Original research
Dentistry
Knowledge, stress levels, and clinical 
practice modifications of Turkish dentists 
due to COVID-19: a survey study
Ayca SARIALIOGLU GUNGOR(a)  Abstract: Dentists are exposed to the highest risk of occupational 
Nazmiye DONMEZ(a)  respiratory and droplet infections by working face-to-face with 
Yesim Sesen USLU(b) patients. The aim of this study was to investigate the knowledge of 
symptoms and modes of transmission of COVID-19, stress levels 
and clinical practice modifications of Turkish dentists during the 
COVID-19 pandemic. An online survey (15 questions) was sent to 
 (a) Bezmialem Vakif University, Faculty of Turkish dentists from May 5 to 12 May, 2020. The survey comprised 
Dentistry, Department of Restorative questions about dentists’ demographic characteristics, their 
Dentistry, Istanbul, Turkey knowledge about COVID-19, stress levels and the measures taken 
 (b) Istanbul Okan University, Faculty of in dental clinics against COVID-19. This study included a total of 
Dentistry, Department of Restorative 1,095 Turkish dentists. The data were expressed as frequency with 
Dentistry, Istanbul, Turkey percentage values for overall variables. Dentists were most familiar 
with high fever among the symptoms of COVID-19 (99.4%) and 99.2% 
of them reported that COVID-19 was transmitted with eye, mouth 
and nasal mucosa contact on surfaces contaminated with the droplets 
of infected persons. While the stress levels of females were higher 
than males, the stress levels of dentists with more than 20 years of 
professional experience were found to be lower. Regarding the 
precautions to be taken as a preventive measure when working again, 
86.6% of the dentists took precautions by increasing daily patient care 
intervals and only 38.4% of the dentists wore an N95 mask. During 
Declaration of Interests: The authors this pandemic, knowing the conditions about when the treatments 
certify that they have no commercial or 
associative interest that represents a conflict can be applied and the precautions to be taken will shed light on 
of interest in connection with the manuscript. dentistry staff. Current recommendations of national authorities 
about the coronavirus should be followed.
Corresponding Author: Keywords: COVID-19; Coronavirus; Dentistry; Dentists.
Ayca Sarıalıoglu Gungor 
E-mail: asarialioglugungor@bezmialem.edu.tr
Introduction
An epidemic viral pneumonia of unknown etiology emerged in Wuhan, 
https://doi.org/10.1590/1807-3107bor-2021.vol35.0048
China by the end of 2019. The pathogen causing the condition was called 
as the 2019 novel coronavirus (2019-nCoV), and the disease caused by 
this pathogen the 2019 coronavirus infectious disease (COVID-19). The 
human-to-human transmission rate of this virus increased significantly since 
Submitted: June 15, 2020 mid-January 2020 and the disease spread rapidly throughout the world.1
Accepted for publication: December 12, 2020 
Last revision: February 8, 2021 On March 10, 2020, one day after the first coronavirus case was 
reported in Turkey, a global epidemic (pandemic) was declared by the 
Braz. Oral Res. 2021;35:e048 1
Knowledge, stress levels, and clinical practice modifications of Turkish dentists due to COVID-19: a survey study
World Health Organization (WHO) in the presence of factors including can adversely affect stress levels 
118,319 diagnosed cases and 4,292 deaths. In Turkey, and mental health of the people, some of them are: 
all schools, including universities, were closed by questions with no definite answers such as the end 
March 13. All meetings, social gatherings, and indoor date of the epidemic and the appropriate methods of 
and outdoor public activities were restricted. Home treatment, constant exposure to a flow of information 
isolation for individuals over the age of 65 and under about the epidemic and its effects, decreased social 
20 was enforced. All elective surgeries, including relationships and recommendations/prohibitions such 
minimally invasive procedures, were postponed as staying at home as much as possible. COVID-19 
(excluding emergency cases). As of May 26, of this pandemic has led an increase in the frequency of 
year, 157,814 coronavirus cases have been reported, symptoms such as anxiety, depression, fear, stress, 
with 4,369 deaths and 121,507 recoveries in Turkey.2 and sleep problems.9 Family income stability and 
When a patient coughs, sneezes, talks or breathes, living with parents were found to be shielding from 
pathogen-laden droplets are released.3 It is widely anxiety symptoms.10 Variables such as occupation, 
known that the novel coronavirus can be transmitted education, and gender affected the symptoms of 
mainly through direct contact and droplets.4 5 COVID-19 anxiety and depression tend to be developed during 
is also likely to spread through high concentrations the epidemic in different ways.11
of aerosols in a relatively closed environment. The To the best knowledge, psychological stress due 
use of high-speed dental equipments such as drills to COVID-19 has not been assessed among Turkish 
and aerators are currently considered to be aerosol dentists although it has done in other countries.8,12 
generating procedures. This aerosol is potentially able The present study aimed to assess the anxiety and 
to carry the virus causing COVID -19.6The dentist, stress levels surrounding the threat of infection 
staff, and patients are under a potential threat during among dentists working during the current viral 
routine dental treatments due to the aerosols formed.4 outbreak. In addition, dentists’ knowledge about 
Dentists are at risk of contracting COVID-19 due to various practice modifications to combat the novel 
one-on-one communication with patients (entailing coronavirus disease (COVID-19) has been evaluated.
