The Effect of the Covid-19 Pandemic on Specialty Choices of Dental Students

The Effect of the Covid-19 Pandemic on Specialty Choices of Dental Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of the Covid-19 Pandemic on Specialty Choices of Dental Students Zehra EDEBAL, Salih DOĞAN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2217141/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract We aimed to evaluate the effect of the COVID-19 pandemic on the career plans and self-perception of knowledge levels of undergraduate dental students. In this multicentre cross-sectional study, a multiple-choice survey was taken by students from three different universities in two countries in 2020. Chi-square test or Fisher’s exact test was used to determine statistically significant differences. Of the 755 students that participated in our study, 66% had fear of being at risk for contagion and only 46% claimed to have adequate knowledge about occupational infections and the methods to protect themselves. Utilization of credible publications, guidelines (57% vs. 34%, p < 0.001), and online education (19% vs. 8%, p < 0.001) were significantly higher in students claiming to have adequate knowledge. 11% of the students debated dropping out of dental education because of the COVID-19 pandemic. These students had a markedly elevated rate of fear of being at risk for contagion because of the COVID-19 pandemic (80% vs. 64%, p = 0.011). 76% of the students were aiming for a dental specialty. 18% changed their desired specialty and 22% were in search of a specialty that requires less close contact procedures because of the COVID-19 pandemic. Providing students with sufficient information from trustworthy sources through distance education, as well as psychological support when needed has crucial importance for a successful dental education and career planning. Dental education Coronavirus Personal protective equipment Career choice Dental Specialty Introduction COVID-19 infection, which was first encountered in China in the last days of 2019 and which became a pandemic after spreading worldwide in months, is caused by a virus that belongs to the Coronavirus family. Because the infection is easily transmitted by close contact, many health sector professionals such as doctors, dentists, nurses, and paramedics became a target for the contagion of the disease. The contagion risk is even higher for dentistry because of their routine methods requiring prolonged face-to-face sessions with patients and utilization of equipment that generate a remarkable amount of aerosols, like dental drills, air-water syringes, and sonic scalers (OSHA, 2020). Therefore, the American Dental Association (ADA) suggested postponing all cases other than the ones requiring urgent or emergency procedures, and just providing emergency dental care at the beginning of the pandemic (ADA, 2020). After the onset of the pandemic, understanding the disease, defining clinical symptoms and findings, managing diagnostic methods, and providing information about protection from the disease required a significant amount of time. These pieces of information are still being updated regularly (OSHA, 2020; ADA, 2020; WHO, 2020). Unproven information reached out to large masses through media like television, the internet, and social media, before credible evidence-based guidelines about the properties of the virus and protection methods were established through research studies. Especially, the distribution of information to large populations through social media may initially seem convenient, but it may contain many misleading headlines and content (Olum et al., 2020; Zanatta et al., 2021). During the pandemic, students can easily be overwhelmed by the fear of the disease and have to face the feeling of pressure (Wong et al., 2004; Lestari et al., 2022). Therefore, institutions like the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and ADA regularly publish announcements aimed at society and professionals to provide a reliable source of information (ADA, 2020; WHO, 2020). Many universities couldn’t continue with face-to-face education because of the quarantine measures taken during the pandemic. To ensure the continuity of education and keep the students motivated, universities with adequate technological infrastructure switched to online education. Different evaluation and measurement methods were applied for assessing the effectiveness of this education modality. But for dentistry, it did not seem plausible for any distance learning course to replace face-to-face education since direct applications which should be performed on the patients during the clinical practice, an integral part of dental education, couldn’t be performed (Iyer et al., 2020). In this study, we aimed to survey dental students about their awareness and knowledge of contagious diseases, protecting themselves from infections, preventive methods, working conditions, and occupational hazards, and demonstrate how the pandemic impacted their education. We also intended to investigate whether the pandemic affected the students’ choice of dental specialties. Materials And Methods This study was conducted with the approval of the Near East University Scientific Research Ethics Evaluation Board with approval number 2020/802-1125. In this multicenter cross-sectional study, participants, who were from two different countries were undergraduate students in the Turkish course of dental faculties of Near East University (NEU), University of Kyrenia (UoK) in the Turkish Republic of Northern Cyprus (TRNC), and Erciyes University (ERU), in Turkey. A survey, which was prepared as per our aims for this cross-sectional study, was distributed as Google Forms, and the answers were collected through the same platform. The participants were asked to take the survey between 20 July and 15 August 2020. There were 15 multiple-choice questions, 4 of which were about the demographics of students; age, class, gender, and university (Table 1). Students in the 4 th and 5 th years were regarded as the clinical students’ group, and 1 st , 2 nd , and 3 rd -year students constituted the preclinical students’ group. All student responses were evaluated for all of the questions. No identifying data about the participants were collected. The questions can be divided into three main sections. The first section aimed to gather data about the students’ feelings of self-confidence about their knowledge of the COVID-19 pandemic, fear of catching a contagious disease, feeling informed about protecting themselves from the disease, and ways of gathering information about this topic. In the second section, students were asked if they ever wanted to drop out of dental education because of the COVID-19 pandemic. For the third section, students were first asked if they were planning to have a post-graduate residency in a dental specialty and about the effects of the COVID-19 pandemic on their dental specialty choice. The Statistical Package for the Social Sciences software version 15 (SPSS Inc., Chicago, U.S.A.) was used for all the statistical analyses. The internal consistency of the given responses was measured by Cronbach's alpha and values over 0.70 were regarded as statistically reliable. The demographic data were analyzed by the median and interquartile range (IQR) values and frequency distribution tables. The results were reported as median (IQR), or percentage. Participants were grouped for certain analyses according to the responses they gave to prior questions. The nominal data were compared using crosstabs. Chi-square test or Fisher’s exact test was used to determine statistically significant differences between these groups. P values less than 0.05 were regarded as statistically significant. Results Demographic Information and Reliability The online survey link was shared with 1532 students in three dental faculties in two countries. Overall, 755 dental students participated in our study, corresponding to a 49% response rate. More than half of the participating students were from ERU (N=394, 52%), while 286 NEU students (38%) and 75 UoK students (10%) responded to the survey. The study population consisted of 338 clinical (45%) and 417 preclinical (55%) students, females comprised 63% (N=474), and men comprised 37% (N=281) of the population. There was no difference in gender distribution between universities (NEU 63% females, UoK 55% females, ERU 64% females, p = 0.292). Cronbach’s analysis was performed to evaluate the consistency of the responses given to the same group of questions. The alpha value of questions about contagious diseases and personal protective equipment (PPE) usage and education in dental specialties were found to be 0.71 and 0.79, respectively. Removing any of the questions didn’t increase the corresponding alpha values. Students’ Fears In all of the 755 students that participated in this study, 92% stated that their awareness about contagious diseases that can be transmitted in the occupational environment increased in the course of the COVID-19 pandemic (Table 2). Also, a fear of being at risk for contagion because of the COVID-19 pandemic emerged in two-thirds of the students. Less than half of the students reported having sufficient knowledge about occupational infections and methods for protection, 64% stated that they knew how to protect themselves from COVID-19 infection while practicing their profession, and 58% reported that they have sufficient information about PPE to protect themselves from COVID-19 (Table 2). Social media was found to be the most common source