|Year : 2022 | Volume
| Issue : 1 | Page : 19-24
Evaluation of attitude and preparedness of dental students to treat patients suffering from infectious diseases
Santosh Mahajan1, S Rehman2, R Mahajan3
1 Department of Biochemistry, BJS Dental College, Hospital and Research Institute, Ludhiana, Punjab, India
2 Department of Physiology, BJS Dental College, Hospital and Research Institute, Ludhiana, Punjab, India
3 Student, BCM Senior Secondary School, Ludhiana, Punjab, India
|Date of Submission||26-Feb-2022|
|Date of Decision||07-Apr-2022|
|Date of Acceptance||26-Apr-2022|
|Date of Web Publication||16-Jul-2022|
Dr. Santosh Mahajan
Department of Biochemistry, BJS Dental College, Hospital and Research Institute, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
Background: Patients carrying serious infections always carry a high risk of transmission during dental treatment. Dentists by their positive attitude and level of preparedness can prevent the transmission of these infections in a dental setting.
Materials and Methods: The present study was a cross-sectional study planned to evaluate the attitude and preparedness of undergraduate and postgraduate students of Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, India, toward patients infected with human immunodeficiency virus and hepatitis B virus during their dental treatment. The study material was a questionnaire consisting of questions from various validated questions from the literature. The data obtained from 464 students (94 males and 360 females) were tabulated and analyzed using “t”-test and “Chi-square” test.
Results: Students showed passive attitude (attitude score < 75%) and poor preparedness with no difference with respect to dentistry year. Females revealed more preparedness, and it was significantly associated with their attitude (t-test, P = 0.007).
Discussion: Unwillingness of the students to treat infected patients is attributable to their fear of being infected during treatment, lack of supporting staff, and unawareness of the importance of biomedical waste disposal and use of disposable instruments.
Conclusions: The study clearly highlighted the need of teaching students about the transmission of these diseases and implementation of universal precautions at regular intervals to increase their moral and practical ability to handle such patients.
Keywords: Attitude, dental students, infectious diseases, preparedness
|How to cite this article:|
Mahajan S, Rehman S, Mahajan R. Evaluation of attitude and preparedness of dental students to treat patients suffering from infectious diseases. Int J Oral Health Sci 2022;12:19-24
|How to cite this URL:|
Mahajan S, Rehman S, Mahajan R. Evaluation of attitude and preparedness of dental students to treat patients suffering from infectious diseases. Int J Oral Health Sci [serial online] 2022 [cited 2022 Aug 8];12:19-24. Available from: https://www.ijohsjournal.org/text.asp?2022/12/1/19/350995
| Introduction|| |
Willingness of health-care professionals including dentists to treat patients suffering from any kind of infectious disease is related to their awareness of the cause, symptoms, and transmission of disease and their attitude and preparedness to manage such patients. Knowledge regarding these infections might be adequate in many health workers, but their attitude may be of question as some of them may not be willing to treat such patients., Despite being unethical everywhere throughout the world, numerous dentists do not treat human immunodeficiency virus (HIV)-positive people. The dread of transmission of diseases is one of the reasons for their decline to treat such patients., Reports are available in the literature where dentists and oral surgeons infected their patients with hepatitis B virus (HBV) during dental procedures suggesting the possibility of HBV transmission when infection control methods are not implicated. Dental professionals including dental students should realize that they are ethically liable to treat their patients with such infections and should have adequate knowledge regarding the transmission of diseases, necessary precautionary measurements, and positive attitude to deliver their responsibility. It is therefore important to assess the attitudes and preparedness of dental students which helps in understanding their willingness to treat HIV/hepatitis B-positive patients and if any modifications have to be incorporated into the dental curriculum to instill positive attitudes in them.