exposure to saliva, blood, and other body fluids) and 
the use of sharp instruments. In fact, it is has been Methodology
reported that dentists are more likely to be infected 
by the novel coronavirus disease than doctors and All procedures conducted were approved by the 
nurses.7 Dentists can also be carriers of the disease. Ethical Committee of Bezmialem Vakif University 
Although there has not yet been a report of the (06/107,05.05.2020).
disease being transmitted from a dental treatment Our study population consisted of dentists working 
environment, given its high contagiousness, dental in Turkey. At the time of the survey, dentists were 
care teams should be cautious and provide a safe not actively taking care of patients. Informed consent 
environment for both patients and themselves. In this was obtained electronically before data were collected 
critical process, understanding aerosol propagation from the participants.
and its importance in dentistry raises the necessity At the present time, most countries around the 
to apply some special measures in addition to those world are in lockdown conditions; therefore, it was 
that are already standard. Due to aerosol production not feasible to conduct physical interviews during 
and exposure to saliva and blood, dental clinicians this critical period. Instead, we decided to use an 
are at high risk of transmission during their routine online platform to collect the necessary data. A new 
dental treatments.8 Therefore, this situation can create survey about COVID-19 was formed for our study. 
anxiety and stress on dentists. First, we carried out a PubMed search in English and 
Traumatic events can decrease people’s feeling Turkish for COVID-19-related content and guidelines 
of security, remind them of the reality of death and by using the keywords “COVID-19,” “coronavirus,” 
have adverse effects on their mental health. Many “dentistry,” “dental treatment,” and “stress level” with 
2 Braz. Oral Res. 2021;35:e048
Sarialiogu Gungor A, Donez N, Uslu YS
and without Boolean operators. Survey questions We also included a section for rating the average 
were formed after reviewing the pertinent literature perceived stress level experienced by dentists during 
and the international guidelines.13,14,15 the pandemic in Turkey. A 10-point Likert scale with 
The questionnaire was designed in Turkish. four questions, where 0 referred to “not at all stressful,” 
Following Zhong et al.,16 who studied the knowledge, 5 referred to “moderately stressful,” and 10 referred to 
attitudes, and practices of COVID-19 infected areas “extremely stressful”,17 was developed to evaluate the 
in China, and Ahmed et al.,12 who investigated the stress levels induced by the COVID-19 outbreak; this 
presence of fear and practice modifications among section asked questions about the suggested sources 
dentists, we prepared a structured questionnaire with of stress emotions (e.g., “I am worried about getting 
a combination of 20 multiple choice, open-ended, and infected”). A psychometric analysis for the scale was 
Likert-type questions. The content adequacy of the finally conducted. Factor analysis was applied to 
survey was examined by experts to assess the clarity determine the sub-dimensions of the “stress scale” 
the wording of the items prior to the main study. The within the scope of the Validity-Reliability. Cronbach’s 
questions were sent to five experts (two restorative Alpha coefficients were calculated within the scope 
dentists, one endodontist, one general dentist, and of reliability analysis of the scale questions. The 
one biostatistician). Based on their comments, five statistical significance level (α) was taken as 5% in 
questions were removed. Then, the final 15 questions calculations. Cronbach’s Alpha value for “stress scale 
were tested in a pilot study with 10 participants. questions” was found to be 0.782 (78.2%). Accordingly, 
Based on the feedback from the pilot study, we the Cronbach’s Alpha value of these scale questions 
finalized the questionnaire with 15 questions. The exceeding 75% indicates that the reliability of these 
final questionnaire was sent to a Turkish language questions (items) is high.
