COVID-19 is an opportunity for reform in dentistry

Dental service utilization and the COVID-19 pandemic, a micro-data analysis

BACKGROUND

Global crises and disease pandemics, such as COVID-19, negatively affect dental care utilization by several factors, such as infection anxiety, disrupted supply chains, economic contraction, and household income reduction. Exploring the pattern of this effect can help policy makers to be prepared for future crises. The present study aimed to investigate the financial impact of COVID-19 disruptions on dental service utilization.

METHODS

Data on the number of dental services offered in Dental School Clinics of Tehran University of Medical Sciences was collected over a period of two years, before and after the initial COVID-19 outbreak in Iran. School of Dentistry operates two clinics; one with competitive service fees and one with subsidies. Regression analyses were performed to determine the effect of the pandemic on the number of dental services divided by dental treatment groups and these clinics. The analyses were adjusted for seasonal patterns and the capacity of the clinics.

RESULTS

There was a significant drop in dental services offered in both clinics across all dental groups in the post-COVID period (on average, 77 (39.44%) fewer services per day). The majority of the procedure loss happened in the Private clinic. Adjusting for seasonal patterns and the service capacity, regression results documented 54% and 12% service loss in Private and Subsidized clinics following the pandemic, respectively. Difference-in-difference analysis documented that the Subsidized clinic performed 40% more treatments than the Private clinic in the post-COVID period.

CONCLUSIONS

Pandemic -reduction in dental care utilization could have long-term ramifications for the oral health of the population, and policymakers need to provide supportive packages to the affected segments of the economy to reverse this trend.

Dental Surgical Activity in Hospitals during COVID-19: A Nationwide Observational Cohort Study

INTRODUCTION

The number of surgical extractions performed in hospitals in England remains unclear. This study reports the volume of surgical extractions conducted in hospitals and change in activity during the COVID-19 pandemic.

METHODS

We conducted a nationwide observational cohort study using Hospital Episode Statistics (HES) in England for patients undergoing surgical removal of a tooth (defined using OPSC-4 code F09) between April 1, 2015, and December 31, 2020. Procedures were stratified by age, gender, and urgency (elective or nonelective), reported using descriptive statistics, number, and percentage. We conducted post hoc modeling to predict surgical activity to December 2023. In addition, we contrasted this with aggregate national data on simple dental extraction procedures and drainage of dental abscesses in hospital as well as dental activity in general practice.

RESULTS

We identified a total of 569,938 episodes for the surgical removal of a tooth (females 57%). Of these, 493,056/569,938 (87%) were for adults and 76,882/569,938 (13%) children ≤18 years. Surgical extractions were most frequent in adult females. Elective cases accounted for 96% (n = 548,805/569,938) of procedures. The median number of procedures carried out per quarter was 27,256, dropping to 12,003 during the COVID-19 pandemic, representing a 56% reduction in activity. This amounted to around 61,058 cancelled procedures. Modeling predicts that this activity has not returned to prepandemic levels.

CONCLUSIONS

The number of surgical extractions taking place in hospitals during the pandemic fell by 56%. The true impact of this reduction is unknown, but delayed treatment increases the risk of complications, including life-threatening infections.

KNOWLEDGE TRANSFER STATEMENT

The result of this study provides an evidence-based overview of the trends relating to surgical extractions of teeth in England taking place in hospitals. This information can be used to inform service and workforce planning to meet the needs of patients requiring surgical extractions. The data also provide an insight into the oral health needs of the population in England.

Reflections on oral health inequalities: Theories, pathways and next steps for research priorities

Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.

The impact of COVID-19 on individual oral health: a scoping review

BACKGROUND

Poor oral health due to dental caries is one of the most prevalent non-communicable diseases worldwide. It has a significant impact on individuals across the lifespan and is a leading cause of preventable hospitalizations. The impacts of COVID-19 on oral health at the practice level are well documented, but gaps in understanding the impact on individual oral health remain. This review addresses this gap.

METHODS

Using a JBI scoping review process we mapped and summarized the evidence to identify the impact of COVID-19 on individual oral health. Key search terms were developed, and searches were undertaken by an experienced research librarian.

