OVID 19 is caused by a novel corona virus SARS-CoV-2, that began in Wuhan, China in late 2019. World Health Organization (WHO) declared Corona virus disease as public health emergency of international concern on January 30, 2020. [1] The transmission of COVID 19 can occur by direct, indirect or close contact with the infected person. The most common routes of transmission are droplets and close contact. Moreover, SARS-CoV-2 is also detected in gastrointestinal tissue, tears and conjunctival secretions of patients with COVID-19. [2] The most commonly stated symptoms of covid-19 are fever, dry cough and myalgia. In addition to these, nausea, diarrhea, reduced sense of smell (hyposmia) and abnormal taste sensation have also been reported. [3] The Dental Practitioners are at high risk of COVID-19 due to the nature of their profession, close proximity to the patient and exposure to saliva, blood and other body fluids during dental procedures. [4] Most of the dental procedures produce droplets and aerosols, for this reason infection control measures must be taken by the dentists. [5] SARS CoV-2 can be prevented in the dental setting by taking protective measures like prescribing mouth rinses prior to dental treatment, wearing medical masks, cleaning and disinfecting workplace, good ventilation and limiting aerosol generating procedures. [6] No specific antiviral treatments or vaccines are available for SARS-CoV-2. Therefore, the treatment is symptomatic and is limited to support and palliative care. [7] The aim of this study is to determine whether dentists of Pakistan are well aware of infection control protocols and are implementing them in their dental practices. This study may be useful in reducing the risk of spreading COVID-19 during clinical practice.

A Cross-sectional study was conducted among dentists working in dental clinics and hospitals of Pakistan. The study was approved by Research Committee of Riphah International University, Islamabad, Pakistan.

A Sample of 250 individuals (118 Males, 132 Females) was collected from dental practitioners working in different dental clinics and hospitals of Pakistan. Their ages ranged from 25 to 40 years.

Respondents for this study were recruited through online google form that included information on demographic characteristics, professional profile and knowledge of infection control measures taken by dentists during COVID-19 outbreak. In total, 250 respondents provided consent to participate in the survey. Participation was on a voluntary basis. The data were collected and statistically analyzed using the Statistical Package for the Social Sciences (IBM SPSS-22).

All the dentists were asked to fill a questionnaire. The questionnaire contained a series of questions regarding infection control measures taken by dentists during COVID 19 outbreak.

The questionnaire was divided into three sections:

The 250 participants were 25-40 years of age, 80.0% were 25-30 years of age, 18.8% were 30-35 years of age, and 1.2% were 35-40 years of age. (Table 1) Of the study participants, 62.8% were graduates of private institutes, 35.6% were graduates of public institutes and 1.6% were graduates of other institutes.

49.2% of the study participants were working in a private firm (hospital/clinic) and 37.2% were working in a public hospital. (Table 3) Participants were asked to describe about their work status during the pandemic. 34.4% of the participants were intermediately prepared to assist patients with confirmed cases of COVID-19, 23.2% were poorly prepared, 23.2% were not prepared at all, 16.0% were well prepared and 2.8% were very well prepared. (Table 7) Participants were asked about PPE availability for appointments in their work place. 24.0% were provided with disposable surgical masks, 21.6% were provided with N95 masks, 13.6% were provided with disposable surgical caps, 13.6% were provided with protective goggles and 16.0% were provided with face shields. 42.4% of the participants were most frequently using disposable surgical masks for assisting patients, 25.6% of the participants were using N95 masks, 17.2% were using surgical masks over N95 masks, 10.0% were using double disposable surgical masks and 0.8% were using surgical masks over reusable fabric masks. (Table 8) According to 36.4% participants, the structure of prime workplace was adapted to allow patient's treatment during the pandemic, according to 28.4% only waiting area was adapted, according to 21.2% the entire work environment was adapted and according to 14.0% the office was adapted. (Table 9) 56.4% of participants and their employees were following official recommendations for the clinical routine in their main workplace, while 30.8% weren't following any recommendations. (Table 10) When asked about COVID-19 screening before appointments in main workplace, 52.0% answered that they perform face to face application of specific questionnaire for COVID 19. 29.2% performed previous application of specific COVID 19 questionnaire via telephone, text message or similar. 10.4% performed temperature check of patients in the office. 5.6% requested temperature check before patient arrival at the office, 2.4% recommended mouthwashes or antimicrobials in the office and 4% recommended mouthwashes or antimicrobials for the patients before their arrival at the office.

33.9% of the participants were using 70% alcohol to disinfect contaminated surfaces at their prime workplace, 18.4% were using diluted sodium hypochlorite, 17.2% were using bleach, 4.9% were using undiluted sodium hypochlorite and 6.4% were not using any disinfectants or antimicrobials. (Table 12)

Universal precautions should be taken by dental practitioners to minimize the spread of corona virus and its associated disease. Centers for Disease Control and Prevention (CDC) recommends using additional infection prevention and control practices during the COVID-19 pandemic, along with standard practices recommended as a part of routine dental healthcare delivery to all patients. According to Centers for Disease Control and Prevention (CDC) recommendations, dental healthcare personnel (DHCP) should wear eye protection in addition to facemask to ensure protection of the eyes, nose, and mouth; use an N95 respirator or a respirator that offers an equivalent or higher level of protection during aerosol generating procedures.

All patients should be considered as potentially infected by Corona virus and all dental practitioners need to review their infection control policies during these challenging times. This might reduce the risk of spreading COVID-19 during clinical practice.

According to predictions, COVID-19 will persist in our population although it will be less virulent. Thus it is important to take precautionary measures to contain the spread of virus. Through this study, we also invite researchers to further investigate the infection control measures taken by dentists during COVID-19 outbreak.

V.

Dentists are at high risk of COVID 19 and its associated disease. Dental practitioners should wear a facemask at all times at their workplace. All patients and their caretakers/attendants should be screened for fever and symptoms consistent with COVID-19 before entering the health care facility. Number of visitors to the health care facility should be limited to only those who are essential for patient's well-being.

The Personal protective equipment (PPE) recommended when caring for a patient with suspected or confirmed COVID-19 includes respirator/facemask, eye protection (goggles or face shield), gloves and gown. Dental Practitioners must receive training on use of PPE, Donning and doffing of PPE and proper disposal of PPE.

Aerosol generating procedures (AGPs) should be avoided as much as possible. If Aerosol generating procedures (AGPs) need to be performed, Dental practitioners should take all protective measures i.e. use of N95 Mask or high level respirator, protective eye goggles, face shield, gloves and gown.