Document Type : Research articles


1 Ph.D., Associate Professor, Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.

2 Assistant Professor, Nursing and Midwifery Department, Tonekabon Branch, Azad University of Medical Sciences, Mazandaran, Iran.


Background: Dentists are more at risk of respiratory infectious diseases, compared to other Health Care Workers (HCWs).
Objectives: This study aimed to determine the relationship of knowledge, attitude, and fear with Coronavirus Disease-2019 (COVID-19) preventive measures amongst Iranian dentists.
Methods: This cross-sectional study was conducted in the northern provinces of Iran. In total, 340 dentists were selected using a multi-stage sampling method, and they were requested to complete the data collection tools, such as demographic characteristics form, knowledge scale, fear scale, attitude scale, and COVID-19 preventive measures scale. The obtained data were then analyzed by independent t-test, chi-square test, one-way ANOVA, correlation coefficient, and stepwise regression.
Results: Dentists' knowledge about issues, such as incubation period, laboratory test, virus survival time on surfaces, and method disinfection was weak. Nearly, 60% of the dentists had a favorable attitude towards the prevention of COVID-19, while their belief was not good on issues, such as adequacy of routine protocols, vulnerability towards COVID-19, suppressed immune system, patient's responsibility, and stigma. Moreover, 82.1% of dentists were fearful of being infected by patients, providing treatment to the suspected ones, the possibility of transmitting the infection to family members, post-infection quarantine, and treatment costs. Additionally, the total score of practice toward COVID-19 preventive measures in dentists was relatively high (21.88±3.8), whereas their practice in criteria, such as presenting a special disinfectant solution or mask for patients, disinfecting surfaces, air conditioning, and examining patients' symptoms was not satisfactory. Regression analysis demonstrated that job history, knowledge, attitude, and fear were significant predictors of dentists' practice describing 62.7% of the variance in practice towards COVID-19 preventive measures.
Conclusion: The findings revealed that dentists had a comparatively good level of knowledge, attitude, and practice towards COVID-19 preventive measures. The current study suggests that dentists' anxiety, fear, and attitude could be remarkably reduced through providing adequate Personal Protective Equipment and subsequently enhancing preventive practice, raising awareness via online training regarding new guidelines, and presenting real-time statistics on the number of HCWS infected with COVID-19.


  1. Gralinski LE, Menachery VD. Return of the coronavirus: 2019-nCoV. Viruses. 2020;12(2):135. doi: 10.3390/v12020135. [PubMed: 31991541].
  2. Neher RA, Dyrdak R, Druelle V, Hodcroft EB, Albert J. Potential impact of seasonal forcing on a SARS-CoV-2 pandemic. Swiss Med Wkly. 2020;150:w20224. doi: 10.4414/smw.2020.20224. [PubMed: 32176808].
  3. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020;12(1):1-6. doi: 10.1038/s41368-020-0075-9. [PubMed: 32127517].
  4. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis. J Infect. 2020;80(6):656-65. doi: 10.1056/NEJMoa2002032. [PubMed: 32109013].
  5. Zhang L, Liu Y. Potential interventions for novel coronavirus in China: a systematic review. J Med Virol. 2020;92(5):479-90. doi: 10.1002/jmv.25707. [PubMed: 32052466].
  6. Wu P, Hao X, Lau EHY, Wong JY, Leung K, Wu JT, et al. Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020. Eur Surveill. 2020;25(3):2000044. doi: 10.2807/1560-7917.ES.2020.25.3.2000044. [PubMed: 31992388].
  7. Schwartz J, King CC, Yen MY. Protecting health care workers during the COVID-19 coronavirus outbreak -Lessons from Taiwan's SARS response. Clin Infect Dis. 2020;71(15):858-60. doi: 10.1093/cid/ciaa255. [PubMed: 32166318].
  8. Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-7. doi: 10.1177/0022034520914246. [PubMed: 32162995].
  9. Barbieri T, Basso G, Scicchitano S. Italian workers at risk during the Covid-19 epidemic. Italian Econ J. 2021;23:1-21. doi: 10.1007/s40797-021-00164-1.
  10. Peditto M, Scapellato S, Marcianò A, Costa P, Oteri G. Dentistry during the COVID-19 epidemic: an Italian workflow for the management of dental practice. Int J Environ Res Public Health. 2020;17(9):3325. doi: 10.3390/ijerph17093325. [PubMed: 32403248].