RESULTS

The 85 included studies were conducted in 23 countries from 5 regions across the world classified using the United Nations Geoscheme system. The majority (82/85) were quantitative, 2 were reviews and there was one qualitative interview study. Cross-sectional surveys were the most common data collection approach followed by an analysis of clinical data, analysis of internet trends and other online methods. Five key areas were identified including changes to the provision of emergency dental services, provision of routine oral health services, oral hygiene maintenance at home, changes in dietary preferences, alternative models of dental provision and help-seeking and attitudes towards dental care in the future.

CONCLUSIONS

This scoping review has demonstrated that the pandemic has impacted on oral health at the individual level. It is important that we are aware of these impacts and ensure that support systems are in place to overcome future periods where access to dental care might be compromised. The provision of preventive care remains a vital first step in ensuring good overall oral health as is paramount during periods where access to dental treatment might be limited.

COVID-19: the impact on oral health care

The COVID-19 pandemic has highlighted the economic, social, and oral care health inequities in societies, especially in the developing world. Severe restrictions have been imposed on dental practices, limiting prophylactic and routine oral care health, allowing treatment only for emergencies. Since dental care includes procedures that generate aerosols, the risk of infection for dental personnel has increased significantly. In this review, a comprehensive and updated source of information about SARS-CoV-2/COVID-19 and the impacts it is having on oral health care is presented. The ongoing repercussions in dental practice and in dental education, including the opportunities for practice innovation that are evolving, are also indicated. Also, a discussion of the psychosocial factors that affect health and the quality of life of an individual, such as stress, depression, and anxiety, is provided. This pandemic may be an opportunity to promote the inclusion of well-established prevention measures, together with the use of teledentistry in academic dental curricula, encourage the implementation of new perspectives for the effective instruction and interactions with students, and foster the transition toward e-learning strategies in dental education.

COVID-19 Effects on Income and Dental Visits: A Cross-sectional Study

OBJECTIVES

In April 2020, the Japanese government declared a state of emergency owing to the outbreak of the novel coronavirus disease (COVID-19) pandemic, which resulted in reduced workforce and job losses. Furthermore, income is one of the most consistent predictors of dental visits. Therefore, this study examined the association between income changes and dental clinic visits during the COVID-19 state of emergency in Japan.

METHODS

An online, self-reported cross-sectional survey about health activities including dental visits during the first COVID-19 state of emergency was conducted in Osaka, Japan (June 23 to July 12, 2020). Among participants with toothaches, the assessment for the association between "refrained from visiting a dentist despite wanting treatment for toothache during the state of emergency (refrained treatment)" and income changes before and after the state of emergency using a multivariate Poisson regression model adjusted for sex, age, self-rated health, frequency of regular dental visits, and employment status.

RESULTS

Among 27,575 participants, 3,895 (14.1%) had toothaches, and 1,906 (6.9%) reported refrained treatment. Among people with decreased income (n = 8,152, 29.6% of overall participants), the proportions of the refrained treatment group were 8.0% (income decreased by 1%-49%), 9.9% (50%-99% decreased), and 9.1% (100% decreased). Among participants with toothache, after adjusting for all variables, compared with participants with no income change, we observed significantly higher prevalence ratios (PRs) for refrained treatment in those who experienced a decreased income owing to COVID-19 (1%-49% decrease: PR = 1.08; 95% confidence interval [CI], 1.005-1.17; 50%-99% decrease: PR = 1.18; 95% CI, 1.06-1.32; 100% decrease: PR = 1.18; 95% CI, 1.04-1.33).

CONCLUSION

Decreased income was associated with refrained dental treatment during the COVID-19 state of emergency in Osaka, Japan. The economic damage related to the COVID-19 pandemic could lead to oral health inequalities.

KNOWLEDGE TRANSFER STATEMENT

Our study found that individuals with decreased income owing to COVID-19 before and after the state of emergency showed significantly higher prevalence ratios for refraining from visiting a dentist despite wanting treatment for toothache. We believe that our study makes a significant contribution because it provides novel, basic data that economic damages related to the COVID-19 pandemic might expand to oral health inequalities.

