements for infection control.
This study aimed to assess the level of awareness, perception, and attitude regarding the coronavirus disease (COVID-19) and infection control among Jordanian dentists.
The study population consisted of dentists who worked in private clinics, hospitals, and health centers in Jordan. An online questionnaire was sent to a sample of Jordanian dentists in March 2020. The questionnaire was comprised of a series of questions about dentists’ demographic characteristics; their awareness of the incubation period, the symptoms of the disease, mode of transmission of COVID-19 and infection control measures for preventing COVID-19; and their attitude toward treating patients with COVID-19.
This study included a total of 368 dentists aged 22-73 years (mean 32.9 years, SD 10.6 years). A total of 112 (30.4%) dentists had completed a master or residency program in dentistry, 195 (53.0%) had received training in infection control in dentistry, and 28 (7.6%) had attended training or lectures regarding COVID-19. A total of 133 (36.1%) dentists reported that the incubation period is 1-14 days. The majority of dentists were aware of COVID-19 symptoms and ways of identifying patients at risk of having COVID-19, were able to correctly report known modes of transmission, and were aware of measures for preventing COVID-19 transmission in dental clinics. A total of 275 (74.7%) believed that it was necessary to ask patients to sit far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease disease transmission.
Jordanian dentists were aware of COVID-19 symptoms, mode of transmission, and infection controls and measures in dental clinics. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. National and international guidelines should be sent by the regional and national dental associations to all registered dentists during a crisis, including the COVID-19 pandemic, to make sure that dentists are well informed and aware of best practices and recommended disease management approaches.
The coronavirus disease (COVID-19) is a newly discovered viral infection that started in Wuhan, China and caused the outbreak of pneumonia in the rest of the world. It seems that the rapidly spreading virus is more contagious than severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus [
A large number of medical staff were reported to have acquired the disease while working with infected individuals [
There are practical guidelines recommended for dentists and dental staff by the Centers for Disease Control and Prevention (CDC), the American Dental Association (ADA), and the World Health Organization to control the spread of COVID-19 [
Despite the availability of prevention guidelines and recommendations on disease control, many dental practices lack the minimum requirements of infection control, which resulted from the low interest in taking the mandatory precautions. This lack of interest in making an extra, but essential, effort could be attributed to the high volume of patients treated in clinics that charge low or reduced dental fees [
Our study population consisted of dentists who work in Jordan, regardless of their place of work, in either private clinics, hospitals, or health centers. This survey was conducted in March 2020. An online questionnaire using Google Forms was used to collect the data. The sample of dentists was selected through Facebook groups for dentists. These groups were created by members of the Jordan Dental Association, and only dentists who work in Jordan can be involved in these groups by confirming their registration with the Jordanian dental association and their places of work. Although there were numerous groups, only five groups were randomly chosen: Jordanian dentists, dentists without borders, Jordanian dental club, Jordanian society of pediatric dentistry, and Jordanian dentists’ forum. Within the five selected groups, 700 dentists were randomly selected to participate in the study by their Facebook profiles. However, each participant who was randomly selected was contacted individually to make sure that they were a dentist and worked in Jordan. The questionnaires were anonymous to maintain the privacy and confidentiality of all information collected in the study. Ethical approval was obtained from the Institutional Review Board at Jordan University of Science and Technology.
The questions on the survey were developed after reviewing pertinent literature and the international guidelines [
Data were analyzed using SPSS (IBM Corp). Descriptive statistical analysis was used to describe items included in the survey. Means and standard deviations were used to describe the continuous variables, and percentages were used to describe the categorical data.
This study included a total of 368 (245 females and 123 males) dentists, forming a response rate of about 52.6% (386 participated out of 700 invited dentists). Their age ranged from 22-73 years with a mean of 32.9 (SD 10.6) years. Years of dental practice ranged from 1-30 years with a mean of 9.4 (SD 8.9) years. The participants’ characteristics are shown in
The characteristics of the 368 dentists enrolled in the study.
Variable | Dentists, n (%) | |
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Female | 245 (66.6) |
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Male | 123 (33.4) |
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<30 | 199 (54.1) |
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≥30 | 169 (45.9) |
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<5 | 185 (50.3) |
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5-10 | 59 (16.0) |
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>10 | 124 (33.7) |
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Middle | 190 (51.6) |
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North | 148 (40.2) |
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South | 30 (8.2) |
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University clinics | 112 (30.4) |
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Military sector | 28 (7.6) |
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Private sector | 144 (39.1) |
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Public sector | 84 (22.8) |
When asked about the incubation period, over one-third of dentists correctly reported 1-14 days. The percentage of dentists who reported the different symptoms of the COVID-19 infection are shown in
Dentists’ awareness about incubation period, symptoms, and mode of transmission of the coronavirus disease infection (N=368).
Variable | Dentists, n (%) | |
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1-14 | 133 (36.1) |
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2-7 | 12 (3.3) |
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7-14 | 162 (44.0) |
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7-21 days | 61 (16.6) |
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Fever | 363 (98.6) |
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Cough | 335 (91.0) |
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Shortness of breath | 316 (85.9) |
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Diarrhea | 147 (39.9) |
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Vomiting | 119 (32.3) |
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Runny nose | 133 (36.1) |
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Sore throat | 105 (28.5) |
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Red eyes | 28 (7.6) |
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Skin rash | 21 (5.7) |
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Joint or muscle pain | 7 (1.9) |
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May present with no symptoms | 127 (34.5) |
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Coughing and sneezing | 333 (90.5) |
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Hand shaking | 315 (85.6) |
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Touching surfaces such as doorknobs and tables | 343 (93.2) |
aCOVID-19: coronavirus disease.
