Perceived Stress in Dentists and Dental Students of Latin America and the Caribbean during the Mandatory Social Isolation Measures for the COVID-19 Pandemic: A Cross-Sectional Study

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.

Generalized anxiety disorder in Brazilian undergraduate dental students during the COVID-19 pandemic: A cross-sectional study

OBJECTIVE

Explore the prevalence of generalized anxiety disorder (GAD) and associated factors in undergraduate dental students during the first wave of the COVID-19 pandemic in Brazil.

MATERIALS AND METHODS

Cross-sectional study. A semi-structured questionnaire addressing the variables of interest was shared with dental students between July 8 and 27 2020. The outcome was determined using the seven-item generalized anxiety disorder (GAD-7) scale. A 'positive' diagnosis was defined as a total of ≥10 points on the scale. Statistical analysis involved descriptive, bivariate and multivariate analyses, with the significance level set at 5%.

RESULTS

Among the 1050 students evaluated, 53.8% had a positive diagnosis for GAD. The multivariate analysis revealed that the prevalence of symptoms was higher among individuals who resided with more than three people, those enrolled at teaching institutions that suspended all clinical and laboratory activities, those who did not have an adequate home situation to maintain distance learning, those who had been diagnosed with COVID-19, those who felt anxious about having to see patients with a suspicion or diagnosis of COVID-19 and those who preferred to interrupt in-person academic activities until the population is vaccinated for the COVID-19 virus.

CONCLUSION

The prevalence of GAD was high. Aspects related to the composition and organization of the home, the suspension of academic activities, a history of COVID-19 contamination, feelings of anxiety in providing dental care to patients with symptoms/suspected of COVID-19 infection and the preference to interrupt in-person academic activities until the population is vaccinated for COVID-19 were factors predisposing the students to anxiety during the first wave of the pandemic.

Proposal of guidelines to assist managers to face pressing challenges confronting Latin American universities: a complexity theory perspective

The Covid-19 pandemic exacerbated pre-existing problems in Latin America and posed unprecedented challenges for Latin American universities (LAU). These challenges can be characterised as complex problems that cannot be understood through reductionist approaches. This paper aims (i) to provide a complex system perspective of the challenges confronting LAUs and (ii) to propose guidelines for managers of LAUs to address them in practice. A multidisciplinary group was formed and conducted an iterative process of research, brainstorming and debate of potential solutions to the following problems considered particularly important by their universities: mental health issues in the university environment, student learning gaps, brain drain, and anti-science movements. Complexity theory and E/HF concepts are integrated to demonstrate that understanding what LAUs are experiencing in a fragmented manner is impossible, and that the interactions between the challenges should be at the centre of the managers' actions plans. Practitioner summary: Managers of LAUs can benefit from the guidelines proposed to understand the pressing challenges confronting universities and develop systemic approaches to address them.

A predictive model of perceived stress during the first wave of the COVID-19 pandemic in university students Ecuadorians

Background and objectives

The situation caused by the confinement due to the COVID-19 pandemic and the mobility restriction implemented by governments worldwide had a significant impact on people's routines. Stressors are known to increase emotional imbalance, uncertainty, and frustration in the general population. This study explores the factors that predispose to the risk of perceived stress from COVID-19 and determines the underlying mediating mechanisms in the Ecuadorian population.

Method

The cross-sectional study an incidental non-probabilistic sample of n = 977 participating student volunteers from the four regions of the Republic of Ecuador (68.6% women and 31.4% men). Data on emotional regulation (ERQ), perceived stress (PSS), active procrastination (APS), diagnosis and symptoms related to COVID-19, social isolation, coexistence, and a sociodemographic questionnaire (biological sex, marital status, and age) were recruited. Statistical analysis was based on a structural equation model.

Results

The risk of suffering perceived stress in the COVID-19 pandemic was higher for single women who have lived longer in social isolation, have lived with more people, have poor emotional regulation and high rates of procrastination. This structural model is similar in all Ecuadorian regions χ² = 21.54 (p = 0.760), RMSEA = 0.001 (95%CI, 0.00-0.02), CFI = 0.998; TLI = 0.999; SRMR = 0.020.

