Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan

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Methods A cross-sectional descriptive study design was used in this research, which was distributed to 198 dental professionals, with Part A dealing with sociodemographic data, Part B focusing on awareness of occupational hazards, and Part C on preventive measures. Responses were analyzed to assess the level of awareness using a five-point scale. The data were also compared using Mann-Whitney U tests to examine the differences between male and female respondents and between final-year dental students and practicing dentists. Results The overall mean proportion of correct answers was 0.71 (71%), indicating moderately high awareness. Part B had a mean of 0.73 (high), and Part C had a mean of 0.69 (medium). High awareness was found in areas such as radiation safety (93.4%), infection control (97.5%) and ergonomics (85.9%). However, gaps were identified in knowledge of lead protective gowns (15.2%) and the inverse square law (8.1%). In Part C, high awareness was noted regarding safety guidelines for electrical devices (85.9%) and protective eyewear (93.4%), but low awareness was found regarding safety boxes for sharp instruments (19.7%) and the scoop technique (31.8%). Mann-Whitney U tests revealed significant differences between male and female respondents (p < 0.001), with females showing higher awareness, although the effect size was small (r = -0.247). No significant difference was observed between the final-year students and practicing dentists (p = 0.575). Conclusions Although dental professionals exhibit a relatively high level of awareness regarding occupational hazards and preventive measures, specific knowledge gaps persist. Addressing these deficiencies through structured educational interventions and continuous professional training is essential to enhance the occupational safety and improve the overall well-being of dental practitioners. 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F1000Research 2025, 14 :639 ( https://doi.org/10.12688/f1000research.166053.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan [version 1; peer review: 1 approved with reservations] Fariha Kamal https://orcid.org/0000-0002-0802-3560 1 , Abdurrahman Anwari https://orcid.org/0000-0002-6347-3353 2 , Farahnaz Ghazanfari 2 , Ahmad Anas Khairzad 3 , Nematullah Sharifi 3 , Fariha Omarzad 3 Fariha Kamal https://orcid.org/0000-0002-0802-3560 1 , Abdurrahman Anwari https://orcid.org/0000-0002-6347-3353 2 , [...] Farahnaz Ghazanfari 2 , Ahmad Anas Khairzad 3 , Nematullah Sharifi 3 , Fariha Omarzad 3 PUBLISHED 01 Jul 2025 Author details Author details 1 Oral Medicine, Kabul University of Medical Sciences, Kabul, Kabul, 1001, Afghanistan 2 Operative Dentistry and Endodontics, Kabul University of Medical Sciences, Kabul, Kabul, 1001, Afghanistan 3 Dentistry Faculty, Kabul University of Medical Sciences, Kabul, Kabul, 1001, Afghanistan Fariha Kamal Roles: Conceptualization, Data Curation, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Abdurrahman Anwari Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Farahnaz Ghazanfari Roles: Data Curation, Investigation, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ahmad Anas Khairzad Roles: Investigation, Resources, Software, Validation, Visualization, Writing – Review & Editing Nematullah Sharifi Roles: Investigation, Resources, Software, Validation, Visualization, Writing – Review & Editing Fariha Omarzad Roles: Investigation, Resources, Software, Validation, Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction This study aimed to evaluate the knowledge and awareness of occupational hazards and preventive measures among dentists and final-year students in two dentistry hospitals in Kabul, Afghanistan. Methods A cross-sectional descriptive study design was used in this research, which was distributed to 198 dental professionals, with Part A dealing with sociodemographic data, Part B focusing on awareness of occupational hazards, and Part C on preventive measures. Responses were analyzed to assess the level of awareness using a five-point scale. The data were also compared using Mann-Whitney U tests to examine the differences between male and female respondents and between final-year dental students and practicing dentists. Results The overall mean proportion of correct answers was 0.71 (71%), indicating moderately high awareness. Part B had a mean of 0.73 (high), and Part C had a mean of 0.69 (medium). High awareness was found in areas such as radiation safety (93.4%), infection control (97.5%) and ergonomics (85.9%). However, gaps were identified in knowledge of lead protective gowns (15.2%) and the inverse square law (8.1%). In Part C, high awareness was noted regarding safety guidelines for electrical devices (85.9%) and protective eyewear (93.4%), but low awareness was found regarding safety boxes for sharp instruments (19.7%) and the scoop technique (31.8%). Mann-Whitney U tests revealed significant differences between male and female respondents (p < 0.001), with females showing higher awareness, although the effect size was small (r = -0.247). No significant difference was observed between the final-year students and practicing dentists (p = 0.575). Conclusions Although dental professionals exhibit a relatively high level of awareness regarding occupational hazards and preventive measures, specific knowledge gaps persist. Addressing these deficiencies through structured educational interventions and continuous professional training is essential to enhance the occupational safety and improve the overall well-being of dental practitioners. READ ALL READ LESS Keywords Occupational Hazards, Awareness, Dentistry, Preventive Measures Corresponding Author(s) Fariha Kamal ( [email protected] ) Close Corresponding author: Fariha Kamal Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Kamal F et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Kamal F, Anwari A, Ghazanfari F et al. Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :639 ( https://doi.org/10.12688/f1000research.166053.1 ) First published: 01 Jul 2025, 14 :639 ( https://doi.org/10.12688/f1000research.166053.1 ) Latest published: 09 Sep 2025, 14 :639 ( https://doi.org/10.12688/f1000research.166053.3 )  There is a newer version of this article available. Suppress this message for one day. Introduction The high incidence of workplace safety hazards is a worldwide phenomenon that is particularly significant in developing countries. Working in a dangerous environment can have a negative impact on many employees’ physical and mental health, which can impact their households and close social networks. An occupational hazard is an illness or injury brought on by one’s job or the environment in which one works. 1 – 3 The recognition of occupational risks dates back to the 18th century, when Bernardino Ramazzini, known as the ‘Father of Occupational Medicine’, first described the connection between occupation and the dynamics of health and disease. Over time, this understanding has expanded, leading to an increased awareness of various hazards in different professions, including dentistry. 4 – 8 Occupational hazards in dentistry encompass a range of risks faced by dental professionals, including noise pollution, psychological stress, chemical exposure, infections, and musculoskeletal disorders. These hazards can significantly affect the health and well-being of dental practitioners, necessitating awareness and preventive measures to mitigate their effects. 9 , 10 Physical and mechanical threats in dentistry include projectiles that cause eye injuries, cutting objects, and puncture wounds from needles or other sharp instruments. These injuries can also lead to the transmission of infectious diseases. Additionally, harmful radiation can damage various body cells, and prolonged exposure to noise and vibration from high-speed and low-speed handpieces, high-volume suction, and ultrasonic instruments can contribute to hearing issues. Musculoskeletal problems, such as wrist pain, lower back pain, and neck discomfort, often arise from repetitive motions and maintenance of fixed working positions. Chemical hazards include inorganic substances such as mercury, organic solvents, resins, and gases, as well as caustic chemicals such as formaldehyde. Allergic reactions such as contact dermatitis from latex gloves are also a concern. Biological hazards, including allergens, infections, toxicity of dental materials, and the risk of cross-contamination, pose additional threats. Lastly, psychological risks, such as stress, excessive workload, job dissatisfaction, professional burnout, and medicolegal concerns can significantly impact mental health. 11 , 12 The prevalence of occupational hazards in dentistry is a significant concern, studies report an alarming prevalence of musculoskeletal disorders among dentists, and ranging from 68% to 100%, with common issues including back pain (29% to 94.6%) and neck pain (26% to 92%). 