Document Type : Original Article


1 Associate Professor, Orthodontic Research Center, Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran

2 Professor, Department of Endodontics, Mashhad University of Medical Sciences, Mashhad, Iran

3 Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Guilan University of Medical Sciences, Rasht, Iran

4 Assistant Professor, Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Orthodontist, Private Practice, Shahre Kord, Tehran, Iran


BACKGROUND: The coronavirus disease (COVID) is predicted to cause serious mental health 
problems among healthcare providers (HCPs) especially dentists. Also understanding the influencing 
factors of the acceptance of COVID‑19 vaccination among HCPs are important aspects in the design 
of effective strategies to improve the vaccine coverage rate. Therefore, this study aimed to assess 
the knowledge, vaccination acceptance, fear, and obsession, as well as the preventive practice 
behaviors of Iranian dentists and dental students in late 2020 toward COVID‑19.
MATERIALS AND METHODS: A descriptive, web‑based cross‑sectional survey was conducted 
among Iranian dental students and dentists (general practitioners and specialists). All Iranian dentists 
and dental students living in the Islamic Republic of Iran regardless of their city and workplace were 
invited to participate in the study. The total number of dentists in Iran was estimated to be 54,927. The 
sample size was calculated 380. The questionnaires used in this study were adapted from previously 
published studies based on the authors’ permission. The questionnaire consisted of four sections 
that sought to collect information on the respondents’ vaccination acceptance, knowledge, preventive 
practice, fear, and obsession toward COVID‑19. The relationship between the study variables was 
assessed using Pearson’s correlation coefficient and also multiple linear regression tests.
RESULTS: Overall, 394 dentists were filled the questionnaire (65 dental students, 151 general 
dentists and 178 specialists). There were no differences in terms of vaccination acceptance, 
knowledge and also fear score in different designation groups. Dentists had significantly higher 
obsession and also preventive practice scores than other designation groups (P < 0.05). The majority 
of respondents had good knowledge (more than 9), acceptable preventive practice (more than 19), 
low fear‑obsession (<2.7), and high acceptance of COVID‑19 vaccination (more than 8.8).
CONCLUSIONS: Although obsession and fear scores were low in all designation groups, dentists 
had higher obsession and also preventive practice scores than other designation groups. More than 
half of respondents preferred imported COVID‑19 vaccines. Finally, organizations such as the World 
Health Organization and the Ministry of Public Health in Iran should increase vaccine convenience 
and accessibility in terms of vaccine importing, distribution, supply, and immunization service.