expert for validation and it was concluded at this The sample size required for the study was 
stage. The questionnaire had four parts: a) dentist’s calculated by a statician. The power analysis estimated 
demographic and professional characteristics (five that survey with 380 or more individuals were needed 
questions); b) knowledge of COVID-19 and dentist’s to have a 95% confidence interval, a population size 
awareness of the incubation period, the symptoms of of 30,128 dentists, with the real value within ± 5% 
the disease, the mode of transmission, and preventive of the surveyed value. However, 1,095 dentists who 
infection control measures (four questions); c) stress answered the web-based survey completely during 
level (four questions); and d) adjustments in the clinical the survey application period were included to 
practice and attitude in the treatment of patients after increase the reliability of the findings. Based on the 
the COVID-19 pandemic (two questions). stratified random sampling method, the minimum 
This self-reportable, online questionnaire form was number required was determined by considering 
designed using Google Forms (Alphabet Co., Mountain the targeted sample size.
View, USA), and the link was shared among all Turkish Data were analyzed using IBM SPSS Statistics 
dentists through several dentist-specific closed social for Windows, version 22.0. To handle missing data, 
media forums, email, WhatsApp, Facebook, Instagram, direct deletion method was used and all surveys with 
etc. We received responses through online survey invalid data were discarded from further analysis 
submission. Anonymity was ensured, and no personal and statistical analysis were conducted based on a 
identification, such as IP address, email address, complete dataset. While evaluating the study data, 
or user ID, were collected. A total of 1,095 Turkish the appropriateness of the parameters to normal 
dentists, all volunteers, answered the questionnaire. distribution was evaluated with the Shapiro–Wilk 
Participation was voluntary, and participants could test. Frequencies and percentages were used to 
withdraw from survey at any time. All participants describe the categorical data. Mann Whitney test was 
provided informed consent prior to completing the used to compare stress items between gender and 
survey. The form was posted on May 5, 2020 at 22:00, institution groups. A Kruskal Wallis test was used to 
and the survey was closed on May 12, 2020 at 22:00. test differences of stress ratings between professional 
Braz. Oral Res. 2021;35:e048 3
Knowledge, stress levels, and clinical practice modifications of Turkish dentists due to COVID-19: a survey study
experience groups. Dunn’s test was used as post hoc symptoms. Regarding the mode of transmission of 
procedure after a significant effect. Significance was COVID-19, 99.2% (1,086) of the dentists thought that 
evaluated at the level of p < 0.05. the disease was transmitted through eye, mouth, and 
nasal mucosa contact with contaminated surfaces. 
Results Of the participants, 100% (1095) thought that they 
could prevent infection by washing their hands 
Frequency distribution of the 1,095 dentists’ with soap and water for at least 20 seconds. While 
demographic characteristics were presented in Table 1. 4.4% (48) of the dentists thought that a COVID-19 
When evaluating the knowledge of the dentists positive patient could be treated when the Reverse 
about COVID-19 symptoms, it was seen that high fever Transcription- Polymerase Chain Reaction (RT-PCR) 
is known with the highest rate (99.4%) among all other test result was negative, 63.1% (691) thought treatment 
could be done 14 days after the RT-PCR test result 
was negative (Table 2).