Factors affecting oral health care for asylum seekers and refugees in England: a qualitative study of key stakeholders' perspectives and experiences

Aims To investigate factors influencing oral health behaviours and access to dental services for asylum seekers and refugees (ASRs).Methods A qualitative research study using purposeful sampling was undertaken in South West England. Online semi-structured interviews with stakeholders working with or supporting ASRs were analysed through reflexive thematic analysis.Results Twelve participants providing support to ASRs in various capacities participated. Two interviewees had lived experience of forced displacement and the UK asylum process. Key themes into what hinders ASRs' oral health care were: prioritising safety and survival; variations in cultural norms and practice; lack of knowledge about dental care; financial hardship and affordability of care; a gulf of understanding of what dental care would be like and experiences of it; and structures of dental services that leave vulnerable groups behind. Opportunities for improving oral health care were: accessible oral health education; partnership working and creating supportive environments; translation; providing culturally sensitive and person-centred care; and incorporating ASRs' views into service design.Conclusions Several factors affect to what extent ASRs can and are willing to engage with oral health care. Co-developing accessible and relevant prevention programmes and ensuring equitable access to dental services for ASRs is important. Future research should explore ASRs' views and experiences of dental care and explore informed suggestions on how to optimise oral health promotion and provision of care.

Dental safety net providers' experiences with service delivery during the first year of COVID-19 should inform dental pandemic preparedness

BACKGROUND

COVID-19 disrupted oral health care delivery and revealed gaps in dental public health emergency preparedness and response (PHEPR). Emerging dental PHEPR frameworks can be strengthened by means of understanding the experiences of the discipline's frontline workers-dental safety net providers-during the initial phase of the COVID-19 pandemic.

METHODS

Experienced qualitative researchers interviewed dental safety net directors and clinicians (n = 21) in 6 states to understand their experiences delivering care from March 2020 through February 2021. Interview transcriptions were analyzed using iterative codes to identify major and minor themes. Conventional qualitative validity checks were used continuously to ensure impartiality and rigor.

RESULTS

Three major themes were identified: unpredictability caused concerns among staff members and patients, while also deepening fulfilling collaborations; care delivery was guided by means of various resources that balanced safety, flexibility, and respect for autonomy; and pandemic-driven changes to oral health care delivery are timely, long-lasting, and can be somewhat fraught.

CONCLUSIONS

The human, material, and policy resources that providers used to control infections, serve vulnerable patients, maintain clinic solvency, and address provider burnout during the first year of the COVID-19 pandemic can improve dental PHEPR.

PRACTICAL IMPLICATIONS

Dental PHEPR should address concerns beyond infection control within and between practice models, governmental agencies, and professional organizations. Examples of such concerns include, but are not limited to, guideline synchronization, materials exigencies, task shifting, and provider resilience.

Public oral health services: impacts caused by the COVID-19 pandemic

The aim of this study was to describe the oral health services offered by the Unified Health System in the northern macro-region of Minas Gerais, Brazil, during the COVID-19 pandemic. This was an observational, cross-sectional and descriptive study. Data collection took place between August and September 2020 through the completion of online questionnaires by oral health managers in the northern municipalities of Minas Gerais and by consultation of information available in the Special Epidemiological Bulletin Coronavirus North Macro-region n° 14. After collection, data were transferred to SPSS® (Statistical Package for the Social Sciences for Windows, version 24.0). Analyses were performed using frequency, mean, standard deviation and percentages. It was found that all included municipalities suspended elective treatments and maintained emergency dental care at all levels of care. In 62.5% of municipalities there were oral health professionals contaminated by COVID-19. Oral health teams implemented specific interventions to address the pandemic,with the most frequent being tele-orientation (74.7%), use of sanitary barriers (72%), and telemonitoring (68%). At the beginning of the pandemic, 62.5% of municipalities lacked personal protective equipment. Comsidering these results, it was found that the COVID-19 pandemic impacted the supply of dental services in northern Minas Gerais due to the suspension of elective care, contamination of professionals, lack of personal protective equipment, and development of new interventions. Thus, oral health teams had to adapt to new contexts of health interventionsto face COVID-19 and maintain dental care services.

Impact of the COVID-19 Pandemic on the Dental Preferences of Patients in the Private Sector

Proper oral health care has an impact on the health of the entire body. The COVID-19 pandemic has affected the functioning of the healthcare sector, including dental services. The aim of this study was to analyse the behaviour of patients with regard to their use of dental services during the pandemic. The data were obtained from paper registration forms taken from five dental offices in the city of Cracow between March 2019 and February 2021. During the analysed periods, interest among first-time patients in dental services decreased to 37% (during the month when interest in dental services was at its lowest) compared to the year preceding the COVID-19 pandemic. The number of cancelled visits increased by between 15% and 50% compared to the pre-pandemic period. During the pandemic, appointments made by existing patients increased by up to 84% compared to 2019. The decision by patients to postpone dental treatment not only has adverse effects on their oral and body health, but in turn results in higher health care costs. Given the potential for another pandemic, further long-term research is required to develop and implement special protocols to make the public aware of the safety of health care.