13 Exposure to hazardous materials such as mercury and the risk of cross infection are notable with, 44% of dental students reporting mercury toxicity and 40.4% concerned about aerosol infections. 14 Stress is prevalent, with 63.5% of dental professionals citing it as a major concern, often linked to patient interaction and financial pressures. 15 Awareness of occupational hazards in dentistry is crucial to ensure the safety of dental professionals. Various studies have highlighted the prevalence of different hazards including noise pollution, sharp injuries, chemical exposure, and blood-borne infections. Despite some awareness, a significant gap remains in the knowledge and preventive measures among dental practitioners and students. A study found that 85% of dentists perceived noise as an occupational hazard, yet only 57.1% were aware of permissible noise levels. 16 In a recent study conducted in Saudi Arabia, awareness of sharp injuries was satisfactory among 64.3% of dental students, but 31.3% reported exposure in the past two years. 17 Similar findings were also observed in another study, which demonstrated approximately 48.12% of dentists in Korea had a serious perception of occupational hazards, with 77.3% experiencing them. 18 Likewise, awareness of bloodborne pathogens and post exposure protocols was low in a recent study, with only 18% correctly following treatment guidelines after exposure. 19 Understanding these work-related threats is essential to raise awareness among dentists. 20 Effective safety practices in dental workplaces include the establishment of an infection prevention program, proper maintenance of work areas, implementation of education and training on physical hazards, and the correct use of personal protective equipment. 21 Although awareness of occupational hazards is improving, many dental professionals still lack comprehensive knowledge and adherence to safety protocols. Reviewing the literature, we found that in the context of Afghanistan, only one study has been conducted on occupational hazards in Afghanistan, which primarily focused on the occurrence and types of these hazards. 22 However, it did not address the knowledge and awareness of individuals regarding this topic, and no research has been conducted in this regard. In light of these considerations, the objective of the current study was to assess the level of awareness regarding occupational hazards and the preventive measures taken by both dentists and final-year students at the Stomatology Teaching Hospital and the National Stomatology Curative and Specialized Hospital in Kabul, Afghanistan. Material and Methods This study was a cross-sectional, survey-based research conducted at the Stomatology Teaching Hospital and National Stomatology Curative and Specialized Hospital, Kabul, Afghanistan. These two hospitals are major dentistry healthcare facilities in Kabul City. Convenience sampling was used to recruit participants. The study included all dentists and final-year dental students from the aforementioned hospitals, who agreed to participate. In total, 198 participants were included in this study. Individuals who declined to participate were excluded from this study. A self-designed questionnaire was developed to assess the knowledge and awareness of occupational hazards and preventive measures in dentistry. It was initially written in English, reviewed, and modified based on feedback from senior dentistry instructors and then translated into Dari for participant convenience. A pilot study was conducted with ten final-year dental students to evaluate the clarity and reliability of the questionnaire. Based on feedback from the pilot study, necessary modifications were made before full-scale data collection. The questionnaire consisted of three main sections: Part A gathered socio-demographic information (QA1-QA5), including questions related to the participants’ age, gender, education, work experience, and position within the dental field. Part B assessed knowledge and awareness regarding occupational hazards in dentistry (QB1-QB23), covering topics such as risks from dental materials, radiation exposure, sharp injuries, and infectious diseases. Part C focused on knowledge and awareness of preventive measures for occupational hazards (QC1-QC24), addressing topics such as personal protective equipment (PPE), sterilization protocols, infection control, and safe handling practices. Each question in Parts B and C offered three response options: “Yes,” “No/Not Established,” and “I Don’t Know.” Before data collection, data collectors were comprehensively trained to guide participants in completing the questionnaire and ensuring that all the questions were answered. All potential respondents were informed about the study’s objectives, procedures, and their rights, including confidentiality and voluntary nature of their involvement. Participation was entirely voluntary and anonymous. Written informed consent was not obtained due to the minimal-risk nature of the study, which involved non-selective data collection through anonymous, self-administered questionnaires. Requiring written consent would have introduced unnecessary administrative burden, particularly in clinical and educational settings. Therefore, verbal informed consent was obtained, and the completion and return of the questionnaire was considered as implied consent. This approach was reviewed and approved by the research committee of the Kabul University of Medical Sciences. As all participants were adults (final-year students and dentists), no minors were involved, thus no parental consent or assent was required. The collected data were entered, systematically coded, cleaned, and analyzed using SPSS version 25. To ensure data quality, a random selection of questionnaires was compared to the data entered at the end. Correct answers to each question were assigned 1 point, while incorrect answers and ‘I do not know’ responses were assigned 0 points. The proportion of correct answers was calculated for each participant separately for Parts B and Part C. The average proportion of correct responses was then calculated across all participants for Part B (occupational hazards knowledge), Part C (preventive measures knowledge), and overall (Parts B and C combined). Awareness levels were categorized as follows: 0.00 – 0.20 (Very Low), 0.21 – 0.40 (Low), 0.41 – 0.70 (Moderate), 0.71 – 0.90 (High), and 0.91 – 1.00 (Very High). The Mann-Whitney U test was used to compare awareness levels between male and female respondents and between final-year dental students and practicing dentists. The effect size was measured using rank-biserial correlation (r). The study was approved by the Research Committee of the Kabul University of Medical Sciences on 24/4/1403 (14/7/2024), protocol 6, agenda no. 3. Results A total of 198 dental professionals participated in this study, including 106 males (53.5%) and 92 females (46.5%). The majority of respondents (90.9%) were aged between 21 and 30 years. Regarding their professional status, 131 (66.2%) were final-year dental students and 67 (33.8%) were dental practitioners. Most participants (80.8%) were affiliated with the Stomatology Teaching Hospital, whereas others were from private dental clinics or academic settings ( Table 1 ). Table 1. Demographic distribution of respondents. Category Subcategory Frequency Percentage Gender Male 106 53.5% female 92 46.5% Total 198 100% Age group 21-30 180 90.9% 31-40 9 4.5% 41-50 4 2.0% More than 50 5 2.5% Total 198 99.9% Clinical Profession Final year students 131 66.2% Dentist 67 33.8% Total 198 100% Hospital Stomatology Teaching Hospital 160 80.8% National Stomatology Curative and Specialty Hospital 38 19.2% Total 198 100% Awareness of occupational hazards among participants was assessed using a set of 14 questions. The mean proportion of correct responses was 0.73, which reflected a high level of general awareness. Several questions demonstrated a particularly high awareness. For instance, 97% of respondents correctly recognized that high-intensity light used during dental procedures can cause eye damage, and 93.4% acknowledged the harmful effects of X-ray radiation exposure. Furthermore, 97.5% were aware that diseases such as Herpes Simplex Virus (HSV), Hepatitis B (HBV), HIV, and Tuberculosis (TB) can be transmitted during dental procedures. However, certain areas revealed notable gaps in their knowledge. Only 14% of participants correctly identified carpal tunnel syndrome as a common occupational hazard in dentistry. Additionally, a significant proportion (62.1%) mistakenly believed that mercury in dental amalgam was carcinogenic. Awareness of other hazards, such as the effects of poor posture on musculoskeletal health and noise-induced hearing loss, showed moderate levels of understanding, with correct response rates ranging from 50% to 70% ( Table 2 ). Table 2. Findings from the analysis of responses to questions regarding awareness of occupational hazards (Part B of the questionnaire). No. Questions Responses Correct Answer (Proportion, category) Yes (Freq, %) No/Not well established (Freq, %) I don’t know (Freq, %) Total (Freq, %) QB1 Can electrical devices in dentistry cause injuries like; burns or short circuits? 