LUHS dental students’ knowledge about the COVID 19 infected patient’s treatment protocols in prosthodontics

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Mawada Dadoue

5th_{year , Group 12}

LUHS dental students’ knowledge about the COVID 19

infected patient’s treatment protocols in prosthodontics

Master’s Thesis

Supervisor

Assistant, Albertas Kriaučiūnas

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LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY

FACULTY OF ODONTOLOGY DEPARTMENT OF PROSTHODONTICS

LUHS dental students’ knowledge about protection methods and the COVID 19 infected patient’s treatment protocols in prosthodontics

Master’s Thesis

The thesis was done

by student Mawada Dadoue. Supervisor ... (signature) (signature) ... ...

(name surname, year, group) (degree, name surname)

... 20…. ... 20….

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EVALUATION TABLE OF CLINICAL–EXPERIMENTAL MASTER’S THESIS Evaluation: ... Reviewer: ...

(scientific degree, name and surname)

Reviewing date: ...

No

. MT parts MT evaluation aspects

Compliance with MT requirements and evaluation Yes Partially No 1 _Summary (0.5 point)

Is summary informative and in compliance with the

thesis content and requirements? 0.3 0.1 0

2 Are keywords in compliance with the thesis _essence? 0.2 0.1 0 3

Introduc-tion, aim, and tasks (1 point)

Are the novelty, relevance and significance of the

work justified in the introduction of the thesis? 0.4 0.2 0 4 Are the problem, hypothesis, aim and tasks formed _{clearly and properly?} 0.4 0.2 0

5 Are the aim and tasks interrelated? 0.2 0.1 0

6

Review of literature

(1.5 points)

Is the author’s familiarization with the works of

other authors sufficient? 0.4 0.2 0

7

Have the most relevant researches of the scientists discussed properly and are the most important results and conclusions presented?

0.6 0.3 0

8 Is the reviewed scientific literature related enough _{to the topic analysed in the thesis?} 0.2 0.1 0 9 Is the author’s ability to analyse and systemize the _{scientific literature sufficient?} 0.3 0.1 0 10

Material and methods (2 points)

IS the research methodology explained comprehensively? Is it suitable to achieve the set aim?

0.6 0.3 0

11 Are the samples and groups of respondents formed and described properly? Were the selection criteria suitable?

0.6 0.3 0

12

Are other research materials and tools (questionnaires, drugs, reagents, equipment, etc.) described properly?

0.4 0.2 0

13

Are the statistical programmes used to analyse data, the formulas and criteria used to assess the level of statistical reliability described properly?

0.4 0.2 0

14

Results (2 points)

Do the research results answer to the set aim and

tasks comprehensively? 0.4 0.2 0

15 Does presentation of tables and pictures satisfy the

requirements? 0.4 0.2 0

16 Does information repeat in the tables, picture and _text? 0 0.2 0.4 17 Is the statistical significance of data indicated? 0.4 0.2 0 18 Has the statistical analysis of data been carried out

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19

Discussio n (1.5 points)

Were the received results (their importance, drawbacks) and reliability of received results assessed properly?

0.4 0.2 0

20 Was the relation of the received results with the _{latest data of other researchers assessed properly?} 0.4 0.2 0 21 Does author present the interpretation of results? 0.4 0.2 0 22 Do the data presented in other sections _{(introduction, review of literature, results) repeat?} 0 0.2 0.3 23

Conclu-sions (0.5 points)

Do the conclusions reflect the topic, aim and tasks

of the Master’s thesis? 0.2 0.1 0

24

Are the conclusions based on the analysed material? Do they correspond to the research results?

0.2 0.1 0

25 Are the conclusions clear and laconic? 0.1 0.1 0

26

Reference s (1 point)

Is the references list formed according to the

requirements? 0.4 0.2 0

27 Are the links of the references to the text correct? Are the literature sources cited correctly and precisely?

0.2 0.1 0

28 Is the scientific level of references suitable for _{Master’s thesis?} 0.2 0.1 0 29 Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than

5 years – at least 40%?

0.2 0.1 0

Additional sections, which may increase the collected number of points

30 Annexes Do the presented annexes help to understand the _{analysed topic?} +0.2 +0.1 0 31

Practical recomme n-dations

Are the practical recommendations suggested and

are they related to the received results? +0.4 +0.2 0

General requirements, non-compliance with which reduce the number of points

32

General

require-ments

Is the thesis volume sufficient (excluding annexes)? 15-20 pages (-2 points) <15 pag es (-5 poi nts) 33 Is the thesis volume increased artificially? -2 points -1 point

34 Does the thesis structure satisfy the requirements of Master’s thesis? -1 point poi-2 nts 35

Is the thesis written in correct language,

scientifically, logically and laconically? -0.5 point -1 poi nts 36 Are there any grammatical, style or computer

literacy-related mistakes? -2 points -1 points 37

Is text consistent, integral, and are the

volumes of its structural parts balanced? _{-0.2 point} 0.5 -poi

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(not evaluated) 39

Is the content (names of sections and sub-sections and enumeration of pages) in compliance with the thesis structure and aims? -0.2 point -0.5 poi nts 40

Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?

-0.2 point -0.5 poi nts 41

Was the permit of the Bioethical Committee received (if necessary)?

-1 poi nt 42

Are there explanations of the key terms and abbreviations (if needed)?

-0.2 point -0.5 poi nts 43

Is the quality of the thesis typography (quality

of printing, visual aids, binding) good? _{-0.2 point} -0.5 poi nts

*In total (maximum 10 points): *Remark: the amount of collected points may exceed 10 points.

Reviewer’s comments: ___________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _________________________________________ ___________________________

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SUMMARY

Aim: to analyse and assess the knowledge about the COVID 19 dental treatment protocols between

IVth and Vth course students with treatment protocols and protection methods.

Objectives: 1. To evaluate the student's knowledge on Covid-19 infection control in a prosthodontics

clinic.2. To access the student's knowledge about the possible transmission routes of covid-19 in prosthodontics clinics.3. To examine students' knowledge about the protection methods in prosthodontics.4. To examine statistically significant difference between 4th and 5th year students' knowledge during COVID-19.

