**4. Discussion**

Perceptions, preventive practices, and oral health practices among the Saudi Arabian population regarding the COVID-19 pandemic were assessed in the present study. This study is the first to discuss all these aspects among the Arabian population residing in various Saudi Arabia regions to the best of the authors' knowledge. In the present study, the overall awareness of COVID-19 was 89.5% of the study population. A similar observation was observed in the Cameroon population [19] found a similar score (84.19%). Contrarily, our findings did not agree with the African-based population study [3], where the authors found 73.5% of awareness regarding COVID-19 in their study population. Earlier, a similar survey in Saudi Arabian population was published in which the knowledge score was found to be 81.64%, which is less than the present study suggesting that the people of Saudi Arabian have a better understanding of the present scenario and are updating them with the COVID-19 knowledge [20]. Overall, 90% of the participants discerned that the incidence of COVID-19 could be minimized by staying at home and not meeting with others in public places during the lockdown period. This knowledge was significantly more in females than in males (*p* = 0.000). In addition, 89% of them knew about the symptoms of COVID-19. In a similar study by Honarvar et al. [21] in the Iranian population, it was found that only 4.8% of the participants were not aware of the symptoms of COVID-19, which suggests that the people of Saudi Arabia are more knowledgeable about the current global pandemic.

The overall perception in the present study was found to be 56.5%. A similar binational survey from the African population [3] observed 64% regarding COVID-19 among the study population. Thirty-six percent of the present study participants thought their monthly income would be affected during the lockdown period, and 61% monitor the daily new cases of affected people by COVID-19 in their city. Eighty-four percent recommend their family members and neighbors to use face masks and gloves for safety when they go out during the lockdown period, and 50% thought that the financial consumption rate would be decreased during the lockdown period. In the present study, perceptions were found more in females (*p* = 0.000), non-Saudi participants (*p* = 0.000), those below 60 years of age, those with more than five family members, and those having an income of less than 10 K (*p* = 0.002).

The overall preventive practice score in the present study was 74.3%. A practice score of 60.8% was observed in a similar study by Ngwewondo et al. [19] in the Cameroon population. In the present study, 93% of the participants agreed that if Coronavirus symptoms exist, they would disclose it and go to the hospital for screening (*p* = 0.000); 61% accepted that they feel an embarrassment in non-shaking hands with others because of the customs and traditions during this COVID-19 lockdown period, whereas 21.8% did not feel any embarrassment in non-shaking hands, in which females were significantly more in number than males (*p* ≤ 0.001). In addition, 89.5% use a face mask and wash 1 s with soap and water or sanitizer to prevent Coronavirus transmission (*p* ≤ 0.001). Sixty-one percent of the participants rated their commitment as 5, suggesting a total commitment to lockdown periods and curfew laws. 62.6% refused their family visitors during the COVID-19 lockdown period, and 79% maintained social distance (*p* ≤ 0.001).

The overall oral health care perceptions were 60% in the present study. 74% of the participants did not experience any dental pain or discomfort during this COVID-19 period, whereas 26% had felt dental pain or discomfort during this COVID-19 period. 67.4% did not prefer to visit the dentist personally during this COVID-19 period, and 52% would like to call the dentist explaining their dental problems rather than visiting the dentist personally before treatment. In the present study, females were found to be more knowledgeable than males. Also, perception, preventive practice, and oral health care perception were more in females than males. Hence, more knowledge was associated with increased perception, more preventive practice, and oral health care perception in females in the present study. Honarvar et al. [21] studied the perception of COVID-19 among the Iranian population and found increased knowledge and preventive practice in females. Similar observations