62, 31.3% 123, 62.1% 13, 6.6% 198, 100% 0.31, Low QB2 Can low intensity light at work place cause eye pain, eye fatigue or headache? 182, 91.9% 14, 7.1% 2, 1.0% 198, 100% 0.92, Very High QB3 Can high intensity light at work place cause eye pain, eye fatigue or headache? 192, 97.0% 4, 2.0% 2, 1.0% 198, 100% 0.97, Very High QB4 Can light emitted from devices such as light curing devices, PC monitors, or lasers induce conjunctivitis or keratitis? 151, 76.3% 17, 8.6% 30, 15.2% 198, 100% 0.76, High QB5 Is it correct that, high speed handpieces, air compressors, suction machines or scalers may cause hearing loss? 136, 68.7% 43, 21.7% 19, 9.6% 198, 100% 0.69, Moderate QB6 Is there any relationship between intensity, frequency and, duration of exposure the aforementioned points and hearing loss? 170, 85.9% 13, 6.6% 15, 7.6% 198, 100% 0.86, High QB7 Does exposure to X-ray radiation without any further protective measurement cause physical or genetical harm? 185, 93.4% 8, 4.0% 5, 2.5% 198, 100% 0.93, Very High QB8 Does exposure to X-rays without proper protective measure gradually threatens life? 177, 89.4% 15, 7.6% 6, 3.0% 198, 100% 0.89, High QB9 Are HSV, HBs, HIV, HCV, and TB the most worrisome infectious agents among dental practitioners? 193, 97.5% 4, 2.0% 1, 0.5% 198, 100% 0.97, Very High QB10 In addition to bacteria, virus, and fungi, are prions also considered a biological threat? 125, 63.1% 8, 4.0% 65, 32.8% 198, 100% 0.63, Moderate QB11 Are saliva and gingival-crevicular fluid a main source of infection? 181, 91.4% 10, 5.1% 7, 3.5% 198, 100% 0.91, Very High QB12 Do aerosols produced during dental procedures play role in infection transmission? 151, 76.3% 21, 10.6% 26, 13.1% 198, 100% 0.76, High QB13 Is it true that high speed handpiece produce aerosol? 152, 76.8% 24, 12.1% 22, 11.1% 198, 100% 0.77, High QB14 Does ultrasonic scalers produce highest number of aerosols? 123, 62.1% 33, 16.7% 42, 21.2% 198, 100% 0.62, Moderate QB15 Are injuries with sharp objects like needle and scalpel very dangerous in terms of cross-contamination? 190, 96.0% 5, 2.5% 3, 1.5% 198, 100% 0.96, Very High QB16 Is mercury in dental amalgam a risk factor for oral cancer? 123, 62.1% 43, 21.7% 32, 16.2% 198, 100% 0.22, Low QB17 Does continuous exposure/contact to methyl-acrylate may cause allergic reaction? 141, 71.2% 7, 3.5% 50, 25.3% 198, 100% 0.71, High QB18 Is it true that, allergy to latex gloves is relatively common? 121 61.1% 66, 33.3% 11, 5.6% 198, 100% 0.61, Moderate QB19 Are musculoskeletal disorders common among dental professionals? 170, 85.9% 22, 11.1% 6, 3.0% 198, 100% 0.86, High QB20 Is carpal tunnel syndrome a common type of musculoskeletal disorder in dentistry? 135, 68.2% 28, 14.1% 35, 17.7% 198, 100% 0.14, Very Low QB21 Is it true that, dental profession is associated with high level of mental stress? 141, 71.2% 43, 21.7% 14, 7.1% 198, 100% 0.71, High QB22 Are lack of social activities or a decline in time spent with family, one of the major causes of stress among Dental professionals? 149, 75.3% 38, 19.2% 11, 5.6% 198, 100% 0.75, High QB23 Are dental office wastes considered hazardous? 174, 87.9% 21, 10.6% 3, 1.5% 198, 100% 0.88, High Mean Proportion of Correct Answers 0.73, High The section on preventive strategies consisted of 11 questions, with participants achieving a mean correct response rate of 0.69, indicating a slightly lower awareness than the hazard-focused questions. High levels of awareness were evident in some areas: 93.9% of participants recognized the importance of taking a detailed medical history to prevent adverse reactions, and 93.4% emphasized the need for protective eyewear during dental procedures. Moreover, 90.9% believed that managing stress by spending time with family was an effective coping strategy for psychological well-being. Nonetheless, other responses indicated critical gaps in knowledge. Only 8.1% correctly understood the inverse square law in radiation protection and 19.7% were aware of the correct use of safety boxes for disposing of sharp instruments. Similarly, only 31.8% answered correctly regarding the use of the scoop technique to prevent needle stick injury. While awareness of the benefits of proper lighting, regular breaks, and ergonomic seating was moderate, some areas related to safe handling and disposal practices were clearly under recognized ( Table 3 ). Table 3. Findings from the analysis of questions focused on awareness regarding preventive measures of occupational hazards in dentistry (Part C of the Questionnaire). No. Questions Responses Correct Answer (Proportion, Category) Yes (Freq, %) No/Not well established (Freq, %) I don’t know (Freq, %) Total (Freq, %) QC1 Can using guideline/manual for electrical devices reduce the chance of injuries caused by them? 170, 85.9% 16, 8.1% 12, 6.1% 198, 100% 0.86, High QC2 Is it right that the use of standard light on dental units may prevent light-induced eye injury? 147, 74.2% 41, 20.7% 10, 5.1% 198, 100% 0.74, High QC3 Can appropriate protective eye-wears provide protection against light emitted from light curing device, laser machine or pc monitors? 185, 93.4% 9, 4.5% 4, 2.0% 198, 100% 0.93, Very High QC4 Is it correct that, dentists should adhere to radiation protection protocols while taking periapical x-rays? 168, 84.8% 22, 11.1% 8, 4.0% 198, 100% 0.85, High QC5 Is it mandatory for physicians to wear lead protective gowns when taking periapical radiographs? 162, 81.8% 30, 15.2% 6, 3.0% 198, 100% 0.15, Very Low QC6 Is the inverse square law (law of distance and position) utilized for the protection of dental professionals from X-rays? 16, 8.1% 145, 73.2% 37, 18.7% 198, 100% 0.08, Very Low QC7 Is dosimetry good for monitoring x ray radiation exposure? 150, 75.8% 8, 4.0% 40, 20.2% 198, 100% 0.76, High QC8 Does patient’s medical history help in preventing the spread of infectious agents to healthcare workers? 186, 93.9% 9, 4.5% 3, 1.5% 198, 100% 0.94, Very High QC9 Is it true that facial masks don’t provide full protection against aerosols? 90, 45.5% 94, 47.5% 14, 7.1% 198, 100% 0.45, Moderate QC10 Has scoop technique been designed to reduce needle stick injuries? 63, 31.8% 25, 12.6% 110, 55.6% 198, 100% 0.32, Low QC11 Does safety boxes reduce the incidence of injuries caused by sharp instruments? 39, 19.7 % 150, 75.8% 9, 4.5% 198, 100% 0.20, Very Low QC12 Can cleaning contaminated equipment with ultrasonic cleaning device in contrast to manual cleaning decrease the risk of sharp instrument injury? 125, 63.1% 54, 27.3% 19, 9.6% 198, 100% 0.63, Moderate QC13 Is it necessary for dental professionals to take the Hepatitis-B vaccine? 156, 78.8% 16, 8.1% 26, 13.1% 198, 100% 0.79, High QC14 After completion of hepatitis-B vaccine doses, is booster doses necessary for healthcare workers? 103, 52.0% 34, 17.2% 61, 30.8% 198, 100% 0.52, Moderate QC15 Can pre-capsulated amalgam reduce the chance of injuries caused by mercury? 151, 76.3% 13, 6.6% 34, 17.2% 198, 100% 0.76, High QC16 Is use of amalgamator safer than mixing amalgam in mortar and pestle? 163, 82.3% 15, 7.6% 20, 10.1% 198, 100% 0.82, High QC17 Can wearing personal protective equipment reduce the chance of allergic reactions? 168, 84.8% 14, 7.1% 16, 8.1% 198, 100% 0.85, High QC18 Does considering a balanced body position reduce the chance of musculoskeletal disorders? 158, 79.8% 14, 7.1% 26, 13.1% 198, 100% 0.80, High QC19 Does taking short breaks during work reduce the chance of musculoskeletal disorders? 177, 89.4% 9, 4.5% 12, 6.1% 198, 100% 0.89, High QC20 Does regular physical exercise help prevent musculoskeletal disorders among dental professionals? 163, 82.3% 24, 12.1% 11, 5.6% 198, 100% 0.82, High QC21 Does dental microscope help dentists to maintain a balanced body position? 168, 84.8% 11, 5.6% 19, 9.6% 198, 100% 0.85, High QC22 Does spending more time with friends and family help in reduction of stress levels among healthcare workers? 180, 90.9% 6, 3.0% 12, 6.1% 198, 100% 0.91, Very High QC23 Is engaging in activities like yoga, drawing, or painting beneficial in reducing stress levels among dental professionals? 159, 80.3% 25, 12.6% 14, 7.1% 198, 100% 0.80, High QC24 Does the waste disposal of dental healthcare facilities require standard protocols? 