Patients awareness, perception, and willingness toward dental treatment during COVID-19 pandemic in India

INTRODUCTION

Coronavirus is a family of viruses that causes respiratory infections, the new coronavirus (SARS-CoV-2) discovered in December 2019 in China comes from the same family. This recent COVID-19 turned into a global public health outbreak.^[1] There is a multi-sectorial impact of the virus as the economic activities of most nations have slowed down.^[2]

Dentistry is one such sector that is severely affected. However, for decades dentists have been dealing with various blood-borne, bacterial, and airborne infections and have been tackling these infections effectively by following various guidelines issued by associations and administrations to prevent cross infection in dental settings. However, due to the mysterious nature of COVID-19, dentists have reduced their patients to only emergencies or completely closed their clinics for fear of spreading COVID-19 infection among their patients and family. However, this has created a tremendous financial burden on the dentist.

In united states, after gradual lifting of lockdown, all dental clinics were open but, only 1.2% did business as usual,^[3] conditions are the same globally as in India. It is important to know the reason behind it from patient perspective. Plenty of literature is available to know the knowledge, perception, and attitude of dentists and dental students about COVID-19. However, dentists are just one side of the coin when it comes to practicing dentistry, patients are the other side. Awareness among patients is equally important as it might help to reduce cross-infection. It is important to know patients’ perception of dental treatment during COVID-19 infection to understand their willingness toward dental treatment. Hence, this study aims to find out the awareness, perception, and willingness of patients toward dentists and dental treatment procedure.

MATERIALS AND METHODS

A Google form of the questionnaire was created. A close ended questionnaire (pre-tested and pre-validated with Cronbach’s alpha as 0.83) and a small message explaining the aims and objectives of the study were sent to participants. The participants were approached by the principal investigator and coinvestigator through personal connections and WhatsApp groups timely reminder were sent weekly. Participation was voluntary and all had an option of opting out of the study by not filling out the questionnaire. The study duration was 30 days. The sample size was calculated using Epi Info and came to be 616.

The questions were close ended. Participants were first asked about their demographic data, age gender, and education. Then, they were asked if they had any dental problems? Three response options were available “yes,” “no,” and “maybe.” The next three questions were on awareness of patients on COVID-19 infection, three response options were available “yes,” “no,” and “maybe.” The next five questions were on participant’s perceptions toward dental treatment and COVID-19 infection, and three questions were on the willingness, with responses of “yes” and “no.” Descriptive statistical methods were used to summarize data on demographic characteristics and responses to questions concerning knowledge, perceptions, and willingness toward dental treatment during COVID-19. ANOVA tests were used to determine the relationship between variables. All data analyses were performed using Statistical Package for the Social Sciences software, version 22. A value of P < 0.005 was considered statistically significant.

RESULTS

The basic data of all questions and the obtained answers percentage are mentioned in [Figures 1-4]. The majority of respondents belong to 40–60 years of age, are females, and with a postgraduate degree. The majority 95.1% were aware of how COVID-19 spreads and 90.9% are aware of various precautions necessary to prevent the spread of the disease. The majority of 74% of respondents are aware that dentists are at higher risk of acquiring COVID-19 infection. Many respondents 76.6% are afraid to visit the dentist, 64% fear being infected in the dental clinic by their dentist, and 85.6% fear being infected by other patients. Around 71.9% of people are concerned about the procedures used by their dentist to sterilize clinics. The majority of 74% think that it is better to delay dental treatment until the numbers of COVID-19 cases start declining. Only 28.2% are not willing to consult a dentist through teledentistry, 30.2% are not willing to provide medical certificates of being COVID negative, and 41.8% are not willing to pay more fees than usual for the extra precaution taken by the dentist to prevent COVID-19 spread.

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Figure 1:

(a) Data on distribution of age. (b) Data on distribution of gender. (c) Data on the distribution of education. (d) Data on dental problem.

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Figure 2:

Data on awareness.

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Figure 3:

Data on perception.

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Figure 4:

Data on willingness of patient.

