The impact of COVID-19 pandemic on patients receiving orthodontic treatment: An online questionnaire cross-sectional study

Percentage of patients shifting to another treatment modality: An experience-guided decision

OBJECTIVE

This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties.

MATERIAL AND METHODS

This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05).

RESULTS

Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch.

CONCLUSIONS

A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

Applications and effectiveness of teledentistry in orthodontic practice during the COVID-19 restrictions

BACKGROUND

The aim of this study was to identify the areas of application for teledentistry and analyze its effectiveness in orthodontic practice during the COVID-19 pandemic.

METHODS

A total of 233 patients (159 women, 74 men) receiving orthodontic treatment were included. During the COVID-19 restriction period, patients were given teledentistry appointments. During these video conferences, remote orthodontic checkups were performed by one orthodontist, who asked the patients for photos or videos. The applications carried out during the interviews were recorded, classified, and analyzed. In addition, clinical emergency patients were identified. After the teledentistry consultations, two different questionnaires were presented to the patients, depending on their attendance at teledentistry appointments, and the results were statistically evaluated.

RESULTS

In all, 21.25% of the patients were identified as having clinical emergencies, including injury because of damage from brackets and wires; 10% of them reported bracket breakage; 17.5% were encouraged to use intermaxillary elastics; and 3.75% were in pain. However, 50% of them were found to be unproblematic. A total of 91% of the participants in the survey reported that online checkups were sufficient to understand and resolve their symptoms. However, 28% wanted to communicate with orthodontists by video call or with photos instead of meeting face to face (65.5%) when unexpected problems arose during the COVID-19 pandemic.

CONCLUSIONS

Teledentistry can be an effective method for motivating patients who are undergoing orthodontic treatments that require cooperation. It is also an effective way of understanding the patients' symptoms and reducing the risk of cross-infection by identifying patients who will require face-to-face emergency treatment during pandemics.

Effect of COVID-19 on orthodontic treatment/practice- A systematic review and meta-analysis

Coronavirus disease of 2019 (COVID-19), which has affected almost all medical professions, has had a significant negative influence on dental care. Additionally, non-urgent dental procedures were stopped during the epidemic in a number of countries. The purpose of this systematic review was to examine the impact of COVID-19 on individuals who had undergone or are currently having orthodontic treatment in any capacity during/after the pandemic's occurrence. After a thorough search of the online journals, a total of 634 documents were found, and 416 of the papers were initially chosen. The removal of 362 similar or duplicate publications that followed led to the initial availability of 54 separate papers. The final selection consisted of 23 documents, mostly in vitro investigations, cross-sectional studies, and comparative evaluations, which satisfied the necessary inclusion and exclusion criteria. COVID-19 had a significant impact on nearly every sphere of the patients' lives who were undergoing orthodontic treatment. However, people who are currently availing of various orthodontic treatment modalities did not experience the same issues as the ones faced by patients earlier. Teleorthodontics emerged as a viable option to access treatment during the lockdown period caused due to the pandemic. COVID-19 also had an overall negative impact on the psyche and morale of orthodontists around the world. PROSPERO Registration Number: CRD42022380823.

Psychological Impact of COVID-19 in the Setting of Dentistry: A Review Article

The worldwide pandemic has exposed healthcare professionals to a high risk of infection, exacerbating the situation of uncertainty caused by COVID-19. The objective of this review was to evaluate the psychological impact of the COVID-19 pandemic on dental professionals and their patients. A literature review was conducted using Medline-Pubmed, Web of Science, and Scopus databases, excluding systematic reviews, narratives, meta-analyses, case reports, book chapters, short communications, and congress papers. A modified version of the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the selected studies. The search retrieved 3879 articles, and 123 of these were selected for the review (7 longitudinal and 116 cross-sectional studies). Elevated anxiety levels were observed in dental professionals, especially in younger and female professionals. Except for orthodontic treatments, patients reported a high level of fear that reduced their demand for dentist treatment to emergency cases alone. The results suggest that the COVID-19 pandemic has had psychological and emotional consequences for dental professionals and their patients. Further research is necessary to evaluate the persistence of this problem over time.