for gathering information about PPE, their properties, and usage (57%), followed by reliable publications and guidelines of organizations (47%), friends and social circle (37%), television (37%), and online education (14%, Table 3). We wanted to investigate the relationship between gathering adequate information and the sources of knowledge, so we separated the students that stated to have knowledge about the PPE for protecting themselves from COVID-19 while treating their patients as PPE group and compared them to the rest of the students about their sources of gathering knowledge. In the PPE group, the use of reliable publications and guidelines (57% vs. 34%, p < 0.001), and online education (19% vs. 8%, p < 0.001) for sources of obtaining information were significantly higher, contrary to friends and social circle (32% vs. 44%, p = 0.001), which were significantly lower. The utilization of television and social media didn’t differ between the PPE group and the rest of the students (p=0.067 and p=0.180 respectively, Table 4). Students’ Thoughts about Dropping out of Dental Education The students were asked if they ever thought of dropping out of dental education because of the COVID-19 pandemic, and the responses are summarized in Table 5. While 675 of the students never considered dropping out, eighty students (11%) had thoughts about quitting dental education. Students that contemplated dropping out had a significantly higher rate of fear of being at risk for contagion because of the COVID-19 pandemic (80% vs. 64%, p = 0.011). Furthermore, the proportion of students that reported knowing occupational infections and how to protect themselves from them (25% vs. 49%, p < 0.001), on how to be protected from COVID-19 in the occupational environment (46% vs. 66%, p < 0.001), and on the PPE that must be used to prevent COVID-19 infection (43% vs. 60%, p < 0.001) were significantly lower among the students that considered dropping out. The ratio of consideration of dropping out of dental education was significantly higher in clinical students, compared to non-clinical students (15% vs. 7%, p < 0.001). Students’ Career Plans The rate of students who were aiming for a dental specialty was 76% (N = 574). This was higher in women (82% vs. 69%, p = 0.004), and lower in clinical students (67% vs. 83%, p < 0.001). Of these 574 students, 18% stated that the COVID-19 pandemic caused a change in the specialty they were aiming for, and 22% stated that they were in search of a specialty that requires less close contact while treating patients. In the students that wanted to change their desired dental specialty because of the COVID-19 pandemic, the fear of facing contagious diseases while practicing their profession was significantly higher (78% vs. 64%, p = 0.004). The students who wanted to change their desired dental specialty also reported having less knowledge about occupational infections and protection methods (32% vs. 48%, p = 0.007), and the PPE used for protection from the COVID-19 infection (47% vs. 63%, p = 0.002). The students who were aiming for a dental specialty education and didn’t have adequate information about the degree of close contact procedures applied to the patients in their preferred specialty tended to change their choice of dental specialty more (29% vs. 15%, p = 0.001), and they were more eager to look for a dental specialty with less close contact with the patients (42% vs. 18%, p < 0.001). The clinical students aiming for education in a dental specialty had a higher rate of looking for a specialty that requires less close contact while treating patients, compared to the preclinical students (28% vs. 19%, p = 0.008). The clinical students also had a higher tendency to choose specialties like oral diagnosis and radiology or oral pathology (33% vs. 21%, p < 0.001). Besides, only 38% of them stated they wouldn’t change their choice of dental specialty due to the COVID-19 pandemic, compared to a 53% ratio of the preclinical students (p < 0.001). Discussion The COVID-19 pandemic affects the health status of all people, as well as social interactions and careers, especially dentistry, which is one of the high-risk professions because of the close physical interaction with the patients and aerosol-producing procedures (OSHA, 2020; Spagnuolo et al., 2020). Dental students were also largely affected during this period. Besides the sudden onset of distance education, they were not able to attend laboratory classes, had to cease face-to-face clinical education, and also suffered from the fear of COVID-19 contagion caused by the pandemic which aggravate their fears (Spanemberg et al., 2020). The COVID-19 pandemic has drawn the attention of people to infectious diseases worldwide and led to increased awareness, and college students are no exception (Atas and Talo Yildirim, 2020; De Stefani et al., 2020; Das et al., 2020). The fear due to COVID-19 varying from moderate to high has been reported in undergraduate dental students, (Atas and Talo Yildirim, 2020) dentists, (De Stefani et al., 2020; Ahmed et al., 2020) and other college students (Das et al., 2020) in many studies. This variation may be attributed to differences in the measures of isolation and quarantine implementation among the governing bodies, together with individual psychological diversity. All the dental faculties in TRNC and Turkey suspended face-to-face education and clinical education due to lockdown measures. As institutes swiftly shifted to online education, students neither had the opportunity to obtain practical education nor sustain personal interactions or gain clinical experience integral to dental education (Kearney et al., 2016). This may be one of the reasons for the lack of confidence in having adequate knowledge about protection from contagious infections that more than half of the students in our study felt. As awareness is higher in this period (Das et al., 2020), more lectures about infectious diseases and protection methods in the curriculum may be beneficial to increase the students’ knowledge and contribute to their professional development. As far as we know, this is the first study in the literature that evaluates the confidence of dental students about their level of knowledge about occupational infections and the prevention of COVID-19 infection. Proper utilization of PPE has the utmost importance in protecting from COVID-19 infection during dental treatment procedures (Gurgel et al., 2020; Villani et al., 2020). For this reason, we wanted to evaluate the source of information they used to gather information about this subject, and if they thought they have adequate information about using PPE. Social media seems to be the most common source of information for participants in this study. It is reported that students usually use the internet and social media sites to gather information about the COVID-19 pandemic, but the students that use journal articles and websites of trustworthy organizations have a significantly higher degree of knowledge (Olum et al., 2020). This is similar to our results, obtaining knowledge from the online lectures of faculties or reliable publications and organizations has a more substantial effect, compared to social media, circle of friends, or television. It should be a higher priority to promote and utilize credible information sources for dental education and to ensure that all students can access these sources in this era of distance learning. Although the majority of the students didn’t consider dropping out of dental education, eighty students in this study had thoughts about this topic, and their fear of contagion while practicing their profession was observed to be at a higher rate. Their rate of feeling adequately knowledgeable about the utilization of PPE for protection from COVID-19 infection was also lower. These results imply that these factors, probably not alone, have contributed to the thought of dropping out in this group of students. Students usually feel aggravated anxiety in the course of outbreaks and pandemics (Gurgel et al., 2020; Løset et al., 2022). This anxiety, which is even more intense in clinical students (Wong et al., 2004; Løset et al., 2022), might impact both their daily lives and career plans directly. Among the clinical students that had thoughts of dropping out of dental education in this study, the ratio of those that were in search of a dental specialty requiring less close contact while treating patients due to the COVID-19 pandemic was significantly higher than the rest, which may also be the attributed to the increased level of anxiety. This echoes the result of a study that reported that 15% of the otolaryngology trainees are affected in making decisions that can have an impact on their future because of the COVID-19 pandemic and this was more widespread in senior-level trainees (Guo et al., 2020). Although otolaryngology and dentistry don’t have the same degree of risk according to the Occupational Safety and Health Administration of the U.S.A. (OSHA) (OSHA, 2020), they indeed share some degree of similarity like working on the same body region and close contact procedures with the upper respiratory tract and to the best of our knowledge, there were no similar studies in the literature comparing clinical and preclinical dental students in this manner. One of the main goals of our study was to investigate the possible changes caused by the COVID-19 pandemic in the specialty choices of dental students. We found that 18% of the students thought about changing their desired dental specialty due to COVID-19, and these