The Impact of the First Wave of the COVID-19 Pandemic on Providing Special Care Dentistry: A Survey for Dentists

Consequences of COVid-19 in Latin American dentists in the first year of the pandemic, the period prior to vaccination campaigns

Objectives

The aim of this investigation was to assess the impact of the COVID-19 pandemic on dentists in Latin America during the initial year of the outbreak, specifically within the timeframe preceding vaccination campaigns. This study determined the various facets in which dentists were affected and exactly what proportion of them was harmed.

Methods

A comprehensive 33 question survey was distributed across 19 Latin American countries after the first year of the COVID-19 pandemic's presence in the region.

Results

There was an absence of statistically significant differences in responses among the surveyed countries in Latin America, with the exception of four questions out of the total 33. Some relevant findings of Latin American were: one in three dental professionals experienced discrimination based on their occupation. Concurrently, three out of four dentists reported initiating new activities to lessen discomfort. Notably, 8.63 % of respondents sought assistance from a psychologist or psychiatrist, while 17.71 % resorted to the consumption of psychoactive substances within the first year of the pandemic.Furthermore, 7.28 % of the professionals indicated that they still had not obtained all the necessary personal protective equipment for their work and 92.05 % disclosing that they personally financed these essential resources. A certain percentage of dentists stated that the quality of care decreased due to the implementation of the new safety measures (40.03 %) or due to their own feelings during patient interactions (23.11 %). Lastly, 38.85 % of dentists contemplated leaving the profession.

Conclusions

The impact of the COVID-19 pandemic on dentists was decidedly adverse, manifesting both in personal and professional fields, despite the diverse measures undertaken by these professionals to mitigate its effects.

The "new normal" of hygiene measures at the end of the COVID-19 epidemic: a survey among French dentists

OBJECTIVES

The COVID-19 epidemic upset the standards in terms of hygiene and protection in the dental office, bringing additional precautions for dentists. The objective of our study was to draw the "new normal" of hygiene measures at the end of the COVID-19 epidemic.

MATERIALS AND METHODS

A self-administered questionnaire about transitional recommendations for oral care in the context of the COVID-19 epidemic was published online in private groups dedicated to French dentists.

RESULTS

The 246 respondents understood the reasons behind those recommendations, since 10 out of 11 measures reached a mean score greater than 2.5 on a 0 (not at all) to 4 (absolutely) scale when it came to determining whether the measure made the practitioner feel safe and ensured patient safety. Besides, more of the respondents intended to maintain the measures than they were to apply them before the epidemic.

CONCLUSIONS

The COVID-19 epidemic reshaped the relationship to hygiene and protection measures in the context of dental practices. The "new normal" of hygiene measures at the end of the COVID-19 epidemic will probably involve more protective measures than before.

CLINICAL RELEVANCE

These results constitute interesting avenues for public health deliberation, which would make it possible to best adapt future health recommendations in order to define the "new normal" of hygiene measures in dental practices at the end of the COVID-19 epidemic. Therefore, it could have an impact on all practitioners in their clinical activities.

The COVID-19 Pandemic and Dental Professionals' Infection Risk Perception: An International Survey

A global survey among dentists was used to identify the various impacts of the COVID-19 pandemic on this professional group. Special attention was given to perception and assessment of infection risk. From May to August 2020, the questionnaire was delivered in 36 countries by respective research groups and was completed by 52,491 dental professionals. The survey was designed as a cross-sectional survey based on a previously standardized questionnaire. This study focuses on the part of the questionnaire that deals with the perception of the infection risk of COVID-19 by dentists and their patients. A logistic regression model was used, which consisted of four Likert items as response options and the additional self-reported routine or emergency treatment as the dependent variable. Analysis by continent found that European and Asian dentists were particularly likely to be infected at work (OR = 1.45 95%CI = 1.02/1.84 and OR = 2.68, 95%CI = 1.45/3.22, respectively), while it was likely that Australian dentists did not feel particularly at risk due to low infection rates. Three quarters of Americans treated only emergencies during this survey period, while Europeans (64.71%) and Asians (66.67%) provided mostly routine care. This could affect the Europeans' confidence that they would not be able to protect themselves from infections in the long-term. The COVID-19 pandemic and its impact on dental professionals' infection risk perception is determined by the geographical origin of dentists. This study shows that, especially in high-incidence countries, infection risk perception was higher when dentists tried to provide routine dental procedures to their patients. Dental professionals can offer themselves and their patients good protection by maintaining high standards of hygiene. However, their concerns should be taken seriously and the dental professionals' group that is of great importance for oral health care and prevention, should not be neglected in the future, even in the event of emerging pandemics.