| Materials and Methods|| |
The present study was a cross-sectional survey conducted on undergraduate and postgraduate dental students. The study protocol was explained to the students, and written consent was obtained from the interested participants. The study material was a questionnaire consisting of questions from various validated questions from the literature. The questionnaire was divided into three sections. Demographic section (Section 1) included the age, sex, and the academic year of the students. Attitude section (Section 2) consisted of 14 questions, and preparedness section (Section 3) had 9 questions. Each question had Yes/No option. The questionnaire was distributed to the students willing to participate in the study. The data obtained were tabulated in MS Excel. The number and percentage of students taking part in the study and their responses to each question were calculated and scored. The attitude score ranged from 0 to 14 and the preparedness score ranged from 0 to 9 (each correct answer scored one point). The mean score was calculated per student and in percentage. The attitude score was interpreted as positive (>75%), passive (50%–75%), and negative (<50%). Preparedness was assessed for the students of clinical years only, i.e., from the 3rd year onward. A score <75% was considered as the poor preparedness of students to treat such patients. Data were analyzed using the Student's t-test and Chi-square test. The significance level was set at P ≤ 0.05.
| Results|| |
A total of 464 students including 94 males and 370 females participated in the study with a response rate of 100%. The attitude score ranged from 65.9% to 70.1% in males and 67.1–70.6 in female students of different academic years. [Figure 1] The mean score was calculated from the scores of the students of different academic years. The mean score was 70.1 ± 3.4 and 67.2 ± 4.6 in males and females, respectively, with no significant difference in the attitude of two sexes (P = 0.3). The score indicated their passive attitude (<75%)) [Table 1]. Ninety-eight percent (98%) of the students believed that it is important to make the patient understand the harmful effect of the diseases and it is their ethical responsibility to treat such patients. Seventy percent (70%) of the students were feared of infection (P = 0.05) and only 65% of the students were willing to treat these patients without hesitation (P = 0.014). Further, the willingness was not correlated to their clinical experience as >50% of inters and >60% of MDS students showed hesitation to treat these patients as compared to their juniors. Fifty-one percent (51%) of the students agreed that infected people should be treated in the same way as normal persons, but only 34.5% were willing to attend them in the outpatient department, and the difference was statistically significant (P = 0.039). Although >85% of the students felt that treating infected people will not affect their married life and their clinical practice, 70% of the students were worried to be at high risk while treating such patients, and 30.8% showed hesitation to deal with these patients (P = 0.02). Statistical significant differences were found on statements that it will be difficult to handle staff fear (P = 0.001) and they will shorten the procedure (P = 0.008) and/or refer the patient to the specialist (P = 0.001). 95.5% of the students believed that proper biomedical waste disposal helps in controlling the infections, but only 78.2% claimed that infection control procedure will not be a financial burden in their practice (P = 0.0001) [Table 2].
|Figure 1: Attitude score (%) of dental students towards HIV and hepatitis-B infected patients|
Click here to view
|Table 1: Association of attitude and preparedness/conscious score (percentage) (mean±standard deviation) of dental students toward human immunodeficiency virus- and hepatitis B-infected patients|
Click here to view
|Table 2: Attitude (percentage) of the students of different dentistry years to treat patients suffering from human immunodeficiency virus/hepatitis B infections|
Click here to view
The mean preparedness score was more in females (76.2 ± 0.02%) than in males (74.1 ± 2.1%) [Figure 2], and the difference was statistically significant (P = 0.009). The interns were found to be more prepared with no difference with respect to genders. With respect to dentistry years, no significant difference was observed regarding their responses on sterilization of instruments and wearing of gloves and mask while treating patients. A significant difference was obtained when enquired about the use of disposable instruments (P = 0.012) and disposal of biomedical waste (BMW) (P = 0.0009) [Table 3]. A statistically significant association was found between attitude and consciousness in females (P = 0.007) [Table 1].