177, 89.4% 13, 6.6% 8, 4.0 198, 100% 0.89, High Mean Proportion of Correct Answers 0.69, Medium The combined mean proportion of correct responses across both sections (Parts B and C) was 0.71 ( Table 4 ), reflecting an overall high level of awareness among participants. However, the variability in responses suggests that while some topics are well understood, others, particularly those involving technical or procedural details, require further emphasis in training and continuing education programs. Table 4. Combined proportion of correct answers. Mean Proportion of Correct Answers for Part B 0.73, High Mean Proportion of Correct Answers for Part C 0.69, Medium Combined Proportion of Correct Answers 0.71, High To determine differences in awareness by gender and professional status, the Mann-Whitney U test was used. The results revealed a statistically significant difference in awareness scores between the male and female participants, with females showing significantly higher awareness levels (p = 0.000) ( Table 5 ). In contrast, no statistically significant difference was found between the final-year students and dental practitioners (p = 0.575), suggesting that both groups had comparable levels of knowledge regarding occupational hazards and preventive measures ( Table 6 ). Table 5. Mann-Whitney U test results comparing male and female awareness levels regarding occupational hazards and their preventive measures. Group Comparison N (Males) N (Females) U Z p-value Mean Rank (Males) Mean Rank (Females) Males vs. Females 106 92 3480.00 -3.481 .000 86.33 114.67 Table 6. Mann-Whitney U test results comparing final year students and dentists’ awareness levels regarding occupational hazards and their preventive measures. Group Comparison N (Final Year Students) N (Dentists) U Z p-value Mean Rank (Final Year Students) Mean Rank (Dentists) Final Year Students vs. Dentists 131 67 4175.00 -0.561 .575 101.13 96.31 Discussion This study assessed the knowledge and awareness of occupational hazards and their preventive measures among dentists and final-year dental students at two dentistry hospitals in Kabul, Afghanistan. The overall awareness level was high (0.73) for hazards, and medium (0.69) for preventive measures, resulting in a combined awareness level of 0.71. However, specific knowledge gaps have been identified, particularly regarding the risks from electrical devices, mercury exposure, and certain musculoskeletal conditions. Notably, female participants had significantly higher awareness than male participants, while no significant difference was observed between final-year students and practicing dentists. To the best of our knowledge, no study has used a specific methodology to assess occupational hazard awareness among dental professionals in Afghanistan. However, the findings from existing studies offer valuable insights and provide a context for understanding the results of our study. Studies involving dental students have reported high levels of awareness regarding needlestick injuries (NSI), with 89.23% of students demonstrating knowledge of NSI and their management in one study. 23 Similarly, 89% of students in another study were aware of post exposure prophylaxis for accidental NSI. In our study, a high level of awareness was observed in response to QB15, where 96.0% of respondents correctly identified the dangers of cross-contamination from sharp objects like needles and scalpels, resulting in a proportion of 0.96. This finding suggests that awareness of NSI is strong among dental professionals in Afghanistan, similar to findings in other regions. One study found that 98% of dental practitioners were aware of the risk of noise-induced hearing loss (NIHL), in contrast to only 34% of dental students. 24 In our study, when exploring the potential for devices such as high-speed handpieces and suction machines to cause hearing loss (QB5), the awareness level was moderate (0.69). While this is lower than the awareness found in practitioners in other studies, it highlights an important area where further education can improve understanding, especially among dental students and new professionals. Another study found that general dentists were more likely to recognize X-rays as a risk factor than specialists. 25 Our study found that awareness of the harmful effects of X-ray radiation without protective measures (QB7) was very high (0.93). However, awareness slightly decreased in QB8, which assessed knowledge of the life-threatening risks posed by prolonged X-ray exposure, resulting in a proportion of 0.89, which is still classified as high. This decrease may reflect the complexity of understanding long-term risks even among those who are aware of immediate hazards. A study assessing ergonomic awareness has generally found that women are more likely to recognize their importance than men. 26 Similarly, one study reported that 75.8% of female dentists had an idea of what the term ergonomics meant compared to 52.6% of male dentists, with a statistically significant difference (p < 0.05). 27 Our study also found a gender difference, with female participants demonstrating a higher overall awareness. This suggests that women may be more attuned to ergonomics, possibly because of both their education and the demands of dental practice. A study assessing basic knowledge of theoretical ergonomics, the ISO 11226 standard, and ways to improve undergraduate ergonomics training found that most students had an average level of knowledge of dental ergonomic principles. 28 In our study, the proportion of correct responses to three key questions—whether a balanced body position (0.80), taking short breaks (0.89), and regular physical exercise (0.82) help prevent musculoskeletal disorders—was categorized as high. While the data may not be directly comparable due to differences in questioning, our findings suggest a strong awareness of practical ergonomic principles among the participants. While no significant difference was found in awareness levels between final-year dental students and practicing dentists, this result could be partly explained by the composition of the sample. With 131 final-year students out of 198 total participants, a large proportion of students may have introduced a bias, as these individuals are currently undergoing extensive training in clinical settings, likely acquiring knowledge about occupational hazards and preventive measures at a similar rate as practicing professionals. As a result, both groups may have had relatively similar exposure to occupational health and safety education, which could account for the lack of a significant difference. Moreover, the absence of a substantial difference could suggest that formal education on occupational hazards provided during the students’ academic curriculum might be sufficient to ensure an awareness level comparable to that of practicing dentists. It is also possible that further practical experience in the field might not drastically change awareness if foundational knowledge imparted during education is strong. The consequences of occupational hazards extend beyond physical injury. Lack of awareness can lead to psychological issues, such as anxiety, depression, and post-traumatic stress disorder (PTSD). When healthcare workers experience repeated exposure to hazardous situations without proper knowledge and support, their mental health deteriorates, leading to burnout and decreased job satisfaction. 1 , 29 Inadequate awareness can not only affect the overall productivity of healthcare workers, but also compromises patient safety and outcomes. 30 , 31 Furthermore, inadequate awareness has a substantial economic impact. Increased healthcare costs due to injuries, loss of productivity, and the need for additional training or recruitment can limit healthcare budgets. In low- and middle-income countries (LMICs), where resources are already limited, this becomes a critical issue affecting the sustainability of health services. 31 , 32 Our study identified several clear gaps in the knowledge regarding occupational hazards and preventive measures, which may contribute to these broader consequences. Notably, there is insufficient awareness about the risks posed by electrical devices, mercury in dental amalgams, and specific musculoskeletal conditions such as carpal tunnel syndrome. Similarly, gaps were evident in the understanding of radiation safety measures, including the importance of wearing lead-protective gowns, applying the inverse square law, and the use of safety boxes for sharp instruments. Addressing these knowledge gaps is essential not only for individual safety, but also for improving mental well-being, reducing economic burdens, and enhancing overall healthcare sustainability. These gaps highlight the need for regular and effective training on occupational hazards and preventive measures. Studies indicate that healthcare workers LMICs, including dental professionals, often lack adequate training, resulting in insufficient knowledge about critical risks, such as blood-borne pathogens and ergonomic hazards. Addressing these deficiencies requires ongoing educational intervention to improve awareness and safety practices. Support from health organizations through counseling services and workplace health programs can play a pivotal role in enhancing awareness. Additionally, analyzing the history of workplace incidents can help identify weaknesses in safety protocols, which can then be used to tailor more effective training programs. It is critical to build and sustain a strong safety culture within dental workplaces, as this has been shown to positively influence employee behavior and adherence to safety protocols. A culture of safety reinforced through continuous education and leadership support can significantly reduce the risks associated with dental practice and improve the well-being of dental professionals. Creating a safe work environment is essential to reduce occupational hazards. Many healthcare workers are exposed to various types of hazards, as mentioned before in this study, which can be mitigated through proper safety protocols. 