students had more fear of contagious diseases and felt inadequate in terms of knowledge and protection, and also found that 22% of the students were looking for a dental specialty in which they would have less close contact with their patients. Additionally, the students who don’t have enough knowledge about the degree of close contact procedures applied to the patients in the dental specialty that they plan to pursue, have a significantly higher ratio of changing their preferred specialties and rather choose the dental specialties that require less close contact with the patients. When these findings are evaluated altogether, it may be presumed that these factors are affecting the career plans of the students. In a recent study, it was reported that the fear of COVID-19 and future workforce career anxiety are closely related, which also supports the findings of our study (Mahmud et al., 2020). Therefore, providing psychological support and guidance to the students in addition to compensating for their lack of information and knowledge during the COVID-19 pandemic is of crucial importance. Our study was carried out during the summer break and in lock-down conditions, which prevented us from successfully reaching out to students in different dental faculties, and the 49% response rate of this study was lower than what we had presumed. The inclusion of more faculties would have led to a nationwide research, providing more robust results. Also, because there were no similar surveys we had to design our own questionnaire for this study. Given the urgency to better understand the nature of COVID, we didn’t have time to perform validity and reliability testing before the study. Furthermore, we didn’t have a scale to measure the anxiety and fear levels of the students. Designing a Likert scale for the anxiety caused by the COVID-19 pandemic and associating this scale with the career plans of undergraduate dental students would produce intriguing outcomes. Conclusion Ensuring that dental students can access sufficient information from reliable sources impacts not only their dental education but also their preferences in the choice of specialty in their career. Therefore, in an era when students cannot be taught only face to face, it is essential to improve the availability of online education materials of faculties and credible information from trustworthy organizations. Also crucial is to keep the knowledge of the students at an optimum level and to provide psychological support when needed to help dental students structure a healthy career path. Declarations CONFLICT OF INTEREST None declared. ACKNOWLEDGEMENTS The authors want to thank Gözde Bahadır Mercan for English editing of the manuscript. APPENDIX The dataset used for this study is made available at the data repository, https://data.scielo.org/dataset.xhtml?persistentId=doi:10.48331/scielodata.MTBJQF https://doi.org/10.48331/scielodata.MTBJQF References ADA (2020). 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DOI 10.1590/1806-9282.20201151 Tables Table 1: Survey questions Question No. Question (Answer Options) 1 Age (Years) 2 Gender (Female, Male) 3 University 4 Class in 2019-2020 academic year (1, 2, 3, 4, 5) 5 In the process of the COVID-19 pandemic, my awareness about the occupational infections that can be transmitted to me from my patients has increased. (Agree, Disagree, indecisive) 6 The process of the COVID-19 pandemic has caused fear of being at risk for contagion while I am practicing my profession. (Agree, Disagree, indecisive) 7 I think that I have sufficient knowledge about occupational infections and the methods to protect myself from these diseases. (Agree, Disagree, indecisive) 8 I know how to protect myself from the COVID-19 infection while I am practicing my profession. (Agree, Disagree, indecisive) 9 I have sufficient information about PPE that I have to use to prevent the transmission of COVID-19 disease from my patients. (Yes, No, indecisive) 10 I use …….. as source of information to gather knowledge about prevention methods against COVID-19 infection, PPE, their properties and usage. (Participants could select more than one option, see Table 3) 11 I have wanted to or have thought of dropping out of dental education because of the fear of COVID-19 contagion. (Yes, No) 12 I have planned to pursue further education in a dental specialty. (Yes, No) 13 I have adequate information about the degree of close contact procedures applied to the patients in the dental specialty of my preference. (Yes, No) 14 I have changed the dental specialty I was aiming for, because of the COVID-19 pandemic. (Yes, No) 15 I am in search for a dental specialty that requires less close contact procedures while treating patients, such as oral diagnosis and radiology or oral pathology. (Yes, No) PPE: Personal Protective Equipment Table 2: Students’ opinions on their knowledge about COVID-19 pandemic and contagious diseases, and comparison of clinical and preclinical students. QUESTIONS Total (N=755) Clinical students (N=338) Preclinical Students (N=417) P-value In the process of the COVID-19 pandemic, my awareness about the occupational infections that can be transmitted to me from my patients has increased. Agree 698 (92%) 304 (90%) 394 (95%) 0.041* Disagree 19 (3%) 13 (4%) 6 (1%) Indecisive 38 (5%) 21 (6%) 17 /4%) The process of the COVID-19 pandemic has caused fear of being at risk for contagion while I am practicing my profession. Agree 499 (66%) 225 (67%) 274 (66%) 0.524 Disagree 99 (13%) 48 (14%) 51 (12%) Indecisive 157 (21%) 65(19%) 92 (22%) I think that I have sufficient knowledge about occupational infections and the methods to protect myself from these diseases. Agree 348 (46%) 166 (49%) 182 (44%) 0.004* Disagree 75 (10%) 20 (6%) 55 (13%) Indecisive 332 (44%) 152 (45%) 180 (43%) I know how to protect myself from the COVID-19 infection while I am practicing my profession. Agree 480 (64%) 215 (64%) 265 (63%) 0.896 Disagree 48 (6%) 20 (6%) 28 (7%) Indecisive 227 (30%) 103 (31%) 124 (30%) I have sufficient information about PPE that I have to use to prevent the transmission of COVID-19 disease from my patients. Agree 441 (58%) 214 (63%) 227 (54%) 0.003* Disagree 17 (2%) 2 (1%) 15 (4%) Indecisive 297 (39%) 122 (36%) 175 (42%) All values are reported as numbers and percentages. PPE: Personal Protective Equipment *Chi-square test, statistically significant. Table 3: The distribution of the frequency of the students’ responses for the source of information they use to gather knowledge about prevention methods against COVID-19 infection, PPE, their properties and usage The source of Information Frequency (%) 1 My friends and social circles 281 (37%) Television and public service broadcasting 281 (37%) Social media 433 (57%) Online education lectures of my faculty 109 (14%) Credible publications and guidelines of organizations (WHO, ADA, Ministry of Health, etc.) 356 (47%) I don’t have a specific interest in gathering information and PPE 17 (2%) Other (research papers, family members, lecture notes, etc.) 16 (2%) 1 Participants were allowed to choose more than one suitable option. WHO: World Health Organization, ADA: American Dental Association, PPE: personal protective equipment Table 4: The difference in the source of information for the students that have knowledge about PPE for protecting themselves from COVID-19 while treating their patients The source of Information Question: “I am aware of the PPE that I have to use to prevent the transmission of COVID-19 disease from my patients.” P-value* Students that responded “AGREE” (PPE group, N:441) Students that responded “DISAGREE / INDECISIVE” (N:314) My friends and social circles 142 (32%) 139 (44%) 0.001* Television and public service broadcasting 152 (35%) 129 (41%) 0.067 Social media 262 (59%) 171 (55%) 0.180 Online education lectures of my faculty 84 (19%) 25 (8%) < 0.001* Reliable publications and guidelines of organizations (WHO, Ministry of Health, etc.) 249 (57%) 107 (34%) < 0.001* I don’t have a specific interest in gathering information and PPE 3 (1%) 14 (5%) 0.001* Other (research papers, family members, lecture notes, etc.) 13 (3%) 3 (1%) 0.074 *Chi-square test, statistically significant. PPE: Personal protective equipment, WHO: World Health Organization Table 5: Students’ thoughts on dropping out of dental education Question: “I have wanted to or have thought of dropping out of dental education because of the fear of COVID-19 contagion.” P-value* Cross tabulated Questions, responded as “Yes/Agree” Yes, I have considered dropping out (N:80) No, I have never thought of it (N:675) The process of the COVID-19 pandemic has caused me fear of being at risk for contagion while I’m practicing my profession. 64 (80%) 435 (64%) 0.011* I think that I have sufficient knowledge about occupational infections and the methods to protect myself from these diseases. 20 (25%) 328 (49%) < 0.001* I know how to protect myself from the COVID-19 infection while I am practicing my profession. 37 (46%) 443 (66%) < 0.001* I am aware of the PPE that I have to use to prevent the transmission of COVID-19 disease from my patients. 