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Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 32-36

Awareness on Bioterrorism among qualified dentists in a teaching dental institution in southern India

1 Department of SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
3 Department of Pedodontontics and Preventive Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
4 Department of Orthodontics and Dentofacial Orthopaedics, Kims Dental College, Amalapuram, Andhra Pradesh, India
5 Department of Public Health Dentistry, Care Dental College, Guntur, Andhra pradesh, India

Date of Submission28-Nov-2019
Date of Acceptance16-Dec-2019
Date of Web Publication14-May-2020

Correspondence Address:
Dr. Bommireddy Vikram Simha
Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh - 522509
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Source of Support: None, Conflict of Interest: None


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Background: Bioterrorism covers a vast spectrum of concerns, from catastrophic terrorism with mass casualties, to micro-events using low technology but producing civil unrest, disruption, disease, disabilities, and death. In such a situation, the medical community should educate the public about the threat. Education of the dental profession regarding the medical and oral manifestations of diseases that may result from a bioterrorist attack will be important. Thus, our aim of the study was to assess the knowledge, practice, and attitude toward bioterrorism among postgraduate dental students and dental staff in a private institution.
Methods: Using convenience sampling, postgraduate dental students and the teaching staff of an institute in Guntur were given a questionnaire to assess them regarding bioterrorism. The questionnaires were collected, and the Chi-square test was performed with IBM. SPSS Statistics version 20 windows program software.
Results: About 61.9% of postgraduate dental students and dental staff were aware of the term bioterrorism. More than 68.18% of postgraduate dental students and 67.7% of dental staff were not aware of the pathogenic agents of bioterrorism, and they have not attended either any lecture on it.
Conclusion: Dental staff had better knowledge about bioterrorism compared to postgraduate dental students. Hence, there is a need to include training and education in the predoctoral dental and dental hygiene curriculums and developing CE courses for practicing dental professionals.

Keywords: Bioterrorism, dentists, dental institution, healthcare

How to cite this article:
Sridevi V, Vikram Simha B, Gayathri Naidu SS, Chowdary KH, Yaragani A, Sree y S. Awareness on Bioterrorism among qualified dentists in a teaching dental institution in southern India. J NTR Univ Health Sci 2020;9:32-6

How to cite this URL:
Sridevi V, Vikram Simha B, Gayathri Naidu SS, Chowdary KH, Yaragani A, Sree y S. Awareness on Bioterrorism among qualified dentists in a teaching dental institution in southern India. J NTR Univ Health Sci [serial online] 2020 [cited 2020 Sep 26];9:32-6. Available from: http://www.jdrntruhs.org/text.asp?2020/9/1/32/284195

  Introduction Top

The primary objective of the war is to render the opponent incapable of offering resistance. Ideally, this is carried out by assassinating as many troops as possible by the force of arms. The major weapons that were used for killing include hand grenades, bullets, bombs, landmines, etc., that all do their bloody duty. However, the thought that biological material can kill more effectively and with less cost, effort, and destruction than the conventional use of bullets which makes it an attractive alternative weapon.[1] Biological agents spread through the air, water, or food. Some can also spread from person to person. They can be very hard to detect. It was reported that these biological agents are easy to prepare and hide as well. These biological weapons have either a great psychological impact or it can be used to threaten the public.[2]

The treats of bioterrorism have been reviewed by the US centers for disease control and prevention (CDC), and they have analyzed and classified the biological agents with their potential for bioterrorism. Based on the severity of the illness and mortality caused by these agents, the CDC categorized these biological agents into three distinct groups: public perception, dissemination potential, and easiness of preparation.[3] A biological weapon can be defined as the microorganisms that infect and grow in the target host producing a clinical disease that kills or incapacitates. Such microbial agents may be either natural, wild-type strains, or genetically modified ones.[4] Hannibal was the person who first introduced biological projectiles when he fired earthen vessels filled with venomous snakes into the flagship of King Eumenes II of Pergamon. It led to decreased resistance of the native population to smallpox.[5]

The European Center for Disease Prevention and Control reviewed the disease prioritization methodology in 2015, in a report examining the best practices for ranking infectious disease threats. They compared five methods of communicable diseases to prioritize the risks with the use of the bibliometric index, Delphi panels, multi-criteria decision analysis, qualitative algorithms, and questionnaires.[6] Assessment regarding bioterrorist threat should be reassessed regularly as these can evolve swiftly with viral disease eradication and emergence of new pathogens, including those related to synthetic biology. In addition, our modern societies are now much more sensitive to unexpected events, with high media exposure, reflecting the emerging role of social networks. Any low-cost bioterrorist attack, even with a minor clinical impact due to a poorly pathogenic agent, can provoke a global deflagration with an immediate and long-lasting fear cost at the social level.[7]

If terrorists released a biological infectious agent, early recognition and prompt public health response would be essential to limit the spread of disease and minimize morbidity and mortality. It is essential that oral health and other professionals know about the various diseases and the systemic oral-dental manifestations of naturally occurring and bioengineered infectious agents.[8] Hence, there is a need for the dentist and other health care professions to have a well-versed knowledge about the causative agents for the outbreak, their symptoms, and the ways to eradicate them. Therefore, our study aimed to assess the knowledge of a postgraduate dentist and the teaching staff in a private institution.