Methodology: This study is a cross-sectional questionnaire conducted to assess dental students'

knowledge about protection methods and the COVID 19 infected patient's treatment protocols in prosthodontics at LUHS during the 2020-2021 study year Lithuanian University of Health Science (LUHS), Bioethics permission approval given from the ethics committee of the Lithuanian University of Health Sciences (LSMU), Kaunas Nr. BEC – OF – 113.The confidentiality of research participants was guaranteed. The poll is anonymous, and all question forms filled anonymously. The data were analyzed using the statistical package (SPSS version 22). Statistical evaluation included Chi-squared tests for differences between 4th and 5th year odontology students' knowledge about the COVID 19 during this pandemic situation, Statistical significance was set at P< 0.05.

Results: In this study, participants were 51.6% female and 48.4% male (p>0.05). Overall, 155

participants were enrolled in our study, 52.3% of 4th year and 47.7% of the 5th year odontology students. Statistically significant differences were not found in students' distribution by academic year (p>0.05). except Q20 p=0.31<0.05), significantly more correct answer for 5th year odontology students (42) than 4th year odontology students (27).

Conclusion: 1. Almost half of the dental student had a good knowledge on Covid-19 infection control

in a prosthodontics clinic. 2.Most of the international dental students showed an adequative level of attitude and knowledge toward the Universal Precaution, infection control and protection methods in prosthodontics at LSMU.4. No statistically significant difference between 4th and 5th year students in answering all the questions (p> 0.05), because correct answers 4th year odontology students 63.70% and correct answers 5th year odontology students 68.24%.

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1. INTRODUCTION

Coronavirus (COVID-19) is a major global concern caused by the acute respiratory syndrome. It was first reported in the Wuhan City of China [1].

COVID-19 epidemic is related to SARS coronavirus and to middle east respiratory syndrome MERS coronavirus, but also the covid-19 is different from SARS-COV. Still, it has the same host receptors, the human angiotensin-converting enzyme 2 (ACE2) [1,2], and still there is a lot of Studies about it. COVID-19 was first reported in December 2019 in Wuhan, Hubei province –china and recognized as a pandemic on march 2019-2020, over the march 2020 the coronavirus disease COVID-19 pandemic has marched over the world [2]. on March 13 (WHO) said that Europe was now the centre of the pandemic. In Italy the number of cases increased frighteningly over time and death in Italy surpassed those in china and the total case was 105,792 on the last day of March 31, many other European countries and the USA report increasing numbers of cases, in that time also Lithuania was trying to help and control the situation, on March 31 Lithuania report more than 500 cases and 7 cases of death, and on April 26 Lithuania report a total 1,438 cases and 41 cases of death the number of infection was increasing even after the quarantine that started on March 16, in April 2 The world was faced with more than a million and last day of April more than 3 million and on February 2021- the world was faced 110,633,075 cases of epidemic coronavirus COVID-19[3,4].

The ways that Coronavirus spread were critical and fast, and the prevalent transmission route of covid-19 Coronavirus from one person to another one more person including direct transmission, for example, (cough, sneeze, and droplet inhalation transmission). And also contact transmission, for example, (contact with oral, nasal, and eye mucous membranes). Covid-19 can be transmitted through the saliva [2].

Due to the characteristics of student practice in prosthodontics clinic, the risk of cross-infection can be high between patients and dental student in clinics that located in areas that are affected with COVID-19 in Lithuania. Careful, strict, and effective infection control protocols are urgently needed. As doctors and students in LSMU university, we must stop this epidemic in the place where we are. Therefore, infection prevention and control measures are critical and important to prevent the spread of COVID-19 in Lithuania and in healthcare facilities. Health care workers and medical students should be aware of all procedures concerning prevention and protection from COVID-19 Coronavirus.

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2. AIMS AND OBJECTIVES

The aim of the study: due to the risks involved in working in dental clinics and the risk of

COVID-19 infection. The aim of our work was to analyze and assess the knowledge about the COVID COVID-19 dental treatment protocols between IVth_{and V}th_{course students with treatment protocols and} protection methods.

Objective:

1- To access and evaluate the student's knowledge on Covid-19 infection control in a prosthodontics clinic.

2- To access and examine the student's knowledge about the possible transmission routes of covid-19 in prosthodontics clinics.

3- To examine students' knowledge about the protection methods in prosthodontics.

4- To examine statistically significant difference between 4th and 5th year students' knowledge during COVID-19 - pandemic situation.

Hypothesis: H0:

We expect that most dental students at LSMU will have difficulty dealing with covid-19 in the prosthodontics department and possible transmission routes of covid-19.

H1:

We reject hypothesis that the majority of dental students at LSMU will have difficulty with dealing with covid-19 in prosthodontics department and possible transmission routes of covid-19 because correct answers 4th-year odontology students 63.70% and correct answers 5th-year odontology students 68.24%.

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3. REVIEW OF LITERATURE

3.1. Covid 19 disease

3.1.1. Definition, signs, and symptoms,

Coronaviruses (CoVs) are enveloped viruses entrapping non-segmented, positive-sense, and single-stranded ribonucleic acid (ssRNA). Covid-19, the seventh member of the family of coronaviruses that infect humans. Their genome size ranges from 26 to 32 kb [3], being the largest known RNA virus. SARS-CoV-2 3’ terminus encodes structural proteins, including spike (S) glycoproteins [4,5], membrane (M) glycoproteins [6], as well as envelope (E)[7], and nucleocapsid (N) proteins [5,8] (Fig. 1) [3].

Fig.1 coronavirus structure [3]

In addition to the genes encoding structural proteins, some of the (specific genomic regions) are encoding for viral proteins required for replication [9], as well as to other non-structural proteins [10,11]. Covid-19 can bind to the human angiotensin-converting enzyme 2 (ACE2). Covid-19 can bind to the ACE2 receptor from the human, bat, civet cat, and pig cells but it cannot bind to the cells without the ACE2 receptor [4]. According to the Centre of Disease Control and Prevention, the incubation period is 14 days, with an estimated median of 5.1 days [12,13]. However, cases with longer incubation of 24 days have been reported [14]. The long incubation period of Covid-19 is the initial reason for the massive infection, as it is mostly asymptomatic yet contagious [13]. Although the estimated patients’ age average is ~70, all age groups are susceptible to this virus. However, the elder population (>60) and people with comorbidities are more likely to develop severe symptoms upon infection [3]. Covid-19 is predominantly infecting the lower airways, ranging from mild respiratory illness to severe acute respiratory syndrome and septic shock in advanced stages [9]. The high affinity between ACE2 and covid-19 S protein also suggested that the population with higher

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symptoms of the patients who suffered from the covid-19 were fever, cough, shortness of breath and myalgia or fatigue with abnormal chest CT, losing smell and taste, and the less common symptoms were sputum production, headache, haemoptysis, and diarrhea [1,16,17]. This infectious agent may affect older males to cause severe respiratory diseases [1,18].

