COMPETITIVE STRATEGY MODEL AND ITS IMPACT ON MICRO BUSINESS UNITOF LOCAL DEVELOPMENT BANKSIN JAWA PJAEE, 17 (7) (2020)

KNOWLEDGE AND AWARENESS ABOUT SPREAD IN DENTAL CLINICS AMONG DENTAL STUDENTS

Mukil P Sunil1, Revathi Duraisamy2,Preetha S3 1Department Of ProsthodonticsSaveetha Dental College,Saveetha Institute Of Medical and Technological Sciences,Chennai, India 2Senior LecturerDepartmentOf ProsthodonticsSaveetha Dental College,Saveetha Institute Of Medical and Technological Sciences,Chennai, India 3Senior Lecturer,Department of Physiology,Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS)Saveetha University, Chennai, India

Mukil P Sunil, Revathi Duraisamy, Preetha S. KNOWLEDGE AND AWARENESS ABOUT AEROSOL SPREAD IN DENTAL CLINICS AMONG DENTAL STUDENTS--Palarch’s Journal Of Archaeology Of Egypt/Egyptology 17(7), 444-458. ISSN 1567-214x

Keywords: Dental, , transmission, contamination, precautions

ABSTRACT Aerosols are solid or liquid particles suspended in air with less than 50 µm in diameter and airborne particles which are larger than 50 µm size are called as splatter. The creation of airborne material during dental systems is evident to the dental specialist, the dental group and the patient. An airborne haze of particulate issue and liquid regularly obvious during dental methodology. Aerosols are produced with the use of high speed handpieces, ultrasonic scalers and air – water syringing. After the procedure is finished , airborne can remain suspended in air and settle some time later. Dental treatment in general significantly increased the level of bacteria air contamination and ultrasonic scaling produced three times contamination than operative dental treatment. Modern dental clinics are closed systems with air conditioning which needs regular monitoring for adequate ventilation to remove aerosols. Bacterial aerosols can be minimised by using air filters and ultraviolet (UV) light.

The aim was to find out the awareness and knowledge on aerosol spread in dental clinics among students in saveetha dental college.

The survey was conducted among 100 dental students in saveetha dental college, in the year of March 2020 to assess the knowledge and awareness about aerosol spread in dental clinics. A questionnaire based survey was done to create knowledge about aerosol spread in dental

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clinics. A total questionnaire of 10 questions were collected by google forms and the data was analysed by SPSS software.The results were collected and analysed using bar graphs. Chi square test was carried out to associate between gender or age and the various responses obtained in the questionnaire.

In this study, almost 49.1% of the respondents were aware of the aerosol transmission.Almost 60% of the respondents are aware of how long aerosols can stay in air.61.4% of the respondents used to wear gloves and masks always in the clinic.In figure 10, it shows association between gender and awareness on contagious aerosol transmission. Chi square test p value was 0.516(p value>0.05). Hence it is statistically not significant.

This study concludes that almost half of the respondents are only aware of aerosol spread in dental clinics in saveetha dental college.

INTRODUCTION A dental aerosol is an aerosol that is produced from dental instruments like ultrasonic scalers, dental handpieces, three way syringes and other high speed instruments. These aerosols are air suspended inside the clinical environment. These aerosols can pose dangers to the clinician, team of workers and other patients as well. The heavier particles of the aerosols suspended within the air for relatively quick, duration and settles down quickly, however the lighter particles tend to stay suspended for longer durations and are capable to enter and get deposited in the when they may be inhaled and possess the potential of transmitting .[2] These dental aerosols also are which might be contaminated with bacteria, fungi and of oral cavity, skin and water used within the dental units [3]. Dental aerosols additionally have micro particles of the burs and silica particles that are one in every additive of the dental filling substances like [4][15]. Depending upon the technique and site, the aerosol composition may change from patient to affected patient. Apart from , these aerosols may include debris from saliva, blood, , , dental debris, oronasal secretions, gingival fluids, and micro particles from grinding of the teeth [5]. They also include abrasive particles which are expelled all through air abrasion and sharpening methods [14]. The size of the dental aerosol particles is less than 50 micrometer. The smaller particles with size between 0.5micrometer to 10micrometer are more likely to be inhaled and have the potential to transmit the [13]. Understanding the risk posed by aerosols will help minimize the possibility of transmission during dental procedures. Respiratory infections, both chronic and acute - contributed to 6 million deaths in 2016 and they are highly communicable.[23] Many respiratory infections have been linked to oral microbiota. Dental procedures that use low or high speed handpieces, lasers, electrosurgery units, ultrasonic scalers, air polishers, prophy angles, hand instruments or air/water syringes can create aerosols and spatter [6][18]. The water used in the dental units may be contaminated with legionella, the aerosols from the handpieces of such dental units may lead to inhalation by dentists, staff and patients. The dental unit water lines can also be contaminated with different microorganisms like microbacteriumspp and

