Dentists’ Awareness about the Spread of COVID-19 Infection Through Oral Cavity and Role of Saliva as a Diagnostic Tool for the Same

Introduction

The Coronavirus disease 2019 (COVID-19) pandemic initially originated in Wuhan, China, in December 2019. It was declared as a public health emergency of international concern by the World Health Organization (WHO).¹ COVID-19 has affected the health professionals around the world.² As dental practitioners work in close proximity to body fluids such as saliva and blood, they are at an increased risk for infection.² Saliva appears to be a promising alternative to nasopharyngeal/ oropharyngeal swabs for COVID-19 diagnosis and monitoring. Numerous salivary biomarkers including the salivary metabolites offer a high promise to be helpful for better understanding of COVID-19 and also in the identification of patients with varying degree of severity, including asymptomatic carriers.³ Dental health care professionals (DHCPs) are perpetually exposed to infectious oral fluids, which might play a main role in the dissemination of infection. DHCPs experience fear and psychological stress due to considerable work overload and low self-belief.⁴ Thus, it is necessary for DHCPs to follow the guidelines and recommendations to effectively treat patients and at the same time protect themselves from disease. Hence to address these issues, a study was conducted among dental professionals to assess their knowledge, attitudes and practices (KAP) regarding COVID-19.

Materials and Methods

This was a cross sectional survey conducted among four hundred subjects. Ethical clearance for the study was obtained from the Institutional review board of Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bangalore. A questionnaire was prepared and sent to all the participants as an online google form. The questionnaire consisted of 15 questions among which five questions were related to knowledge, five questions were related to attitude and remaining five questions were related to the practice.

The questionnaire was designed to assess the knowledge, attitude and practice towards the spread of COVID-19 infection through oral cavity and regarding role of saliva as a diagnostic tool. The google form questionnaire was distributed to faculty, postgraduates and dental practitioners of Bangalore city and the responses were collected.

Statistical analysis

Statistical Package for Social Sciences [SPSS] for Windows Version 22.0 of 2013. Armonk, NY: IBM Corporation, was used to perform the statistical analyses.

Descriptive analysis of all the informatory and outcome parameters was done using mean and standard deviation for quantitative variables, frequency and proportions for categorical variables.

Chi Square Goodness of Fit Test was used to compare the difference in the distribution of responses towards the study questionnaire among the participants.

Independent Chi square test was used to compare the responses for the study questionnaire based on the designation and other important socio-demographic characteristics of the study participants.

The level of significance [p-value] was set at p <0.05

Results

A total of four hundred participants were included in the study among which 186 were postgraduate students and 214 were faculty/dental practitioners (Figure 1, Table 1) in Bangalore city.

When the responses for knowledge, attitude and practice based questions were compared among the study participants, all the questions showed statistical significant results (Table 2, 3, 4). However, on comparing the responses given by postgraduates and faculty/dental practitioners, faculty/dental practitioners were found to be better at knowledge, attitude and practice towards the spread of COVID-19 infection and saliva as a diagnostic tool.

Regarding the knowledge (Table 5), 69.4% of postgraduates and 82.7% of faculty/dental practitioners were aware that saliva can be used as a diagnostic tool for COVID-19 in asymptomatic or mild cases. 61.8% of postgraduates and 75.7% of faculty/dental practitioners were aware that there will be presence of strains in saliva even 29 days after infection. 59.7% of postgraduates and 71.5% of faculty/dental practitioners knew that ACE-2 receptors are responsible for the entry and replication of Coronavirus in human salivary glands.

Regarding the attitude (Table 6), 62.9% of postgraduates and 76.6% of faculty/dental practitioners preferred hand scaling during the pandemic. 56.5% of postgraduates and 69.6% of faculty/ dental practitioners felt anxious while treating the patients during pandemic.

Regarding practice (Table 7), 58.1% of postgraduates and 74.3% of faculty/dental practitioners were aware that Coronavirus can be disinfected using 0.1% sodium hypochlorite. 76.9% of postgraduates and 78% of faculty/dental practitioners follow safe dental practice procedures which include use of high volume salivary ejections during dental procedures.

Discussion

One of the recent studies reported that self-collection of saliva sample for SARS-CoV-2 testing was achievable and can produce test results which could be relied upon.

Saliva can be considered a good reservoir for viruses that originate from oral cavity, secretions from the lower respiratory tract, nasopharynx and presumably infected salivary glands.¹ The diagnostic prospective of saliva was achieved by studies which revealed that, like serum, saliva contains hormones, antibodies, growth factors, enzymes, microbes and their products which can enter the saliva through blood via passive diffusion, active transport or extracellular ultrafiltration. Therefore, saliva can be a reliable fluid for monitoring the physiological functions of the body.²

Diagnosis of saliva-based viral infections depend on the presence of viral DNA, RNA, micro RNA, antigens or host antibodies in saliva. In this frame work, some viruses have been identified in saliva 29 days after infection, indicating that a saliva-based non-invasive diagnostic platform can be useful for early diagnosis and for monitoring the disease and treatment.³

In the present study, 77.08% participants demonstrated fair knowledge about COVID-19 test, and saliva as a diagnostic agent in detection of SARS-CoV2. In a study conducted by Arora et al.,² 88.8% of participants showed fair knowledge, while 92.7% showed a fair level of knowledge in a study conducted by Kamate et al. ³ The majority (81.3%) of the dentists agreed that wearing personal protective equipment like mask can be effective in preventing transmission of COVID-19 which is in accordance with the study conducted by Khader et al., ⁵ where 92.9% of respondents reported the same. 82.3% of the participants were aware that 0.12% chlorhexidine could be used as a pre-procedural mouth rinse to reduce the load of Coronavirus in saliva. In the present study, 89.74% followed fair practices which differed from the findings reported by Putrino et al., in which 25.3% of the participants had knowledge of practice.² ”

Conclusion

• Saliva-based testing can be an alternative to the widely used nasopharyngeal/oropharyngeal swabs for COVID-19 diagnosis and disease monitoring.
• Our results showed that both the groups demonstrated adequate levels of knowledge, while poor attitude and lack of practice was observed among the postgraduate students compared to the faculty/ practitioners.
• Further studies are required for better understanding of the mutual relationship between COVID-19 and saliva, which can help us in the adaptation of less invasive diagnostic techniques and facilitating the application of molecular tests on a large scale, a central strategy to keep the epidemic in check.

Source(s) of support

Nil

Conflict of Interest

Nil