were made by Al-Hanawi et al. [20], Brug et al. [22], Bish and Michie [23]. In contrast, Ngwewondo et al. [19] have observed more preventive practice in males than females. Saudi participants were more knowledgeable than the non-Saudi participants in the present study (*p* > 0.05); nonetheless, perceptions were less among the Saudi participants than the non-Saudi participants. However, preventive practice and oral health care perception were more in Saudi participants than in the non-Saudi participants (*p* < 0.05). Hence, their increased knowledge was associated with higher preventive practice and oral health care perception. The perception was more in participants below 60 years of age. However, preventive practice and oral health care perception were found more in elderly participants over 60 years because older people are more prone to infectious diseases. The present study also observed more preventive practices in older people, and these findings are consistent with a Chinese study [18] and a Nigerian study [24] Zhang et al. [18]. This outcome explains that older people with or without comorbid diseases gained more preventive practices than other age groups. Similarly, increased age associated with an increased preventive approach was observed by Zhong et al. [18], Al-Hanawi et al. [20], and Lorfa et al. [24] in their respective studies. Honarvar et al. [22] have observed less knowledge and less preventive practice in the elderly age groups. Participants with less than five members were found to have more knowledge and oral health care perception, but the perception and preventive practice were found more in those with more than five family members. These differences were not statistically significant. None of the reported studies have reported family members' effect on perception and preventive practices regarding COVID-19 and oral health care perceptions during COVID-19. Perceptions, preventive practice, and oral health care perception were observed more in participants with a monthly income of more than 10 K, whereas perception was observed more in those with less than 10 K income (*p* = 0.000). Al-Hanawi et al. [20] have also found more awareness of COVID-19 in participants with higher income in their study.

The COVID-19 pandemic outbreak severely impacted the healthcare profession, especially in dentistry [6,8]. This pandemic has changed dental care providers' opinions and opinions of dental care receivers [25–27]. Almost 50% of participants from an American study reported delaying their dental appointments due to the COVID-19 pandemic [28]. Only a few participants preferred to visit the dental operatory. Comparing the gender, nationality, monthly income, and the number of family members showed statistical significance. However, no prior study compared these factors on dental visit preference during COVID-19 lockdown from Saudi Arabia. Comparatively, most survey participants preferred to have a telephonic conversation with the dentist before a dental appointment. The health authority provides guidelines for safe and effective dental practice during this pandemic outbreak [29]. The use of personal protection equipment (PPE), including N95 respirators, face shields, eye protection, surgical masks, and protective clothing, is strictly recommended to avoid the contraction of COVID-19 in the dental operatory. It explains the need for a telemedicine model in such pandemic situations. A recent article by Benzian and Niederman [26] explained SAFER dentistry that could benefit both the patients and dental care providers. Focusing on the source of information regarding COVID-19 amongst the people is also plays an essential role in perception and preventive practices. In the present study, only 4% of the participants relied on the WHO website. In Alanazei et al. [30] study, 18% of the participants preferred the WHO website. However, Alanazei et al. [20] findings are not comparable because they used multiple options for the source of information utilized for COVID-19. It has also been reported that the different sources of information had copious associations with the assurance in managing with concern to COVID-19 [31]. Participants in the present study used a multiplicity of sources for information concerning the COVID-19. The Saudi Arabia Ministry of Health website was utilized by most participants (55%) in the study to know information on COVID-19. Alanezi et al. [30] also reported similar findings. The authors reported that 65% of the participants utilized the Ministry of Health, Saudi Arabia, as a source of information. Furthermore, it explains the health authorities from Saudi Arabia were very successful in reaching people in the country with

information regarding COVID-19 based on our study. Risk perceptions refer to people's spontaneous estimations of vulnerabilities they might be exposed to, with unwanted effects that the population associates with a precise cause [14,32,33]. Risk perception of a country means interpretations of the populations. Sharma et al. [34] used a fourth-generation multi-theory model (MTM) to explain and explore the hand-washing behavior among American college students.

A survey from Saudi Arabia also confirmed the risk perceptions regarding COVID-19 among dental undergraduate students [35]. A multinational study from 15 countries [36] reported that there need to develop a proper public health intervention to address college students' emotional and psychosocial needs during this COVID-19 Pandemic. A recent study [37] reported that dental specialists showed adequate knowledge regarding preventive measures. Furthermore, a recent study [38] suggested that it is imperative to promote the infection control protocols among dental students through training programs to avoid the potential risk of COVID-19. Cori et al. [39] opined that government authorities' administration of risk communication is required to establish consciousness and rationality. A recent study [40] found a higher prevalence rate of anxiety, depression, sleep problems, stress, and psychological distress among the general population during this pandemic outbreak. However, in the present study, we have not evaluated the psychological aspects of the populations. There is a need to evaluate the stress levels among the general population in Saudi Arabia. Based on the present study findings, the authors opine that the perception of risk regarding COVID-19 might associate with perceptions about COVID-19 and that will impact preventive behavior.