3.1.2. The possible transmission route of covid-19 Coronavirus

Analysis of conjunctival samples from the cases of covid-19 suggests that the transmission of covid-19 is not confined to the respiratory tract [2,19], and that eye exposure can also provide an efficient way for the covid-19 virus to entering the body [2,20], notably, studies have shown that respiratory viruses can be transmitted between people through direct or indirect contact, or through coarse or small droplets [21,22].Studies have suggested that coronavirus , Covid-19 may be

(airborne through aerosols), that created during dental procedures [2,23,24].

3.2 Covid-19 in dentistry/prosthodontics.

3.2.1 The possible transmission route of covid-19 Coronavirus in dental/prosthodontics clinic.

Covid-19 could be passed directly from person to another person, by a small aqueous droplet produced by exhalation (respiratory droplets), consisting of saliva or mucus and other matter derived from respiratory tract surfaces.[25] Evidence also indicates that it may be transmitted through contact and also fomites, materials which are likely to carry infection, such as (clothes, dental instruments, and dental chair.)[2,20].In addition , the incubation period for individuals infected with Corona but without symptoms is approximately 1-14 days.[2,26]. And it was confirmed that asymptomatic patients could spread the virus. [2,25,27].

Due to the peculiarity of dental procedures in prosthodontics clinics (Fig.2) [2], which include frequent communication, face-to-face contact with patients, frequent exposure to saliva, blood, and other body fluids, and handling sharp instruments such as (dental drill, probe, spoon excavator, scaler, etc.) Dental patients and prosthodontists can be exposed to viruses and bacteria (pathogenic microorganisms), that infect the oral cavity and the respiratory system. [1,2]. Infections could be existing through any of these circumstances involved in an infected person in a dental clinic also hospitals, especially during the outbreak of covid-19.

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[2] nCoV in dental clinics -transmission routes of 2019 2 Fig. 3.2.2. Airborne spread

Many kinds of prosthodontics procedures, such as preparing a crown, bridge, etc,could produce aerosols and droplets that are contaminated with virus [29]. Thus, it is very important to pay attention in prosthodontics department because it is hard to avoid the generation of large amounts of aerosol and droplets that are mixed with patient's saliva and blood during dental practice [30]. In addition to the infected patient's cough and breathing, dental devices such as high-speed, dental handpieces use high-speed gas to drive the turbine to rotate at high speed and work with running water. A large amount of aerosol and droplets mixed with the patient's saliva or blood could be generated during prosthetic dental procedure. Particles of droplets and aerosols are really small enough and can stay airborne for long period, before they settle on environmental surfaces or entering the respiratory tract.

3.2.3. Contact spread

A dental professional's recurrent direct or indirect contact with human materials, patient fluids, or defiled dental instruments and environmental surfaces makes a possible spread of viruses [30]. In addition, prosthodontist/dental students and other patients have likely contact of conjunctival, nasal, or oral mucosa with droplets and aerosols containing microorganisms generated from an infected individual and propelled a short distance by coughing and talking, without protection equipment.

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3.2.4. Contaminated surfaces spread

Coronaviruses (covid-19) can persist on the surfaces like metal, glass, or plastic for up to a couple of days [31]. Therefore, contaminated surfaces that are recurrently contacted in the prosthodontics department are a prospective source of coronavirus transmission. Dental practices derived droplets and aerosols from infected patients, which likely contaminate the whole surface in dental offices. In addition, it was shown at room temperature that coronavirus covid-19 remains infectious from 2 h to 9 days, and continues 50% with 30% relative humidity. Thus, keeping a clean and dry

environment in the dental prosthodontics department would help to decrease the persistence of covid-19.

3.3. infection control for a dental practice in prosthodontics department;

Standard & Suggested Dental Office Protocols [2,33,34]

1-Initial tele-screening of dental patients to distinguish suspected COVID-19 carriers 2-Every patient should be considered as a prospective asymptomatic COVID-19 carrier

3-Recently recovered patients should be considered as potential virus carriers for at least 30 days after the recovery confirmation by a laboratory test

4-Patients should be asked to fill out a detailed questionnaire regarding COVID-19. It is important to make a meticulous screening of even (asymptomatic patients)

5-Maintenance of proper record, address, contact details are of paramount importance. Since the incubation period of SARS-CoV-2 may extend over two weeks, a positive response to any of the above query's mandates deferring the appointment for at least two weeks. Additionally, the patients should be encouraged to self-quarantine at home and contact their primary care physician for tele-consultation [32,34]

6-Those patients who must come for dental treatment should be asked to wear a surgical face mask and to come alone or with a single attendant at the time of their dental visit

7-Prosthodontics department and the waiting area should be well ventilated at all times, along with spaced-out seating of patients

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9-Remove magazines, reading materials, toys, and other things

10-Schedule appointments to minimize possible contact with other patients in the waiting room 11-Use of contactless thermal screen and pulse oximeter device should be considered even if the patient answers no to all the COVID symptoms questions [3]

12-Use of a pulse oximeter can be expanded in general dental office screening procedures during this pandemic. Oxygen saturation of below 90% is a good marker for some form of oxidative distress in the body. The use of pulse oximeters can help in the screening of patients that might be asymptomatic but are having the disease

13-Patients should be leaded for hand sanitization and proper handwashing as soon as they enter the clinic

14-The prosthodontist should ensure that the entire team and all students are well versed with the universal precautions [16]

Dental emergencies

Dental emergencies can be potentially life-threatening requires immediate treatment to stop ongoing tissue bleeding, alleviate severe pain or infection, and include;

1-Uncontrolled bleeding

2-Cellulitis or a diffuse soft-tissue bacterial infection with intra-oral or extra-oral swelling that potentially compromises the patient's airway [35].

3-Trauma involving facial bones, potentially compromising the patient’s airway [35,36].

Prosthodontic emergencies

Although the word 'emergency' may not apply to the prosthodontic treatment in the true medical sense, there are many situations in which prosthodontic attention is required urgently, as specified in the ADA guidelines for better understand [2,37]. This urgent care is needed so that the patient can carry on with his usual activities without impairment in oral function or appearance. Some of such situations are: (fig. 3) [32]

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• Dental trauma because of denture fracture • Repair of broken dentures

• The need for temporary or immediate dentures

• Final crown/bridge repair or cementation if the temporary restoration is lost or broken. • Problems with implants or implant prosthesis

• Ulceration due to sharp edges of tooth or prosthesis [32].