The impact of the COVID-19 pandemic on oral health inequalities and access to oral healthcare in England

While the impact of the coronavirus disease (COVID-19) pandemic on health inequalities is documented, oral health has been absent from this discussion. This commentary highlights the potential impacts of the COVID-19 pandemic on oral health inequalities in England in February 2021. It includes a literature review, Public Health England and Kantar Worldpanel sales data on health behaviours and analysis of NHS dental services data. Purchasing data indicate, except for smoking, increases in health-compromising behaviours. Since the resumption of dental services, NHS general dental service use modestly recovered among adults but not children by October 2020. There are clear inequalities among children and older adults, with more deprived groups having lower uptake of dental service use than more affluent groups. Oral cancer referrals and hospital admissions for tooth extractions in children dramatically declined, with the latter primarily affecting children in more deprived areas. Many oral health programmes in schools and care homes were disrupted or suspended throughout this period. All these indicate that oral health inequalities have widened due to the COVID-19 pandemic. An oral health plan of action requires prioritising long-term investment in public health programmes and transforming commissioning pathways to support those with the greatest needs to access oral healthcare services.

People living in more deprived areas have fared worse than people living in less deprived areas, in terms of uptake of NHS primary dental care following the resumption of services in June 2020.

The cessation of oral health improvement programmes in the community and the dramatic decline of hospital dental services due to the COVID-19 pandemic have also primarily impacted the more socially disadvantaged groups, further widening inequalities.

Addressing the widened oral health inequalities requires long-term investment in oral health, prioritising public health programmes and supporting access to services.

Changes in Oral Health Policies and Guidelines During the COVID-19 Pandemic

The aim of this study was to describe the changes in oral health policies and guidelines in response to the Coronavirus disease 2019 (COVID-19) pandemic in different countries and regions around the world. Information on oral health policies and guidelines from 9 countries (Canada, China including Hong Kong, Egypt, India, Japan, New Zealand, Nigeria, Switzerland, and Thailand) were summarized, and sources of the information were mostly the national or regional health authorities and/or dental council/associations. The changes made to the oral health guidelines depended on the severity of the COVID-19 pandemic. This included suspension of non-emergency dental care services at the peak of the COVID-19 outbreak, and easing the restrictions on non-essential and elective dental care when the pandemic became under control. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. The COVID-19 pandemic has shown a major impact on dental practice. Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation.

A qualitative analysis of dental professionals' beliefs and concerns about providing aerosol generating procedures early in the COVID-19 pandemic

INTRODUCTION

In response to the COVID-19 pandemic, the Scottish Dental Clinical Effectiveness Programme (SDCEP) initiated a rapid review of the evidence related to the generation and mitigation of aerosols in dental practice. To support this review, a survey was distributed to better understand the provision of aerosol generating procedures (AGPs) in dentistry.

METHODS

An online questionnaire was distributed to dental professionals asking about their current practice and beliefs about AGPs. Data were analysed using qualitative content analysis.

RESULTS

Analysis revealed confusion and uncertainty regarding mitigation of AGPs. There was also frustration and scepticism over the risk of SARS-COV-2 transmission within dental settings, the evidence underpinning the restrictions and the leadership and guidance being provided, as well as concern over financial implications and patient and staff safety.

DISCUSSION

The frustration and concerns expressed by respondents mirrored findings from other recent studies and suggest there is a need for reflection within the profession so that lessons can be learned to better support staff and patients.

CONCLUSION

Understanding the profession's views about AGP provision contributed to the SDCEP rapid review and provides insights to help inform policymakers and leaders in anticipation not only of future pandemics but in considering the success of any large scale and/or rapid organisational change.

Indicators for dental appointment scheduling in primary health care: a national cross-sectional study

Background

Integrated dental services within the Health System, particularly at primary health care, are crucial to reverse the current impact of oral diseases, which are among the most prevalent diseases worldwide. However, the use of dental services is determined by complex phenomena related to the individual, the environment and practices in which care is offered. Therefore, factors associated with dental appointments scheduling can affect positively or negatively the use of dental services. The aim of the present study was to evaluate the indicators for dental appointment scheduling in Primary Health Care (PHC).