34 (43%) 407 (60%) < 0.001* Cross tabulation with clinical students Clinical Students 52 (15%) 286 (85%) < 0.001* Preclinical Students 28 (7%) 389 (93%) *Chi-square test, statistically significant. PPE: Personal protective equipment Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2217141","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":148505103,"identity":"ef205c35-2ac4-4d19-afa8-f601d7e83790","order_by":0,"name":"Zehra EDEBAL","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIie2PvWrDMBCAJQ6cRcnsQqheIUFTwY1fxUbgyVkzGwLy4jRrQoe+RWYbQabg2aA+QgZlMyWFSikdY3ssRB/cz3Afd4eQw/EvISY820BZatuPhiteXO1sgeEKYZLctvUINN8cdbsKFtt3Ecng60AngLC+pPcVXNR8X9QJ333KUi7f1FwAgqf94b4CfsrQWEiOmiSSy0Jho3gw7lA8emb42yi0SWfypVBhr0J8wsBsWcysgloV9yo+SRlM6ySam8OqTaa4ALzu/IXmJ4bPqyB8brjU7VW9fuTrSl86lD/izGYsbjnrnzeEv+U6aNjhcDgejB/LolK0LTRReQAAAABJRU5ErkJggg==","orcid":"","institution":"Near East University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Zehra","middleName":"","lastName":"EDEBAL","suffix":""},{"id":148505104,"identity":"be1f9e56-3c91-4d51-9399-23f75ea4d783","order_by":1,"name":"Salih DOĞAN","email":"","orcid":"","institution":"Erciyes University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Salih","middleName":"","lastName":"DOĞAN","suffix":""}],"badges":[],"createdAt":"2022-10-29 20:14:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2217141/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2217141/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":29035808,"identity":"5f4dcf9e-35ad-4335-91e7-5f083c244144","added_by":"auto","created_at":"2022-11-14 15:59:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":284797,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2217141/v1/a70fe331-cad1-4493-beef-752e25198bc9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Effect of the Covid-19 Pandemic on Specialty Choices of Dental Students\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCOVID-19 infection, which was first encountered in China in the last days of 2019 and which became a pandemic after spreading worldwide in months, is caused by a virus that belongs to the Coronavirus family. Because the infection is easily transmitted by close contact, many health sector professionals such as doctors, dentists, nurses, and paramedics became a target for the contagion of the disease. The contagion risk is even higher for dentistry because of their routine methods requiring prolonged face-to-face sessions with patients and utilization of equipment that generate a remarkable amount of aerosols, like dental drills, air-water syringes, and sonic scalers (OSHA, 2020). Therefore, the American Dental Association (ADA) suggested postponing all cases other than the ones requiring urgent or emergency procedures, and just providing emergency dental care at the beginning of the pandemic (ADA, 2020).\u003c/p\u003e\n\u003cp\u003eAfter the onset of the pandemic, understanding the disease, defining clinical symptoms and findings, managing diagnostic methods, and providing information about protection from the disease required a significant amount of time. These pieces of information are still being updated regularly (OSHA, 2020; ADA, 2020; WHO, 2020). Unproven information reached out to large masses through media like television, the internet, and social media, before credible evidence-based guidelines about the properties of the virus and protection methods were established through research studies. Especially, the distribution of information to large populations through social media may initially seem convenient, but it may contain many misleading headlines and content (Olum et al., 2020; Zanatta et al., 2021). During the pandemic, students can easily be overwhelmed by the fear of the disease and have to face the feeling of pressure (Wong et al., 2004; Lestari et al., 2022). Therefore, institutions like the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and ADA regularly publish announcements aimed at society and professionals to provide a reliable source of information (ADA, 2020; WHO, 2020).\u003c/p\u003e\n\u003cp\u003eMany universities couldn\u0026rsquo;t continue with face-to-face education because of the quarantine measures taken during the pandemic. To ensure the continuity of education and keep the students motivated, universities with adequate technological infrastructure switched to online education. Different evaluation and measurement methods were applied for assessing the effectiveness of this education modality. But for dentistry, it did not seem plausible for any distance learning course to replace face-to-face education since direct applications which should be performed on the patients during the clinical practice, an integral part of dental education, couldn\u0026rsquo;t be performed (Iyer et al., 2020). \u003c/p\u003e\n\u003cp\u003eIn this study, we aimed to survey dental students about their awareness and knowledge of contagious diseases, protecting themselves from infections, preventive methods, working conditions, and occupational hazards, and demonstrate how the pandemic impacted their education. We also intended to investigate whether the pandemic affected the students\u0026rsquo; choice of dental specialties.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eThis study was conducted with the approval of the Near East University Scientific Research Ethics Evaluation Board with approval number 2020/802-1125. In this multicenter cross-sectional study, participants, who were from two different countries were undergraduate students in the Turkish course of dental faculties of Near East University (NEU), University of Kyrenia (UoK) in the Turkish Republic of Northern Cyprus (TRNC), and Erciyes University (ERU), in Turkey. A survey, which was prepared as per our aims for this cross-sectional study, was distributed as Google Forms, and the answers were collected through the same platform. The participants were asked to take the survey between 20 July and 15 August 2020. There were 15 multiple-choice questions, 4 of which were about the demographics of students; age, class, gender, and university (Table 1). Students in the 4\u003csup\u003eth\u003c/sup\u003e and 5\u003csup\u003eth\u003c/sup\u003e years were regarded as the clinical students\u0026rsquo; group, and 1\u003csup\u003est\u003c/sup\u003e, 2\u003csup\u003end\u003c/sup\u003e,\u003csup\u003e \u003c/sup\u003eand 3\u003csup\u003erd\u003c/sup\u003e-year students constituted the preclinical students\u0026rsquo; group. All student responses were evaluated for all of the questions. No identifying data about the participants were collected. The questions can be divided into three main sections. The first section aimed to gather data about the students\u0026rsquo; feelings of self-confidence about their knowledge of the COVID-19 pandemic, fear of catching a contagious disease, feeling informed about protecting themselves from the disease, and ways of gathering information about this topic. In the second section, students were asked if they ever wanted to drop out of dental education because of the COVID-19 pandemic. For the third section, students were first asked if they were planning to have a post-graduate residency in a dental specialty and about the effects of the COVID-19 pandemic on their dental specialty choice. \u003c/p\u003e\n\u003cp\u003eThe Statistical Package for the Social Sciences software version 15 (SPSS Inc., Chicago, U.S.A.) was used for all the statistical analyses. The internal consistency of the given responses was measured by Cronbach\u0026apos;s alpha and values over 0.70 were regarded as statistically reliable. The demographic data were analyzed by the median and interquartile range (IQR) values and frequency distribution tables. The results were reported as median (IQR), or percentage. Participants were grouped for certain analyses according to the responses they gave to prior questions. The nominal data were compared using crosstabs. Chi-square test or Fisher\u0026rsquo;s exact test was used to determine statistically significant differences between these groups. P values less than 0.05 were regarded as statistically significant.\u003c/p\u003e"},{"header":"Results ","content":"\u003cp\u003e\u003cstrong\u003eDemographic Information and Reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe online survey link was shared with 1532 students in three dental faculties in two countries. Overall, 755 dental students participated in our study, corresponding to a 49% response rate. More than half of the participating students were from ERU (N=394, 52%), while 286 NEU students (38%) and 75 UoK students (10%) responded to the survey. The study population consisted of 338 clinical (45%) and 417 preclinical (55%) students, females comprised 63% (N=474), and men comprised 37% (N=281) of the population. There was no difference in gender distribution between universities (NEU 63% females, UoK 55% females, ERU 64% females, p = 0.292). \u003c/p\u003e\n\u003cp\u003eCronbach\u0026rsquo;s analysis was performed to evaluate the consistency of the responses given to the same group of questions. The alpha value of questions about contagious diseases and personal protective equipment (PPE) usage and education in dental specialties were found to be 0.71 and 0.79, respectively. Removing any of the questions didn\u0026rsquo;t increase the corresponding alpha values. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudents\u0026rsquo; Fears \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn all of the 755 students that participated in this study, 92% stated that their awareness about contagious diseases that can be transmitted in the occupational environment increased in the course of the COVID-19 pandemic (Table 2). Also, a fear of being at risk for contagion because of the COVID-19 pandemic emerged in two-thirds of the students. Less than half of the students reported having sufficient knowledge about occupational infections and methods for protection, 64% stated that they knew how to protect themselves from COVID-19 infection while practicing their profession, and 58% reported that they have sufficient information about PPE to protect themselves from COVID-19 (Table 2). Social media was found to be the most common source for gathering information about PPE, their properties, and usage (57%), followed by reliable publications and guidelines of organizations (47%), friends and social circle (37%), television (37%), and online education (14%, Table 3). We wanted to investigate the relationship between gathering adequate information and the sources of knowledge, so we separated the students that stated to have knowledge about the PPE for protecting themselves from COVID-19 while treating their patients as PPE group and compared them to the rest of the students about their sources of gathering knowledge. In the PPE group, the use of reliable publications and guidelines (57% vs. 34%, p \u0026lt; 0.001), and online education (19% vs. 8%, p \u0026lt; 0.001) for sources of obtaining information were significantly higher, contrary to friends and social circle (32% vs. 44%, p = 0.001), which were significantly lower. The utilization of television and social media didn\u0026rsquo;t differ between the PPE group and the rest of the students (p=0.067 and p=0.180 respectively, Table 4). \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudents\u0026rsquo; Thoughts about Dropping out of Dental Education\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe students were asked if they ever thought of dropping out of dental education because of the COVID-19 pandemic, and the responses are summarized in Table 5. While 675 of the students never considered dropping out, eighty students (11%) had thoughts about quitting dental education. Students that contemplated dropping out had a significantly higher rate of fear of being at risk for contagion because of the COVID-19 pandemic (80% vs. 64%, p = 0.011). Furthermore, the proportion of students that reported knowing occupational infections and how to protect themselves from them (25% vs. 49%, p \u0026lt; 0.001), on how to be protected from COVID-19 in the occupational environment (46% vs. 66%, p \u0026lt; 0.001), and on the PPE that must be used to prevent COVID-19 infection (43% vs. 60%, p \u0026lt; 0.001) were significantly lower among the students that considered dropping out. The ratio of consideration of dropping out of dental education was significantly higher in clinical students, compared to non-clinical students (15% vs. 7%, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudents\u0026rsquo; Career Plans\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe rate of students who were aiming for a dental specialty was 76% (N = 574). This was higher in women (82% vs. 69%, p = 0.004), and lower in clinical students (67% vs. 83%, p \u0026lt; 0.001). Of these 574 students, 18% stated that the COVID-19 pandemic caused a change in the specialty they were aiming for, and 22% stated that they were in search of a specialty that requires less close contact while treating patients. In the students that wanted to change their desired dental specialty because of the COVID-19 pandemic, the fear of facing contagious diseases while practicing their profession was significantly higher (78% vs. 64%, p = 0.004). The students who wanted to change their desired dental specialty also reported having less knowledge about occupational infections and protection methods (32% vs. 48%, p = 0.007), and the PPE used for protection from the COVID-19 infection (47% vs. 63%, p = 0.002). The students who were aiming for a dental specialty education and didn\u0026rsquo;t have adequate information about the degree of close contact procedures applied to the patients in their preferred specialty tended to change their choice of dental specialty more (29% vs. 15%, p = 0.001), and they were more eager to look for a dental specialty with less close contact with the patients (42% vs. 18%, p \u0026lt; 0.001). \u003c/p\u003e\n\u003cp\u003eThe clinical students aiming for education in a dental specialty had a higher rate of looking for a specialty that requires less close contact while treating patients, compared to the preclinical students (28% vs. 19%, p = 0.008). The clinical students also had a higher tendency to choose specialties like oral diagnosis and radiology or oral pathology (33% vs. 21%, p \u0026lt; 0.001). Besides, only 38% of them stated they wouldn\u0026rsquo;t change their choice of dental specialty due to the COVID-19 pandemic, compared to a 53% ratio of the preclinical students (p \u0026lt; 0.001). \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe COVID-19 pandemic affects the health status of all people, as well as social interactions and careers, especially dentistry, which is one of the high-risk professions because of the close physical interaction with the patients and aerosol-producing procedures (OSHA, 2020; Spagnuolo et al., 2020). Dental students were also largely affected during this period. Besides the sudden onset of distance education, they were not able to attend laboratory classes, had to cease face-to-face clinical education, and also suffered from the fear of COVID-19 contagion caused by the pandemic which aggravate their fears (Spanemberg et al., 2020). \u003c/p\u003e\n\u003cp\u003eThe COVID-19 pandemic has drawn the attention of people to infectious diseases worldwide and led to increased awareness, and college students are no exception (Atas and Talo Yildirim, 2020; De Stefani et al., 2020; Das et al., 2020). The fear due to COVID-19 varying from moderate to high has been reported in undergraduate dental students, (Atas and Talo Yildirim, 2020) dentists, (De Stefani et al., 2020; Ahmed et al., 2020) and other college students (Das et al., 2020) in many studies. This variation may be attributed to differences in the measures of isolation and quarantine implementation among the governing bodies, together with individual psychological diversity. All the dental faculties in TRNC and Turkey suspended face-to-face education and clinical education due to lockdown measures. As institutes swiftly shifted to online education, students neither had the opportunity to obtain practical education nor sustain personal interactions or gain clinical experience integral to dental education (Kearney et al., 2016). This may be one of the reasons for the lack of confidence in having adequate knowledge about protection from contagious infections that more than half of the students in our study felt. As awareness is higher in this period (Das et al., 2020), more lectures about infectious diseases and protection methods in the curriculum may be beneficial to increase the students\u0026rsquo; knowledge and contribute to their professional development. As far as we know, this is the first study in the literature that evaluates the confidence of dental students about their level of knowledge about occupational infections and the prevention of COVID-19 infection.\u003c/p\u003e\n\u003cp\u003eProper utilization of PPE has the utmost importance in protecting from COVID-19 infection during dental treatment procedures (Gurgel et al., 2020; Villani et al., 2020). For this reason, we wanted to evaluate the source of information they used to gather information about this subject, and if they thought they have adequate information about using PPE. Social media seems to be the most common source of information for participants in this study. It is reported that students usually use the internet and social media sites to gather information about the COVID-19 pandemic, but the students that use journal articles and websites of trustworthy organizations have a significantly higher degree of knowledge (Olum et al., 2020). This is similar to our results, obtaining knowledge from the online lectures of faculties or reliable publications and organizations has a more substantial effect, compared to social media, circle of friends, or television. It should be a higher priority to promote and utilize credible information sources for dental education and to ensure that all students can access these sources in this era of distance learning.\u003c/p\u003e\n\u003cp\u003eAlthough the majority of the students didn\u0026rsquo;t consider dropping out of dental education, eighty students in this study had thoughts about this topic, and their fear of contagion while practicing their profession was observed to be at a higher rate. Their rate of feeling adequately knowledgeable about the utilization of PPE for protection from COVID-19 infection was also lower. These results imply that these factors, probably not alone, have contributed to the thought of dropping out in this group of students. Students usually feel aggravated anxiety in the course of outbreaks and pandemics (Gurgel et al., 2020; L\u0026oslash;set et al., 2022). This anxiety, which is even more intense in clinical students (Wong et al., 2004; L\u0026oslash;set et al., 2022), might impact both their daily lives and career plans directly. Among the clinical students that had thoughts of dropping out of dental education in this study, the ratio of those that were in search of a dental specialty requiring less close contact while treating patients due to the COVID-19 pandemic was significantly higher than the rest, which may also be the attributed to the increased level of anxiety. This echoes the result of a study that reported that 15% of the otolaryngology trainees are affected in making decisions that can have an impact on their future because of the COVID-19 pandemic and this was more widespread in senior-level trainees (Guo et al., 2020). Although otolaryngology and dentistry don\u0026rsquo;t have the same degree of risk according to the Occupational Safety and Health Administration of the U.S.A. (OSHA) (OSHA, 2020), they indeed share some degree of similarity like working on the same body region and close contact procedures with the upper respiratory tract and to the best of our knowledge, there were no similar studies in the literature comparing clinical and preclinical dental students in this manner.