Fig. 3 treatment of dental patient during covid-19.

3.4 Evaluation of patients [recommendation for dealing with covid-19 in prosthodontics department]

Prosthodontist and dental students should be able to recognize a suspected case of coronavirus COVID-19. In general, it is not recommended for a patient with COVID-19 who is in the acute febrile phase of the disease to visit the prosthodontics clinic Fig.4. If that happened, the prosthodontist and dental student inside the department should be able to distinguish the patient with a suspected covid-19 infection and should not treat the patient inside the department, but should immediately quarantine the patient and should report to the infection control department as soon as possible, especially in the epidemic period of covid-19 Coronavirus.

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The patient's body temperature should be measured in the first place. A contact-free forehead thermometer is highly recommended. A questionnaire should be used to screen patients with the possible covid-19 infection before starting the treatment.

The questions should contain the following: (1). Do you have fever on the last 14 days? (2). Have you experienced a recent onset of respiratory problems, in last 14 days? (3) Have you, traveled in last 14 days to Wuhan city, (4). Did you have any contact with a patient with a confirmed coronavirus infection in last 14 days? (5). Did you have any contact with people who come from Wuhan city in the last 14 days.

If a patient responds yes to any part of the questions, and the body temperature was below 37.3 °C, the dentist/prosthodontist can defer the treatment until 14 days after the exposure event. The patient should be informed to make self-quarantine at home and report to any fever experience or flu-like syndrome to the local health department. If a patient responds yes to any part of the questions, and the body temperature is not less than 37.3 °C, the patient should be directly quarantined, and the dental professionals/prosthodontist should report to the infection control department of the hospital or the local health department. If a patient response no to all questions, and the body temperature is less than 37.3 °C, the dentist/prosthodontist can make the treatment for the patient with a protection measure. If a patient response no to all the questions, but the body temperature is not below 37.3 °C, the patient should be instructed to the fever clinics or special clinics for COVID-19 for further medical care.

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4. MATERIAL AND METHODS

This study is a cross-sectional questionnaire conducted to assess dental students' knowledge about protection methods and the COVID 19 infected patient's treatment protocols in prosthodontics at LUHS during the 2020-2021 study year Lithuanian University of Health Science (LUHS), Kaunas, Lithuania. Bioethics permission approval was obtained from the ethics committee of the Lithuanian University of Health Sciences (LSMU), Kaunas Nr. BEC – OF – 113.

4.1 Subjects

The subjects of the research were dental students of the 4th and fifth academic years at LSMU. Two hundred thirty anonymous questionnaires were distributed to fourth and 5th-year dental students. Participation was voluntary and anonymous; thus, the return of the completed questionnaire was considered as acceptance to participate. A total of 155 students had responded and participated in this study. Participants were 51.6% female and 48.4% male.

4.2 The questionnaire

This questionnaire was designed to evaluate the students' knowledge about the protection methods, infection control, and the possible transmission routes of covid-19 in prosthodontics clinics. The anonymous self-administered questionnaire was developed by the investigator (MD) and scientific supervisor (AK). The type of survey was used Web-based survey by sending the link to particular persons. The questionnaire consisted of 26 questions. The first part of the questionnaire covered demographic data [gender, age, nationality, living status, and academic year]. The second part consisted of questions about the students' knowledge on the Covid-19 pandemic [symptoms, incubation period, receptor, host, and the main route of transmission and spread the infection]. The last part of the questions consisted of examining the students' knowledge about infection control and the possible transmission routes of covid-19, and the protection methods in prosthodontics clinics. The questionnaire covered questions about all protection methods and the COVID 19 infected patient's treatment protocols in prosthodontics. The confidentiality of research participants is guaranteed. The poll is anonymous, ID will not be disclosed, and all question forms filled in anonymously and confidentially. Research data used only for scientific purposes. Considering students' knowledge about the protection methods, infection control, and the possible transmission routes of covid-19 in prosthodontics clinics, questions asked how does COVID-19 spread in the prosthodontics department (frequent direct or indirect contact of prosthodontics doctors with human

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communication with the patients, a dental instrument such as high-speed that make a large amount of aerosol and droplets mixed with the patient's saliva or blood will make a small particles of droplets that stay airborne for a long period before they stabilize on environmental surfaces or enter the respiratory tract, all answers are correct, I don't know).Question regarding how can prosthodontist and students prevent the spread of COVID-19 had five options;[Washing hands with alcohol-sanitizer (before and after patient examination),(protection equipment, including protective eyewear, masks, gloves, caps, face shields, and protective outwear), (doctors and students should avoid touching their own eyes, mouth, and nose), all answers are correct, I don't know].Answers to questions regarding usage of rubber dam had the followed options ;(increase airborne particles, reduce airborne particles, I don't know).Questions related to students' knowledge about sterilization had five types of questions, first the packets that containing the models , casts , dentures etc, needs to be disposed of (with BMW protocols ,with hygiene protocols ,with the hospital protocols),2nd in case when the cast/model becomes contaminated with blood from any patient, or with saliva from and infectious patient (the gypsum must be treated as “infectious” clinical waste ,dental casts/gypsum must be disposed of in its own separate container, which is stored in surgery ,the gypsum must be disposed of in a sharps bin), 3rd the lathe machine should be(cleaned and heat sterilized between each patient ,cleaned and disinfected at the start and end of each day or when contaminated, should be cleaned and disinfected daily),4th methods of disinfecting Dental casts(can be immersed in Sodium Hypochlorite for 20 mins ,can be immersed in Sodium Hypochlorite for 10 mins ,can be immersed in Sodium Hypochlorite for 15 mins),5th methods of disinfecting Zinc-oxide eugenol impression paste(0.5% Sodium, Hypochlorite, Iodophors, Cidex ,2% Glutaraldehyde).Questions regarding students' knowledge about the Covid-19 pandemic covered information about what is COVID-19 (middle east respiratory syndrome, coronavirus syndrome, respiratory syndrome, severe acute respiratory syndrome, all answer are correct, I don't know ), is COVID-19 contagious ( yes, no, I don't know ), typical symptoms of COVID-19 (fever, cough, and headache or shortness of breath or loss of smell or taste, all answer are correct, I don't know ), is there any vaccine for coronavirus COVID-19 had three options: ( yes, no, I don't know ), the main route of transmission and spread the infection had five options : ( airborne droplet, cough, face to face communication, handling of sharp instruments, I don't know ).The question about the incubation period of COVID-19 had five options:(14 days,24 days, 27 days, I don't know).Regarding the question Can the Covid-19 infected person be asymptomatic had the followed options(yes, no, I don't know ).The question about a possible primary host of COVID-19 had five options: (Bat, palm civets, Raccoon dogs, all correct, I don't know). Finally, the last question regarding students' knowledge about Covid-19was about the entry receptor of covid-19 in humans (ACE receptor, ACE2 receptor, ACE4 receptor). Finally, the last three questions covered information about the students' knowledge about protection methods and patient evaluation.