  Materials and Methods Top

Ethical clearance was obtained from institutional ethical committee (2/IEC/SIDS/UG/2018). A questionnaire was prepared on bioterrorism and its adverse effects as a survey to ask the postgraduate dental students and teaching staff. The survey was conducted in a dental institution in Guntur. Andhra Pradesh, India. The sample size was chosen based on convenience sampling, and it included all postgraduate dental students and the teaching staff. The questionnaire was prepared and finalized after discussing it with the panelist. Initially, a pilot study was carried out prior to the main survey to assess if participants could comprehend the questions easily.

The pro forma consisted of a self-administered structured questionnaire comprising of

  • Demographic questions such as age, gender, and qualification
  • Research question: It consists of 17 questions, among which 16 are close-end multiple-choice questions, and 1 was an open-ended question, which was divided based on the knowledge, attitude, and practices (KAP) of oral hygiene maintenance.

Statistical analysis

The information was coded and entered into a Microsoft Excel Spreadsheet. The analysis was done utilizing IBM. SPSS Statistics version 20 windows program software. Descriptive statistics were calculated. Statistical tests that were applied are the Chi-square test, which was used to compare the values between the groups. Confidence interval and level of significance were set at 95% and 5%, respectively.

  Results Top

The present study was carried out among postgraduate dental students and their teaching staff. A total of 121 members have participated in the study, among which males are slightly at a higher rate than females, which was negligible. [Table 1] When the knowledge, attitude, and practice were assessed between the genders, there was no statistically significant difference observed. [Table 2]
TABLE 1: Describe the percentage distribution of dental students and staff based on gender and designation

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TABLE 2: describes the questionnaire involved in the study and the description of p based on gender

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A statistically significant difference (P = 0.05) was observed between the staff (73.8%) and postgraduate (PG) students (55.6%) when they were asked about the meaning of bioterrorism and was depicted in [Chart 1]. Almost 90.9% PG students and 100% of staff considered bioterrorism as a threat to India and disturb global peace as well, and the results are found to be highly statistically significant. When they were asked about the need for including forensic science into the dental curriculum, it has been considered by 81.8% PG students and 90.32% dental staff, but it does not reach the significant value. More than 68.18% of postgraduate dental students and 67.7% of dental staff were not aware of the pathogenic agents of bioterrorism. [Table 3] Most of the students, as well as staff, had attended either a CDE program or heard a lecture to understand bioterrorism, and the values are significant statistically. [Chart 2]
TABLE 3: The results of the study between the postgraduate dental students and the dental staff

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  Discussion Top

The present study was undertaken to assess the knowledge, attitude, and practice (KAP) regarding bioterrorism, among the postgraduate students and teaching staff.

Bioterrorist attacks could be caused by virtually any pathogenic microorganism. However, microorganisms (like viruses, bacteria, fungi, or toxins) to be effective as a bioterrorist agent should consistently produce a given effect, death or disease, at low concentrations. The agent should be highly contagious, have a short and predictable incubation period. The target population should have little or no immunity against the organism. Hence, there is a need for both medical and dental practitioners to have thorough knowledge about the bioterrorism agents and their effect on the community.

In our study, when we asked about the term bioterrorism, almost 70% of postgraduate students and dental staff were aware of the term. Only 65% of postgraduate students and dental staff agreed on the fact that there is a different type of bioterrorism biological agents. The previous studies report a lower actual knowledge and preparedness in bioterrorism management among the dental community. Therefore, it is important to evaluate the dental community's knowledge, interests, needs, and expertise in bioterrorism education and preparedness.[9],[10] When they were asked about the bioterrorism agents, 34 postgraduates and 29 dental staff have given the right agents. Our study is in contrast with another study, Katz et al. (2006), where they found 64% of dentists were aware of the highest priority pathogens. Such a large difference between the two studies could be attributed to the fact that Katz et al. has involved the study population of dentists.[10]

The first four questions are very important in assessing the knowledge about bioterrorism. However, more than 70% of postgraduate dental students and staff did not have the idea of the ways in which bioterrorism epidemic spreads. In addition, more than 50% of PG students and staff were not aware of the signs and symptoms caused due to bioterrorism-related disorders. This shows that there is a tremendous lack of knowledge among dentists regarding the bioterrorism. Our study is in agreement with a study by Bhoopathi et al. where they found that there is a lack of awareness among dental professions in New England and Oregon.[11]