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[11]. Infection from legionella species causes infection like legionellosis and numerous like diseases[8][19]Modern dental clinics are closed systems with air conditioning which needs regular monitoring. Bacterial aerosols can be minimised by using air filters and ultraviolet (UV) light. So this survey aims at evaluating the awareness and knowledge on aerosol spread in dental clinics among students.[20]

MATERIALS AND METHODS The present study was carried out among a group of dental college students, in the year of March 2020 to assess the knowledge and awareness about aerosol spread in dental clinics. . A questionnaire based observational cross sectional type of study comprising 100 students who were willing to take up the survey. A self administrative questionnaire was circulated through an online survey. The online survey was created in google forms. The data was analysed and represented in pie chart and bar graph means. The data collected in google forms was converted to excel sheet . The data in the excel sheet was transferred to SPSS software. It involves both statistical and percentage analysis and results were in the form of a bar graph. The independent variables used were age, gender, and knowledge, while the dependent variables include awareness and knowledge.

ANALYSIS Statistical software: SPSS Statistical test used : Chi Square Test

Types OfAnalytics: Descriptive analysis - demographic data

RESULTS The respondents in this survey were from different age group.40.4% from 19- 22 years of age group and 26.3% of the respondents were from 22-25 years of age (Figure 1). 61.4% of females attended the survey (Figure 2).In this survey just 49.1% of the respondents were only aware of the aerosol contamination and transmission in clinics (Figure 3).60% of the respondents knew how long dental aerosols stay in the air (Figure 4). 43.9% of the respondents knew how long aerosols can travel (Figure 5). 44.6% of the respondents knew tooth debris can lead to aerosol transmission (Figure 6). 61.4% of the respondents always wear a mask and gloves while in the clinic (Figure 7). 54.4% of the respondents knew dental drills can transmit aerosolized particles(Figure 8). 56.1% of respondents were aware of all risk factors and basic properties of aerosol particles (Figure 9).In figure 10, it shows association between gender and awareness on contagious aerosol transmission. Chi square test p value was 0.516(p value>0.05). Hence it was statistically not significant. In figure 11, it shows association between gender and awareness on tooth debris leading to aerosol transmission. Chi square test p value was 0.722(p value>0.05). Hence it was statistically not significant. In figure 12, it shows association between gender and awareness on all risk factors of aerosols generated. Chi square test p value was 0.459(p value>0.05). Hence it was statistically not significant. In the above three graphs, females were more aware than males. In figure 13, it shows association between age and awareness on contagious aerosol

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transmission.Chisquare test p value was 0.364(p value>0.05). Hence it was statistically not significant. In figure 14, it shows association between age and awareness on tooth debris leading to aerosol transmission. Chi square test p value was 0.797(p value>0.05). Hence it was statistically not significant. In figure 15, it shows association between age and awareness on all risk factors of aerosols generated. Chi square test p value was 0.923(p value>0.05). Hence it was statistically not significant.