Impact of COVID-19 on Dental Practices in El Salvador and Mexico: A Comprehensive Survey Analysis

BACKGROUND AND OBJECTIVES

This study aimed to identify the relationship between prevention measures and protective barriers in dental practice in El Salvador and Mexico during the COVID-19 pandemic in 2020 and 2021.

MATERIALS AND METHODS

A longitudinal study was conducted from June 2020 to December 2021, involving 1,719 dentists divided into four groups based on location and year. A 20-question survey in Spanish was utilized and validated with a Cronbach's alpha value of 0.84.

RESULTS

The use of phone triage (OR = 1.3), thermometers (OR = 1.4), physical distancing (OR = 1.7), and face shields (OR = 2.6) was significantly associated with dental practice in both countries during the pandemic.

CONCLUSIONS

During 2020 and 2021, dental care in El Salvador and Mexico was significantly linked to COVID-19 preventive measures. Phone triage, thermometers, distancing, and face shields positively correlated with dental services. National health agencies should promote the use of minimum preventive measures in dental care, preparing for potential reinfections or new pandemics from emerging virus variants.

Trends in dental insurance claims in the United States in the context of the COVID-19 pandemic: A 3-year perspective (2019-2022)

OBJECTIVES

We showed in a previous analysis the patterns of disruption for private dental insurance claims in the United States caused by the SARS-CoV-2 pandemic in 2020. The present report examines trends during 2020 and 2021, that is, contrasting perspectives during 2019 with the acute phase of the pandemic in 2020, and 2021.

METHODS

Private dental insurance paid claims from a data warehouse were obtained, encompassing a 5% random sample of records between January 2019 and December 2021 for child and adult insureds who filed a claim in 2019, 2020, and 2021. We classified claims into one of four categories based on the likelihood of being associated with urgent/emergency care.

RESULTS

The precipitous reduction in dental care claims in March-June 2020 recovered to almost pre-pandemic levels by the fall of 2020. However, a downward decline in private dental insurance claims started in the late fall of 2020 and continued through 2021. Differential impacts in dental care categories-in terms of urgency of care-were evident 2021, closely resembling previous trends in 2020.

CONCLUSIONS

Dental care claims from the first year of the 2020 SARS-CoV-2 pandemic were contrasted with perspectives in 2021. A downward trend in demand/availability changes in dental care insurance claims set in for 2021, perhaps linked to perceptions of the overall economic situation. Such downward trend has continued overall, even after considering seasonal changes and the acceleration of the pandemic during the Delta, Omicron, and other variants.

Challenges in providing special care dentistry during COVID-19 pandemic: a survey of public dental care services in Italy

BACKGROUND

The aim of this paper was to assess COVID-19 pandemic impact over the public health care services (HCS) involved in special care dentistry (SCD).

METHODS

Customized questionnaire was sent to 45 HCS involved in SCD. Healthcare personnel (HP) on duty, safety of HCS, time of suspension and reduction of routine dental practice in special needs patients (SNP), kind of SNP mostly penalized during pre-COVID period/T1, lockdown (phase 1/T2) and post pandemic reopening (phase 2/T3) were analyzed by statistical means (P<0.05).

RESULTS

21 questionnaires were returned. A significant decrease of median number of HP during T2 was observed. Prevalence of COVID-19 infection among HP was not significantly different between T2 vs. T3. Medical surveillance of HP during T2 was significantly lower than during T3. Patients with lack of cooperation were the most disadvantaged during both phases dental procedures were significantly lower between T1 and T2 and between T1 and T3 as well. Patients with lack of cooperation and/or living in residential care homes were the most disadvantaged in relation to access to dental care during both phases.