|Figure 2: Preparedness score (%) of dental students towards HIV and hepatitis–B infected patients|
Click here to view
|Table 3: Preparedness of students of different dentistry years to treat patients suffering from human immunodeficiency virus/hepatitis B infections|
Click here to view
| Discussion|| |
With an increasing number of people with HIV/hepatitis receiving dental care, dentists should have sufficient knowledge of these diseases and their attitude should meet professional expectations. Despite having good knowledge score regarding HIV and hepatitis B infections reported previously, the attitude of our students was nonprofessional (passive). The mean attitude score was 68.7%, with no significant difference between the genders (P = 0.3). Our scores are similar to that of Malaysian dental students (69.08%) to treat HIV-infected patients, while Iranian dental students showed a negative attitude (attitude score: 57.4%) toward such patients with no difference in the knowledge and attitude of the two sexes. A positive attitude (77.7%) has been reported in Indian dental students to manage HIV patients. Although 98.1% of students feel that it is their ethical responsibility to treat infected patients, passive attitude of the students in our study is correlated [Figure 2] significantly to their fear of being infected (P = 0.05) and difficulty in handling staff fear (P = 0.001) while dealing with these patients, thus preferring to refer these patients to the specialist or shorten the procedure as far as possible. This behavior has indicated the difference in their practical skill and theoretical knowledge. Fear of handling staff fear has also been indicated in earlier studies., The attitude of referring the patient to the specialist is not as per the WHO guidelines which affirms that dentists must not refuse to treat HIV patients and they cannot refer the patients' specialty clinics for routine checkup. In our study, 65% of the students were willing to treat HIV/hepatitis B patients which was more than Nigerian dental students (58.8%) and Saudi dental students (10.2%)., Low willingness of the study sample has been attributed to their risk of being infected. Willingness to treat hepatitis B-, hepatitis C-, and HIV-infected patients has been reported as 80%, 75%, and 49%, respectively. About 93% of Chinese dental students were not willing to treat HIV patients despite having good knowledge. To our surprise, senior students (interns and MDS students) were less willing to treat infected patients than their juniors. This could probably be because of the role of teaching classes regarding diseases and their manifestations in various subjects they are taught till the 4th year of their dentistry and more formal training related to diseases in clinics, thereby increasing their awareness than interns and MDS students who are supposed to be preequipped with these information.
Hesitation to treat infected patients and fear of infection of the students in our study is related to their poor preparedness (preparedness score <75%) [Table 1]. Poor preparedness is reflected from their responses of not using disposable instruments (P = 0.009) during examination and not monitoring BMW disposal (P = 0.012), a root cause of infection. Although 96% of the students were aware that proper biomedical waste plays a major role in controlling infections, only 79.8% were following proper waste segregation rules, and the difference was statistically significant (P = 0.012). Passive attitude can also be attributed to their lack of confidence and awareness as indicated by their response on advice to be given to a person susceptible to be infected. Female students, however, showed significantly more preparedness than male students (P = 0.02), and there was a significant association of their attitude with their preparedness (P = 0.007). Female students scored higher on self-protection (P = 0.005), injury management (P = 0.0.001), and sterilization (P = 0.001) than male students of public dental schools in Egypt. Similar results have recently been found in Indonesian dental students where female students scored more in preparedness than males (P = 0.05). Previous studies have shown female students and health-care workers are more cautious in practicing infection control procedures. More preparedness of females can be associated with their natural instinct to be more cautious to deal with hazards of any kind as compared to relax attitude of males. The gender difference in preparedness has been attributed to the cost-related attitude of males while spending for infection control as compared to females.
| Conclusions|| |
Fear of being infected during the course of treatment, resistance of supporting staff, and poor protection control measures act as a barrier among dentists for their passive attitude. No difference in the attitude and the preparedness of students with dentistry years and significantly less preparedness of male students needs to be attended seriously.
Knowledge of BMW management and use of disposable instrument is prerequisite for dental students to prevent the transmission of these diseases. Regular educational programs to handle patients suffering from infectious diseases should be conducted at all levels to increase their moral and attitude and to understand the need of infection control measurements to prevent the threat of transmission while treating these patients.
We are highly thankful to the institute for providing all the facilities needed during the course of study. The authors would like to thank the students of the institute for their willingness to participate in the study and their co-operation during the collection of data. Nonteaching staff of the Department of Biochemistry is highly acknowledged for their help in collecting the data. We express our appreciation to the computer operator of the institute for his time to time help.