DISCUSSION This is an external descriptive on the knowledge and awareness on aerosol spread in clinics among students in Saveetha Dental College, Chennai. In the present study almost 49.1% of the respondents were aware of the contagious aerosol contamination in dental clinics (Figure 3). In a similar kind of study by S Acharya and H Priya, almost half of the respondents were only aware of aerosol contamination[10][16] In the present study, 44.6% of the respondents know that tooth debris can lead to aerosol transmission (Figure 5 ) In a similar kind of study by A Caralho almost 59% of the respondents knew that tooth debris can lead to aerosol transmission. It may be because they conducted the survey among masters students, they have more experience in [11].[21] In this study, when students were asked if they wear a mask and gloves always when treating a patient, 61.4% responded positively (Figure 7) In a study by G R Frank, the respondents gave similar results supporting the present study[12][17]. It is mandatory that a dental surgeon and assistants should use personal protection measures (Surgical gowns, gloves, masks, protective eyewear ,Face shields) can decrease the penetration of or reduce contact with bacterial aerosols and splatter In this survey 54.4% of the respondents knew that even dental drills can spread aerosolized particles.(Figure 8 ) King et al. suggested the use of aerosol reduction device as an effective method in reducing the number of microorganisms generated during ultrasonic scaling, and drilling therefore reducing the risk of transmission[26] In this survey, almost 60% of the respondents knew how long dental aerosols can travel and stay ( Figure 5) In a similar kind of survey by Kedjarune in 2000, they got a similar kind of results supporting the present study.[27] Whenever an ultrasonic scaler, high speed handpieces or air polisher is used the following steps should be followed: (1) high volume evacuation(2) barrier protection, and (3) pre procedural rinsing advised to the patient. Each of these adds a layer of protection for the operator and others in the dental office. The limitations in the present study include the less number of people included in the study and similar geographical area. More number of people should be included in the survey with the more relevant questions regarding PPE and it should not stick into a particular geographical area, otherwise we cannot generalise the results. Including more participants and comparing with the present study can help in getting precise results in the coming future.

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Figure 1:The bar graph depicts the distribution of age groups of respondents who attended the survey. X axis represents age group and Y axis represents the number of participants.40.4% were from 19-22 years of age, 26.3% were from 22-25 years of age, 22.8% were from 16-19 years of age and 10.5% were above 25 years of age.

Figure 2: The bar graph depicts the gender classification of respondents who attended the survey. X axis represents gender and Y axis represents the number of participants.61.4% were females and 38.6% were males.

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Figure 3:The bar graph depicts the percentage distribution of awareness on contagious aerosol contamination in dental clinics. X axis represents awareness on contagious aerosol contamination and Y axis represents the number of participants, where yes (blue) and no (red). 50.9% were not aware and 49.1% were aware of aerosol contamination.

Figure 4:dental aerosols stay in the air.X axis represents respondents who knew how long dental aerosols can stay in air and Y axis represents the number of participants, where yes (blue) and no (red). 60% of the respondents were aware of it and 40% were not

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Figure 5: The bar graph depicts the percentage distribution of respondents who knew how long dental aerosols can travel. X axis represents awareness on how long dental aerosols can travel and Y axis represents the number of participants, where yes (blue) and no (red). 56.1% of the respondents were aware of it and 43.9% were not aware.

Figure 6: The bar graph depicts the percentage distribution of respondents who knew dental debris can lead to aerosol transmission.X axis represents awareness on tooth debris leading to aerosol transmission and Y axis represents the number of participants, where yes (blue) and no (red). 44.6% were aware and 55.4% of the respondents were not aware of it.

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Figure 7: The bar graph depicts the percentage distribution of respondents who always wear gloves and masks while treating a patient.X axis represents awareness on wearing masks and gloves while treating a patient and Y axis represents the number of participants, where yes (blue) and no (red). 61.4% of the respondents always used to wear gloves and masks while treating a patient, while 38.6% of the respondents were not aware.

Figure 8:The bar graph depicts the percentage distribution of respondents who knew dental drills can spread aerosolized particles.X axis represents awareness on dental drills leading to aerosol transmission and Y axis represents the number of participants, where yes (blue) and no (red). 54.4% of the

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respondents were aware of it and 45.6% of the respondents were not aware of it.