The majority of the 368 dentists reported that cleaning hands frequently by using alcohol-based hand rub or soap and water, routinely cleaning and disinfecting surfaces in contact with known or suspected patients, and wearing personal protective equipment can help prevent transmission from patients with known or suspected COVID-19. The percentages of dentists who reported other specific measures are shown in
Dentists’ awareness of measures for the prevention of coronavirus disease transmission in dental clinics (N=368).
Measures for prevention | Dentists, n (%) |
Frequently clean hands by using alcohol-based hand rub or soap and water | 354 (96.2) |
Routinely clean and disinfect surfaces in contact with known or suspected patients | 347 (94.3) |
Personal protective equipment such as dental goggles, masks, and gloves | 342 (92.9) |
Put facemask on known or suspected patients | 325 (88.3) |
Avoid moving and transporting patients out of their area unless necessary | 310 (84.2) |
All health staff members wear protective clothing | 304 (82.6) |
Place known or suspected patients in adequately ventilated single rooms | 284 (77.2) |
A total of 65 (17.7%) of the 368 dentists perceived COVID-19 as very dangerous, 264 (71.7%) perceived it as moderately dangerous, and 35 (9.5%) perceived it as not dangerous. Almost one-third (n=135, 36.7%) of dentists believed that COVID-19 is not a serious public health issue. The majority (n=360, 97.8%) reported that it is important to educate people about COVID-19 to prevent the spread of the disease.
More than half (n=203, 55.2%) of the 368 dentists reported that COVID-19 symptoms often resolve with time and do not require any special treatment. Regarding dentists’ precautionary actions in the dental clinic, a total of 275 (74.7%) believed that it was necessary to ask patients to sit far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease disease transmission, while 80 (21.7%) believed that this was not necessary and could cause panic. However, a total of 304 (82.6%) dentists reported that they prefer to avoid working with a patient with a suspected case of COVID-19.
Dentists reported different attitudes toward a patient sneezing or coughing in their clinics: 161 (43.8%) mentioned that they would refer the patient to the hospital without treating them, 17 (4.6%) mentioned that they would refuse treating the patient and ask them to leave the clinic, 182 (49.5%) mentioned that they would treat the patient and ask them to go to the hospital.
Moreover, a total of 119 (32.3%) dentists reported that they would allow any of their dental staff to work with patients if they had flu-like symptoms. Only 214 (58.2%) reported that they know whom to contact in a situation where there has been an unprotected exposure to a patient with known or suspected COVID-19, and 279 (75.8%) reported that they know what to do if they have signs or symptoms suspected of COVID-19 infection.
For the dentists’ role in spreading information and increasing awareness, a total of 249 (67.7%) dentists reported that the dentist role in teaching others about COVID-19 is very significant, and 94 (25.5%) reported that it is moderately significant.
This survey provides an insight on the level of awareness, perception, and attitude of Jordanian dentists on infection control with a special emphasis on COVID-19 at the time of the outbreak in 2020. This study included a sample of Jordanian dentists. Females were predominant in this sample, which might be explained because the number of female dentists in Jordan is higher than the number of male dentists based on the latest Jordan Dental Association statistics [
The estimated incubation period of COVID-19 is up to 14 days [
There has been no evidence-based specific treatment for COVID-19, and management of COVID-19 has been largely supportive [
The attitude of dentists regarding what to do in case a patient was sneezing or coughing in their clinics varied; 43.8% (n=161) would refer the patient to the hospital without treating them, 4.6% (n=17) would refuse treatment, and 49.5% (n=182) would treat the patient and then refer them to the hospital. Some dentists (n=119, 32.3%) would allow their dental staff to work with patients if they had flu-like symptoms. During the outbreak of COVID-19, dentists should evaluate risk of transmission through measurements of the temperature of every staff and patient as a routine procedure. Patients should be asked about their health status and any history of recent contact or travel [
Over half of the dentists (n=214, 58.2%) knew whom to contact in a situation of an unprotected exposure to a known or suspected COVID-19 patient, and 75.8% (n=279) reported that they knew what to do if they had signs or symptoms of a suspected COVID-19 infection. By now, there has been no consensus on provision of dental treatment during the COVID-19 epidemic. Based on relevant guidelines and research, dentists should take strict personal protection measures and avoid or minimize operations that may produce droplets or aerosols [
Despite the findings introduced here, it is important to stress that this survey had limitations, including the relatively low response rate, which resulted in a smaller than expected sample size. This could have been caused by the short period of data collection. However, this is considered a moderate sample size. Moreover, this pandemic has caused many to be busy with watching the news and taking care of personal affairs. This means that those who were active on social media during the short period of data collection were the only ones that had the chance to participate in the study. This could result in selection bias and sampling error, which prevents the ability to generalize our results.
In conclusion, Jordanian dentists were aware of COVID-19 symptoms, mode of transmission, infection control, and measures in dental clinics. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. Guidelines released by reputable institutions should be sent by the regional and national dental associations to all registered dentists during a crisis, including this COVID -19 pandemic, to make sure that dentists are well informed and aware of the best practices and recommended disease management approaches.
American Dental Association
Centers for Disease Control and Prevention
coronavirus disease
None declared.