CONCLUSIONS

COVID-19 pandemic determined significant restrictions in daily access to routine oral care resulting in reduction of preventive evaluations and decline of oral health in a population which is already at a higher risk of oral pathologies. Our data reveal that reduction of dental procedures, healthcare professionals and days of suspension of clinical activity were still considerable also in T3 with respect to T1 and in some cases not significantly different from T2.

A retrospective study on the effect of the COVID-19 pandemic on dental treatments in adults

Background

The aim was to analyze the prevalence of dental treatments that were not performed in a dental care university referral center in the capital of Spain during the first wave of the COVID-19 pandemic.

Methods

This was a retrospective observational study based on the registry of medical records. Sex, age, nationality, and the type of treatment that was not performed in the service of the Integrated Adult Dental Clinic subject of the Dentistry degree at the Rey Juan Carlos University of Madrid were analyzed.

Results

A total of 392 medical records were analyzed. The prevalence of the treatments that were not performed was 58.67% (95% CI 53.74–63.44) of conservative treatments, 47.45% (95% CI 42.55–52.39) of periodontal treatments, 27.30% (95% CI 23.12–31.91) and 13.52% (95% CI 10.49–17.26) of clinical activities. The patients most affected by the absence of dental treatment ranged in age from 35 to 74 years. Age, sex, and nationality were not influential in not performing dental treatments.

Conclusions

The COVID-19 pandemic could have negatively influenced treatments, such as conservative and periodontal treatments, that increasing the risk of tooth loss in adults.

The Impact of COVID-19 on the Oral Health of Patients with Special Needs

In March 2020, the World Health Organization declared a global public health emergency due to the spread of COVID-19, and medical and dental elective care was suspended, disproportionally affecting persons with special needs. As many of the special needs population live in a communal environment, they were at higher risk of being infected with and dying of COVID-19. Consequently, their access to medical and dental services was limited to emergency care. A method of reaching these populations evolved by the expansion of telehealth, including dentistry, to provide diagnosis, management, prevention, and provision of psychosocial support for patients.

A multi-country survey on the impact of COVID-19 on dental practice and dentists' feelings in Latin America

BACKGROUND

The COVID-19 pandemic has significantly influenced the routine of healthcare workers. This study investigated the impact of the pandemic on dental practice and dentists' feelings in Latin America.

METHODS

A survey was conducted with dentists from 11 Spanish-speaking Latin American countries in September-December 2020. Professionals were invited by email and via an open campaign promoted on social media. The questions investigated dental care routines, practice changes, and feelings about the pandemic. Descriptive statistics were used to identify frequencies and distributions of variables. Proportions were compared using chi-square tests.

RESULTS

A total of 2127 responses were collected from a sample with diverse demographic, sex, work, and education characteristics. The impact of COVID-19 was considered high/very high by 60% of respondents. The volume of patients assisted weekly was lower compared with the pre-pandemic period (mean reduction = 14 ± 15 patients). A high rate of fear to contracting the COVID-19 at work was observed (85%); 4.9% of participants had a positive COVID-19 test. The main professional challenges faced by respondents were reduction in the number of patients or financial gain (35%), fear of contracting COVID-19 (34%), and burden with or difficulty in purchasing new personal protective equipment (22%). The fear to contracting COVID-19 was influenced by the number of weekly appointments. A positive test by the dentists was associated with their reports of having assisted COVID-19 patients. The most cited feelings about the pandemic were uncertainty, fear, worry, anxiety, and stress. Negative feelings were more prevalent for professionals who did not receive training for COVID-19 preventive measures and those reporting higher levels of fear to contract the disease.

CONCLUSION

This multi-country survey indicated a high impact of the pandemic on dental care routines in Latin America. A massive prevalence of bad feelings was associated with the pandemic.

Trends in dental insurance claims in the United States before and during the SARS-CoV-2 pandemic in 2020

OBJECTIVES

The SARS-CoV-2 pandemic disrupted health care services. Previous reports estimated reductions in demand and supply of dental care services, but actual changes have not been reported. The present report depicts a perspective of trends in claims from private dental practice in the United States during 2019 and 2020.

METHODS

Private dental insurance paid claims data from a data warehouse (encompassing 66+ carriers in the United States) were obtained for children and adults (treatments identified by their American Dental Association Code of Dental Procedures and Nomenclature [CDT]), encompassing a 5% random sample of all records between January 2019 and December 2020. A market-based treatment classification placed CDT codes into one of four categories based on the likelihood of being associated with urgent/emergency care.