Methods

The present is a cross-sectional analytical study that used data from the external assessment of the third cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), carried out between 2017 and 2018, in Brazil. The final sample consisted of 85,231 patients and 22,475 Oral Health teams (OHTs). The outcome variable was the fact that the user sought for a dental appointment at the Primary Health Care Unit. A multilevel analysis was carried out to verify the association between individual variables (related to users) and contextual variables (related to the OHTs) in relation to the outcome.

Results

Only 58.1% of the users interviewed at these Primary Health Care Units seek the available dental care. The variables with the greatest effect on the outcome were the patient’s age up to 42 years old (OR = 2.03, 95% CI: 1.96–2.10), at individual level, and ‘oral health teams that assisted no more than a single family health team (FHT)’ (OR = 1.29, 95% CI: 1.23–1.36) at contextual level. Other variables were also associated with the outcome, but with a smaller effect size.

Conclusion

In conclusion, users’ age and work process of OHT were indicators for dental appointment scheduling. Our results suggest that when OHT put the National Oral Health Policy guidelines into practice, by assisting only one FHT, the chance for PHC users seeking dental appointments is higher than OHTs that assist more than one FHT. Regarding age, patients aged up to 42 years are more likely to seek an appointment with a dentist.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12319-x.

Dentists deployed: an insider's perspective of life on the NHS front line

The COVID-19 pandemic has stretched and overburdened healthcare services within the UK. This national crisis has led to the widespread redeployment of healthcare workers and reorganization of services throughout the NHS in the UK. The flexible and altruistic nature of healthcare workers has been inspiring, and central in the UK's response to the COVID-19 pandemic. This article describes the 'first-hand' experience of a secondary care dentist, highlighting the redeployment journey to the emergency department (ED) of a major trauma hospital in the North-West of England during the first wave of the COVID-19 pandemic.

Eating Disorders in the Adolescent Patient

Eating disorders such as anorexia nervosa, female athlete triad, bulimia nervosa, obesity, and binge eating initially emerge during adolescence. These disorders are present primarily in females, but males may also present with these conditions. Dentistry has a pivotal role in the management of patients with such diet-related disorders. Because dentists examine their patients at frequent intervals and may be the health care professionals with whom patients feel more comfortable discussing eating disorders, dentists must have knowledge of the etiology, diagnostic criteria, systemic effects, and intraoral manifestations of eating disorders. In addition, the dental professional may be the first health care provider to identify the condition and refer the patient appropriately to medical colleagues for subsequent treatment. This chapter provides dentists with current and relevant information to recognize, diagnose, and integrate dental treatment for their adolescent patients who may exhibit manifestations of an eating disorder.

Digital surveillance: The interests in toothache-related information after the outbreak of COVID-19

Objectives

The aim of this ecological study was to analyze the relationship of social restriction measures and people's interest in searching toothache‐related information on the Internet.

Materials and Methods

The following indicators Stringency Index (SI), Years Lived with Disability (YLDs) for untreated caries in permanent teeth, Google market share, Internet penetration, and relative search volume (RSV) for the Topic "Toothache" in Google Trends were determined for 21 countries with available data, from April 2018 to May 2020. Statistical analysis was performed using Mann–Whitney U test, t‐Student test, Pearson's Chi‐square test, and Spearman and Pearson's cross‐correlation tests (α = 0.05).

Results

Relative search volume values increased significantly after restriction measures in all countries, except for Japan. Higher RSV values were found among 11 countries that presented a cross‐correlation between RSV and SI with r≥│0.6│. The most common queries were linked to the treatment and self‐resolution of toothache, with a sudden increase of searches that combined the symptom with COVID‐19.

Conclusions

The interests in toothache‐related digital information were associated with social restriction measures. These results allow the identification of dental demands of distinct populations, contributing to the planning of specific public health policies during and after the pandemic period.