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Questions regarding an elderly patient who is a denture wearer, infected with COVID-19 how should she/he act had four options; (should immediately discard wearing the denture, should disinfect denture with 100% Vinegar (acetic acid) for 6-8 hours, should disinfect denture with 3% Hydrogen Peroxide for 30 mins, I don't know ).Question asked what should the dentist do if a patient who came to him was traveling or had contact with a corona patient in the previous 14 days and his/her body temperature is below 37.3 °C (the dentist should defer the treatment until 14 days after the exposure event, the doctor should not do anything because there is no critical situation, the patient should be instructed to self-quarantine at home for 14 days and defer the dental appointment, the patient should be immediately quarantined, and the dental professionals should report to the infection control department of the hospital or the local health department, I don't know ).Question asked what should the dentist do if a patient who came to him was traveling or had contact with a Corona patient in the previous 14 days and his/her body temperature is no less than 37.3 °C(the dentist should defer the treatment until 14 days after the exposure event, the doctor should not do anything because there is no critical situation, the patient should be instructed to self-quarantine at home for 14 days and defer the dental appointment, the patient should be immediately quarantined, and the dental professionals should report to the infection control department of the hospital or the local health department).

4.3 Statistical analysis

The data were analyzed using the statistical package (SPSS version 22). Statistical evaluation included Chi-squared tests for differences between 4th and 55th-yearodontology students' knowledge about the COVID 19 during this pandemic situation, Statistical significance was set at P< 0.05.

Permission issued by the ethics committee

This study was approved by the Bioethics Department of Lithuanian University of Health Sciences, the Committee of Bioethics has granted permission Nr. BEC – OF – 113. (annex 4). Issued on 2021.04.16

Ensuring of confidentiality

The confidentiality of research participants is guaranteed. The poll is anonymous, ID will not be disclosed, and all question forms will be filled anonymously and confidentially. Research data will be used only for scientific purposes.

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5. RESULTS

In this study, participants were 51.6% female and 48.4% male (p>0.05) (Table 1). Overall, 155 participants were enrolled in the study, and the age mean of the students was between 22-25 years.52.3% of 4th-year odontology student was participant, while the 5th academic year participants were 47.7%. Statistically significant differences were not found in students' distribution by academic year (p>0.05). Considering the living status, a majority of students were living in Lithuania 95.5%.

Table 1. Demographic characteristics of participants.

Q numbers Frequency Percent Valid

Percent Q1. Sex male 75 48.4 Female 80 51.6 Q2. Age 18-21 15 9.7 22-25 115 74.2 26-30 24 15.5 More than 30 1 0.6

Q3. Academic year 4th_year ₈₁ _52.3

5th_year ₇₄ _47.7

Q5. Your living status now In Lithuania 148 95.5

In your country from a month or more

3 1.9

In your country since the beginning of Corona

4 2.6

Q6. - Is the source of COVID-19 pandemic information in Lithuania readily available in both Lithuanian and English?

Yes 124 80.0

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5.1 Students’ knowledge on Covid-19 pandemic

About 46.5 of the students answered correctly about the question related to what is Covid -19 table 2. Total of 39 from 4th year answered correct and 33 students from 5th year. The study showed that there is no statistically significant difference between 4th and 5th-year students in answering the question What is COVID 19 (p> 0.05) (0.077>0.05) table 3. We can see that in question-related to is COVID-19 contagious? 77 of 4th year answered yes and 73 of 5th-year odontology students answered yes.96.8% answered correctly statistically p-value is >0.05 (0.207 >0.05) so this means there is no statistically significant difference between the two groups of students. In question what the typical symptoms of COVID-19 are, 104 answered correct, 47 students from 4th year and 57 from 5th year, statistically p-value is >0.05 (0.083 >0.05) so this means there is no statistically significant difference between two groups of students. in question number 10, we had 99.4% correct answer 81 of students from 4th_{year answered correct and 73 from the 5}th_{year odontology students, P= 0.294 >0.05, a. 2} cells (50.0%) have expected count less than 5. The minimum expected count is 0.48. In question number 11, total of 150 (96.8%) answered correct, P=0.207 >0.05, a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 2.39, in question number 12, we had 7.1% said I don’t know but 83.2% answered correct, P=0.409 >0.05, a. 6 cells (60.0%) have expected count less than 5. The minimum expected count is 0.95.Q13, no statistics are computed because of Q13. Is there any vaccine for coronavirus COVID-19 is a constant. Q14, related to the main route of transmission and spread the infection, we had 12.3% said face to face communication and 77.4 said airborne droplet, P= 0.138 >0.05, a. 4 cells (40.0%) have expected count less than 5. The minimum expected count is 0.95. In Q15 related to the he entry receptor of covid-19 in humans, 32.3% of students don’t know the correct answer and 8.4 % said ACE receptor, but the majority of students 49% answered correct ACE2 receptor, P= 0.669 >0.05, a. 0 cells (0.0%) have expected count less than 5, the minimum expected count is 6.21. As we can see from the performed calculations, there is no statistically significant difference between 4th and 5th year students in answering all the questions (p> 0.05).

