INTRODUCTION
Coronaviruses
is a group of viruses that can cause disease in animals or humans. Some types
of corona virus are known to cause airway infections in humans ranging from
cold, coughs, to more serious ones such as Middle East Respiratory Syndrome
(MERS) and Severe Acute Respiratory Syndrome (SARS). The most common symptoms
of COVID-19 are fever, fatigue, and dry cough. Approximately 1 in 6 people
affected by COVID-19 are seriously ill and have difficulty breathing, COVID-19
can transmit from human-to human through droplets from the nose or mouth that
come out when COVID-19 patients coughs or exhales.
These droplets then fall onto nearby objects and surfaces. People who touch
these objects or surface and then touch their eyes, nose or mouth, may get
infected with COVID-19.
Dentists are
very often exposed to bioaerosol produced during dental treatment. There are
202 dentists in Indonesia who died from exposure to the covid-19 virus.3
The behavior of dentists facing the covid-19 virus outbreak is very instrumental
to prevent the transmission of the virus in the practice room, Dentists must
understand how the spread of covid-19, how to identify patients with this virus
infection, and what protective measures should be taken during practice, to
prevent transmission.
Figure .1.
how to
transmit covid-19 in the dentist's practice room (Peng et al., 2020)
In figure 1
shows the flow of transmission of the virus covid-19 patients who have been
infected with the virus and then producing aerosols that can transmit to
dentists who do not use optimal personal protective equipment and contaminate
the equipment and practice room, then will also transmit to the next patient.
So that is the spread of covid-19 virus transmission in other communities.
METHOD
This
research was descriptive qualitative research with an explorative approach. The
research was conducted to find out the extent of knowledge, attitudes and actions
of dentists in preventing the transmission of covid-19 in their practice room,
so that researchers tried to understand more deeply about the problems felt by
informants through in-depth interviews.
The
informant consisted of the main informant and the supporting informant. The
selection of informants was taken purposively in accordance with the principles
of conformity and adequacy. Data collection techniques were conducted with
in-depth interviews and literature searches related to dentist behavior towards
the prevention of covid-19 transmission. From the data collected, a transcript
of the data was then created that records all the data obtained as it was. The
analysis was conducted using theme design and data validity test using source
triangulation and data triangulation.
RESULTS
AND
DISCUSSION
In table 1 shows the characteristics of
the dentist. The main informants are 3 people, the gender of all women and have
been practicing for more than 15 years, while the supporting informant is the
chairman of PDGI Riau with a 25-year practice.
Table 1
Characteristics of
Informants
|
Informant Code
|
Education
|
Position
|
Age
|
Gender
|
Years of Practice
|
|
Main Informant 1
(U1)
|
S2- drg
|
governmental
|
42 th
|
Woman
|
16 years
|
|
Main Informant 2
(U2)
|
S1-drg
|
governmental
|
52 th
|
Woman
|
25 years
|
|
Main Informant 3
(U3)
|
Si-drg
|
PNS
|
51 th
|
Woman
|
26 years
|
|
Supporting
Informant (P1)
|
S2-drg
|
Chairman of PDGI
Riau Region
|
51 th
|
Woman
|
25 years
|
(Source : Interview Results 2020)
From the results of
in-depth interviews all informants knew that the pandemic that occurs at this
time was caused by coronavirus, symptoms were fever with temperature ≥ 38
degrees Celsius, cough, cold, sore throat and shortness of breath. and can be
transmitted by aerosol through inhaled droplets or contact with patients whose
hands touch the nose or eyes. All informants also knew that transmission of
this virus could be prevented by using personal protective equipment when
treating patients. and very understand that their job as dentists is a very
risky job to being infected with this covid-19 disease.
Based on the results
of the study, all dentists agreed with the covid-19 protocol in order to prevent
the transmission of coronavirus. This is stated by reason: (1) it is no longer difficult
to invite the patient to take precautions on him in the practice room such as
wearing a mask, washing hands with soap or using a hand sanitizer and keeping a
distance in the practice room; (2) the dentist him/herself is more disciplined
in using personal protective equipment (PPE) than before covid-19 pandemic for
fear of getting infected; (3) cost problems, although dentists are a little
troubled by the increasing costs for the procurement of complete equipment and
PPE and mostly charge patients with the addition of service money but still within
the limits of fairness and ability of patients to pay. Based on the results of
the interview, the addition of service money varies in size, ranging from not
adding a penny, the addition of ten thousand IDR, a hundred thousand IDR to
additional 10% of service applied before the covid-19 pandemic, as quoted
below:
�Raised but a little... Rp.10.000... a lot of spending to buy disinfectant
.....PPE ...... examination equipment is
multiplied.... minimized the transmission that can be done (IU1)" or
"Indeed the cost during the pandemic covid-19 is increased and there is no
additional cost of fixed patient services before covid-19"(IU2) or
"Services raised 10% for the purchase of 1x disposable tools per 1
patient" (IU3).