Table 1. Frequency distribution of dentists’ demographic The levels of stress about being infected ranged 
characteristics. from 1 to 10 and the scores given by the participants 
Variable n % were shown in Figure 1. The results showed that 
Age (years) the dentists had the “extremely stress” from 
20–30 312 28,5 infecting their families (28.4%, 311) and they had 
31–40 342 31,2
concerns regarding current or future financial and 
41–50 270 24,7
organizational difficulties (27.3%, 299). The results of 
51–60 135 12,3
61+ 36 3,3 the comparative evaluation of the responses to the 
Gender stress scale items according to gender, professional 
Female 702 64,1 experience and the type of institution were shown in 
Male 393 35,9 Figures 2, 3 and 4. The level of stress related to family 
Professional experience and patient safeties of dentists with 0–10 years and 
0–5 274 25 11-20 years of professional experience were found to 
6–10 165 15,1 be statistically similar (p > 0.05), while the level of 
11–15 162 14,8 stress was found to decrease statistically in dentists 
16–20 190 17,4 with more than 20 years of professional experience 
21–25 114 10,4 (p < 0.05) (Figure 3). Post-hoc analyses showed that 
26+ 190 17,4 increases in stress regarding professional practice were 
Working place significantly associated with the type of institution 
University-based hospitals 263 24 (p < 0.001) (Figure 4). Although the level of stress was 
Government hospitals 179 16,3
higher among females than males (Figure 2), there 
Private hospitals/Medical centers 338 30,9
was no statistical difference between females and 
Private practice 298 27,2
Others 17 1,6 males regarding their professional practice (concerns 
Profession regarding current or future financial) (p = 0.074).
General dental practitioner 651 59,5 Regarding the precautions to be taken as a preventive 
Oral maksillofacial surgeon 56 5,1 measure in the clinic when working again, 86.6% (948) 
Orthodontist 51 4,7 of the dentists took precautions by increasing daily 
Prosthodontist 67 6,1 patient care intervals, 73.1% (800) reported that they 
Periodontist 57 5,2 would measure the fever of each patient coming into 
Pedodontist 59 5,4 the clinic, 49.2% (539) would sterilize the clinical 
Endodontist 68 6,2 environment with UV systems, and 55.9% (612) would 
Restorative dentist 80 7,3 use aerosol absorber machine. It was revealed that 
Oral diagnosis and radiology 6 0,5 90.9% (995) would wear special protective masks, 
4 Braz. Oral Res. 2021;35:e048
Sarialiogu Gungor A, Donez N, Uslu YS
Table 2. Dentists’ awareness about symptoms, mode of transmission, measures for prevention and dental treatment time of the 
COVID-19 (+) patient.
Variable n %
Symptoms of COVID-19 
High fever 1088 99,4
Dry cough 1073 98
Fatigue 1010 92,2
Shortness of breath 1082 98,8
Chest pain 728 66,5
Runny nose 257 23,5
Headache 775 70,8
Lumbago 332 30,3
Other 125 11,4
Mode of transmission
Coughing and sneezing 1078 98,4
Eye, mouth and nasal mucosa contact on surfaces contaminated with the droplets of infected persons 1086 99,2
Having more than 15 minutes of contact with the infected person 878 80,2
Being 1 meter or closer to the infected person 942 86
Can be transmitted from animals to humans 132 12,1
It does not transmit from human to human 423 38,6
Measures for prevention in daily life
Washing hands with soap and water for at least 20 seconds 1095 100
Using alcohol-based hand antiseptics 1071 97,8
Avoiding contact with people with respiratory diseases 833 76,1
Avoiding contact of the hands with mouth, nose and eyes as much as possible. 1086 99,2
Not being in crowded places 1083 98,9
Wearing a mask in public areas 1052 96,1
We cannot be protected from COVID 19 infection 10 0,9
Dental treatment time of the COVID-19(+) patient
When rRT-PCR test result is negative 48 4,4
14 days after rRT-PCR test result is negative 691 63,1
30 days after rRT-PCR test result is negative 239 21,8
14 days after home quarantine 81 7,4
Other 36 3,3
88% (964) would wear protective goggles, and 60.6% number of cases increased day by day and peaked in 
(664) would wear overalls, while 1.6% (18) were not May. This study was carried out using a web-based 
considering taking extra measures (Table 3). survey made available between May 5 and 12, 2020.