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Table 2about the students' knowledge on the Covid-19 pandemic

Q numbers Frequency Percent Valid Percent

Chi-square Asymp. sig Q7. What is

COVID-19

I don't know 7 4.5

0.862 0.353 Middle east respiratory

syndrome 14 9.0

Coronavirus syndrome 24 15.5

Respiratory syndrome 26 16.8

Severe acute respiratory

syndrome 72 46.5

All answer are correct 12 7.7

Q8. Is COVID-19 contagious No 5 3.2 1.584 0.208 Yes 150 96.8 Q9. What is the typical symptoms of COVID-19 I don't know 1 0.6 5.420 0.020 Fever, cough, and headache 27 17.4

Shortness of breath 9 5.8

Loss of smell or taste 14 9.0

Q10. What is the incubation period of COVID-19 14 days 154 99.4 1.095 0.295 24 days 1 0.6

Q11Can the Covid-19 infected person be asymptomatic No 5 3.2 1.584 0.208 Yes 150 96.8 Q12. The possible primary host of COVID-19 is I don't know 11 7.1 0.501 0.479 Palm civets 9 5.8 Bat 129 83.2 Raccoon dogs 4 2.6

Q13. Is there any vaccine for coronavirus COVID-19 Yes 155 100.0 0.000 1.000 No 0 0 Q14. What is the main route of transmission and spread the infection

I don't know 2 1.3

1.467 0.226

Cough 11 7.1

Handling of sharp instruments 3 1.9 Face to face communication 19 12.3

Airborne droplet 120 77.4 Q15. the Entry receptor of covid-19 in humans is I don't know 50 32.3 1.400 0.237 ACE receptor 13 8.4 ACE2 receptor 76 49.0

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Table 3. P*-comparison between 4th and 5th year odontology student; Chi-square test Q numbers Frequency 4th year odonto logy studen ts 5th_year odontolo gy students Total of 4th and 5th year Pearson Chi-square Value Asymp. Sig. (2-sided) Q7. What is COVID-19 I don't know 2 5 7 9.946a 0.077

Middle east respiratory

syndrome 10 4 14

Coronavirus syndrome 7 17 24

Respiratory syndrome 16 10 26

Severe acute respiratory syndrome

39 33 72

All answer are correct 7 5 12

Q8. Is COVID-19 contagious No 4 1 5 1.594a 0.207 Yes 77 73 150 Q9. What is the typical symptoms of COVID-19 I don't know 0 1 1 8.234a 0.083

Fever, cough, and headache 18 9 27

Shortness of breath 6 3 9

Loss of smell or taste 10 4 14

Q10. What is the incubation period of COVID-19 14 days 81 73 154 1.102a 0.294 24 days 0 1 1

Q11Can the Covid-19 infected person be asymptomatic No 4 1 5 1.594a 0.207 Yes 77 73 150 Q12. The possible primary host of COVID-19 is I don't know 5 6 11 3.977a 0.409 Palm civets 6 3 9 Bat 67 62 129 Raccoon dogs 3 1 4

Q13. Is there any vaccine for coronavirus COVID-19 Yes 81 74 155 No 0 0 0 Q14. What is the main route of transmission and spread the infection

I don't know 0 2 2

6.965a 0.138

Cough 4 7 11

Handling of sharp instruments 3 0 3

Face to face communication 12 7 19

Airborne droplet 62 58 120 Q15. the Entry receptor of covid-19 in humans is I don't know 23 27 50 1.558a 0.669 ACE receptor 7 6 13

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5.2 Students' knowledge about infection control and protection methods in the prosthodontics department

In Q16. How does COVID-19 spread in prosthodontics clinic, we had 72.9% of total correct answers 55 of them from 4th year and 58 from 5th year. P-value 0.380 (p> 0.05). In question 17 we had 133 (85.8%) correct answers 67of them from 4th year and 66 from 5th year. P value 0.770 (p> 0.05). In question 18 that related to Usage of rubber dam we had 125 (80.6%) of correct answer 60of them from 4th year and 65 from 5th year. P value 0.093 (p> 0.05), in Q19 the correct answer was With Bio-Medical Waste (BMW) protocols we had total of 59 (38.1%) correct answer 35 of them from 4th year and 24 of 5th year odontology student, p value 0.355 (p> 0.05), in question 20, (in the case when the cast/model becomes contaminated with blood from any patient, or with saliva from and infectious patient.), total correct answer was 69 (44.5%) p=0.31<0.05). In Q20 question significantly more correct answer for 5th year odontology students (42) than 4th year odontology students (27). In Q21 Related to lathe machine and how we can sterilized, we had 32 of correct answer from 4th year and 37 from 5th year, with total 69 (44.5%) p value 0.227 (p> 0.05). In question number 22 we had 36 correct answer from 4th year and 31 from 5th year with total 67 (34.2%),p value 0.489 (p> 0.05).in question 23 we had 26 correct answer from 4th year and 23from 5th year with total 49 (31.6%),p value 0.670(p> 0.05). considering all the questions related to examining the students' knowledge about infection control, and the protection methods in prosthodontics clinics. From the performed calculations, there is no statistically significant difference between 4th and 5th year students in answering all the questions (p> 0.05), except Q20 (In case when the cast/model becomes contaminated with blood from any patient, or with saliva from and infectious patient. p=0.31<0.05). In Q20 question significantly more correct answer for 5th year odontology students (42) than 4th year odontology students (27) table4 and table5.

Table 4. examining the students' knowledge about infection control and the possible transmission

routes of covid-19, and the protection methods in prosthodontics clinics

Q numbers Frequency Percent Valid Percent

Chi-square Asymp.sig

Q16. How does COVID-19 spread in prosthodontics department

I don't know 4 2.6

1.703 0.192 Frequent direct or indirect contact

of a prosthodontics doctors with human fluids

9 5.8

Face to face communication with the patients

9 5.8

Dental instrument such as high-speed that make a large amount of aerosol and droplets mixed

20 12.9

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Q17. How can prosthodontist and students prevent the

spread of COVID-19 Washing hands with alcohol-sanitizer (before and after patient examination)

4 2.6

Protection equipment, including protective eyewear, masks, gloves, caps, face shields, and protective outwear

8 5.2

Doctors and students should avoid touching their own eyes, mouth, and nose.

7 4.5

Q18. Usage of rubber dam

could I don't know 26 16.8

4.571 0.033 Increase airborne particles 4 2.6

Reduce airborne particles 125 80.6

Q19. The packets that containing the models , casts , dentures etc. needs to be disposed off

I don't know 52 33.5

0.230 0.632 With hygiene protocols 27 17.4

With the hospital protocols 17 11.0

With BMW protocols 59 38.1

Q20. In case when the cast/model becomes contaminated with blood from any patient, or with saliva from and infectious patient.

0.312 0.576 The gypsum must be treated as

“infectious” clinical waste ?

69 44.5

Dental casts/Gypsum must be disposed of in its own separate container, which is stored in surgery?