Based on the results of interviews with several dentists it is known
that all dentists took precautions against every patient who came to visit by
doing the following: (1) most dentist practices provided sinks for hand washing
using soap ;(2) all dentists obliged their patients and companions who came
using masks; (3) some dentists conducted screening such as temperature checks,
general disease history and previous trips; (4) all dentists had their patients
gargle with betadine solution and (5) gave instructions on covid protocol such
as always washing hands and wearing masks, using ethics if coughing and
sneezing and keeping a distance. Not all dentists did temperature checks with
the base and tools used have been damaged and have not had time to replace them
and other anamneses were not done because some patients object to tell the
symptoms of other diseases and wanted to do dental treatment only. As the
following interview excerpt:
"Sometimes
asked .. sometimes not .....
almost all patients say no previous illness or fever even just told to do dental
treatment only. For fever sometimes patients do not
want to tell ... patient objected to be asked the history of previous covid-19
infection ... No temperature measurement is performed. Patients are reluctant
to seeing doctor with PPE clothes and feel uncomfortable..
especially pediatric patients" (IU1).
In addition, almost
all dentists did some activities and increased food supply to increase
endurance such as exercise, sunbathing, inhaling eucalyptus oil, consuming
vitamins and fruits and adequate rest by reducing their hours of practice.
SARS-CoV-2, the
virus that causes COVID-19 allows transmission in dentistry practice due to the
possibility of inhalation of aerosols or droplets containing viruses or direct
contact with mucous membranes, oral fluids, and instruments and surfaces
contaminated with the virus. (Vickers, 2017) According to (Sari, Afriza, & Roesnoer,
2014), the lack of
knowledge of dentists towards infection control, it is stated that 48% of
respondents have low knowledge and 52% of respondents have high knowledge of
infection control. Based on the results of the study, respondents showed better
knowledge and understanding about the prevention of covid-19 transmission. This
may be because there has been a lot of information circulating about how to
prevent the transmission of covid 19. Most dentists agree with government
regulations imposed by health protocols to prevent covid. Based on a survey
conducted by North American Dental Group (NADG), the attitude of patients to
see a dentist has changed during the COVID-19 pandemic. Among the findings
stated 64% believe in taking treatment to a dentist's practice, because they
believe dentists know how to prevent the spread of COVID-19. Thanks to the
dental association, there is clear information on preventive procedures during
dentistry practice during COVID-19. As many as 60% of respondents said they
were comfortable visiting the dentist for regular cleaning or checkups, this
doubled from the previous month (F.N, 2020).
Dentistry can cause
aerosols from saliva or blood from patients, especially when using ultrasonic
scalers, high speed handpieces and three-way syringes. Aerosols containing
various microorganisms that can be inhaled and enter the respiratory tract of
patients as well as dentists and other officers (Liasari & Lesmana,
2020). In the case of
COVID-19 positive patients, if dental treatment is performed, especially scaling
with ultrasonic scalers can cause saliva containing the virus to be isolated
and spread and contaminate the dental unit. The virus can last up to 3 hours in
aerosols and can be detected on the surface of objects for up to 72 hours. This
leads to a high risk of dental health workers being exposed (Passarelli, Rella,
Manicone, Garcia-Godoy, & D�Addona, 2020). The spread of
COVID-19 virus occurs not only in patients who already have symptoms, but also
asymptomatic patients (Chang, Xu, Rebaza, Sharma,
& Cruz, 2020). Based on several
references to measures that can be taken in dentist practice by conducting
patient management and prevention of nosocomial infections prior to dental
treatment, the use of personal protective equipment for dentists and teams,
precautions during dental care, and environmental sanitation /practice room (Ather, Patel, Ruparel,
Diogenes, & Hargreaves, 2020);(Passarelli et al., 2020); (Peditto, Scapellato,
Marcian�, Costa, & Oteri, 2020).
Based on the results
of the study, the dentist's action against the prevention of covid-19
transmission has been good even though it was not optimal. During the pandemic,
patient management was necessary and prevention of transmission. Patients who come
to the clinic need to be restricted to avoid the spread of the virus between
patients (Lai,
Tang, Chau, Fung, & Li, 2020). Restrictions on
the number of patients coming to the clinic can be done by means of screening.
Screening of
patients by phone or other communication media needed to be done so that
patients can be grouped. Remote screening or tele-screening can be a
questionnaire containing questions asked to patients, including questions about
whether or not contact with others who are covid-19 patients, having traveled
to areas with high incidence rates, or whether or not there are symptoms of
fever and cough (Ather et al., 2020); Ge et al., 2020; (Lai et al., 2020). Likewise, in the
clinic waiting room, it needs to be arranged in such a way that there is a
minimum distance of 1 meter between patients (Vickers, 2017); (Rahman & Bahar, 2020).
The waiting room
should be facilitated with hand sanitizer. The patient is checked for body
temperature and required to wear a surgical mask. The use of this surgical mask
complies with level 1 personal protective equipment standards according to the
Classification of the American Society for Testing and Materials (ASTM). (ASTM Standards
&COVID-19, no date) Surgical masks can withstand 97.14% of viruses from
aerosols. (Lustig et al., 2020).
CONCLUSION
Dentist knowledge about covid-19 was good, all
dentists had knowledge about the causes of covid-19, symptoms of disease if
exposed to covid-19, consequences, ways of transmission and what measures were
taken to prevent transmission. The dentist's attitude towards preventing the
transmission of covid-19 strongly agrees with the covid-19 protocol. Prevention
behavior of covid-19 transmission conducted by dentists in self-service
practice room was not optimal, it was expected that dentists wear level 3
personal protective equipment and the government facilitates regular swab
examinations and vaccinations.
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Dentists� Behavior of Preventive
Measures toward COVID-19 transmission at Dental Clinics in Pekanbaru City