RESULTS

Claims for 3.8 million patients constituted the 5% random sample for analyses. Substantial drops in the provision of treatment items were quantified for a large segment of private dental insurance plans at a national level, showing differential impacts in dental care categories.

CONCLUSIONS

Week-by-week, detailed descriptions of demand/availability changes in dental care throughout the first year of the 2020 SARS-CoV-2 pandemic were obtained through contrasting perspectives in 2019. Provision of dental care and associated impacts fluctuated over time subject to treatment urgency, but also modified as the weeks/months of dental office lockdowns ebbed in and out of the dental market.

Transition to adult dental care from a pediatric hospital dental home for patients with special health care needs

AIMS

This study describes patients with complex Special Health Care Needs (SHCN) transitioning from a pediatric hospital clinic dental home to adult care and evaluates effectiveness of transition practices.

METHODS AND RESULTS

Demographics, medical/behavioral complexity, and documentation of transition processes were collected for patients graduated from the service in 2018/2019. An invitation to complete a survey assessing transition was sent to patients/guardians ≥ 14 months after the final visit. Seventy-nine patients graduated and 94% required accommodation for SHCN: 47% medical, 42% medical + behavioral, and 5% behavioral only. Of 63 eligible patients/guardians, 29 completed surveys. While 90% of surveyed patients had established some/all adult medical care, only 41% completed a dental visit, and less than 28% established a dental home. Medical/behavioral complexity, payer, and time since graduation did not impact having a visit.

CONCLUSIONS

This study found ineffectiveness of departmental protocol for transition to adult dental homes for patients with SHCN. Developing an optimal transition process is complex and will require collaboration of all stakeholders. Introducing transition in early teen years, tracking progress at subsequent visits, assessing patient readiness, summarizing history for receiving providers, and verifying transition are elements of medical transition programs that should be included in dental transitions.

Meta-Analysis of Prevalence of Depression in Dental Students during COVID-19 Pandemic

Background and Objectives: The COVID-19 pandemic has a negative impact on the mental health of the population in general, and in college students in particular. Dental students have seen their teaching altered and their clinical practice reduced. This study was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among dental students during the COVID-19 and estimating the pooled prevalence of depression. Materials and Methods: Medline via PubMed and other databases were searched for studies on the prevalence of depression in dental undergraduates, published from 1 December 2019 to 1 September 2021. The pooled proportions of depression were calculated with random effects models. Results: We identified 13 studies from 9 countries. The pooled prevalence of depression in dental students was 37% (95% CI: 26-49%) with no variation due to gender, response rate or methodological quality. We only found a significantly higher prevalence of depression in studies from Asia compared to Europe and America. Conclusions: Our results suggest that dental students are suffering from higher levels of depression compared with the general population or other college students during the COVID-19 pandemic, with differences across regions. Measures to improve mental health and wellbeing of dental students during the pandemic are needed.

The impact of COVID-19 on access to dental care for people with disabilities: a global survey during the COVID-19 first wave lockdown

BACKGROUND

It is unclear what immediate impact the COVID-19 pandemic has had on delivery of oral healthcare to people with disabilities worldwide.

AIM

To report the international impact of COVID-19 lockdown on oral healthcare provision for people with disabilities before, during and after the first lockdown (March to July 2020).

MATERIAL AND METHODS

Cross-sectional online self-administered survey of dentists who treat people with disabilities completed 10th to 31st of July 2020. Responses allowed comparison from before, during and immediately after the first wave lockdowns of the COVID-19 pandemic. Data were analysed using McNemar's test to compare reported practice before to during lockdown, and before to after lockdown.

RESULTS

Four-hundred-thirty-six respondents from across global regions reported a significant reduction from before to during and from before to after lockdown regarding: the proportion of dentists treating people with all types of disability (p <0.001) and the number of patients with disabilities seen per week (p<0.0001). The proportion reporting no availability of any pharmacological supports rose from 22% pre-lockdown to 61% during lockdown (p < 0.001) and a persistent 44% after lockdown (p < 0.001). An increase in teledentistry was observed.