49 31.6

The gypsum must be disposed of in a sharps bin?

4 2.6

Q21. The lathe machine should be

0.042 0.838 Cleaned and heat sterilized between

each patient. 46 29.7

Cleaned and disinfected at the start and end of each day or when contaminated.

69 44.5

Should be cleaned and disinfected

daily 12 7.7

Q22. Methods of disinfecting

Dental casts I don't know 27 17.4

1.939 0.164 Can be immersed in Sodium

Hypochlorite for 20 mins 29 18.7 Can be immersed in Sodium

Hypochlorite for 10 mins 67 34.2 Can be immersed in Sodium

Hypochlorite for 15 mins

32 20.6

Q23.Methods of disinfecting Zinc-oxide euge0l impression paste I don't know 63 40.6 0.657 0.418 0.5% Sodium Hypochlorite 29 18.7 Iodophors 10 6.5 Cidex 4 2.6 2% Gluteraldehyde 49 31.6

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Table 5. P*-comparison between 4th and 5th year odontology student; Chi-square test

Q numbers Frequency 4th_year

odontology students 5th_year odontology students Total of 4th and 5th year Pearson Chi-square Value Asymp. Sig. (2-sided) Q16. How does COVID-19 spread in prosthodontics department I don't know 3 1 4 4.194a _0.380

Frequent direct or indirect contact of a

prosthodontics doctors with human fluids

4 5 9

Face to face

communication with the patients

5 4 9

Dental instrument such as high-speed that make a large amount of aerosol and droplets mixed

14 6 20

Q17. How can prosthodontist and students prevent the spread of COVID-19

I don't know 2 1 3

1.814a _0.770

Washing hands with alcohol-sanitizer (before and after patient examination)

2 2 4

Protection equipment, including protective eyewear, masks, gloves, caps, face shields, and protective outwear

5 3 8

Doctors and students should avoid touching their own eyes, mouth, and nose.

5 2 7

Q18. Usage of rubber dam could

I don't know 18 8 26

4.740a _0.093

Increase airborne particles 3 1 4

Reduce airborne particles 60 65 125

Q19. The packets that containing the models , casts , dentures etc. needs to be disposed off

3.249a _0.355

With hygiene protocols 14 13 27

With the hospital

protocols 6 11 17

With BMW protocols 35 24 59

Q20. In case when the cast/model becomes contaminated with blood from any patient, or with saliva from and infectious patient.

8.887a _0.031

The gypsum must be treated as “infectious” clinical waste?

27 42 69

Dental casts/Gypsum must be disposed of in its own separate container, which

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The gypsum must be disposed of in a sharps bin?

3 1 4

Q21. The lathe

machine should be I don't know 17 11 28

4.341a _0.227

Cleaned and heat sterilized between each patient.

23 23 49

Cleaned and disinfected at the start and end of each day or when

contaminated.

32 37 69

Should be cleaned and

disinfected daily 9 3 12 Q22. Methods of disinfecting Dental casts I don't know 16 11 27 2.423a _0.489 Can be immersed in Sodium Hypochlorite for 20 mins

16 13 29

Can be immersed in Sodium Hypochlorite for 10 mins

36 31 67

Can be immersed in Sodium Hypochlorite for 15 mins 13 19 32 Q23.Methods of disinfecting Zinc-oxide euge0l impression paste I don't know 29 34 63 2.359a _0.670 0.5% Sodium Hypochlorite 18 11 29 Iodophors 6 4 10 Cidex 2 2 4 2% Glutaraldehyde 26 23 49

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5.3 comparison of knowledge between 4th and 5th year odontology students about infection control during covid 19 pandemic.

Considering all the questions related to infection control for a dental practice in prosthodontics department. From the performed calculations, there is no statistically significant difference between 4th and 5th year students in answering all the questions (p> 0.05), p value of question number 24 p= 0.135 (p> 0.05), and question number 25 p=0.345(p> 0.05), and for question number 26 p= 0.184 (p> 0.05) table 6.

Table 6. P*-comparison between 4th and 5th year odontology student; Chi-square test

Q numbers Frequency 4th_year

odontology students 5th_year odontology students Total of 4th_and 5th_year Pearson Chi-square Value Asymp. Sig. (2-sided) Q24. If elderly patient who

is a denture wearer, infected with COVID-19

5.557a _0.135 Should immediately discard

wearing the denture. 23 29 52

Should disinfect denture with 100% Vinegar (acetic acid) for 6-8 hours.

20 8 28

Should disinfect denture with 3%

Hydrogen Peroxide for 30 mins 19 19 38

Q25. What should the dentist do if a patient who came to him was traveling or had contact with a corona patient in the previous 14 days and his/her body temperature is below 37.3 ?°C

I don't know 6 8 14

4.480a _0.345 The doctor should not do

anything because there is no critical situation.

3 0 3

The patient should be instructed to self-quarantine at home for 14 days and defer the dental appointment.

48 46 94

The dentist should defer the treatment until 14 days after the exposure event

19 13 32

The patient should be

immediately quarantined, and the dental professionals should report to the infection control department of the hospital or the local health department

5 7 12

Q26. What should the dentist do if a patient who came to him was traveling or had contact with a Corona patient in the previous 14 days and his/her body temperature is 0t less than 37.3 ?°C

I don't know 8 5 13

6.207a _0.184 The doctor should not do

anything because there is no critical situation.

0 2 2

The patient should be instructed to self-quarantine at home for 14 days and defer the dental appointment.

18 9 27

The dentist should defer the treatment until 14 days after the exposure event

4 7 11

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dental professionals should report to the infection control department of the hospital or the local health department

How dental students handle denture wearing patients infected with COVID-19 (Figure 1). The majority of answers (33.55%) were correct. Patient should immediately discard wearing the denture.

Fig. 1 Answers of question related to denture patients

How dental students handle patients arriving to the dental clinic who were traveling or had contact with a corona patient in the past 14 days and his/her body temperature is below 37.3 ° C, (figure 2). The majority of answers (60.65%) were correct. The patient should be instructed to self-quarantine at home for 14 days and defer the dental appointment.

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How dental students handle patients arriving to the dental clinic who were traveling or had contact with a corona patient in the past 14 days and his/her body temperature is not less than 37.3 °C, figure 3. The majority of answers (65.8%) were correct. The patient should be immediately quarantined, and the dental professionals should report to the infection control department of the hospital or the local health department.