  1. Taghrir MH, Borazjani R, Shiraly R. COVID‑19 and Iranian 
    medical students; A survey on their related‑knowledge, 
    preventive behaviors and risk perception. Arch Iran Med 
    2. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical 
    characteristics of 138 hospitalized patients with 2019 novel 
    coronavirus‑infected pneumonia in Wuhan, China. JAMA 
    3. World Health Organization. (2020). Coronavirus disease 2019 
    (COVID-19): situation report, 82. World Health Organization.
    4. Cagetti MG, Cairoli JL, Senna A, Campus G. COVID‑19 outbreak 
    in North Italy: An overview on dentistry. A questionnaire survey. 
    Int J Environ Res Public Health 2020;17:3835.
    5. Harrel SK, Molinari J. Aerosols and splatter in dentistry: A brief 
    review of the literature and infection control implications. J Am 
    Dent Assoc 2004;135:429‑37.
    6. Cleveland JL, Gray SK, Harte JA, Robison VA, Moorman AC, 
    Gooch BF. Transmission of blood‑borne pathogens in US 
    dental health care settings: 2016 update. J Am Dent Assoc 
  2. 7. WHO. Report of the WHO‑China Joint Mission on Coronavirus 
    Disease 2019 (COVID‑19). Geneva: WHO; 2020.
    8. Centers for Disease Control and Prevention (CDC) . Guidance for 
    Dental Settings: Interim Infection Prevention and Control Guidance 
    for Dental Settings During the COVID-19 Response. (2020). 
    Available online at: (May 19, 2020)..
    9. Volgenant CM, de Soet JJ. Cross‑transmission in the dental office: 
    Does this make you ill? Curr Oral Health Rep 2018;5:221‑8.
    10. Szymańska J. Dental bioaerosol as an occupational hazard in a 
    dentist’s workplace. Ann Agric Environ Med 2007;14:203‑7.
    11. Yoosefi LebniJ, Abbas J, Moradi F, SalahshoorMR, Chaboksavar F, 
    Irandoost SF, et al. How the COVID‑19 pandemic effected 
    economic, social, political, and cultural factors: A lesson from 
    Iran. Int J Soc Psychiatry 2021;67:298‑300.
    12. Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, et al. Mental health 
    problems and social media exposure during COVID‑19 outbreak. 
    PLoS One 2020;15:e0231924.
    13. Zulkifli NA, Sivapatham S, Guan NC. Brief psychotic disorder 
    in relation to coronavirus, COVID‑19 outbreaks: A case report. 
    MJPOnlineEarly Vol 29, No 1 (2020).
    14. Saravanan C, Mahmoud I, Elshami W, Taha MH. Knowledge, 
    anxiety, fear, and psychological distress about COVID‑19 among 
    university students in the United Arab Emirates. Front Psychiatry 
    15. Abbas J, Wang D, Su Z, Ziapour A. The role of social media in 
    the advent of COVID‑19 pandemic: Crisis management, mental 
    health challenges and implications. Risk Manag Healthc Policy 
    16. Azizi MR, Atlasi R, Ziapour A, Abbas J, Naemi R. Innovative 
    human resource management strategies during the COVID‑19 
    pandemic: A systematic narrative review approach. Heliyon 
    17. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, 
    Greenberg N, et al. The psychological impact of quarantine 
    and how to reduce it: Rapid review of the evidence. Lancet 
    18. Tan BY, Chew NW, Lee GK, Jing M, Goh Y, Yeo LL, et al.
    Psychological impact of the COVID‑19 pandemic on health care 
    workers in Singapore. Ann Intern Med 2020;173:317‑20.
    19. Sögüt S, Dolu İ, Cangöl E. The relationship between COVID‑19 
    knowledge levels and anxiety states of midwifery students during 
    the outbreak: A cross‑sectional web‑based survey. Perspect 
    Psychiatr Care 2021;57:246‑52.
    20. Dureab F, Al‑Awlaqi S, JahnA. COVID‑19 in Yemen: Preparedness 
    measures in a fragile state. Lancet Public Health 2020;5:e311.
    21. Alrubaiee GG, Al‑Qalah TA, Al‑Aawar MS. Knowledge, attitudes, 
    anxiety, and preventive behaviours towards COVID‑19 among 
    health care providers in Yemen: An online cross‑sectional survey. 
    BMC Public Health 2020;20:1541.
    22. Nguyen T, Henningsen KH, Brehaut JC, Hoe E, Wilson K. 
    Acceptance of a pandemic influenza vaccine: A systematic review 
    of surveys of the general public. Infect Drug Resist 2011;4:197‑207.
    23. Yaqub O, Castle‑Clarke S, Sevdalis N, Chataway J. Attitudes to 
    vaccination: A critical review. Soc Sci Med 2014;112:1‑11.
    24. Wang J, Jing R, Lai X, Zhang H, Lyu Y, Knoll MD, et al. Acceptance 
    of COVID‑19 vaccination during the COVID‑19 pandemic in 
    China. Vaccines (Basel) 2020;8:482.
    25. Lau JT, Yeung NC, Choi KC, Cheng MY, Tsui HY, Griffiths S. 
    Factors in association with acceptability of A/H1N1 vaccination 
    during the influenza A/H1N1 pandemic phase in the Hong Kong 
    general population. Vaccine 2010;28:4632‑7.
    26. Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P. 
    Understanding vaccine hesitancy around vaccines and 
    vaccination from a global perspective: A systematic review of 
    published literature, 2007‑2012. Vaccine 2014;32:2150‑9.
    27. Gates B. Responding to COVID‑19 – A once‑in‑a‑century 
    pandemic? N Engl J Med 2020;382:1677‑9.
    28. Kraemer MU, Yang CH, Gutierrez B, Wu CH, Klein B, Pigott DM,
    et al. The effect of human mobility and control measures on the 
    COVID‑19 epidemic in China. Science 2020;368:493‑7.
    29. Yoosefi Lebni J, Ziapour A, Mehedi N, Irandoost SF. The role of 