Figure 9: The bar graph depicts the percentage distribution of respondents who are aware of all risk factors and basic properties of aerosols generated.X axis represents awareness on all risk factors and basic properties of aerosols generated and Y axis represents the number of participants, where yes (blue) and no (red). 56.1% of the respondents were aware of all risk factors while 43.9% were notaware of it.

Figure 10:The bar graph represents the association between gender and awareness on contagious aerosol transmission. The X axis represents the gender and Y axis represents the number of responses. Blue denotes yes and

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red denotes no. Females were more aware than males on contagious aerosol transmission. Chi square test was carried out to associate the variables, where yes (blue) and no (red). Chi square test p value was found to be 0.516 (p value>0.05) which is statistically not significant

Figure 11: The bar graph represents the association between gender and awareness on tooth debris leading to aerosol transmission. The X axis represents the gender and Y axis represents the number of responses. Blue denotes yes and red denotes no. Females were more aware than males on tooth debris can lead to aerosol transmission. Chi square test was carried out to associate the variables. Chi square test p value was found to be 0.722 (p value>0.05) which is statistically not significant.

Figure 12:The bar graph represents the association between gender and awareness on all risk factors and basic properties on aerosols generated. The X axis represents the gender and Y axis represents the number of responses. Blue denotes yes and red denotes no. Females were more aware than males on all

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risk factors and basic properties on aerosols generated. Chi square test was carried out to associate the variables. Chi square test p value was found to be 0.459 (p value>0.05) which is statistically not significant.

Figure 13: The bar graph represents the association between age and awareness on contagious aerosol transmission. The X axis represents the age and Y axis represents the number of responses. Blue denotes yes and red denotes no. Respondents of 19-22 years of age group were more aware than other age groups about aerosol contamination in dental clinics. Chi square test was carried to associate the variables. Chi square test p value is found to be 0.364 (p value>0.05) which is statistically not significant .

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Figure 14: The bar graph represents the association between age and awareness of tooth debris leading to aerosol transmission. The X axis represents the age and Y axis represents the number of responses. Blue denotes yes and red denotes no. Respondents of 19-22 years of age group were more aware than other age groups about tooth debris can lead to aerosol transmission. Chi square test was carried out to associate the variables. Chi square test p value is 0.697 (p value>0.05) which is statistically not significant.

Figure 15: The bar graph represents the association between age and awareness on all risk factors and basic properties on aerosols generated. The X axis represents the age and Y axis represents the number of responses. Blue denotes yes and red denotes no. Respondents of 19-22 years of age group were more aware than other age groups on the risk factors of aerosol generated. Chi square test was carried out to associate the variables. Chi square test p value is found to be 0.923 (p value>0.05) which is statistically not significant.

CONCLUSION From the study it can be concluded that only half of the respondents were aware of the aerosol spread of infection in dental clinics. So it is necessary to create more awareness and knowledge about it in the future. The advent of Corona and its reemergence, in dental clinics minimal aerosol producing procedures should be encouraged.

AUTHOR CONTRIBUTION Author 1 (Mukil Sunil) carried out the by collecting data and drafted the manuscript after performing statistical analysis. Author 2(DrRevathiDuraisamy) aided in conception of the topic, has participated in the study design, statistical analysis and has supervised in preparation of the

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manuscript. Author 3 (Dr. Preetha S) has participated in the study design and has coordinated in developing the manuscript. All the authors have discussed the results among themselves and contributed to the final manuscript.

ACKNOWLEDGEMENT The team extends our sincere gratitude to the Saveetha Dental College and Hospitals for their constant support and successful completion of this work.