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6. DISCUSSION

Despite several studies conducted regarding Covid-19, studies focused on signs and symptoms and the possible transmission route of covid-19 Coronavirus. Our study focused on the possible transmission route of covid-19 Coronavirus in dental/prosthodontics clinic and infection control for a dental practice. We add recommendations for dealing with covid-19 patients inside prosthodontics clinics. Revealed in this prospective questionnaire-based study carried out on a sample of 4th and 5th year odontology students that about more than half of the fourth and fifth-year dental students had knowledge about the protection methods and the possible transmission routes of covid-19 in prosthodontics clinics, where correct answers of 4th-year odontology students 63.70% and correct answers of 5th-year odontology students 68.24%.

Studies have suggested that covid-19 may be airborne through aerosols formed during medical procedures [2.23]. Respondents identified that airborne droplet is now considered as the main route of transmission and spread the infection [3] with high proportion (77.4%) Also, a report in Germany indicates that the covid-19 coronavirus may also be transmitted through contact with asymptomatic patients [2,22] a high proportion (96.8%) of respondents was aware about this., it has been confirmed that covid-19 enters the cell in the same path as SARS coronavirus, that is, through the ACE2 cell receptor [25], in our study we can see that 32.3% of student said that the entry receptor of covid-19 in humans is ACE2.However,32.3% of students do not know the correct answer, and 96.8% knew that COVID-19 is contagious ,this finding at least reveals respondents’ awareness of mode of transmission and the importance knowledge on Covid-19 infection . Studies have shown that there are methods of cleaning and disinfecting [38], first disinfecting dentures, the denture should be soaking in 3% Hydrogen Peroxide for 30 mins, also can be soaking in 0.2% Chlorhexidine gluconate for 10 mins (More potent than Sodium hypochlorite). or with 100% Vinegar (acetic acid) for 6-8 hours. Second disinfecting Impressions. (Alginate – 0.5 % Sodium Hypochlorite or iodophors or 2% Glutaraldehyde), (Zinc-oxide eugenol impression paste – 2% Glutaraldehyde or Chlorine compounds), Elastomeric impression materials – 2% Glutaraldehyde or Cidex) [38].

Third disinfecting Trays & Cast [38].

1- Prefer disposable trays, for example metal trays to be autoclaved. 2-Plastic trays/Bite rim 2% Glutaraldehyde solution for 10 mins.

3-Dental casts & die can be immersed in Sodium Hypochlorite for 10 mins.

The majority of respondents were aware of the measures adopted of sterilizing. The majority of students 43.2%were aware of the methods of disinfecting Dental casts, we can see that 31.6% of student said that the methods of disinfecting Zinc-oxide eugenol impression paste is 2%

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The main infection prevention for a dental practice in prosthodontics department for managing covid-19 infection are important and well documented. [1,2,5]. Protection equipment, including a protective eyewear, masks, gloves, caps, face shields, and protective outwear, is highly recommended for all healthcare in the clinics including dental student in prosthodontics department during the epidemic period of covid-19 coronavirus [2]. However, the majority of respondents (85.5%) were aware of the measures adopted for prevent the spread of COVID-19 and 72.9% knew How can COVID-19 spread in prosthodontics department. Studies found that the (using of rubber dams can significantly reduce the production of saliva- and blood-defiled aerosol or splatter, the use of rubber dam could reduce airborne particles significantly in ~3-foot diameter of the operational field by 70% [40]. When applying the rubber dam, extra high-volume suction should be used for aerosol and spatter during the procedures along with regular suction [41]. the most important is to reduce the generation of aerosol as much as we can) [2]. dental professionals and students should be able to recognize a suspected case of COVID-19. In general, it is not recommended for a patient with COVID-19 to visit the dental clinic. If that happened, the dental professional and dental students should be able to distinguish the patient with a suspected covid-19 infection and should be able to protect them self as well as patient. Wherefore Our study focused on the importance of following safety procedures regarding patient treatment.

From the results of this survey, it is very encouraging to conclude that dental students in LSMU had good knowledge of covid-19 (etiology, symptoms, protection), however our data indicate the need for further continuing education among medical staff, as well as improving public education about infection control.

The main limitation of our study was that this study enrolled only 4th and 5th year dental students. Thus, the sample of this study does not represent all odontology students at LSMU. Also, fourth-year students have similarities in practical studies with fifth-year students. This was the reason for not seeing much of different answers among fourth year and fifth students.

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7. CONCLUSIONS

1. Almost half of the dental student had a good knowledge on Covid-19 infection control in a prosthodontics clinic.

2. Studies showed that students experience in practice related to possible transmission routes of covid-19 in prosthodontics clinics is good enough. Participants behaviour during covid -covid-19 pandemic situation was great.

3. Most of the international dental students showed an adequative level of attitude and knowledge toward the Universal Precaution, infection control and protection methods in prosthodontics at LSMU.

4. No statistically significant difference between 4th and 5th year students in answering all the questions (p> 0.05), because correct answers 4th year odontology students 63.70% and correct answers 5th year odontology students 68.24%.

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8. PRACTICAL RECOMMENDATIONS

Since the risk of cross-infection can be high between patients and dental students, I believe that awareness about COVID-19 among dental students should be raised by education and clinical practices.

1.To include seminars about the possible transmission routes of covid-19 in prosthodontics clinics. 2.Include initial training and safe practice classes about the protection methods and infection control in prosthodontics clinics.

3.Seminars should be oriented towards educating and protecting students instead of focusing solely on giving a large amount of information. That would lead the students to be more aware of this pandemic situation and potentially could decrease the risk of covid-19 infections.

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ACKNOWLEDGMENTS

I devote this thesis to my beloved family for their constant encouragement and unwavering faith in me. I want to thank my father Eng. Qusay Dadoue, and mother Khawla Shawee for their tremendous support, always inspiring me to follow my dreams. This journey would not have been possible without the help of my Brothers Eng.Mohamed Dadoue , MamounDadoue and Sisters pharmacist Rima Dadoue , Marwa Dadoue and friends, professors, and university staff.

Finally, I am utterly, grateful for Dr. Albertas Kriaučiūnas invaluable assistance, support, and collaboration. Your patience, guidance, dedication, and encouragement were inspirational towards reaching the standard of work we always wanted.

CONFLICT OF INTERESTS

The author has not encountered any conflict of interest during this research.

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LUHS dental students’ knowledge about the COVID 19 infected patient’s treatment protocols in prosthodontics

Mawada Dadoue