The present study reported the awareness and knowledge of the undergraduate dental students and interns about the signs and symptoms of the Corona viral infection (COVID-19), and the required infection control measures to be taken during the current viral outbreak.
Questionnaire-based studies are proven as highly effective for gathering information regarding the awareness and knowledge of the dental students about COVID-19 and the protection equipment preferences of participants; however, careful data collection and interpretation is required (Sengupta et al. 2020).
The questionnaire used in the present study collected information objectively, through an online site for a period of two weeks. High level of participation was noted (n = 1555), which exceeded the calculated sample size (n = 1066) and increased the validity and reliability of the obtained results. The high level of participation possibly due to the fact that COVID-19 is a current issue which the dentists and dental students are worried about and interested in, as they do not know precisely the appropriate reactions and actions needed to be taken.
Since it has been approved that the primary route for transmission of COVID-19 is through air droplets and aerosols (Singhal 2020), the transmission of COVID-19 poses a risk for people who come in close contact with an infected individual, and the risk is greater among those who are in close proximity to or work near the patient. The distance between the working field and the dentist is approx. 35–40 cm, and certain procedures can be very time-consuming, thereby increasing the risk of dentists getting infected and further spreading the virus (Nejatidanesh et al. 2013).
Transmission of COVID-19 most commonly occurs when an infected patient sneezes, coughs, or even talks, then droplet from his mouth/nose is inhaled by another individual, which indicates that saliva can transmit the disease as it was reported by 97.2% of the participants.
The current study found that a large number of students agree that COVID-19 is a highly dangerous virus (96.9%) that was in accordance with Sengupta et al. (2020) who reported that 95% of the dentists from different countries reported COVID-19 as fatal disease.
Nonetheless, it was found that Egyptian dental students in this research were aware about the main symptoms of COVID-19, which helps the students to recognize the threat and take the necessary precautions, during their future dental practice, which is considered a fundamental part in the management and control of the spread of the virus (Meng et al. 2020; Gaffar et al. 2019).
It was reported that half of participants thought that it is vital to postpone the dental visit for a suspected infected patient with COVID-19, and these results were in accordance with a study done by Guo et al. (2020) and also in accordance with a research conducted by Ahmed et al. (2020), who reported that most of the dentists were fearful to perform dental treatment for a suspected infected patient.
It was established that droplets, saliva and aerosols are considered the main route for transmission of coronavirus (Ather et al. 2020) and that makes the dentists and healthcare workers at high risk of being infected or transmit the disease to their families or to other patients (Ahmed et al. 2020), and it was noticed that most of the participants (97.2%) agreed that saliva can transmit the disease which reflect their knowledge and awareness about routes of transmission of COVID-19.
In the literature, it has been indicated that aerosols and high-speed hand piece have the potential to spread bacteria and viruses to the dentist and dental staff (Barabari and Moharamzadeh 2020; Shah 2020; Checchi et al. 2020). So, choosing hand instruments or low-speed hand piece by most of the participants for dental management of suspected COVID patient indicated their awareness about the role of aerosols in spreading of the viral infection and that proper dental management for a suspected COVID patient is preferred to be by hand instruments.
Most of the students and interns (72%) had no idea about the anti-retraction valve hand piece. Using of high-speed hand piece with anti-retraction valves is considered one of the most important safety measures that hinders microbial cross-infection between patients, as it prevents the backflow of oral fluids and aspiration of biologicals fluids/microbes into the dental air and water tubes; therefore, cross-contamination of the dental unit is prevented (Peng et al. 2020; Xu et al. 2020; Fallahi et al. 2020).
Using rubber dam during dental treatment of the patients plays an essential role not only in isolation of the operating field but it also decreases the splatters of saliva and blood, which consequently decrease the risk of transmission of the viral infection through saliva (Ather et al. 2020; Xu et al. 2020; Villani et al. 2020).
The majority of the participants agreed that they should use rubber dams and saliva ejectors with low or high volume to reduce droplets and aerosols production during endodontic procedure and pulp therapy for children. So, this indicates that the information related to the way of contamination and spreading of COVID-19 and the measures for protection are well known (Peng et al. 2020; Wang et al. 2016; Bizzoca et al. 2020).
All the dental clinics/settings should be cleaned and disinfected as per the applicable regulatory standards, after each patient (Andersen et al. 2006; Gurzawska-Comis et al. 2020); all the work surfaces should be efficiently cleaned and decontaminated with ethyl alcohol (70%). If blood is visible on a surface, it is necessary to use sodium hypochlorite (0.5%) in cleaning and disinfecting the surfaces. It is essential to use protective gloves during sanitization and disinfection. All the procedures should be carried out with care to avoid contact of the disinfecting agents with the skin, eyes or mucosa (Jamal et al. 2020).
One of the most essential steps in preserving the safety and health of medical professionals, healthcare workers, including dentists, is the presence of effective infection control measures, and persistent use of convenient levels of personal protective equipment (PPE) (Khader et al. 2020).
Personal protective equipment (PPE) refers to wearable equipment that is designed to provide protection from exposure to or contact with infectious agents. PPE that is relevant to various types of patient interactions and efficiently covers personal clothing and skin prone to be exposed to saliva, blood or other potentially infectious materials should be used. These include gloves, face masks, protective eye wear, face shields, and protective clothing (e.g., reusable or disposable gown) (Odeh et al. 2020).
The students’ response in favor of personal protective equipment showed that (98.6%) recommended using face shields to provide protection from any blood or saliva splatters and (96.3%) chose disposable gowns as one of the most important personal protective equipment. Surgical masks are used to protect the nose and mouth from the large particles containing pathogens (such as droplets, sprays or splashes). It was also found that surgical masks do not create adequate seal against the skin of the face and therefore are not recommended to protect people from airborne infectious diseases and that clarify the preference of 88.4% of the participants for the N95 mask over the surgical mask (Bizzoca et al. 2020).
Concerning the limitations, being a cross-sectional study, so it recorded the knowledge and awareness of the dental students at the time of the survey and could not follow the improvement of knowledge and awareness of the dental students, that occurs with time.
Regarding the strengths, the results of the current study can be considered as a baseline record which facilitates further evaluation of the improvement of knowledge and awareness of the dental students about COVID-19 and the necessary infection control measures required during performing dental treatment.