CONFLICT OF INTERESTS The authors have none to declar

REFERENCES Rj GB, Microbiology, Madhuri KR, Microbiology. Evaluation of bacterial aerosol contamination during dental procedures [Internet]. Vol. 5, IP International Journal of Medical Microbiology and Tropical Diseases. 2019. p. 23–7. Available from: http://dx.doi.org/10.18231/2581- 4761.2019.0006 Rivera-Hidalgo F, Barnes JB, Harrel SK. Aerosol and Splatter Production by Focused Spray and Standard Ultrasonic Inserts [Internet]. Vol. 70, Journal of Periodontology. 1999. p. 473–7. Available from: http://dx.doi.org/10.1902/jop.1999.70.5.473 Zemouri C, de Soet H, Crielaard W, Laheij A. A scoping review on bio- aerosols in healthcare and the dental environment [Internet]. Vol. 12, PLOS ONE. 2017. p. e0178007. Available from: http://dx.doi.org/10.1371/journal.pone.0178007 Sivakumar I, Arunachalam KS, Solomon EGR. Occupational health hazards in a prosthodontic practice: review of risk factors and management strategies [Internet]. Vol. 4, The Journal of Advanced Prosthodontics. 2012. p. 259. Available from: http://dx.doi.org/10.4047/jap.2012.4.4.259 King TB, Muzzin KB, Berry CW, Anders LM. The Effectiveness of an Aerosol Reduction Device for Ultrasonic Sealers [Internet]. Vol. 68, Journal of Periodontology. 1997. p. 45–9. Available from: http://dx.doi.org/10.1902/jop.1997.68.1.45 Spendlove J. Standard precautions in dentistry [Internet]. Vol. 7, Dental Nursing. 2011. p. 692–5. Available from: http://dx.doi.org/10.12968/denn.2011.7.12.692 Bartram J, Chartier Y, Lee JV, Pond K, Surman-Lee S. Legionella and the Prevention of Legionellosis. World Health Organization; 2007. 252 p. Hutton MD, Polder JA. Guidelines for preventing transmission in health care settings: What’s new? [Internet]. Vol. 20, American Journal of Infection Control. 1992. p. 24–6. Available from: http://dx.doi.org/10.1016/s0196-6553(05)80121-x Acharya S, Priya H, Purohit B, Bhat M. Aerosol contamination in a rural university dental clinic in south India [Internet]. Vol. 6, International Journal of Infection Control. 2010. Available from: http://dx.doi.org/10.3396/ijic.v6i1.003.10 Brignardello-Petersen R. Insufficient evidence to claim that a 2-arm interdental cleaning device has better reachability and accessibility than a 1-arm interdental cleaning device [Internet]. Vol. 148, The

456

COMPETITIVE STRATEGY MODEL AND ITS IMPACT ON MICRO BUSINESS UNITOF LOCAL DEVELOPMENT BANKSIN JAWA PJAEE, 17 (7) (2020)

