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 Table of Contents  
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 49-56

Knowledge, attitude, and perception of orthodontists toward coronavirus disease 2019 pandemic: A cross-sectional study

1 Assistant Professor, Department of Dental Surgery, Pune, India
2 Department of Dental Surgery, AFMC, Pune, India
3 Department of Orthodontics, KIDS (KIITS University), Bhubaneswar, Odisha, India

Date of Submission15-Sep-2021
Date of Decision20-Dec-2021
Date of Acceptance21-Jan-2022
Date of Web Publication05-Apr-2022

Correspondence Address:
Paras Angrish
(Dental Officer), 303 Field Hospital, Tangste, Leh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jodd.jodd_39_21

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Background: Coronavirus disease 2019 (COVID-19) is a global pandemic with more than 30,300,000 cases in India and continuously affecting the dental community.
Objectives: The aim of present study was to assess the knowledge, attitude, and perception (KAP) of orthodontists of India, regarding COVID-2019 pandemic.
Methods: An online questionnaire was distributed among Orthodontists, using a combination of convenience and snowball sampling. The questionnaire had 31 questions depicting knowledge, awareness, attitude, and perception regarding COVID-19. The descriptive statistical analysis was done to compute frequency and percentages.
Results: Around 101 orthodontists participated in the study, out of 101 responders, 1 did not respond to even one question. Only 72% showed accurate knowledge with respect to the common symptoms of coronavirus. Mix responses regarding knowledge of sanitization of environment in clinic were reported among responses. Eighty-three percentage of orthodontist responded that COVID-19 pandemic has impact on orthodontic practice. Ninety-three percentage believe that they could transmit infection to their family members. Only 52% of the participants feels that they are safe at work.
Conclusion: Results of the present study suggest that COVID-19 is a major challenge to all the dental practitioners including orthodontists. This study is highlighting the lesser known facts about orthodontic practitioners, i.e., only half (52%) of them feel safe at work and majority of them feel that they can transmit the infection to their families from orthodontic setup. Moreover, a larger part of orthodontists feels that COVID-19 will permanently change the contemporary orthodontic practice.

Keywords: Attitude, awareness, coronavirus disease 2019, knowledge, orthodontists

How to cite this article:
Kamboj A, Sharma M, Jayan B, Chopra SS, Angrish P, Mohanty P. Knowledge, attitude, and perception of orthodontists toward coronavirus disease 2019 pandemic: A cross-sectional study. J Dent Def Sect. 2022;16:49-56

How to cite this URL:
Kamboj A, Sharma M, Jayan B, Chopra SS, Angrish P, Mohanty P. Knowledge, attitude, and perception of orthodontists toward coronavirus disease 2019 pandemic: A cross-sectional study. J Dent Def Sect. [serial online] 2022 [cited 2022 Nov 29];16:49-56. Available from: http://www.journaldds.org/text.asp?2022/16/1/49/342644

  Introduction Top

Coronavirus disease 2019 (COVID-19) infection is a respiratory disease that is caused by a member of the coronavirus (CoV) family called novel CoV.[1] High transmissibility and low pathogenicity are the unique features that distinguish it from other members of the CoV family, namely (severe acute respiratory syndrome [SARS-CoV]) and (Middle Eastern Respiratory Syndrome-CoV).[2],[3] Its incubation period ranges from 2 days to 21 days (median incubation period is estimated to be 5.1 days). The presence of asymptomatic population act as carriers and makes it challenging for health-care professionals to recognize the presence of COVID-19 infections, which could further increase the spread of the disease.[4],[5],[6] Human-to-human transmission of the virus occurs through airborne droplets, contact, or touch of an infected person or from a contaminated surface.[7] The main route of human-to-human transmission is through respiratory droplets (coughing and sneezing). It is also transmitted from contact (shaking hands) with an infected person or touching a contaminated surface and transferring it to the mouth, nose, or eyes.[8]

Infection preventive and control measures that can reduce the risk of exposure include use of face masks, covering coughs, and sneezes with a flexed elbow, regular hand washing with soap or disinfection with hand sanitizer containing at least 70% alcohol and maintaining a social distance of minimum 1.5–2 meters from humans.