\u003c/p\u003e\n\u003cp\u003eOne of the main goals of our study was to investigate the possible changes caused by the COVID-19 pandemic in the specialty choices of dental students. We found that 18% of the students thought about changing their desired dental specialty due to COVID-19, and these students had more fear of contagious diseases and felt inadequate in terms of knowledge and protection, and also found that 22% of the students were looking for a dental specialty in which they would have less close contact with their patients. Additionally, the students who don\u0026rsquo;t have enough knowledge about the degree of close contact procedures applied to the patients in the dental specialty that they plan to pursue, have a significantly higher ratio of changing their preferred specialties and rather choose the dental specialties that require less close contact with the patients. When these findings are evaluated altogether, it may be presumed that these factors are affecting the career plans of the students. In a recent study, it was reported that the fear of COVID-19 and future workforce career anxiety are closely related, which also supports the findings of our study (Mahmud et al., 2020). Therefore, providing psychological support and guidance to the students in addition to compensating for their lack of information and knowledge during the COVID-19 pandemic is of crucial importance.\u003c/p\u003e\n\u003cp\u003eOur study was carried out during the summer break and in lock-down conditions, which prevented us from successfully reaching out to students in different dental faculties, and the 49% response rate of this study was lower than what we had presumed. The inclusion of more faculties would have led to a nationwide research, providing more robust results. Also, because there were no similar surveys we had to design our own questionnaire for this study. Given the urgency to better understand the nature of COVID, we didn\u0026rsquo;t have time to perform validity and reliability testing before the study. Furthermore, we didn\u0026rsquo;t have a scale to measure the anxiety and fear levels of the students. Designing a Likert scale for the anxiety caused by the COVID-19 pandemic and associating this scale with the career plans of undergraduate dental students would produce intriguing outcomes.\u003c/p\u003e"},{"header":"Conclusion ","content":"\u003cp\u003eEnsuring that dental students can access sufficient information from reliable sources impacts not only their dental education but also their preferences in the choice of specialty in their career. Therefore, in an era when students cannot be taught only face to face, it is essential to improve the availability of online education materials of faculties and credible information from trustworthy organizations. Also crucial is to keep the knowledge of the students at an optimum level and to provide psychological support when needed to help dental students structure a healthy career path.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors want to thank G\u0026ouml;zde Bahadır Mercan for English editing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAPPENDIX\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used for this study is made available at the data repository, https://data.scielo.org/dataset.xhtml?persistentId=doi:10.48331/scielodata.MTBJQF \u003c/p\u003e\n\u003cp\u003ehttps://doi.org/10.48331/scielodata.MTBJQF\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eADA (2020). As Dental Practices Resume Operations, ADA offers Continued Guidance. Retrieved 18.08.2020, from https://www.ada.org/en/press-room/news-releases/2020-archives/may/as-dental-practices-resume-operations-ada-offers-continued-guidance#\u003c/li\u003e\n\u003cli\u003eAhmed, M. A., Jouhar, R., Ahmed, N., Adnan, S., Aftab, M., et al. (2020). Fear and Practice Modifications among Dentists to Combat Novel Coronavirus Disease (COVID-19) Outbreak. Int J Environ Res Public Health, 17 (8), 2821. DOI 10.3390/ijerph17082821\u003c/li\u003e\n\u003cli\u003eAtas, O. \u0026amp; Talo Yildirim, T. (2020). Evaluation of knowledge, attitudes, and clinical education of dental students about COVID-19 pandemic. PeerJ, 8, e9575. DOI 10.7717/peerj.9575\u003c/li\u003e\n\u003cli\u003eDas, D., Shenoy, R., Mukherjee, M., Unnikrishnan, B. \u0026amp; Rungta, N. (2020). Awareness Among Undergraduate Students of Mangalore City Regarding Novel Coronavirus (COVID-19): A Questionnaire Study. Disaster medicine and public health preparedness, 1-4. DOI 10.1017/dmp.2020.204\u003c/li\u003e\n\u003cli\u003eDe Stefani, A., Bruno, G., Mutinelli, S. \u0026amp; Gracco, A. (2020). COVID-19 Outbreak Perception in Italian Dentists. Int J Environ Res Public Health, 17 (11). DOI 10.3390/ijerph17113867\u003c/li\u003e\n\u003cli\u003eGuo, T., Kiong, K. L., Yao, C., Windon, M., Zebda, D., et al. (2020). Impact of the COVID-19 pandemic on Otolaryngology trainee education. Head Neck. DOI 10.1002/hed.26368\u003c/li\u003e\n\u003cli\u003eGurgel, B. C. V., Borges, S. B., Borges, R. E. A. \u0026amp; Calderon, P. D. S. (2020). COVID-19: Perspectives for the management of dental care and education. J Appl Oral Sci, 28, e20200358. DOI 10.1590/1678-7757-2020-0358\u003c/li\u003e\n\u003cli\u003eIyer, P., Aziz, K. \u0026amp; Ojcius, D. M. (2020). Impact of COVID-19 on dental education in the United States. Journal of Dental Education, 84 (6), 718-722. DOI 10.1002/jdd.12163\u003c/li\u003e\n\u003cli\u003eKearney, R. C., Premaraj, S., Smith, B. M., Olson, G. W., Williamson, A. E., et al. (2016). Massive Open Online Courses in Dental Education: Two Viewpoints: Viewpoint 1: Massive Open Online Courses Offer Transformative Technology for Dental Education and Viewpoint 2: Massive Open Online Courses Are Not Ready for Primetime. J Dent Educ, 80 (2), 121-7. http://www.ncbi.nlm.nih.gov/pubmed/26834128\u003c/li\u003e\n\u003cli\u003eLestari, W., Yazid, N. H., Azhar, Z. N., Ismail, A. \u0026amp; Sukotjo, C. (2022). Impact of COVID-19 on Malaysian dental students\u0026rsquo; physical, mental, financial and academic concerns. BMC Oral Health, 22 (1), 46. DOI 10.1186/s12903-022-02081-w\u003c/li\u003e\n\u003cli\u003eL\u0026oslash;set, I. H., L\u0026aelig;greid, T. \u0026amp; Rodakowska, E. (2022). Dental Students\u0026apos; Experiences during the COVID-19 Pandemic-A Cross-Sectional Study from Norway. Int J Environ Res Public Health, 19 (5). DOI 10.3390/ijerph19053102\u003c/li\u003e\n\u003cli\u003eMahmud, M. S., Talukder, M. U. \u0026amp; Rahman, S. M. (2020). Does \u0026apos;Fear of COVID-19\u0026apos; trigger future career anxiety? An empirical investigation considering depression from COVID-19 as a mediator. The International journal of social psychiatry, 20764020935488-20764020935488. DOI 10.1177/0020764020935488\u003c/li\u003e\n\u003cli\u003eOlum, R., Kajjimu, J., Kanyike, A. M., Chekwech, G., Wekha, G., et al. (2020). Perspective of Medical Students on the COVID-19 Pandemic: Survey of Nine Medical Schools in Uganda (Original Paper). JMIR Public Health Surveill, 6 (2), e19847. DOI 10.2196/19847\u003c/li\u003e\n\u003cli\u003eOSHA (2020). U.S. Department of Labor Occupational Safety and Health Administration OSHA 3990-03 Guidance on Preparing Workplaces for COVID-19. Retrieved 17.08.2020, from https://www.osha.gov/Publications/OSHA3990.pdf\u003c/li\u003e\n\u003cli\u003eSpagnuolo, G., De Vito, D., Rengo, S. \u0026amp; Tatullo, M. (2020). COVID-19 Outbreak: An Overview on Dentistry (Editorial). Int J Environ Res Public Health, 17 (6). DOI 10.3390/ijerph17062094\u003c/li\u003e\n\u003cli\u003eSpanemberg, J. C., Sim\u0026otilde;es, C. C. \u0026amp; Cardoso, J. A. (2020). The impacts of the COVID-19 pandemic on the teaching of dentistry in Brazil. Journal of Dental Education, 84 (11), 1185-1187. DOI https://doi.org/10.1002/jdd.12364\u003c/li\u003e\n\u003cli\u003eVillani, F. A., Aiuto, R., Paglia, L. \u0026amp; Re, D. (2020). COVID-19 and Dentistry: Prevention in Dental Practice, a Literature Review. Int J Environ Res Public Health, 17 (12), 4609. DOI 10.3390/ijerph17124609\u003c/li\u003e\n\u003cli\u003eWHO (2020). WHO Global Infection Prevention and Control Network Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Interim Guidance. Retrieved 10.08.2020, from https://www.who.int/publications/i/item/10665-331495\u003c/li\u003e\n\u003cli\u003eWong, J. G. W. S., Cheung, E. P. T., Cheung, V., Cheung, C., Chan, M. T. Y., et al. (2004). Psychological responses to the SARS outbreak in healthcare students in Hong Kong. Medical Teacher, 26 (7), 657-659. DOI 10.1080/01421590400006572\u003c/li\u003e\n\u003cli\u003eZanatta, E. T., Wanderley, G. P. M., Branco, I. K., Pereira, D., Kato, L. H., et al. (2021). Fake news: the impact of the internet on population health. Rev Assoc Med Bras (1992), 67 (7), 926-930. DOI 10.1590/1806-9282.20201151\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Survey questions\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion (Answer Options)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eAge (Years)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eGender (Female, Male)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eClass in 2019-2020 academic year (1, 2, 3, 4, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eIn the process of the COVID-19 pandemic, my awareness about the occupational infections that can be transmitted to me from my patients has increased. (Agree, Disagree, indecisive)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eThe process of the COVID-19 pandemic has caused fear of being at risk for contagion while I am practicing my profession. (Agree, Disagree, indecisive)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eI think that I have sufficient knowledge about occupational infections and the methods to protect myself from these diseases. (Agree, Disagree, indecisive)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eI know how to protect myself from the COVID-19 infection while I am practicing my profession. (Agree, Disagree, indecisive)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eI have sufficient information about PPE that I have to use to prevent the transmission of COVID-19 disease from my patients. (Yes, No, indecisive)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eI use \u0026hellip;\u0026hellip;.. as source of information to gather knowledge about prevention methods against COVID-19 infection, PPE, their properties and usage. (Participants could select more than one option, see Table 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eI have wanted to or have thought of dropping out of dental education because of the fear of COVID-19 contagion. (Yes, No)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eI have planned to pursue further education in a dental specialty. (Yes, No)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eI have adequate information about the degree of close contact procedures applied to the patients in the dental specialty of my preference. (Yes, No)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eI have changed the dental specialty I was aiming for, because of the COVID-19 pandemic. (Yes, No)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"88.88888888888889%\"\u003e\n \u003cp\u003eI am in search for a dental specialty that requires less close contact procedures while treating patients, such as oral diagnosis and radiology or oral pathology. (Yes, No)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePPE: Personal Protective Equipment\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Students\u0026rsquo; opinions on their knowledge about COVID-19 pandemic and contagious diseases, and comparison of clinical and preclinical students.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.05154639175258%\"\u003e\n \u003cp\u003e\u003cstrong\u003eQUESTIONS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(N=755)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003eClinical students\u003c/p\u003e\n \u003cp\u003e(N=338)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003ePreclinical Students\u003c/p\u003e\n \u003cp\u003e(N=417)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"35.05154639175258%\"\u003e\n \u003cp\u003eIn the process of the COVID-19 pandemic, my awareness about the occupational infections that can be transmitted to me from my patients has increased.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e698 (92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e304 (90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e394 (95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e19 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e13 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e6 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eIndecisive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e38 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e21 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e17 /4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"35.05154639175258%\"\u003e\n \u003cp\u003eThe process of the COVID-19 pandemic has caused fear of being at risk for contagion while I am practicing my profession.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e499 (66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e225 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e274 (66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e99 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e48 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e51 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eIndecisive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e157 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e65(19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e92 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"35.05154639175258%\"\u003e\n \u003cp\u003eI think that I have sufficient knowledge about occupational infections and the methods to protect myself from these diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e348 (46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e166 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e182 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e75 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e20 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e55 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eIndecisive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e332 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e152 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e180 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"35.05154639175258%\"\u003e\n \u003cp\u003eI know how to protect myself from the COVID-19 infection while I am practicing my profession.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e480 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e215 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e265 (63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e48 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e20 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e28 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eIndecisive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e227 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e103 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e124 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"35.05154639175258%\"\u003e\n \u003cp\u003eI have sufficient information about PPE that I have to use to prevent the transmission of COVID-19 disease from my patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e441 (58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.371134020618557%\"\u003e\n \u003cp\u003e214 (63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.43298969072165%\"\u003e\n \u003cp\u003e227 (54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"11.34020618556701%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e17 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e15 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003eIndecisive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e297 (39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.076923076923077%\"\u003e\n \u003cp\u003e122 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.923076923076923%\"\u003e\n \u003cp\u003e175 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAll values are reported as numbers and percentages.\u003c/p\u003e\n\u003cp\u003ePPE: Personal Protective Equipment\u003c/p\u003e\n\u003cp\u003e*Chi-square test, statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e The distribution of the frequency of the students\u0026rsquo; responses for the source of information they use to gather knowledge about prevention methods against COVID-19 infection, PPE, their properties and usage\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.83838383838383%\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe source of Information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.161616161616163%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.83838383838383%\"\u003e\n \u003cp\u003eMy friends and social circles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.161616161616163%\"\u003e\n \u003cp\u003e281 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.83838383838383%\"\u003e\n \u003cp\u003eTelevision and public service broadcasting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.161616161616163%\"\u003e\n \u003cp\u003e281 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.83838383838383%\"\u003e\n \u003cp\u003eSocial media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.161616161616163%\"\u003e\n \u003cp\u003e433 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.83838383838383%\"\u003e\n \u003cp\u003eOnline education lectures of my faculty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.161616161616163%\"\u003e\n \u003cp\u003e109 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.83838383838383%\"\u003e\n \u003cp\u003eCredible publications and guidelines of organizations (WHO, ADA, Ministry of Health, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.161616161616163%\"\u003e\n \u003cp\u003e356 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.83838383838383%\"\u003e\n \u003cp\u003eI don\u0026rsquo;t have a specific interest in gathering information and PPE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.161616161616163%\"\u003e\n \u003cp\u003e17 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"83.83838383838383%\"\u003e\n \u003cp\u003eOther (research papers, family members, lecture notes, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.161616161616163%\"\u003e\n \u003cp\u003e16 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e Participants were allowed to choose more than one suitable option.