Dentists have been shown to have a high risk of 
Discussion becoming infected with COVID-19 due to the aerosol 
spread when performing especially prosthetic, 
The study aimed to provide an insight into the restorative, and endodontic treatments in their working 
changes in Turkish dentists’ clinics in the preparation conditions.15 The identification of such symptoms 
period of returning to routine dental treatment can help dentists to recognize the threat as early as 
practices after the peak of the COVID-19 epidemic possible and take the necessary precautions, which 
in Turkey in May 2020. The first official COVID-19 is a critical step in the management18 and control of 
case in Turkey was detected on March 10, 2020. The the spread of the disease 15. Similar to the results of 
Braz. Oral Res. 2021;35:e048 5
Knowledge, stress levels, and clinical practice modifications of Turkish dentists due to COVID-19: a survey study
10
8
6
4
2
0
Stress regarding your personal Stress regarding the safety of Stress regarding the safety of Stress regarding your 
safety (‘’I am worried about your family (‘’I am worried your patients (‘’I am worried professional practice 
getting infected’’) about infecting my family’’) about infecting my patients’’) (concerns regarding current or 
future financial and 
organizational difficulties)
Figure 1. Distribution of perceived stress levels of dentists during the COVID-19 pandemic.
10
8
6
4
2
0 *** *** *** NS
10
8
6
4
2
0
Stress regarding your personal Stress regarding the safety of Stress regarding the safety of Stress regarding your 
safety (‘’I am worried about your family (‘’I am worried your patients (‘’I am worried professional practice 
getting infected’’) about infecting my family’’) about infecting my patients’’) (concerns regarding current or 
future financial and 
organizational difficulties)
Figure 2. Box-plot representing the statistical relation of gender and stress scale responses. [Data represented as median (horizontal 
bars inside the box) and range (Y-error bars). *** = represents significant difference (p < 0.001). NS= Non-significant (p > 0.05).
a study in the literature,19 Turkish dentists were able as high fever (99.4%), shortness of breath (98.8%), dry 
to identify the main symptoms of COVID-19, such cough (98%), and fatigue (92.2%) (Table 2).
6 Braz. Oral Res. 2021;35:e048
Response Scale
Response Scale
Gender
Female Male
Sarialiogu Gungor A, Donez N, Uslu YS
10
8
6
4
NS
2
NS
0
10
8 *
6 *
4
2 *
0 *
10
8
6
4
2
0 NS NS
Stress regarding your personal Stress regarding the safety of Stress regarding the safety of Stress regarding your 
safety (‘’I am worried about your family (‘’I am worried your patients (‘’I am worried professional practice 
getting infected’’) about infecting my family’’) about infecting my patients’’) (concerns regarding current or 
future financial and 
organizational difficulties)
Figure 3. Box-plot representing the statistical relation of professional experience and stress scale responses. [Data represented 
as median (horizontal bars inside the box) and range (Y-error bars). * = represents significant difference (p < 0.05). 
NS = Non-significant (p > 0.05).