Integrated care: a new model for dental education

The COVID-19 pandemic has had a devastating health, economic and social impact on the UK health services. The learning from redeployment demonstrated that dental professionals can be rapidly integrated into the wider healthcare system, but the challenge is how this can be sustained in the future. This is an opportunity for dental training to be incorporated into a more integrated model of care, and this article outlines a collaboration between NHS England and NHS Improvement, Health Education England and Local Dental Networks to establish a novel training opportunity. This Assistant Dentist Integrated Care Pilot Programme has provided retention of dentists within areas of unmet need and introduced innovative opportunities for dental workforce transformation.

Local workforce opportunities may improve recruitment and retention within the dental profession.

Innovative 'outside the box' thinking is crucial to develop healthcare, including dentistry.

Collaboration is key, not just between stakeholders but also between dentistry and wider health and social care.

Impact of COVID-19 on Dental Care during a National Lockdown: A Retrospective Observational Study

The coronavirus disease 19 (COVID-19) has challenged dental health professions. This study analyzes its impact on urgent dental care in the Department of Conservative Dentistry and Periodontology, University Hospital Munich and Bavaria, Germany. Patient numbers without and with positive/suspected COVID-19 infection, their reasons for attendance, and treatments were retrospectively recorded (February–July 2020) and linked to local COVID-19 infection numbers, control measures, and numbers/reasons for closures of private dental practices in Bavaria, Germany. Patient numbers decreased within the urgent care unit and the private dental practices followed by a complete recovery by the end of July. While non-emergency visits dropped to almost zero during the first lockdown, pain-related treatments were administered invariably also in patients with positive/suspected COVID-19 infections. Reasons for practice closures were lack of personal protective equipment (PPE), lack of employees, staff’s increased health risks, and infected staff, which accounted for 0.72% (3.6% closures in total). Pain-driven urgent dental care remains a constant necessity even in times of high infection risk, and measures established at the beginning of the pandemic seem to have provided a safe environment for patients as well as oral health care providers. PPE storage is important to ensure patients’ treatment under high-risk conditions, and its storage and provision by regulatory units might guarantee a stable and safe oral health care system in the future.

Advocacy for a Digital Oral Health That Leaves No One Behind

KNOWLEDGE TRANSFER STATEMENT

This position paper could be used by oral health stakeholders to convince their government to implement digital oral health program.

Dental Pain and Worsened Socioeconomic Conditions Due to the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has led to economic contraction and significant restrictions on society. The shock to the economy could lead to a deterioration of physical health outcomes, including dental health. The present study investigated the association between worsened socioeconomic conditions due to the COVID-19 pandemic and dental pain in Japan. The mediating effects of psychological distress and oral health-related behaviors were also evaluated. Cross-sectional data from the Japan COVID-19 and Society Internet Survey conducted from August to September 2020 (n = 25,482; age range, 15-79 y) were analyzed. Multivariable logistic regression models were fitted to evaluate the independent associations of household income reduction, work reduction, and job loss due to the COVID-19 pandemic with dental pain within a month. Dental pain was reported by 9.8%. Household income reduction, work reduction, and job loss were independently associated with dental pain after adjusting for confounders (odds ratios: 1.42 [95% confidence interval (CI), 1.28-1.57], 1.58 [95% CI, 1.41-1.76], 2.17 [95% CI, 1.64-2.88], respectively). The association related to household income reduction was mediated by psychological distress, postponing dental visits, toothbrushing behavior, and between-meals eating behavior by 21.3% (95% CI, 14.0-31.6), 12.4% (95% CI, 7.2-19.6), 1.5% (95% CI, -0.01 to 4.5), and 9.3% (95% CI, 5.4-15.2), respectively. Our findings showed that worsened socioeconomic conditions due to the COVID-19 pandemic deteriorated dental health. Policies that protect income and job loss may reduce dental health problems after the pandemic.

Examining the impact of oral hygiene advice and/or scale and polish on periodontal disease: the IQuaD cluster factorial randomised controlled trial

Objective To compare the clinical effectiveness and cost benefit of different frequencies of scale and polish (S&P) treatments in combination with different types of oral hygiene advice (OHA).

Design Multi-centre, multi-level cluster randomised factorial open trial with blinded outcome evaluation. UK dental practices were cluster randomised to deliver OHA as usual or personalised. In a separate randomisation, patients were allocated to receive S&P 6-monthly, 12-monthly or never.

Setting UK primary dental care.

Participants Practices providing NHS care and adults who had received regular dental check-ups.

Main outcome measures The percent of sites with bleeding on probing, patient confidence in self-care, incremental net benefits (INB) over three years.