When a question related to the role of dental professions in reducing the severity of bioterrorism was asked, most of them did not agree with it. This is in complete contrast with a study by Shetyia et al. where 87% of dentists know their role in reducing the severity caused by bioterrorism. Their article also described that dentists could help in surveillance, referral, immunizations, medications, and infection control.[12] This finding was similar to the finding of Katz et al. (2006), where they found 76% of dentists were aware of dentists' role in bioterrorism and mass disaster management.[10]

90% and 93% of postgraduate dental students and dental staff, respectively, showed a positive response on attending special lectures on bioterrorism. This is in agreement with the study by Shetyia et al. where 86% and 79% of medical interns and dental interns, respectively, showed a positive attitude to attend an additional training program on bioterrorism.[12]

Overall comparison between postgraduate dental students and dental staff showed that dental staff has better knowledge about bioterrorism and its agents.

  Conclusion Top

In conclusion, no difference between postgraduate dental students and the dental staff was observed in terms of actual knowledge, opinions, and perceived need for bioterrorism education, which was the aim of our study. Although willing, both the postgraduate dental students and dental staff had low actual knowledge in bioterrorism preparedness, which is a concern. Studies have consistently found that health professionals with adequate training and education have higher knowledge and willingness to provide care than those without.[13],[14],[15] Without adequate training and education in bioterrorism preparedness, the dental community will be unable to respond to the challenges of a bioterrorist event. Hence, we recommend including training and education in the predoctoral dental and dental hygiene curriculums and developing CE courses for practicing dental professionals and mandating their attendance, in order to better prepare the dental community to respond during a bioterrorism event.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Bacon DR. the history of bioterrorism: an over view. Am Soc Anesthesiology Newsletter Journal 2002; 66:6-8.  Back to cited text no. 1
AZDHS | Public Health Emergency Preparedness-Bioterrorism [Internet]. Arizona Department of Health Services. [cited 2019 Oct 13]. Available from: http://www.azdhs.gov/preparedness/emergency-preparedness/bioterrorism/index.php.  Back to cited text no. 2
Rotz LD, Khan AS, Lillibridge SR, Ostroff SM, Hughes JM. Public health assessment of potential biological terrorism agents. Emerg Infect Dis 2002;8:225-30.  Back to cited text no. 3
Kumar A, Verma A, Yadav M, Sabri I, Asthana A. Biological warfare, Bioterrorism and Biodefence. J Indian Forensic Med 2011;33:69-73.  Back to cited text no. 4
Robertson AG, Robertson LJ. From asps to allegations. Biological war in history. Mil Med 1995;160:369-73.  Back to cited text no. 5
European Centre for Disease Prevention and Control. Best practices in ranking emerging infectious disease threats—A literature review. 2015.  Back to cited text no. 6
Gasser M, Zingg W, Cassini A, Kronenberg A, and the Swiss Centre for Antibiotic Resistance. Available from: www.thelancet.com/infection. Vol 19. January 2019.  Back to cited text no. 7
American Dental Association's 143rd Annual Session; 19-Oct 2002.  Back to cited text no. 8
Scott TE, Bhansal S, Mascarenhas AK. Willingness of New England dental professionals to provide assistance during a bioterrorism event. Biosecur Bioterror 2008;6:253-60.  Back to cited text no. 9
Katz AR, Nekorchuk DM, Holck PS, Hendrickson LA, Imrie AA, Effler PV. Dentists' preparedness for responding to bioterrorism: A survey of Hawaii dentists. JAm Dent Assoc 2006;137:461-7.  Back to cited text no. 10
Bhoopathi V, Mashabi SO, Scott TE, Mascarenhas AK. Dental professionals' knowledge and perceived need for education in bioterrorism preparedness. J Dent Educ 2010; 74:1319-26.  Back to cited text no. 11
Chaudhari A, Shetiya SH, Kakodkar P, Shirahatti R. Knowledge, Attitude and Practice Regarding Bioterrorism amongst the Medical and Dental Interns in D.Y. Patil Deemed University - A Questionnaire Study. Journal Of The Indian Association Of Public Health Dentistry; 2011(18); 94-9.  Back to cited text no. 12
Steginga SK, Dunn J, Dewar AM, McCarthy A, Yates P, Beadle G. Impact of an intensive nursing education course on nurses' knowledge, confidence, attitudes, and perceived skills in the care of patients with cancer. Oncol Nurs Forum 2005;32:375-81.  Back to cited text no. 13
Ashe TE, Elter JR, Southerland JH, Strauss RP, Patton LL. North Carolina dental hygienists' oral cancer knowledge and opinions: Implications for education. J Cancer Educ 2006;21:151-6.  Back to cited text no. 14
Silverman S, Kerr AR, Epstein JB. Oral and pharyngeal cancer control and early detection. J Cancer Educ 2010;25:279-81.  Back to cited text no. 15


  [Table 1], [Table 2], [Table 3]


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