The Depression Anxiety Stress (DASS) scale contraction threat, most of dentists were concerned 
consists of 42 questions. The high number of questions about their families and about themselves. The 
in the scale complicates the process of data collection severity of psychological symptoms depends on age, 
and analysis. According to some authors, as the gender, occupation, and proximity to the infected 
number of items on the scale increases, it tires the patient.24 Females were correlated to higher risk of 
participants and provides less reliable answers.20,21 At experiencing anxiety and stress which may be due 
the same time, frequently asking similar questions to to the already reported gender difference for anxious 
measure a particular dimension can be both tiring and depressive symptoms.25 Previous studies claimed 
and disappointing, whereas measuring a dimension that females had higher depression and anxiety levels 
with less substance has the opposite effect.22 Therefore, than male during the pandemic of COVID-19.26 27 
in our study, we created our own stress scale (four However, it was also reported in a study that gender 
questions) to determine the stress levels of dentists was not associated with anxiety and depression 
in relation to the COVID-19 pandemic. during the COVID-19 pandemic.28 Although our 
Turkish dentists were found to be very concerned study revealed that female gender was associated 
for their families and their stress levels exceeded with higher self reported anxiety and stress levels, 
the average stress value (Figure 1). Dentists were there was no significant difference between females 
expected to be worried about getting infected with and males regarding current or future financial 
2019-nCoV and transmitting it to their close family and organizational difficulties. Older people, city 
members.12 Additionally, incompatible with our residents, and people with stable income present 
results, Duruk et al.,23 reported that facing COVID-19 with low anxiety and depression.29 Educated young 
Braz. Oral Res. 2021;35:e048 7
Response ScaleProfessional experience
0-10 years 11-20 years >20 years
Knowledge, stress levels, and clinical practice modifications of Turkish dentists due to COVID-19: a survey study
10
8
6
4
2
0 NS NS NS ***
10
8
6
4
2
0
Stress regarding your personal Stress regarding the safety of Stress regarding the safety of Stress regarding your 
safety (‘’I am worried about your family (‘’I am worried your patients (‘’I am worried professional practice 
getting infected’’) about infecting my family’’) about infecting my patients’’) (concerns regarding current or 
future financial and 
organizational difficulties)
Figure 4. Box-plot representing the statistical relation of type of institution and stress scale responses. [Data represented 
as median (horizontal bars inside the box) and range (Y-error bars). *** = represents significant difference (p < 0.001). 
NS = Non-significant (p > 0.05).
people are more likely to follow pandemic related always be washed with soap and water.13 In our 
news that increases the anxiety and stress levels.30 study, dentists considered that the most important 
Current study showed that older dentists with measures for prevention against COVID-19 were 
more than 20 years of professional experience have “washing hands with soap and water for at least 20 
lower stress levels than less experienced colleagues. seconds (sec) (100%)” and “avoiding contact of the 
Among dental staffs, being young and having less hands with mouth, nose, and eyes (99.2%)” (Table 2). 
professional experience usually means low monthly It is now confirmed that COVID-19 is transmitted 
income, lacking experience, and knowledge in dealing through human contact and in the form of droplets, 
with terrible infectious diseases. but airborne transmission is not rejected yet.33,34 
Researchers have revealed that the new type of Authorities recommended people to abstain from 
coronavirus (SARS-CoV-2) that causes COVID-19 can crowded places, including hospitals and dental clinics, 
live on different surfaces, such as metal, glass, or as much as possible to guard against cross-infection 
plastic, for hours and even up to nine days.31 Luckily, resulting from the rapid transmission of COVID-19 
the virus can be efficiently inactivated within one since the end of January 2020. Similarly, in our study, 
minute by using surface disinfection products with avoiding crowded places (98.9%) and wearing masks 
62–71% ethanol, 0.5% hydrogen peroxide, or 0.1% in public areas (96.1%) were found to be the most 
sodium hypochlorite.32 If soap and water are not effective protective measures to take by Turkish 
available and hands are not visibly dirty, an alcohol- dentists (Table 2).
based hand sanitizer containing at least 60% alcohol Of the dentists participated in this survey, at least 
can be used. However, visibly dirty hands should 38.4% wore an N95 mask (Table 3). The reason behind 
8 Braz. Oral Res. 2021;35:e048
Response ScaleType of Institution
State-run hospitals Private sector
Sarialiogu Gungor A, Donez N, Uslu YS
Table 3. Personal protective equipment used by dentists and additional precautions to take as preventive measures against infection in clinics.