    clerics in confronting the COVID‑19 crisis in Iran. J Relig Health 
    30. Kim JS, Choi JS. Middle East respiratory syndrome‑related 
    knowledge, preventive behaviours and risk perception among 
    nursing students during outbreak. J Clin Nurs 2016;25:2542‑9.
    31. Nemati M, Ebrahimi B, Nemati FJ. Assessment of Iranian nurses’ 
    knowledge and anxiety toward COVID‑19 during the current 
    outbreak in Iran. Arch Clin Infect Dis. Online ahead of Print; 
    15(COVID‑19):e102848. doi: 10.5812/archcid.102848.
    32. Ahmadi H, Ebrahimi A, Ghorbani F. The impact of COVID‑19 
    pandemic on dental practice in Iran: A questionnaire‑based report. 
    BMC Oral Health 2020;20:354.
    33. A v a i l a b l e f r o m : h t t p s : / / s t a t s . i r i m c . o r g / M 
    e m b e r s /ActiveMembersByDegree/Details last accessed at 
    December 27, 2020.
    34. Rezaei S, Hajizadeh M, Irandoost SF, Salimi Y. Socioeconomic 
    inequality in dental care utilization in Iran: A decomposition 
    approach. Int J Equity Health 2019;18:161.
    35. Nasser Z, Fares Y, Daoud R, Abou‑Abbas L. Assessment 
    of knowledge and practice of dentists towards coronavirus 
    disease (COVID‑19): A cross‑sectional survey from Lebanon. 
    BMC Oral Health 2020;20:281.
    36. Lee SA. How much “Thinking” about COVID‑19 is clinically 
    dysfunctional? Brain Behav Immun 2020;87:97‑8.
    37. Abdolahian S, Ozgoli G, Ebadi A, Kariman Nl. Translation and 
    psychometric assessment of the Persian version of patient trust in 
    midwifery care scale. Evidence Based Care Journal 2019;8:52‑60.
    38. Lawshe CH. A quantitative approach to content validity. 
    PHRSONNHL PSYCHOI.OGY1975;28:563‑75.
    39. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator 
    of content validity? Appraisal and recommendations. Res Nurs 
    Health 2007;30:459‑67.
    40. Rahman A, Sathi NJ. Knowledge, attitude, and preventive 
    practices toward COVID‑19 among Bangladeshi internet users. 
    ElectronicJournalofGeneralMedicine2020;17 (5):245.
    41. Al‑Hanawi MK, Mwale ML, Alshareef N, Qattan AM, Angawi K, 
    Almubark R, et al. Psychological distress amongst health workers 
    and the general public during the COVID‑19 pandemic in Saudi 
    Arabia. Risk Manag Healthc Policy 2020;13:733‑42.
    42. Eastwood K, Durrheim DN, Jones A, Butler M. Acceptance of 
    pandemic (H1N1) 2009 influenza vaccination by the Australian 
    public. Med J Aust 2010;192:33‑6.
    43. Organization WHO SAGE Values Framework for the Allocation 
    and Prioritization of COVID 19 Vaccination, 14 September 2020. 
    World Health Organization; 2020.
    44. Henrich N, Holmes B. The public’s acceptance of novel vaccines 
    during a pandemic: A focus group study and its application to 
    influenza H1N1. Emerg Health Threats J 2009;2:e8.
    45. Schmid P, Rauber D, Betsch C, Lidolt G, Denker ML. Barriers 
    of influenza vaccination intention and behavior – A systematic 
    review of influenza vaccine hesitancy, 2005‑2016. PLoS One 
    46. WHO. Behavioural Considerations for Acceptance and Uptake 
    of COVID 19 Vaccines: WHO Technical Advisory Group on 
    Behavioural Insights and Sciences for Health, Meeting Report, 
    15 October 2020; 2020. 
    47. Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. 
    Increasing vaccination: Putting psychological science into action. 
    Psychol Sci Public Interest 2017;18:149‑207.
    48. Huynh G, Nguyen TN, Tran VK, Vo KN, Vo VT5, Pham LA l. 
    Knowledge and attitude toward COVID 19 among healthcare 
    workers at District 2 Hospital, Ho Chi Minh City. Asian Pacific Journal of Tropical Medicine 2020;13:260.
    49. Alqahtani AS. Knowledge and attitude toward Middle 
    East respiratory syndrome coronavirus among heath 
    colleges’ students in Najran, Saudi Arabia. Int J Community 
    Med Public Health 2017;4:2641‑7.
    50. Francis LJ, Ok Ü, Robbins M. Religion and happiness: 
    A study among university students in Turkey. J Relig Health 
    51. Schapman AM, Inderbitzen‑Nolan HM. The role of religious 
    behaviour in adolescent depressive and anxious symptomatology. 
    J Adolesc 2002;25:631‑43.
    52. Farooq I, Ali S. COVID‑19 outbreak and its monetary implications 
    for dental practices, hospitals and healthcare workers. Postgrad 
    Med J 2020;96:791‑2.
    53. Tork HM, Mersal F A . M i d d l e e a s t r e s p i r a t o r y 
    syndrome‑corona virus: Knowledge and attitude of Qassim 
    university students. KSA 2018;7:90‑7.
    54. Chang SC. Raising clinical awareness for better dengue fever 
    outbreak control. J Formos Med Assoc 2015;114:1025‑6.
    55. O’Connor C, Murphy M. Going viral: Doctors must tackle fake 
    news in the COVID‑19 pandemic. BMJ 2020;369:m1587.
    56. Khasawneh AI, Humeidan AA, Alsulaiman JW, Bloukh S, 
    Ramadan M, Al‑Shatanawi TN, et al. Medical students and 
    COVID‑19: Knowledge, attitudes, and precautionary measures. 
    A descriptive study from Jordan. Front Public Health 2020;8:253.
    57. Dilucca M, Souli DJ. Knowledge, attitude and practice of 
    secondary school students toward COVID‑19 epidemic in Italy: 
    A cross selectional study. Biorxiv.2020 2020.05.08