33 , 34 Challenging working conditions, such as long hours and high stress, contribute to burnout and this condition can impair their ability to recognize and respond to hazards effectively. 30 , 35 Regular and effective training on occupational hazards and preventive measures is critical. Studies show that healthcare workers in LMICs often lack adequate training, leading to insufficient knowledge about risks, such as blood-borne pathogens and ergonomic hazards. Support from organizations through counseling services and health programs can enhance awareness, and analyzing the history of workplace incidents can help identify safety weaknesses and improve training programs. A strong safety culture within the workplace significantly impacts employee behavior and adherence to safety protocols. 36 , 37 This study had certain limitations. The use of a self-made questionnaire may have impacted the validity and reliability of the findings, as it was not pre-validated against standardized measures. Additionally, the convenience sampling method limits the generalizability of the results, as the participants may not be fully representative of all dental professionals in Kabul. Future research should consider using a validated questionnaire and randomized sampling approach to improve the robustness of the findings. Future research could explore intervention-based approaches, such as training programs, to assess whether targeted education might enhance awareness of lesser-known occupational hazards. Additionally, conducting a larger multicenter study involving different regions of Afghanistan could offer a more comprehensive understanding of awareness levels nationwide. By addressing these issues, future studies may contribute to further enhancing the safety and well-being of dental professionals. Conclusion In conclusion, while dental professionals exhibit a relatively high level of awareness of occupational hazards and preventive measures, specific knowledge gaps persist. Addressing these deficiencies through structured educational interventions and continuous professional training is essential to enhance the occupational safety and improve the overall well-being of dental practitioners. Ethics approval and informed consent The study was approved by the Research Committee of the Kabul University of Medical Sciences on 24/4/1403 (14/7/2024), protocol 6, agenda no. 3. Verbal informed consent was obtained, and the completion and return of the questionnaire was considered as implied consent. Data availability The datasets generated and analyzed during the current study are publicly available on Figshare: ▪ SPSS dataset: Anonymized raw dataset in.sav format used for statistical analysis. https://doi.org/10.6084/m9.figshare.29328428.v1 38 ▪ Questionnaire file: Structured blank survey questionnaire (pdf in Dari and English) used for data collection in this study. https://doi.org/10.6084/m9.figshare.29328377.v1 38 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. AlDhaen E: Awareness of occupational health hazards and occupational stress among dental care professionals: Evidence from the GCC region. 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Publisher Full Text 34. Ndejjo R, Musinguzi G, Yu X, et al. : Occupational health hazards among healthcare workers in Kampala, Uganda. J. Environ. Public Health. 2015; 2015 : 913741. Epub 2015 Jan 31. PubMed Abstract | Publisher Full Text | Free Full Text 35. Occupational hazards in the health sector: [cited 2025 Feb 4]. Reference Source 36. Occupational health: health workers: [cited 2025 Feb 4]. Reference Source 37. Mossburg S, Agore A, Nkimbeng M, et al. : Occupational Hazards among Healthcare Workers in Africa: A Systematic Review. Ann. Glob. Health. 2019 Jun 6 [cited 2025 Feb 4]; 85 (1). PubMed Abstract | Publisher Full Text | Free Full Text 38. Fariah K, et al. : Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan. Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 01 Jul 2025 ADD YOUR COMMENT Comment Author details Author details 1 Oral Medicine, Kabul University of Medical Sciences, Kabul, Kabul, 1001, Afghanistan 2 Operative Dentistry and Endodontics, Kabul University of Medical Sciences, Kabul, Kabul, 1001, Afghanistan 3 Dentistry Faculty, Kabul University of Medical Sciences, Kabul, Kabul, 1001, Afghanistan Fariha Kamal Roles: Conceptualization, Data Curation, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Abdurrahman Anwari Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Farahnaz Ghazanfari Roles: Data Curation, Investigation, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ahmad Anas Khairzad Roles: Investigation, Resources, Software, Validation, Visualization, Writing – Review & Editing Nematullah Sharifi Roles: Investigation, Resources, Software, Validation, Visualization, Writing – Review & Editing Fariha Omarzad Roles: Investigation, Resources, Software, Validation, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 09 Sep 2025, 14:639 https://doi.org/10.12688/f1000research.166053.3 version 2 Revised Published: 26 Aug 2025, 14:639 https://doi.org/10.12688/f1000research.166053.2 version 1 Published: 01 Jul 2025, 14:639 https://doi.org/10.12688/f1000research.166053.1 Copyright © 2025 Kamal F et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Kamal F, Anwari A, Ghazanfari F et al. Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :639 ( https://doi.org/10.12688/f1000research.166053.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 01 Jul 2025 Views 0 Cite How to cite this report: Anggraini W. Reviewer Report For: Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :639 ( https://doi.org/10.5256/f1000research.182890.r401176 ) The direct URL for this report is: https://f1000research.com/articles/14-639/v1#referee-response-401176 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 14 Aug 2025 Wita Anggraini , Universitas Trisakti, Jakarta, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.182890.r401176 Review Results: Material and Methods Paragraph 1: State the inclusion and exclusion criteria in this study. Paragraph 3: What is the researcher's rationale for the 'No/Not well Established’ and "I don't know" answers?. ... Continue reading READ ALL Review Results: Material and Methods Paragraph 1: State the inclusion and exclusion criteria in this study. Paragraph 3: What is the researcher's rationale for the 'No/Not well Established’ and "I don't know" answers?. Regarding the two "No" answers above, is it possible that final-year students, or even working dentists, have never been exposed to the occupational safety culture knowledge being studied? Please explain this in the methods section. Paragraph 4, in the last sentence: As all participants were adults (final-year students and dentists), no minors were involved, thus no parental consent or assent was required.--This statement does not need to be written, because the research method has been approved by the relevant Ethics Committee. Paragraph 5: Awareness levels were categorized as follows: 0.00– 0.20 (Very Low), 0.21– 0.40 (Low), 0.41– 0.70 (Moderate), 0.71– 0.90 (High), and 0.91– 1.00 (Very High).-- This range statement requires a library source. Results In Tables 1 and 2: The Yes/No/I don't know and frequency answer columns will be clearer if they are separated into 2 columns each, for example: the yes answer column and the frequency column. Discussion In the discussion section: you need to address respondents who answered 'No/Not well established’ and ‘I don't know’. Does this impact the results of this study? you need to review how the Occupational Safety and Health curriculum is delivered during education, as this relates to the knowledge gaps and low levels of awareness found in dentists and students. Paragraph 6: Much research has been done on dental ergonomic, it is necessary to explain in more depth why there are gender differences in occupational health related to ergonomics. Paragraph 16: Are the number of hours worked per day for each respondent recorded? If yes, it would be better for the author to include it, so that it is relevant to the statements in reference sources numbers 30 and 35. Conclusion The conclusion should be made more pointed, such as the importance of knowledge and awareness of occupational hazards and their preventive measures. It is important for dentists and students to be aware of and willing to prevent various aspects of their occupational hazards, for example: noise, light, ergonomic positions, etc. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly References 1. Anggraini W, Ranggaini D, Ariyani A, Sulistyowati I: World Trends in Dental Ergonomics Research: A Bibliometric Analysis. International Journal of Environmental Research and Public Health . 2024; 21 (4). Publisher Full Text 2. Kholinne E, Azalia X, Rahayu E, Anestessia I, et al.: The prevalence and risk factors of musculoskeletal disorders among Indonesian dental professionals. Frontiers in Rehabilitation Sciences . 2025; 6 . Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Human Anatomy, Ergonomic Dentistry, Anthropometry and Periodontology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Anggraini W. Reviewer Report For: Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :639 ( https://doi.org/10.5256/f1000research.182890.r401176 ) The direct URL for this report is: https://f1000research.com/articles/14-639/v1#referee-response-401176 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Sep 2025 Fariha Kamal , Oral Medicine, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan 10 Sep 2025 Author Response Dear Reviewer, We sincerely appreciate your thorough review of our manuscript entitled “Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry ... Continue reading Dear Reviewer, We sincerely appreciate your thorough review of our manuscript entitled “Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan” . We are grateful for your constructive comments, which have helped us to improve the quality and clarity of our paper. Below, we address each of your points in detail and indicate the corresponding changes made in the revised manuscript. Material and Methods Inclusion and Exclusion Criteria: We have now added a clear statement of the inclusion and exclusion criteria in the first paragraph of the Methods section. Rationale for “No/Not well established” and “I don’t know” answers: We have explained that these options were included to capture both lack of knowledge and lack of familiarity with occupational safety culture, which might occur even among practicing dentists in Afghanistan due to limited exposure in curricula and continuing education. This explanation has been added to the Methods section. Removal of parental consent sentence: The statement regarding the absence of minors and parental consent has been removed, as it is unnecessary given the ethics committee approval. Categorization ranges: We have cited a relevant source to support the categorization of awareness levels (0.00–0.20 Very Low, 0.21–0.40 Low, etc.). Results 5. We have modified Tables 1 and 2 so that “Yes/No/I don’t know” responses and their corresponding frequencies are presented in separate columns for better clarity. Discussion 6. We have discussed the possible implications of “No/Not well established” and “I don’t know” responses, including their potential effect on the interpretation of the study results. 7. We have added a review of how Occupational Safety and Health (OSH) topics are currently delivered in dental education in Afghanistan and related this to the identified knowledge gaps. 8. We have elaborated on gender differences in ergonomic-related occupational health, drawing from relevant literature. 9. We have clarified that hours worked per day were recorded and have incorporated this information into the discussion to align with references #30 and #35 Conclusion 10. We have revised the conclusion to make it more focused, emphasizing the importance of awareness and prevention of various occupational hazards among both dentists and students. We appreciate your valuable input and believe these revisions have significantly strengthened our manuscript. Best regards, Dr. Fariha Kamal (On behalf of all co-authors) Dear Reviewer, We sincerely appreciate your thorough review of our manuscript entitled “Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan” . We are grateful for your constructive comments, which have helped us to improve the quality and clarity of our paper. Below, we address each of your points in detail and indicate the corresponding changes made in the revised manuscript. Material and Methods Inclusion and Exclusion Criteria: We have now added a clear statement of the inclusion and exclusion criteria in the first paragraph of the Methods section. Rationale for “No/Not well established” and “I don’t know” answers: We have explained that these options were included to capture both lack of knowledge and lack of familiarity with occupational safety culture, which might occur even among practicing dentists in Afghanistan due to limited exposure in curricula and continuing education. This explanation has been added to the Methods section. Removal of parental consent sentence: The statement regarding the absence of minors and parental consent has been removed, as it is unnecessary given the ethics committee approval. Categorization ranges: We have cited a relevant source to support the categorization of awareness levels (0.00–0.20 Very Low, 0.21–0.40 Low, etc.). Results 5. We have modified Tables 1 and 2 so that “Yes/No/I don’t know” responses and their corresponding frequencies are presented in separate columns for better clarity. Discussion 6. We have discussed the possible implications of “No/Not well established” and “I don’t know” responses, including their potential effect on the interpretation of the study results. 7. We have added a review of how Occupational Safety and Health (OSH) topics are currently delivered in dental education in Afghanistan and related this to the identified knowledge gaps. 8. We have elaborated on gender differences in ergonomic-related occupational health, drawing from relevant literature. 9. We have clarified that hours worked per day were recorded and have incorporated this information into the discussion to align with references #30 and #35 Conclusion 10. We have revised the conclusion to make it more focused, emphasizing the importance of awareness and prevention of various occupational hazards among both dentists and students. We appreciate your valuable input and believe these revisions have significantly strengthened our manuscript. Best regards, Dr. Fariha Kamal (On behalf of all co-authors) Competing Interests: No competing interest was disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Sep 2025 Fariha Kamal , Oral Medicine, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan 10 Sep 2025 Author Response Dear Reviewer, We sincerely appreciate your thorough review of our manuscript entitled “Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry ... Continue reading Dear Reviewer, We sincerely appreciate your thorough review of our manuscript entitled “Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan” . We are grateful for your constructive comments, which have helped us to improve the quality and clarity of our paper. Below, we address each of your points in detail and indicate the corresponding changes made in the revised manuscript. Material and Methods Inclusion and Exclusion Criteria: We have now added a clear statement of the inclusion and exclusion criteria in the first paragraph of the Methods section. Rationale for “No/Not well established” and “I don’t know” answers: We have explained that these options were included to capture both lack of knowledge and lack of familiarity with occupational safety culture, which might occur even among practicing dentists in Afghanistan due to limited exposure in curricula and continuing education. This explanation has been added to the Methods section. Removal of parental consent sentence: The statement regarding the absence of minors and parental consent has been removed, as it is unnecessary given the ethics committee approval. Categorization ranges: We have cited a relevant source to support the categorization of awareness levels (0.00–0.20 Very Low, 0.21–0.40 Low, etc.). Results 5. We have modified Tables 1 and 2 so that “Yes/No/I don’t know” responses and their corresponding frequencies are presented in separate columns for better clarity. Discussion 6. We have discussed the possible implications of “No/Not well established” and “I don’t know” responses, including their potential effect on the interpretation of the study results. 7. We have added a review of how Occupational Safety and Health (OSH) topics are currently delivered in dental education in Afghanistan and related this to the identified knowledge gaps. 8. We have elaborated on gender differences in ergonomic-related occupational health, drawing from relevant literature. 