Routine dental treatment includes many aerosol-generating procedures such as ultrasonic scaler and high-speed hand piece, thus increasing the chances of cross infection between dental practitioners and patients. Dental clinics and hospitals in countries affected with COVID-19 should follow strict protocol and guidelines for infection control. Standard operating procedures issued by several government organizations should be followed.

Hence, this survey was conducted to assess the knowledge, attitude, and perception (KAP) among orthodontists of India through online platform on infection control regarding the COVID-19 pandemic.

  Methods Top

This cross-sectional study was conducted among orthodontists who worked in Govt and private dental clinics, hospitals, or dental institutions in different cities of India.

Appropriate ethical approval for the study was obtained.

Sample size estimation was done using the following method.[9]


Z1-a/2 = Is standard normal variate (at 5% Type 1 error (P < 0.05) it is 1.01 for this study and at 1% Type 1 error (P < 0.01) it is 2.1). As in majority of studies P values are considered significant below 0.05 hence 1.01 is used in formula.

P = Expected proportion in population based on previous studies or pilot studies.

d = Absolute error or precision – Has to be decided by researcher.

If a researcher wants to calculate this sample size with the precision/absolute error of 5% and at Type 1 error of 5%. So if we use the above formula.

Hence, for this cross-sectional study, researcher has to take at least 100 subjects. If the researcher wants to increase the error (decrease the precision), then denominator will increase and hence sample size will decrease and viceversa.

The online questionnaire was prepared to collect data using Google forms. The questionnaire was distributed personally to orthodontists through E-mail. The study was done for a period of 2 months from January 2021 to February 2021. The participants were selected among members of different orthodontic study groups across India.

The questionnaire consisted of structured multiple-choice questions which were divided into sections. The first section had 10 questions regarding knowledge regarding COVID-19 infection and next section consisted of 10 questions regarding their attitude and last section had 11 questions pertaining to perception of COVID-19 pandemic. Out of 101, a total of 100 responses were received and results were analyzed using the Statistical Package for the Social Sciences (SPSS, version 21.0, Chicago, Illinois, USA: SPSS Inc).

  Results Top

A total of 100 responses were collected, out of which 95 orthodontists completed the entire questionnaire.

[Table 1], [Table 2], [Table 3] shows the response of the participants on different questions on KAP, respectively, which were used to calculate the total percentages.
Table 1: Frequency distribution of knowledge items

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Table 2: Frequency distribution of attitude items

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Table 3: Frequency distribution of perception items

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As depicted in [Table 1], most of the orthodontic practitioners were aware of causative agent, the common symptoms of COVID-19 infection, mode of infection, and gold standard for detecting COVID-19 infection (94% [Figure 1] responded reverse transcription polymerase chain reaction). However, knowledge regarding hand washing, sanitization, and viral load testing was not uniform among the respondents.
Figure 1: 10. Gold standard for detecting COVID-19 infection in a patient is

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Almost 83% [Table 2] responds to impact on practice and susceptibility of getting infection [Figure 2]. Mixed responses were given to questions like Govt. policies [Figure 3] on COVID-19 prevention, its accurate diagnosis and stress at work.
Figure 2: 12. Will COVID-19 Pandemic have impact on orthodontic practice?

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Figure 3: 14. Regulations taken by the govt. are enough to combat COVID-19 threat:

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73% of the participants [Figure 4] feels that there will be reduction in patients seeking orthodontic treatment and almost 70% [Figure 5] feels that COVID-19 will permanently change the contemporary orthodontic practice.
Figure 4: Do you think COVID-19 will lead to reduction in the number of patients seeking orthodontic treatment?

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Figure 5: 20. As an orthodontist, do you think COVID-19 will permanently change the way you practice orthodontics:

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[Table 3] shows 93% feels that they can transmit infections to their families [Figure 6] and 89.8% [Figure 7] feels that orthodontic setup can transmit infection. However, only 61% [Figure 8] feels that they are prepared to handle COVID-19 cases. Only 52% [Figure 9] of the participants feels that they are safe at work.
Figure 6: 21. I could transmit infection to my family

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Figure 7: 24. The circumstances in the dental center are suitable for transmitting infection

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Figure 8: 26. Do you feel prepared to handle COVID-19 cases?