\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization, ADA: American Dental Association, PPE: personal protective equipment\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e The difference in the source of information for the students that have knowledge about PPE for protecting themselves from COVID-19 while treating their patients\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"25.97173144876325%\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe source of Information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"60.7773851590106%\"\u003e\n \u003cp\u003eQuestion: \u0026ldquo;I am aware of the PPE that I have to use to prevent the transmission of COVID-19 disease from my patients.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"13.250883392226148%\"\u003e\n \u003cp\u003eP-value*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.25581395348837%\"\u003e\n \u003cp\u003eStudents that responded \u0026ldquo;AGREE\u0026rdquo; (PPE group, N:441)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.74418604651163%\"\u003e\n \u003cp\u003eStudents that responded \u0026ldquo;DISAGREE / INDECISIVE\u0026rdquo; (N:314)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.97173144876325%\"\u003e\n \u003cp\u003eMy friends and social circles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.328621908127207%\"\u003e\n \u003cp\u003e142 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.448763250883392%\"\u003e\n \u003cp\u003e139 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.250883392226148%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.97173144876325%\"\u003e\n \u003cp\u003eTelevision and public service broadcasting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.328621908127207%\"\u003e\n \u003cp\u003e152 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.448763250883392%\"\u003e\n \u003cp\u003e129 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.250883392226148%\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.97173144876325%\"\u003e\n \u003cp\u003eSocial media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.328621908127207%\"\u003e\n \u003cp\u003e262 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.448763250883392%\"\u003e\n \u003cp\u003e171 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.250883392226148%\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.97173144876325%\"\u003e\n \u003cp\u003eOnline education lectures of my faculty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.328621908127207%\"\u003e\n \u003cp\u003e84 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.448763250883392%\"\u003e\n \u003cp\u003e25 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.250883392226148%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.97173144876325%\"\u003e\n \u003cp\u003eReliable publications and guidelines of organizations (WHO, Ministry of Health, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.328621908127207%\"\u003e\n \u003cp\u003e249 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.448763250883392%\"\u003e\n \u003cp\u003e107 (34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.250883392226148%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.97173144876325%\"\u003e\n \u003cp\u003eI don\u0026rsquo;t have a specific interest in gathering information and PPE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.328621908127207%\"\u003e\n \u003cp\u003e3 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.448763250883392%\"\u003e\n \u003cp\u003e14 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.250883392226148%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.97173144876325%\"\u003e\n \u003cp\u003eOther (research papers, family members, lecture notes, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.328621908127207%\"\u003e\n \u003cp\u003e13 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.448763250883392%\"\u003e\n \u003cp\u003e3 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.250883392226148%\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Chi-square test, statistically significant.\u003c/p\u003e\n\u003cp\u003ePPE: Personal protective equipment, WHO: World Health Organization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Students\u0026rsquo; thoughts on dropping out of dental education\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"46.464646464646464%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"40.4040404040404%\"\u003e\n \u003cp\u003eQuestion: \u0026ldquo;I have wanted to or have thought of dropping out of dental education because of the fear of COVID-19 contagion.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"13.131313131313131%\"\u003e\n \u003cp\u003eP-value*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.11764705882353%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCross tabulated Questions,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eresponded as \u0026ldquo;Yes/Agree\u0026rdquo;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.705882352941178%\"\u003e\n \u003cp\u003eYes, I have considered dropping out (N:80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.176470588235293%\"\u003e\n \u003cp\u003eNo, I have never thought of it (N:675)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eThe process of the COVID-19 pandemic has caused me fear of being at risk for contagion while I\u0026rsquo;m practicing my profession.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e64 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e435 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eI think that I have sufficient knowledge about occupational infections and the methods to protect myself from these diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e20 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e328 (49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eI know how to protect myself from the COVID-19 infection while I am practicing my profession.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e37 (46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e443 (66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eI am aware of the PPE that I have to use to prevent the transmission of COVID-19 disease from my patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e34 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e407 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCross tabulation with clinical students\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.93877551020408%\"\u003e\n \u003cp\u003eClinical Students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\"\u003e\n \u003cp\u003e52 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e286 (85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"13.26530612244898%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.11764705882353%\"\u003e\n \u003cp\u003ePreclinical Students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.705882352941178%\"\u003e\n \u003cp\u003e28 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.176470588235293%\"\u003e\n \u003cp\u003e389 (93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Chi-square test, statistically significant.\u003c/p\u003e\n\u003cp\u003ePPE: Personal protective equipment\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dental education, Coronavirus, Personal protective equipment, Career choice, Dental Specialty,","lastPublishedDoi":"10.21203/rs.3.rs-2217141/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2217141/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"We aimed to evaluate the effect of the COVID-19 pandemic on the career plans and self-perception of knowledge levels of undergraduate dental students. In this multicentre cross-sectional study, a multiple-choice survey was taken by students from three different universities in two countries in 2020. Chi-square test or Fisher’s exact test was used to determine statistically significant differences. Of the 755 students that participated in our study, 66% had fear of being at risk for contagion and only 46% claimed to have adequate knowledge about occupational infections and the methods to protect themselves. Utilization of credible publications, guidelines (57% vs. 34%, p \u003c 0.001), and online education (19% vs. 8%, p \u003c 0.001) were significantly higher in students claiming to have adequate knowledge. 11% of the students debated dropping out of dental education because of the COVID-19 pandemic. These students had a markedly elevated rate of fear of being at risk for contagion because of the COVID-19 pandemic (80% vs. 64%, p = 0.011). 76% of the students were aiming for a dental specialty. 18% changed their desired specialty and 22% were in search of a specialty that requires less close contact procedures because of the COVID-19 pandemic. Providing students with sufficient information from trustworthy sources through distance education, as well as psychological support when needed has crucial importance for a successful dental education and career planning.","manuscriptTitle":"The Effect of the Covid-19 Pandemic on Specialty Choices of Dental Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-03 06:25:04","doi":"10.21203/rs.3.rs-2217141/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c5bb26bd-6aa4-4c75-82ea-024ecdac86bd","owner":[],"postedDate":"November 3rd, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-11-14T15:59:29+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-03 06:25:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2217141","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2217141","identity":"rs-2217141","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}