Journal of the American Dental Association. 2017. p. e177. Available from: http://dx.doi.org/10.1016/j.adaj.2017.08.019 Ariga P, Nallaswamy D, Jain AR, Ganapathy DM. Determination of Correlation of Width of Maxillary Anterior Teeth using Extraoral and Intraoral Factors in Indian Population: A Systematic Review [Internet]. Vol. 9, World Journal of Dentistry. 2018. p. 68–75. Available from: http://dx.doi.org/10.5005/jp-journals-10015-1509 Jyothi S, Robin PK, Ganapathy D, Anandiselvaraj. Periodontal Health Status of Three Different Groups Wearing Temporary Partial Denture [Internet]. Vol. 10, Research Journal of Pharmacy and Technology. 2017. p. 4339. Available from: http://dx.doi.org/10.5958/0974- 360x.2017.00795.8 Duraisamy R, Krishnan CS, Ramasubramanian H, Sampathkumar J, Mariappan S, NavarasampattiSivaprakasam A. Compatibility of Nonoriginal Abutments With Implants: Evaluation of Microgap at the Implant-Abutment Interface, With Original and NonoriginalAbutments. Implant Dent. 2019 Jun;28(3):289–95. Selvan SR, Ganapathy D. Efficacy of fifth generation cephalosporins against methicillin-resistant Staphylococcus aureus-A review [Internet]. Vol. 9, Research Journal of Pharmacy and Technology. 2016. p. 1815. Available from: http://dx.doi.org/10.5958/0974-360x.2016.00369.3 Ganapathy D. Effect of Resin Bonded Luting Agents Influencing Marginal Discrepancy in All Ceramic Complete Veneer Crowns [Internet]. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. 2016. Available from: http://dx.doi.org/10.7860/jcdr/2016/21447.9028 Subasree S, Murthykumar K, Dhanraj. Effect of Aloe Vera in Oral Health-A Review [Internet]. Vol. 9, Research Journal of Pharmacy and Technology. 2016. p. 609. Available from: http://dx.doi.org/10.5958/0974-360x.2016.00116.5 Ranganathan H, Ganapathy DM, Jain AR. Cervical and Incisal Marginal Discrepancy in Ceramic Laminate Veneering Materials: A SEM Analysis. ContempClin Dent. 2017 Apr;8(2):272–8. Vijayalakshmi B, Ganapathy D. Medical management of cellulitis [Internet]. Vol. 9, Research Journal of Pharmacy and Technology. 2016. p. 2067. Available from: http://dx.doi.org/10.5958/0974-360x.2016.00422.4 Ganapathy DM, Kannan A, Venugopalan S. Effect of Coated Surfaces influencing Screw Loosening in Implants: A Systematic Review and Meta-analysis [Internet]. Vol. 8, World Journal of Dentistry. 2017. p. 496–502. Available from: http://dx.doi.org/10.5005/jp-journals-10015- 1493 Ashok V, Suvitha S. Awareness of all ceramic restoration in rural population [Internet]. Vol. 9, Research Journal of Pharmacy and Technology. 2016. p. 1691. Available from: http://dx.doi.org/10.5958/0974- 360x.2016.00340.1 Ashok V, Nallaswamy D, Benazir Begum S, Nesappan T. Lip Bumper Prosthesis for an Acromegaly Patient: A Clinical Report. J Indian Prosthodont Soc. 2014 Dec;14(Suppl 1):279–82. Venugopalan S, Ariga P, Aggarwal P, Viswanath A. Magnetically retained silicone facial prosthesis. Niger J ClinPract. 2014 Mar;17(2):260–4.

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COMPETITIVE STRATEGY MODEL AND ITS IMPACT ON MICRO BUSINESS UNITOF LOCAL DEVELOPMENT BANKSIN JAWA PJAEE, 17 (7) (2020)

Kannan A, Venugopalan S. A systematic review on the effect of use of impregnated retraction cords on gingiva [Internet]. Vol. 11, Research Journal of Pharmacy and Technology. 2018. p. 2121. Available from: http://dx.doi.org/10.5958/0974-360x.2018.00393.1 Basha FYS, Ganapathy D, Venugopalan S. Oral Hygiene Status among Pregnant Women [Internet]. Vol. 11, Research Journal of Pharmacy and Technology. 2018. p. 3099. Available from: http://dx.doi.org/10.5958/0974-360x.2018.00569.3 Ajay R, Suma K, Ali S, Sivakumar JK, Rakshagan V, Devaki V, et al. Effect of surface modifications on the retention of cement-retained implant crowns under fatigue loads: An In vitro study [Internet]. Vol. 9, Journal of Pharmacy And Bioallied Sciences. 2017. p. 154. Available from: http://dx.doi.org/10.4103/jpbs.jpbs_146_17 King MD, Kaufman YJ, Tanré D, Nakajima T. Remote sensing of tropospheric aerosols from space: Past, present, and future. Bull Am Meteorol Soc. 1999;80(11):2229–60. Kedjarune U, Kukiattrakoon B, Yapong B, Chowanadisai S, Leggat PA. Bacterial aerosols in the dental clinic: effect of time, position and type of treatment [Internet]. Vol. 50, International Dental Journal. 2000. p. 103–7. Available from: http://dx.doi.org/10.1002/j.1875- 595x.2000.tb00807.x

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