Results Sixty-three practices and 1,877 adult patients were randomised and 1,327 analysed (clinical outcome). There was no statistically significant or clinically important difference in gingival bleeding between the three S&P groups (for example, six-monthly versus none: difference 0.87% sites, 95% CI: 1.6 to 3.3, p = 0.48) or between personalised or usual OHA groups (difference -2.5% sites, -95%CI: -8.3 to 3.3, p = 0.39), or oral hygiene self-efficacy (cognitive impact) between either group (for example, six-monthly versus none: difference -0.028, 95% CI -0.119 to 0.063, p = 0.543). The general population place a high value on, and are willing to pay for, S&P services. However, from a dental health perspective, none of the interventions were cost-effective.

Conclusion Results suggest S&P treatments and delivering brief personalised OHA provide no clinical benefit and are therefore an inefficient approach to improving dental health (38% of sites were bleeding whatever intervention was received). However, the general population value both interventions.

Describes the process of successfully delivering a multi-centre, cluster randomised factorial open trial in general dental practice in the NHS, for the most frequently provided dental treatment, scale and polish (S&P), and oral hygiene advice.

Highlights the clinical, economic and patient-centred outcomes from providing S&P at different time intervals alongside personalised or routine oral hygiene advice to over 2,000 participants for three years.

Evidence from IQuaD concludes that there was no difference in gingival bleeding across trial arms at three years; however, the general population are willing to pay for and place a high value on both S&P and personalised oral hygiene advice.

Examining the effectiveness of different dental recall strategies on maintenance of optimum oral health: the INTERVAL dental recalls randomised controlled trial

Objective To compare the clinical effectiveness of different frequencies of dental recall over a four-year period.Design A multi-centre, parallel-group, randomised controlled trial with blinded clinical outcome assessment. Participants were randomised to receive a dental check-up at six-monthly, 24-monthly or risk-based recall intervals. A two-strata trial design was used, with participants randomised within the 24-month stratum if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or six-month recall interval.Setting UK primary dental care.Participants Practices providing NHS care and adults who had received regular dental check-ups.Main outcome measures The percentage of sites with gingival bleeding on probing, oral health-related quality of life (OHRQoL), cost-effectiveness.Results In total, 2,372 participants were recruited from 51 dental practices. Of those, 648 were eligible for the 24-month recall stratum and 1,724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding on probing between intervention arms in any comparison. For those eligible for 24-month recall stratum: the 24-month versus six-month group had an adjusted mean difference of -0.91%, 95% CI (-5.02%, 3.20%); the 24-month group versus risk-based group had an adjusted mean difference of 0.07%, 95% CI (-3.99%, 4.12%). For the overall sample, the risk-based versus six-month adjusted mean difference was 0.78%, 95% CI (-1.17%, 2.72%). There was no evidence of a difference in OHRQoL (0-56 scale, higher score for poorer OHRQoL) between intervention arms in any comparison. For the overall sample, the risk-based versus six-month effect size was -0.35, 95% CI (-1.02, 0.32). There was no evidence of a clinically meaningful difference between the groups in any comparison in either eligibility stratum for any of the secondary clinical or patient-reported outcomes.Conclusion Over a four-year period, we found no evidence of a difference in oral health for participants allocated to a six-month or a risk-based recall interval, nor between a 24-month, six-month or risk-based recall interval for participants eligible for a 24-month recall. However, patients greatly value and are willing to pay for frequent dental check-ups.

The inconspicuous nature of COVID-19 and its impact to dentistry

To state that the new coronavirus SARS-CoV-2 has broadly and deeply impacted our lives is an understatement. Since it first showed up on our radar in December 2019, the new coronavirus has wreaked havoc on virtually all businesses and industries across the globe. The impact is equally felt in developing, developed, industrialized, rural, rich, and poor countries and communities, irrespective of how well-prepared those countries and communities felt they were 9 months ago. To this day we are still learning to prepare for, respond to, and adapt to the broad and deep impact of this virus. This essay presents different perspectives on the impact of the novel coronavirus to dentistry, through the lenses of a private practice-based general dentist, a nursing home-based public health dentist, and a school of dentistry clinical director. The goal of the essay is to share our experiences and challenges, as well as highlight our capacity to respond to a crisis with resilience, determination, creativity, inventivity, and, most importantly, humility and altruism.