  11. Sarkarat F, Tootoonchian A, Haraji A, Rastegarmoghaddam M, Mostafavi SM, Naghibi S. Evaluation of dentistry staff involvement with COVID-19 in the first 3 month of epidemiologic spreading in Iran. J Res Dent Sci. 2020;17(2):137-45. doi: 10.29252/jrds.17.2.137.
  12. Krithikadatta J, Nawal RR, Amalavathy K, McLean V, Gopikrishna A. Endodontic and dental practice during COVID-19 pandemic: position statement from the Indian Endodontic Society, Indian Dental Association, and International Federation of Endodontic Associations. Endodontology. 2020;32(2):55-66.
  13. Occupational Safety and Health Administration. Guidance on preparing workplaces for COVID-19. Washington, D.C: Occupational Safety and health Administration; 2020.
  14. Mceachan R, Hons BA, Taylor N, Lawton R, Gardner P, Conner M. Meta-analysis of the reasoned action approach (RAA) to understanding health behaviors. Ann Behav Med. 2016;50(4):592-612. doi: 10.1007/s12160-016-9798-4. [PubMed: 27169555].
  15. Geldsetzer P. Use of rapid online surveys to assess people's perceptions during infectious disease outbreaks: a cross-sectional survey on COVID-19. J Med Internet Res. 2020;22(4):e18790. doi: 10.2196/18790. [PubMed: 32240094].
  16. Ge Z, Yang L, Xia J, Fu XH, Zhang YZ. Possible aerosol transmission of COVID-19 and special precautions in dentistry. J Zhejiang Univ Sci. 2020;21(5):361-8. doi: 10.1631/jzus.B2010010. [PubMed: 32425001].
  17. Gan[S1]  WH, Lim JW, Koh D. Preventing intra-hospital infection and transmission of coronavirus disease 2019 in health-care workers. Saf Health Work. 2020;11(2):241-43. doi: 10.1016/ [PubMed: 32292622].
  18. Bhagavathula AS, Aldhaleei WA, Rahmani J, Mahabadi MA, Bandari DK. Knowledge and perceptions of COVID-19 among health care workers: cross-sectional study. JMIR Public Health Surveill. 2020;6(2):e19160. doi: 10.2196/19160. [PubMed: 32320381].
  19. Guo H, Zhou Y, Liu X, Tan J. The impact of the COVID-19 epidemic on the utilization of emergency dental services. J Dent Sci. 2020;15(4):564-7. doi: 10.1016/j.jds.2020.02.002. [PubMed: 32296495].
  20. Ahmed MA, Jouhar R, Ahmed N, Adnan S, Aftab M, Zafar MS, et al. Fear and practice modifications among dentists to combat novel coronavirus disease (COVID-19) outbreak. Int J Environ Res Public Health. 2020;17(8):2821. doi: 10.3390/ijerph17082821. [PubMed: 32325888].
  21. Shacham M, Hamama-Raz Y, Kolerman R, Mijiritsky O, Ben-Ezra M, Mijiritsky E. COVID-19 factors and psychological factors associated with elevated psychological distress among dentists and dental hygienists in Israel. Int J Environ Res Public Health. 2020;17(8):2900. doi: 10.3390/ijerph17082900. [PubMed: 32331401].
  22. Harper CA, Satchell LP, Fido D, Latzman RD. Functional fear predicts public health compliance in the COVID-19 pandemic. Int J Ment Health Addict. 2020;27:1-14. doi: 10.1007/s11469-020-00281-5. [PubMed: 32346359].
  23. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17:1729. doi: 10.3390/ijerph17051729. [PubMed: 32155789].
  24. Ren SY, Gao RD, Chen YL. Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic. World J Clin Cases. 2020;8(4):652-7. doi: 10.12998/wjcc.v8.i4.652. [PubMed: 32149049].
  25. Consolo U, Bellini P, Bencivenni D, Iani C, Checchi V. Epidemiological aspects and psychological reactions to COVID-19 of dental practitioners in the northern italy districts of Modena and Reggio Emilia. Int J Environ Res Public Health. 2020;17(10):3459. doi: 10.3390/ijerph17103459. [PubMed: 32429193].
  26. Putrino A, Raso M, Magazzino C, Galluccio G. Coronavirus (COVID-19) in Italy: knowledge, management of patients and clinical experience of Italian dentists during the spread of contagion. BMC Oral Health. 2020;20(1):200. doi: 10.1186/s12903-020-01187-3. [PubMed: 32650753].