Variables n %
Personal protective equipment 
Gloves 1061 96,9
Surgical mask 956 87,3
N95 mask 421 38,4
FFP2 / FFP3 respirator 419 38,3
Safety goggles/ Face shield 982 89,7
Overshoe 821 75
Disposable apron 274 25
Gown 753 68,8
Overalls 215 19,6
Other 9 0,8
Precautions to be taken as a preventive measure to the clinic when working again
Increasing patient care intervals 948 86,6
Measuring the fever of each patient coming to the clinic 800 73,1
Sterilization of the clinical environment with UV systems 539 49,2
Aerosol absorbing machine 612 55,9
Special protective masks 995 90,9
Wearing overalls 664 60,6
Goggles 964 88
I do not intend to take extra precautions 18 1,6
Other 44 4
such an unexpected low rate could be the limited crucial to avoid contact with other people whether 
number of the masks and their high cost throughout they show any symptoms or not. Social distancing 
the world.35. Similarly, Khader et al. found 92.9% can help to limit the contact with infected people and 
of dentists to wear personal protective equipment contaminated surfaces. There should be a distance of 
such as masks, gloves, and goggles, and 96.2% to at least two meters between people and gathering in 
frequently clean their hands using alcohol-based groups should be avoided to practice social or physical 
antiseptics along with soap and water.20 Furthermore, distancing. Social distancing is particularly important 
Khader et al.19 reported that although Jordanian for people who carry higher risk due to their health 
dentists were beware of COVID-19 symptoms, its conditions.37 Similar to a study in the literature,23 our 
mode of transmission, infection control, and measures results showed that Turkish dentists believed in the 
in dental clinics; they had limited comprehension importance of social distancing in mitigating the 
of additional precautionary measures to protect the spread of the virus, and most of the dentists (86%) 
dental staff and patients from COVID-19. However, thought that there should be at least one meter of 
there were no “local” cases in Jordan at the time of distance from others who may be infected (Table 2).
data collection. Due to the possibility of COVID-19 recusancy 
COVID-19 transmission can occur between humans and the fact that some viruses can be present in 
who are in close contact (within about two meters) saliva for as long as 29 days after recovery 38, it is 
of each other. Additionally, the infected people important to be cautious when deciding upon the 
who are infected but show no symptoms of the timing of non-emergency elective dental treatments 
disease are also likely to play a role in the spread of a COVID-19 (+) patient. A recovery is confirmed 
of COVID-19.36 People can spread the virus before if the patient has been asymptomatic for at least 
they become aware of their sickness. Therefore, it is 30 days after the last negative laboratory test.39 
Braz. Oral Res. 2021;35:e048 9
Knowledge, stress levels, and clinical practice modifications of Turkish dentists due to COVID-19: a survey study
Knowing the dental treatment time of COVID-19 (+) be interpreted carefully and not be globalized. Even 
patients can help in reducing and preventing new though the survey was sent to dentists all over 
outbreaks. In our study, dentists mostly responded Turkey, there was a lack of response and resultant 
to the question on this topic by suggesting that small sample size. The reason for this could be that 
procedures could be done 14 days after the rRT-PCR not all dentists use Internet and social media. It is 
test result turned out to be negative (63.1%) (Table aimed to carry out a study in which higher number 
2). The lack of information on this issue may be due of dentists are involved.
to the time it takes for symptoms to appear after 
confrontation with the virus, and the period within Conclusion
which symptoms appear can be extended up to 14 
days. Also, the time that the virus stays in the saliva There has been a significant increase in stress 
may not be known by dentists. levels due to the uncertainty of the working conditions 
The main limitation of this study was the use of Turkish dentists during the COVID-19 pandemic 
of an adapted stress scale. Future studies should, if period, as can be said to be the case with dentists all 
possible, employ other more objective questionnaire over the world. Accordingly, there will likely be an 
using a stress scale which has been proven to be increase in the personal and professional protective 
reliable and valid. According to our findings, dentists’ measures that they will take when they return to their 
stress and anxiety levels related to COVID-19 had routine clinical practices. Further studies with more 
increased. Although the results here are similar to participants and longer follow-up term are needed 
other studies in the literature,40,41 it still may not be to achieve more precise results.
possible to generalize on this issue, since we do not 
use all the questions of the perceived stress scale. Acknowledgements
Another limitation of this study was the survey The authors thank all participants for their valuable 
was conducted only with dentists in Turkey and contribution to this study and all healthcare workers 
not included all the dentists in Turkey. The results who devoted themselves to the coronavirus pandemic. 
will likely vary according to the general conditions The authors also would like to thank Ebru Osmanoglu 
of each country and the degree of exposure to from Variance Statistical Consultancy, who carried 
COVID-19. Therefore, the results of our study should out statistical analysis.
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