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[Tables 1-3] represent data on awareness, [Table 1] shows data on awareness about the spread of disease, and there is a high statistical significance between age, education, and awareness about how COVID-19 spreads. However, no significance is seen between gender and awareness about the spread of COVID-19 infection (P = 0.013). [Table 2] shows data on awareness about various precautions necessary to prevent the spread of COVID-19. There is a statistical significance between age, gender, education, and awareness of various precautions necessary to prevent the spread of COVID-19 (P = 0.002, 0.001, and 0.005, respectively). [Table 3] shows data on awareness about dentists being at higher risk for acquiring the COVID-19 infection. There is no statistical significance in any group.

[Tables 4-6] show the perception of responses toward the dentist and spread of COVID-19 in the dental clinic. [Table 4] shows that data of respondents afraid to visit the dentist during the COVID-19 period. Although the majority of respondents are afraid to visit the dentist during the COVID-19 period, there is no significant difference between the groups based on age, education, and problem in oral health. [Table 5] shows that data on probable cause of why people may be afraid to visit the dental clinic during COVID period. Being aware that dentists are at higher risk for acquiring COVID-19 infection is not the statistically significant reason for people to be afraid to visit the dentist P = 0.862. Getting infected in the dental setting by the dentist (64%) and by other patients (85.6%) shows a highly statistically significant reason for patients being afraid to visit the dentist p-value 0.00l. Being concerned about the procedures used by the dentist to sterilize the clinic properly are also one of the reasons for respondents being afraid to visit the dentist p-value 0.001. [Table 6] shows data for do you think it is better to delay dental treatment until the number of COVID-19 cases starts declining. Distribution of age group shows a statistical significance P = 0.001 to wait for cases to decline before going for dental treatment. The majority of people think it is better to delay dental treatment. However, a greater percentage of people below 20 years of age do not think it is better to delay. There is no statistical significance between male and female to delay dental treatment, till cases are on decline P = 0.136. According to the education, those who are below intermediate (80%) think that they should not delay their dental treatment. There is no statistical significance in that group P = 0.64.

[Tables 7-9] show the preference and willingness of respondents toward dental treatment.

[Table 7] shows the willingness to choose to consult a dentist through teledentistry. The majority prefer to consult a dentist through teledentistry, no statistical significance was found in the age group and gender (P = 0.291 and 0.753), respectively. Statistical significance is found in the education group 0.001 and the presence of dental problems 0.005. [Tables 8 and 9] show the willingness of respondents to provide a medical certificate before treatment and willingness to pay more than usual fees for extra precautions taken by the dentist to prevent COVID-19 spread. No significance was found in any group except for those who have any dental problem and willingness to pay more than usual fees for extra precaution taken by your dentist to prevent COVID-19 spread P = 0.001.

DISCUSSION

The outbreak of COVID-19 brought dentistry at lowest point economically. In his study, we tried to find out the reason behind it, by knowing the perception of people toward dentist and dental treatment. Perception is built by knowledge and awareness. Hence, in this study, we study the awareness, perception, and willingness of patients toward dentist and dental treatment during COVID-19 times.

The majority of participants are in age group 20–60, and well educated, this distribution may be due to two reasons; first, the use of mobile phone and access to internet, second, the interest in filling the questionnaire. The number of people with dental problems is 282; it is important to know if the population is suffering from the dental problem or not as it greatly influences their perception and attitude toward dentist and dental treatment.

CONCLUSION

Certainly, COVID-19 has economically affected many sectors, dentistry being one severely affected. Patients are delaying their treatment due to fear of acquiring the infection from the dentist and other patients in the dental setting. The perception of people needs to be changed about dental treatment and acquiring the infection. For perception to change; first, dentists should follow all the guidelines provided by various associations and OSHA for personal safety as well follow the sterilization process to prevent cross infection in the dental setting. Second, the dentist should also educate and make people aware of all the extra precautionary measures taken by them during the COVID-19 period to prevent cross infection and make people feel safer in the dental setting. Most people are ready to consult their dentist through teledentistry so the dentist can encourage this and consult the majority of patients online and call only emergency patients to the clinic so that the clinic is not crowded. If possible, teleconsultations could be charged. Routine fees can be increased as the majority is ready to pay more. Teledentistry, a medical fitness certificate before treatment, and extra precautionary measures are the need of time during this period, and also spread of awareness about this is equally important.