  27. Gambhir SR, Dhaliwal SJ, Aggarwal A, Anand S, Anand V, Kaur Bhangu A. Covid-19: a survey on knowledge, awareness and hygiene practices among dental health professionals in an Indian scenario. Rocz Panstwow Zakl Hig. 2020;71(2):223-9. doi: 10.32394/rpzh.2020.0115. [PubMed: 32519827].
  28. Michie S, van Stralen MM, West R. The behavior change wheel: a new method for characterizing and designing behavior change interventions. Implement Sci. 2011;6:42. doi: 10.1186/1748-5908-6-42. [PubMed: 21513547].
  29. Araújo-Soares V, Hankonen, N, Justin P, Rodrigues A, Sniehotta FF. Developing behavior change interventions for self-management in chronic illness. Eur Psychol. 2018;24(1):7-25. doi: 10.1027/1016-9040/a000330. [PubMed: 31496632].
  30. Kamate SK, Sharma S, Thakar S, Srivastava D, Sengupta K, Hadi AJ, et al. Assessing knowledge, attitudes and practices of dental practitioners regarding the COVID-19 pandemic: a multinational study. Dent Med Probl. 2020;57(1):11-7. doi: 10.17219/dmp/119743. [PubMed: 32307930].
  31. Khader Y, Al Nsour M, Al-Batayneh OB. Dentists' awareness, perception, and attitude regarding COVID-19 and infection control: cross-sectional study among Jordanian dentists. JMIR Public Health Surveill. 2020;6(2):e18798. doi: 10.2196/18798. [PubMed: 32250959].
  32. Prasetyo Y, Castillo AM, Salonga LJ, Sia JA, Seneta JA. Factors affecting perceived effectiveness of COVID-19 prevention measures among Filipino during enhanced community quarantine in Luzon, Philippines: integrating protection motivation theory and extended theory of planned behavior. Int J Infect Dis. 2020;99:312-23. doi: 10.1016/j.ijid.2020.07.074. [PubMed: 32768695].
  33. Bakaeen LG, Masri R, AlTarawneh S, Garcia LT, AlHadidi A, Khamis AH, et al. Dentists knowledge, attitudes and professional behavior towards COVID-19 pandemic: a multi-site survey of dentists’ perspectives. J Am Dent Assoc. 2021;152(1):16-24. doi: 10.1016/j.adaj.2020.09.022. [PubMed: 33250171].
  34. Mohammadzadeh N, Shahriary M, Shirmohammadlou N, Lohrasbi V. A glance at the prevalence of coronavirus disease 19 (COVID-19) in Iran: strengths and weaknesses. Inf Control Hosp Epidemiol. 2020;41(12):1479-82. doi: 10.1017/ice.2020.193. [PubMed: 32362292].
  35. Sezgin GP, ŞirinoĞlu Çapan B. Assessment of dentists' awareness and knowledge levels on the Novel Coronavirus (COVID-19). Braz J Oral Res. 2020;34:e112. doi: 10.1590/1807-3107bor-2020.vol34.0112. [PubMed: 32876114].
  36. Nasser Z, Fares Y, Daoud R, Abou-Abbas L. Assessment of knowledge and practice of dentists towards coronavirus disease (COVID-19): a cross-sectional survey from Lebanon. BMC Oral Health. 2020;20(1):281. doi: 10.1186/s12903-020-01273-6. [PubMed: 33050914].
  37. Arora S, Abullais Saquib S, Attar N, Pimpale S, Saifullah Zafar K, Saluja P, et al. Evaluation of knowledge and preparedness among indian dentists during the current COVID-19 pandemic: a cross-sectional study. J Multidiscip Healthc. 2020;13:841-54. doi: 10.2147/JMDH.S268891. [PubMed: 32922024].
  38. Saqlain M, Munir MM, Ur Rehman S, Gulzar A, Naz S, Ahmed Z. Knowledge, attitude, practice and perceived barriers among health‑ care professionals regarding COVID-19: a cross-sectional survey from Pakistan. J Hosp Infect. 2020;105(3):419-23. doi: 10.1016/j.jhin.2020.05.007. [PubMed: 32437822].
  39. Huynh G, Nguyen TN, Vo KN, Pham LA. Knowledge and attitude toward COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City. Asian Pac J Trop Med. 2020;13(6):260. doi: 10.4103/1995-7645.280396.
  40. Pîrvu C, Pătraşcu I, Pîrvu D, Ionescu C. The dentist's operating posture - ergonomic aspects. J Med Life. 2014;7(2):177-82. [PubMed:25184007].