Utility of Teleorthodontics in Orthodontic Emergencies during the COVID-19 Pandemic: A Systematic Review

Background. Coronavirus disease has subjected the whole of humanity to two years of social isolation and a series of restrictions. These circumstances have led to the use of information technology in an increasingly widespread manner. Even in the dental field, telematic means have been used to respond to emergencies. The aim of this systematic review of the literature is to evaluate the types of orthodontic emergency that occurred most often and how they were managed by teleorthodontics during the COVID-19 pandemic. The secondary aim is that clinicians will use teleorthodontics not only during pandemics but as an additional tool to manage orthodontics. Materials and Methods. Out of 1695 articles available on PubMed, Science Direct, Cochrane and SciELO, eight articles were selected for this systematic literature review. Google Scholar was used as a secondary source to confirm that there were no additional articles. The screened papers comprised editorials, clinical studies, cross-sectional studies and retrospective studies in Italian, English or Spanish language. Results. The articles showed that the means by which patients most often communicated with their orthodontists were voice calls and smartphone applications such as WhatsApp^® Messenger. Through these media, patients communicated their orthodontic emergencies. These mainly involved fixed multibracket appliances and the most common issues were discomfort and pain, fracture or loss of the appliance, protruding distal ends of archwires, brackets, tubes and bands or retainer detachment. Through teleorthodontics, patients could solve these issues by using orthodontic relief wax, cutting the protruding distal ends of the archwire with a nail clipper or a stronger cutter and removing or replacing detached bands, brackets, tubes or metallic ligature with a clean tweezer. Conclusions. In situations where personal contact is limited, teleorthodontics represents a valuable aid for professionals and patients facing orthodontic emergencies. The hope is that it may continue to represent a valuable aid for patients with difficulties in planning an in-office visit.

Orthodontic Adolescent Patients’ Attitudes toward Protective Face Mask Wearing during the COVID-19 Pandemic

Background and Objectives: The COVID-19 pandemic led to restrictive measures, which aimed to limit the spread of the SARS-CoV-2 virus. These restrictions impacted all areas of life, including the activity of dental offices. For patients with orthodontic appliances, closing the dental offices was a major issue, as most orthodontic treatments last for more than a year and require regular checkups. The aim of this research was to assess the impact that the restrictive measures that were imposed during the COVID-19 pandemic, and, especially, wearing a face mask had on a sample of Romanian teenagers undergoing fixed orthodontic treatment. Material and Methods: The study group consisted of 277 orthodontic patients, with ages between 12 and 17.9 years, from North-Western Romania. They completed a 9-item questionnaire. The control group consisted of 231 participants, with ages between 12 and 17.9 years. They completed an 8-item questionnaire. Results: Most patients from the study group were not worried that wearing a protective face mask would hide their braces (never—49.5%; rarely—26.7%), and their desire to undergo an orthodontic treatment was not affected by the compulsoriness of face mask wearing (never—51.6%; rarely—26%). In contrast to that, in the control group, more than 50% of the participants were worried to some degree that wearing a protective face mask would hide their smile (occasionally—29.9%; frequently—18.2%; very frequently—2.2%). The majority of the participants from the study group did not consider interrupting the orthodontic treatment due to the COVID-19 pandemic (62.5%), and the majority of the participants from the control group did not consider not going to the dentist due to the COVID-19 pandemic (70.6%). Most of the participants from the study group were not happy that they had to wear a face mask, which covered their orthodontic appliances, during the orthodontic treatment (68.6%). The attitude was similar to that of the participants from the control group, who were not happy that they had to wear a face mask, that covered their smile (51.1%). In the study group, most patients did not want face mask wearing to continue to be compulsory, given the fact that their orthodontic appliances were no longer visible (52%). In the control group, the attitude was similar, with 48.1% of the participants not wanting face mask compulsoriness to be maintained. Conclusions: In conclusion, although, most patients would not like to continue wearing a face mask as a mandatory regulation, they were not concerned or negatively affected by wearing a protective face mask, even though face masks hid their braces.

1 year impact of COVID-19 pandemic on Italian dental professionals: a cross-sectional survey

BACKGROUND

The Covid-19 pandemic has disrupted the daily work of the dental professionals, assuming unprecedented economic, managerial, and psychological implications. The aim of this cross-sectional survey was to analyze the extent of the impact linked to the imposed working conditions on the Italian dental team.

METHODS

The survey was administered with a web-based form (Google Forms®) to Italian dentists and hygienists. To be enrolled in the study, participants had to reach the adulthood and agree to sign the privacy policy. The impact of Covid-19 was analyzed through a 27-items questionnaire, which was divided into 4 main domains: personal protective equipment (PPE), operative procedures, secretarial organization, and self-reported quality of life (including elearning appraisal).

RESULTS

A total of 614 between dentists and dental hygienists completed the questionnaire. Compared to the pre-pandemic period, the use of PPE such as face shields, surgical caps and disposable gowns were implemented after the Covid-19 outbreak. Almost the whole interviewed (99.9%) received the Covid-19 vaccine. An increased use of preoperatory mouthwashes and rubber dam was referred during the pandemic, while aerosolization (i.e. ultrasound) was drastically reduced. A certain number of respondents (30% dentists, 27% hygienists) suffered from work-related stresses during the pandemic until they desired to change jobs. E-learning was considered beneficial for the 70% of participants.