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Figure 9: 27. Do you feel safe at work?

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  Discussion Top

The study found that orthodontists' knowledge of the mode of transmission (68%), vaccines (86.6%), and preventive dental practices (60%) for COVID-19 was better than the knowledge of the viral load testing (52.5%), symptoms of COVID-19 (72%), and sanitization method (60%).

The rapidly evolving nature of the pandemic means that information assessed in this study may have already become outdated by the time we conducted the analysis. The validity of our conclusions is, therefore, time relevant. However, this analysis focuses on orthodontic academics and provides useful insights. The findings are valuable for designing and planning continuing education programs for orthodontic academics on COVID-19 and for identifying areas where emphasis on updated information is needed.

In the present study, the internal consistency of the items used to measure knowledge just reached the acceptable level (1.01) and was low. This may be explained by the inclusion of measures of various domains of knowledge pertaining to COVID-19, of which participants were not well versed at the time of conducting this study. The study findings can help develop COVID-19-related training curricula when pretraining evaluation cannot be conducted, especially among orthodontists.

The respondents' level of comfort with relevant knowledge of COVID-19 and available measures to prevent the spread of disease in orthodontic practice was low and similar to that for providing elective or emergency treatment to a patient with confirmed or suspected COVID-19, understandably more so with the former. These findings could be attributed to the novelty of the disease, with published reports on human-to-human transmission in the community and evidence that SARS-CoV-2 transmission through respiratory aspirates, aerosols, and saliva mucous contact is highly likely.[10],[11]

Ninety-three percentage of the participants think that the risk of getting COVID-19 is higher for them and their families as a part of their job. Researchers found that fear of transmitting the virus to family and co-workers was the top concern of dentists and frontline health-care workers.[12]

This study has limitations: The first is the cross-sectional design, which cannot cover the change in orthodontic academics' knowledge at different points of time. During the pandemic, with more exposure to data flowing from many sources including social media, the knowledge of practitioners may change with passage of time. Thus, our results may underestimate knowledge over the time. In addition, the convenience sampling may reduce statistical representativeness. However, convenience sampling strategy is the only feasible method to sample exclusive orthodontists in the absence of a framework to gather information from single specialty practitioners. The low response rate limits the generalizability of the study findings. Low response may be explained by the academics being busy with online teaching,[13] and the saturation occurring due to exposure to multiple surveys about COVID-19. We addressed this low response rate by sending reminders, using personalized E-mails. Previous studies also reported low response in surveys conducted among health-care professionals send for online surveys in general, and our study response rate falls within the rate reported for online surveys.[14] Despite these limitations, the inclusion of single-specialty dental academics/practitioners from different educational systems, orthodontists of both private and govt setups, increases the generalizability of the findings.

In our current study, the majority of respondents were confident that they had sound COVID-19 related knowledge and this is in corroboration with the cross-sectional study by Hua et al.[15]

In an online cross-sectional survey conducted among Indonesian dentists,[16] it was found that knowledge and awareness of COVID-19 among Indonesian dentists were reasonably good (67%) and these findings are in validation of our present study.

In a web-based cross-sectional study conducted in Saudi Arabia[17] to assess knowledge, attitudes, and practices regarding COVID-19 among dental health-care professionals, it was concluded that dental professionals displayed an average level of knowledge (51.6%) that needed to be enhanced and these findings does not corroborate with our study which shows a sound knowledge among orthodontic professionals.

  Conclusion Top

Results of the present study suggest that, during the POST LOCKDOWN PHASE of Jan 2021 of the COVID-19 epidemic in India, when orthodontic services were gradually resuming, orthodontic professionals in India were generally confident that they understand COVID-19-related risks, however, only 60% of them were willing to treat or care for COVID-19 patients with proper protective gears.

Among precautions for several infectious diseases, COVID-19 is a major challenge to all the dental practitioners including orthodontists. This study is highlighting the lesser-known facts about orthodontic practitioners, i.e., only half (52%) of them feel safe at work and majority of them feel that they can transmit the infection to their families from orthodontic setup. Moreover, a larger part of orthodontists feels that COVID-19 will permanently change the contemporary orthodontic practice.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]

  [Table 1], [Table 2], [Table 3]


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