  41. Gan WH, Lim JW, Koh D. Preventing intra-hospital infection and transmission of coronavirus disease 2019 in health-care workers. Saf Health Work. 2020;11(2):241-43. doi: 10.1016/ [PubMed: 32292622].
  42. Taghrir MH, Borazjani R, Shiraly R. COVID-19 and Iranian medical students; a survey on their related-knowledge, preventive behaviors and risk perception. Arch Iran Med. 2020;23(4):249-54. doi: 10.34172/aim.2020.06. [PubMed: 32271598].
  43. Abdel Wahed WY, Hefzy EM, Ahmed MI. Assessment of knowledge, attitudes, and perception of health care workers regarding COVID-19, a cross-sectional study from Egypt. J Community Health. 2020;45(6):1242-51. doi: 10.1007/s10900-020-00882-0. [PubMed: 32638199].
  44. Zhang M, Zhou M, Tang F, Wang Y, Nie H, Zhang L, et al. Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. J Hosp Infect. 2020;105(2):183-7. doi: 10.1016/j.jhin.2020.04.012. [PubMed: 32278701].
  45. Jiang l, Ng IHL, Hou Y, Li D, Tan L, Ho H, et al. Infectious disease transmission: survey of contacts between hospital-based healthcare workers and working adults from the general population. J Hosp Infect. 2018;98(4):404-11. doi: 10.1016/j.jhin.2017.10.020. [PubMed: 29097147].
  46. Maleki S, Najafi F, Farhadi K, Fakhri M, Hosseini F. Knowledge, attitude and behavior of health care workers in the prevention of COVID-19. BMG Med Educ. 2020;3:1-17. doi: 10.21203/
  47. Yesilgul G, Cicek H, Avci M, Huseyniklioglu B. Nurses’ knowledge levels and perceptions regarding occupational risks and hazards. Int J Caring Sci. 2018;11(2):1117-24.
  48. Abdelhafiz AS, Mohammed Z, Ibrahim ME. Knowledge, perceptions, and attitude of Egyptians towards the novel coronavirus disease (COVID-19). J Community Health. 2020;45(5):881-90. doi: 10.1007/s10900-020-00827-7. [PubMed: 32318986].
  49. Kabbash IA, Abo Ali EA, Elgendy MM, Abdrabo MM, Salem HM, Gouda MR, et al. HIV/AIDS-related stigma and discrimination among health care workers at Tanta University Hospitals Egypt. Environ Sci Pollut Res Int. 2018;25(31):30755-62. doi: 10.1007/s11356-016-7848-x. [PubMed: 27752955].
  50. Aly MM, Elchaghaby MA. Impact of novel coronavirus disease (COVID-19) on Egyptian dentists' fear and dental practice (a cross-sectional survey). BDJ Open. 2020;6:19. doi: 10.1038/s41405-020-00047-0. [PubMed: 33072400].
  51. Kumar J, Katto MS, Siddiqui AA, Sahito B, Ahmed B, Jamil M, et al. Predictive factors associated with fear faced by healthcare workers during COVID-19 pandemic: a questionnaire-based study. Cureus. 2020;12(8):e9741. doi: 10.7759/cureus.9741. [PubMed: 32944456].
  52. de Leo D, Trabucchi M. COVID-19 and the fears of Italian senior citizens. Int J Environ Res Public Health. 2020;17(10):3572. doi: 10.3390/ijerph17103572. [PubMed: 32443683].
  53. COVID-19 Scientific Advisory Group. COVID-19 Scientific advisory group rapid response report. Edmonton, AB: Alberta Health Services; 2020.
  54. Liu M, Cheng S, Xu K, Yang Y, Zhu, QT, Zhang H, et al. Use of personal protective equipment against coronavirus disease 2019 by healthcare professionals in Wuhan, China: Cross sectional study. BMJ. 2020;369:m2195. doi: 10.1136/bmj.m2195. [PubMed: 32522737].
  55. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi: 10.1001/jamanetworkopen.2020.3976. [PubMed: 32202646].
  56. Kluytmans-van den BF, Buiting AG, Pas SD, Bentvelsen RG, van den Bijllaardt W, van Oudheusden A, et al. Prevalence and clinical presentation of health care workers with symptoms of coronavirus disease 2019 in 2 Dutch hospitals during an early phase of the pandemic. JAMA Netw Open. 2020;3(5):e209673. doi: 10.1001/jamanetworkopen.2020.9673. [PubMed: 32437576].
  57. Taylor S. The psychology of pandemics: preparing for the next global outbreak of infectious disease. Newcastle upon Tyne: Cambridge Scholars Publishing; 2020.