CONCLUSIONS

Covid-19 pandemic influenced dental professionals' life, leading to a rearrangement of professional, managerial, and cultural life for both dentists and hygienists even after 1 yr from the outbreak.

Orthodontic emergencies and mental state of Chinese orthodontic patients during the COVID-19 pandemic

Background

The ongoing COVID-19 pandemic postponed routine follow-up visits of many orthodontic patients, which compromised their treatment process and mental states. This study was aimed to assess orthodontic emergency occurrence and psychological states of Chinese orthodontic patients during this pandemic.

Methods

Orthodontic patients in China were invited to answer an anonymous online questionnaire from February 20, 2020 to March 5, 2020, when routine dental care was suspended in China. The questionnaire included self-assessment of oral hygiene and compliance, orthodontic emergencies, perceptions and feelings about COVID-19 and anxiety self-rating scale, etc. Collected data was statistically analyzed with Chi-square, independent t test and univariable generalized estimating equations regression analysis.

Results

A total of 1078 respondents (292 male; 786 female) from 30 provinces of China were included in this study. About one-third (33.67%) of patients reported that they encountered orthodontic problems during the pandemic. Patients with clear aligners reported fewer orthodontic problems than those with fixed appliances or removable appliances. Female patients, elder patients and patients who encountered orthodontic emergencies were more anxious than other patients.

Conclusions

The compliance and occurrence of orthodontic emergencies differed in patients with different orthodontic appliances. Patients with orthodontic emergencies exhibited higher anxiety states.

Patient reported experiences and treatment outcomes of orthodontic patients treated within secondary care settings in the South West of England during the COVID-19 pandemic

OBJECTIVE

To assess the impact of the temporary cessation of orthodontic services on patients undergoing treatment during the COVID-19 pandemic.

DESIGN

Two-phase multicentre service evaluation.

SETTING

Secondary care orthodontic departments in the South West of England.

MATERIALS AND METHODS

Phase 1 - Patient-Reported Experience Measure questionnaire (PREM). The questionnaire was distributed to patients who had undergone orthodontic treatment during the COVID-19 pandemic once services had resumed. Phase 2 - assessment of treatment outcomes, specifically with the Peer Assessment Rating (PAR) Index. A total of 280 PAR scores were obtained from a cohort of patients treated before and during the pandemic.

RESULTS

A total of 711 PREM questionnaires were completed. Participants generally felt relaxed when visiting secondary care settings, orthodontic departments and whilst wearing orthodontic appliances during the pandemic. Nearly 40% of participants were concerned that the pandemic would impact on their treatment, particularly treatment length. Treatment outcomes revealed that patients treated before and during the pandemic experienced percentage PAR score reductions of 83.9% and 80.6%, respectively. Patients receiving treatment during the pandemic experienced longer treatment durations of 126 days.

CONCLUSION

During the pandemic, low levels of anxiety were reported with respect to receiving orthodontic treatment in secondary care settings. Irrespective of the pandemic, a high standard of orthodontic treatment was provided. However, patient concerns regarding treatment length were justified.

The Implications of the COVID-19 Pandemic on the Interest in Orthodontic Treatment and Perspectives for the Future. Real-Time Surveillance Using Google Trends

Background: The COVID-19 pandemic outbreak may have a large impact on orthodontic treatment. Regular orthodontic visits were strongly and widely interrupted by the unprecedented epidemiological threat. Methods: The data regarding orthodontic queries were investigated in a real-time surveillance using Google Trends. Search terms “braces”, “invisalign”, “get braces”, “get braces off”, “braces pain” and the phrase “social distancing” were analyzed regarding the year preceding the pandemic outbreak and the time of the pandemic. Moreover, the five-year trend for queries “braces” vs. “invisalign”, as an example of different types of orthodontic appliances, was compared. Results: There was a significant decrease in orthodontics phrase queries in the spring of 2020, connected with the worldwide restrictions and lockdowns announced all over the world. There was a lower interest in the “braces pain” query during the first lockdown in 2020. The number of searches for “invisalign” increased steadily over time, while the number of searches for “braces” was relatively stable across the investigated time period. Conclusions: The course of the COVID-19 pandemic has had a large impact on the orthodontic-related search queries. Orthodontists must be better-prepared for any sudden changes in the possible future in the epidemiological situation that may change accessibility to dental offices.