We are highly thankful to the institute for providing all the facilities needed during the course of study. The authors would like to thank the students of the institute for their willingness to participate in the study and their cooperation during the collection of data. Nonteaching staff of the Department of Biochemistry is highly acknowledged for their help in collecting the data. We express our appreciation to the computer operator of the institute for his time to time help.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kadeh H, Saravani S, Golzari P. Knowledge, attitude and practice of dentists towards patients with HIV, hepatitis B and hepatitis C infections. Avicenna J Dent Res 2014;6:1-6.
Aggarwal A, Panat SR. Knowledge, attitude, and behavior in managing patients with HIV/AIDS among a group of Indian dental students. J Dent Educ 2013;77:1209-17.
Jessri M, Fatemitabar SA. Implication of ethical principlesin chairside dentistry. Iran J Allergy Asthma Immunol 2007;6:53-9.
Peeran SW, Peeran SA, Alsaid FM, Murugan M. Hepatitid-C: Knowledge and attitude of graduating dentist from faculty of dentistry, Sebha, Libya. Dent Med Res 2016;4:18-23. [Full text]
Singh VP, Osman IS, Rahmat NA, Bakar NA, Razak NF, Nettem S. Knowledge and attitude of dental students towards HIV/AIDS patients in Melaka, Malaysia. Malays J Med Sci 2017;24:73-82.
Ahtone J, Goodman RA. Hepatitis-B and dental personnel: Transmission to patients and preventive issues. J Am Dent Assoc 1983;106:219-22.
Mahajan S, Bhardwaj K, Rehman S, Kaur P. Awareness about HIV and hepatitis B infections among dental students: A comparative cross-sectional study. BFUDJ 2021;11:21-9.
Sadeghi M, Hakimi H. Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients. J Dent Educ 2009;73:7740-5.
McCarthy GM, Ssali CS, Bednarsh H, Jorge J, Wangrangsimakul K, Page-Shafer K. Transmission of HIV in the dental clinic and elsewhere. Oral Dis 2002;8 Suppl 2:126-35.
Alrahmah WS, Ebrahim H, Younus M.
Knowledge and attitude of dental students towards the treatment of patients with hepatitis and HIV, A survey done in Riyadh, Saudi Arabia. J Dent Oral Hyg 2018;4:31-9.
Azodo CC, Ehigiator O, Oboro HO, Ehizele AO, Umoh A, et al
. Nigerian dental students' willingness to treat HIV-positive patients. J Dent Educ 2010;74:446-52.
Khalil H. Willingness of Saudi dental professionals to treat hepatitis B virus-infected patients. Niger J Clin Pract 2015;18:247-50.
] [Full text]
Hu SW, Lai HR, Liao PH. Comparing dental students' knowledge of and attitudes toward hepatitis B virus-, hepatitis C virus-, and HIV-infected patients in Taiwan. AIDS Patient Care STDS 2004;18:587-93.
Li R, Dong W, He W, Liu Y. Chinese dental students' knowledge and attitudes toward HIV/AIDS. J Dent Sci 2016;11:72-8.
El-Saaidi C, Dadras O, Musumari PM, Ono-Kihara M, Kihara M. Infection control knowledge, attitudes, and practices among students of public dental schools in Egypt. Int J Environ Res Public Health 2021;18:6248.
Wimardhani YS, Ossa YF, Wardhany II, Maharani DA, Lee C. Indonesian dental students' attitudes, knowledge, preparation, and willingness to treat HIV/AIDS patients. Eur J Dent 2022;10.1055/s-0041-1740350.
Shaghaghian S, Golkari A, Pardis S, Rezayi A, Author C. Occupational exposure of Shiraz dental students to patients' blood and body fluid. J Dent Shiraz Univ Med Sci 2015;16:206-13.
McCarthy GM, MacDonald JK. Gender differences in characteristics, infection control practices, knowledge and attitudes related to HIV among Ontario dentists. Community Dent Oral Epidemiol 1996;24:412-5.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]