CONCLUSIONS

During the first COVID-19 lockdown, there was a significant negative impact on the delivery of dental care to people with disabilities. Oral healthcare access was significantly restricted for people with disabilities with access to sedation and general anaesthesia particularly affected. There is now an increased need to ensure that no-one is left behind in new and existing services as they emerge post-pandemic.

Prevalence of Anxiety in Dental Students during the COVID-19 Outbreak: A Meta-Analysis

Background: Since the onset of the COVID-19 pandemic, the psychological state of university students has been a cause for concern. In particular, odontology students have experienced symptoms of anxiety due to the closure of universities and the suspension of clinical training. Methods: Medline via PubMed was searched for studies on the prevalence of anxiety in dental undergraduates, published from 1 December 2019 to 1 August 2021. Results: A total of fifteen studies were included in this review. Our results show a prevalence of anxiety of 35% reported by dental students, which was independent of gender, response rate or methodological quality. The only significant finding was a lower prevalence of anxiety in studies located in Europe compared to those located in other continents. Conclusions: The results suggest dental students are experiencing significant levels of anxiety during this COVID-19 pandemic and that there seem to be differences between students from different regions of the world. Therefore, it is important to help dental students psychologically as the pandemic situation continues.

Occupational Infections among Dental Health Workers in Germany-14-Year Time Trends

Dental health workers (DHW) are at increased risk of acquiring occupational infections. Due to various protective measures, it can be assumed that infections have decreased over the past 14 years. Secondary data from a German accident insurance company was analyzed in terms of reported and confirmed occupational diseases (OD) in DHW from 2006 to 2019. A total of 271 claims were reported, of which 112 were confirmed as OD, representing an average of eight per year. However, the number of claims and confirmed ODs has decreased by 65.6% and 85.7%, respectively. The decrease was most evident for hepatitis B (HBV) and C (HCV) infections, while tuberculosis (TB) infections were stable. A total of 44 HCV, 33 HBV, 6 TB and 24 latent TB infections were confirmed as ODs. For DHW, 0.05, and for hospital workers, 0.48 claims per 1000 full-time equivalents (FTE) were registered in 2019. In a separate documentation system, between March 2020 and February 2021, 155 COVID-19 claims were registered, and 47 cases were confirmed as ODs. For DHW, 0.7, and for hospital workers, 47.3 COVID-19 claims per 1000 FTE were registered since 2020. Occupational infectious diseases rarely occur among DHW. Nevertheless, new infectious diseases such as COVID-19 pose a major challenge for DHW. Continued attention should be paid to infectious disease prevention.

Recommendations for Safe Dental Care: A Systematic Review of Clinical Practice Guidelines in the First Year of the COVID-19 Pandemic

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.

Methodology for Addressing Infectious Aerosol Persistence in Real-Time Using Sensor Network

Human exposure to infectious aerosols results in the transmission of diseases such as influenza, tuberculosis, and COVID-19. Most dental procedures generate a significant number of aerosolized particles, increasing transmission risk in dental settings. Since the generation of aerosols in dentistry is unavoidable, many clinics have started using intervention strategies such as area-filtration units and extraoral evacuation equipment, especially under the relatively recent constraints of the pandemic. However, the effectiveness of these devices in dental operatories has not been studied. Therefore, the ability of dental personnel to efficiently position and operate such instruments is also limited. To address these challenges, we utilized a real-time sensor network for assessment of aerosol dynamics during dental restoration and cleaning producers with and without intervention. The strategies tested during the procedures were (i) local area High-Efficiency Particle Air (HEPA) filters and (ii) Extra-Oral Suction Device (EOSD). The study was conducted at the University of Washington School of Dentistry using a network of 13 fixed sensors positioned within the operatory and one wearable sensor worn by the dental operator. The sensor network provides time and space-resolved particulate matter (PM) data. Three-dimensional (3D) visualization informed aerosol persistence in the operatory. It was found that area filters did not improve the overall aerosol concentration in dental offices in a significant way. A decrease in PM concentration by an average of 16% was observed when EOSD equipment was used during the procedures. The combination of real-time sensors and 3D visualization can provide dental personnel and facility managers with actionable feedback to effectively assess aerosol transmission in medical settings and develop evidence-based intervention strategies.