9. We have clarified that hours worked per day were recorded and have incorporated this information into the discussion to align with references #30 and #35 Conclusion 10. We have revised the conclusion to make it more focused, emphasizing the importance of awareness and prevention of various occupational hazards among both dentists and students. We appreciate your valuable input and believe these revisions have significantly strengthened our manuscript. Best regards, Dr. Fariha Kamal (On behalf of all co-authors) Dear Reviewer, We sincerely appreciate your thorough review of our manuscript entitled “Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan” . We are grateful for your constructive comments, which have helped us to improve the quality and clarity of our paper. Below, we address each of your points in detail and indicate the corresponding changes made in the revised manuscript. Material and Methods Inclusion and Exclusion Criteria: We have now added a clear statement of the inclusion and exclusion criteria in the first paragraph of the Methods section. Rationale for “No/Not well established” and “I don’t know” answers: We have explained that these options were included to capture both lack of knowledge and lack of familiarity with occupational safety culture, which might occur even among practicing dentists in Afghanistan due to limited exposure in curricula and continuing education. This explanation has been added to the Methods section. Removal of parental consent sentence: The statement regarding the absence of minors and parental consent has been removed, as it is unnecessary given the ethics committee approval. Categorization ranges: We have cited a relevant source to support the categorization of awareness levels (0.00–0.20 Very Low, 0.21–0.40 Low, etc.). Results 5. We have modified Tables 1 and 2 so that “Yes/No/I don’t know” responses and their corresponding frequencies are presented in separate columns for better clarity. Discussion 6. We have discussed the possible implications of “No/Not well established” and “I don’t know” responses, including their potential effect on the interpretation of the study results. 7. We have added a review of how Occupational Safety and Health (OSH) topics are currently delivered in dental education in Afghanistan and related this to the identified knowledge gaps. 8. We have elaborated on gender differences in ergonomic-related occupational health, drawing from relevant literature. 9. We have clarified that hours worked per day were recorded and have incorporated this information into the discussion to align with references #30 and #35 Conclusion 10. We have revised the conclusion to make it more focused, emphasizing the importance of awareness and prevention of various occupational hazards among both dentists and students. We appreciate your valuable input and believe these revisions have significantly strengthened our manuscript. Best regards, Dr. Fariha Kamal (On behalf of all co-authors) Competing Interests: No competing interest was disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 01 Jul 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 3 (revision) 09 Sep 25 read Version 2 (revision) 26 Aug 25 read read Version 1 01 Jul 25 read Wita Anggraini , Universitas Trisakti, Jakarta, Indonesia Nataša Trifunović , University of Sarajevo, Sarajevo, Bosnia and Herzegovina Putranto Manalu , Universitas Prima Indonesia, Medan, Indonesia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Manalu P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 23 Sep 2025 | for Version 3 Putranto Manalu , Universitas Prima Indonesia, Medan, Indonesia 0 Views copyright © 2025 Manalu P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I have reviewed the submission and confirm that I have the necessary expertise to evaluate its scientific merit. This study addresses a crucial and relevant topic: the awareness of occupational hazards among dental professionals, including both final-year students and practicing dentists. The research is valuable as it highlights specific knowledge gaps and misconceptions that have direct implications for the health, safety, and well-being of dental practitioners. The finding of no significant difference in awareness between students and experienced dentists is particularly noteworthy and warrants further discussion. While the study is promising, there are several key areas that require significant revision to strengthen the methodology, deepen the analysis, and enhance the overall impact of the manuscript. The following report provides a summary of the article's findings and expands on four major points that must be addressed before the article can be considered scientifically sound for publication. 1. Inability to Determine the Study's Response Rate A significant methodological limitation is the inability to calculate the study's response rate. The authors report that 198 dental professionals participated in the survey. However, they also state that the precise number of eligible individuals who were invited but declined to participate or were absent could not be determined. Consequently, the response rate could not be calculated. This omission raises concerns regarding potential non-response bias, as the resulting sample may not be fully representative of the target population of dentists and final-year students in the selected hospitals. It is plausible that individuals with a higher pre-existing awareness of occupational hazards were more inclined to participate, potentially skewing the results toward a higher overall awareness level. 2. Discrepancy in Awareness of Musculoskeletal Disorders (MSDs) The results present a notable discrepancy regarding awareness of MSDs. Participants demonstrated high general awareness that MSDs are a common hazard in dentistry, with 85.9% correctly identifying them as such. In stark contrast, awareness of carpal tunnel syndrome as a specific and common type of MSD was exceptionally low, with only 14% of participants providing the correct answer. The manuscript's discussion section does not sufficiently explore the reasons for this significant gap between general knowledge and specific knowledge. An in-depth analysis of potential causes, such as deficiencies within the dental education curriculum regarding specific ergonomic-related conditions, would provide valuable context for this finding. 3. Substantiation of "Correct" Answers Regarding Mercury Carcinogenicity The study classifies the belief that mercury in dental amalgam is a risk factor for oral cancer as incorrect. A majority of respondents (62.1%) held this belief. Given that a significant proportion of the professional sample holds this view, the manuscript's argument would be strengthened by substantiating the "correct" answer with a citation from an authoritative body, such as the World Health Organization or a major international dental association. This would provide a firm evidentiary basis for labeling the belief as a misconception and would offer readers important context. 4. Interpretation of No Significant Difference Between Students and Dentists The finding that there was no statistically significant difference in awareness levels between final-year students and practicing dentists (p=0.575) is a key result that invites deeper interpretation. The authors propose this may be due to the large number of students in the sample or the adequacy of the formal curriculum. However, the discussion should also consider an alternative interpretation: the lack of difference could indicate a stagnation of knowledge among practicing dentists post-graduation, possibly due to insufficient or ineffective continuing professional education in occupational health and safety. Exploring this possibility would lend greater weight to the study's conclusion that continuous training is essential for enhancing and maintaining awareness among dental practitioners. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Occupational and Safety Health, Ergonomic I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Manalu P. Peer Review Report For: Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :639 ( https://doi.org/10.5256/f1000research.187757.r413236) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-639/v3#referee-response-413236 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Anggraini W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Sep 2025 | for Version 2 Wita Anggraini , Universitas Trisakti, Jakarta, Indonesia 0 Views copyright © 2025 Anggraini W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Congratulations to the authors, you have revised very well, so that your manuscript is more informative and the writing is better. Competing Interests No competing interests were disclosed. Reviewer Expertise Human Anatomy, Ergonomic Dentistry, Anthropometry and Periodontology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Anggraini W. Peer Review Report For: Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :639 ( https://doi.org/10.5256/f1000research.186839.r409319) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-639/v2#referee-response-409319 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Trifunović N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Sep 2025 | for Version 2 Nataša Trifunović , University of Sarajevo, Sarajevo, Bosnia and Herzegovina 0 Views copyright © 2025 Trifunović N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Since changes have been made to the manuscript, I will refer to Version 2 with modifications in the Results and Discussion sections. My comment concerns the Methodology section – it is necessary to clearly and more precisely state the exclusion criteria for the study (e.g., exclusion criteria may include dentists and final-year students who, at the time of the study, were not present at work/university due to sick leave, annual leave, maternity leave, or extended medical leave). Please ensure that both the inclusion and exclusion criteria are explicitly stated in this study. In the introductory part of the Results section, it is important to report the number of final-year students and dentists in the region where the study was conducted, the total number of participants invited to take part, and the number who declined participation, in order to provide the response rate. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 10 Sep 2025 Fariha Kamal, Oral Medicine, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan We would like to thank the reviewer for their valuable comments and suggestions, which helped us improve the clarity of the manuscript. Comment 1: Please state the exclusion criteria more clearly. Response: Thank you for this valuable suggestion. We have revised the Methods section to explicitly include both inclusion and exclusion criteria. Exclusion criteria now specify individuals who declined participation, gave incomplete responses, or were absent due to sick leave, annual leave, maternity leave, or extended medical leave. Comment 2: Please report the total number of eligible participants, those who declined, and the response rate. Response: We appreciate this comment. In the Results section, we now state that 198 participants (131 students and 67 dentists) completed the survey. Some individuals may have declined or been absent, but as the exact numbers were not recorded, the precise response rate could not be determined. View more View less Competing Interests No competing interest was disclosed. reply Respond Report a concern Trifunović N. Peer Review Report For: Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :639 ( https://doi.org/10.5256/f1000research.186839.r404361) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-639/v2#referee-response-404361 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Anggraini W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 14 Aug 2025 | for Version 1 Wita Anggraini , Universitas Trisakti, Jakarta, Indonesia 0 Views copyright © 2025 Anggraini W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Review Results: Material and Methods Paragraph 1: State the inclusion and exclusion criteria in this study. Paragraph 3: What is the researcher's rationale for the 'No/Not well Established’ and "I don't know" answers?. Regarding the two "No" answers above, is it possible that final-year students, or even working dentists, have never been exposed to the occupational safety culture knowledge being studied? Please explain this in the methods section. Paragraph 4, in the last sentence: As all participants were adults (final-year students and dentists), no minors were involved, thus no parental consent or assent was required.--This statement does not need to be written, because the research method has been approved by the relevant Ethics Committee. Paragraph 5: Awareness levels were categorized as follows: 0.00– 0.20 (Very Low), 0.21– 0.40 (Low), 0.41– 0.70 (Moderate), 0.71– 0.90 (High), and 0.91– 1.00 (Very High).-- This range statement requires a library source. Results In Tables 1 and 2: The Yes/No/I don't know and frequency answer columns will be clearer if they are separated into 2 columns each, for example: the yes answer column and the frequency column. Discussion In the discussion section: you need to address respondents who answered 'No/Not well established’ and ‘I don't know’. Does this impact the results of this study? you need to review how the Occupational Safety and Health curriculum is delivered during education, as this relates to the knowledge gaps and low levels of awareness found in dentists and students. Paragraph 6: Much research has been done on dental ergonomic, it is necessary to explain in more depth why there are gender differences in occupational health related to ergonomics. Paragraph 16: Are the number of hours worked per day for each respondent recorded? If yes, it would be better for the author to include it, so that it is relevant to the statements in reference sources numbers 30 and 35. Conclusion The conclusion should be made more pointed, such as the importance of knowledge and awareness of occupational hazards and their preventive measures. It is important for dentists and students to be aware of and willing to prevent various aspects of their occupational hazards, for example: noise, light, ergonomic positions, etc. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly References 1. Anggraini W, Ranggaini D, Ariyani A, Sulistyowati I: World Trends in Dental Ergonomics Research: A Bibliometric Analysis. International Journal of Environmental Research and Public Health . 2024; 21 (4). Publisher Full Text 2. Kholinne E, Azalia X, Rahayu E, Anestessia I, et al.: The prevalence and risk factors of musculoskeletal disorders among Indonesian dental professionals. Frontiers in Rehabilitation Sciences . 2025; 6 . Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Human Anatomy, Ergonomic Dentistry, Anthropometry and Periodontology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 10 Sep 2025 Fariha Kamal, Oral Medicine, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan Dear Reviewer, We sincerely appreciate your thorough review of our manuscript entitled “Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan” . We are grateful for your constructive comments, which have helped us to improve the quality and clarity of our paper. Below, we address each of your points in detail and indicate the corresponding changes made in the revised manuscript. Material and Methods Inclusion and Exclusion Criteria: We have now added a clear statement of the inclusion and exclusion criteria in the first paragraph of the Methods section. Rationale for “No/Not well established” and “I don’t know” answers: We have explained that these options were included to capture both lack of knowledge and lack of familiarity with occupational safety culture, which might occur even among practicing dentists in Afghanistan due to limited exposure in curricula and continuing education. This explanation has been added to the Methods section. Removal of parental consent sentence: The statement regarding the absence of minors and parental consent has been removed, as it is unnecessary given the ethics committee approval. Categorization ranges: We have cited a relevant source to support the categorization of awareness levels (0.00–0.20 Very Low, 0.21–0.40 Low, etc.). Results 5. We have modified Tables 1 and 2 so that “Yes/No/I don’t know” responses and their corresponding frequencies are presented in separate columns for better clarity. Discussion 6. We have discussed the possible implications of “No/Not well established” and “I don’t know” responses, including their potential effect on the interpretation of the study results. 7. We have added a review of how Occupational Safety and Health (OSH) topics are currently delivered in dental education in Afghanistan and related this to the identified knowledge gaps. 8. We have elaborated on gender differences in ergonomic-related occupational health, drawing from relevant literature. 9. We have clarified that hours worked per day were recorded and have incorporated this information into the discussion to align with references #30 and #35 Conclusion 10. We have revised the conclusion to make it more focused, emphasizing the importance of awareness and prevention of various occupational hazards among both dentists and students. We appreciate your valuable input and believe these revisions have significantly strengthened our manuscript. Best regards, Dr. Fariha Kamal (On behalf of all co-authors) View more View less Competing Interests No competing interest was disclosed. reply Respond Report a concern Anggraini W. Peer Review Report For: Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :639 ( https://doi.org/10.5256/f1000research.182890.r401176) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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