Discussion

Although our findings are consistent and revealing for the scientific community, the lack of discrimination of the data due to strict isolation measures, taken at different periods by the Ecuadorian government against positive cases of COVID-19, is discussed. The research was applied to the university population, it would be representative to extend the study to schools and colleges.

Conclusion

We consider this work as a starting point for the creation of preventive models against perceived stress in the university environment in the event of health emergencies.

Effect of COVID-19 on dental service delivery in Fiji: Perspective of Dental Officers (Dos) and Dental Managers (DMs)

BACKGROUND

Corona Virus Disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization (WHO) has had significant impact on dentistry in Fiji. Due to lack of previous study, this study aims to explore the perspective of Dental Officers (DOs) and Dental Managers (DMs) on the effects of COVID-19 on dental service delivery in Fiji Islands.

METHODS

This qualitative study was conducted amongst 30 DOs and 17 DMs between 9th August to 12th September, 2021. It was conducted in the government dental clinics, private dental clinics and the School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji. The study settings were randomly selected. Purposive sampling method was used for the selection of participants who met the study criteria. Semi-structure open ended questionnaires were used for data collection through in-depth interviews via zoom. Manual thematic analysis of the data was conducted to derive themes and codes.

RESULTS

The participants interviewed for the study included more female DOs (66.7%) and male DMs (58.8%). Seven themes emerged from data analysis: range of services delivered, appointment versus walk-in patients for aerosol generating procedures (AGPs), impact of pandemic on clinic opening hours, impact of COVID-19 on patient numbers, quality of services delivered, resources and infrastructure, perceptions about the burden of disease.

CONCLUSION

COVID-19 has significantly affected dental service delivery. Mostly emergency dental services were delivered. AGPs were delivered on appointment basis. Most participants stated the quality of services had improved. Participants stated that they were not given adequate resources and the infrastructure was not up to standard to provide dental services during the pandemic. The dental disease burden had increased during the pandemic as per the participants. Future research can be conducted amongst other dental professionals in other divisions of the country.

Perceptions and conducts of oral and maxillofacial surgeons during the COVID-19 pandemic: A qualitative study

Oral and maxillofacial surgeons are among the frontline healthcare workers and are classified as a high-risk group for COVID-19 infection; however, it has not yet been defined how these professionals were impacted. The aim of this study was to explore the conducts and perceptions of oral and maxillofacial surgeons during the COVID-19 pandemic in Brazil. Nine individuals, mean age 34.8 years, 66.6% men, were included in the study. A semi-structured interview with a qualitative approach was applied to professionals belonging to a messaging application group (WhatsApp). Content analysis was performed in the light of Hellerian theory in its daily theoretical framework for the interpretation of the memories reported by the participants. Four themes were identified. The lack of knowledge about COVID-19 and the fear of being contaminated during care were the main factors responsible for changes in the professionals' work routine. An important point was the collective reflection of the participants about the increase in biosafety barriers, which ensured a greater sense of security. The need for social isolation to contain the virus was also described. As a result, there was a great distance between professionals and their families, which generated high levels of anxiety in the former. Repetitive reports of slowness and reduced attendance directly related to financial loss and aggravated stress were also highlighted. The findings of this study reveal that oral and maxillofacial surgeons had their professional-personal axis affected in terms of daily habits, family life and financial strain, aspects that were responsible for impacting stress and anxiety levels.

Stressors and mental health impacts of COVID-19 in dental students: A scoping review

OBJECTIVE

The COVID-19 pandemic has led to mental health hazards to healthcare providers in general and to undergraduate dental students. The present study undertakes a scoping review to identify and discuss the mental health issues and stressors impacting dental students globally during the COVID-19 pandemic.

METHODS

A systematic search following the Joanna Briggs Institute's framework for scoping reviews was conducted on Embase, MEDLINE by Ovid, Web of Science, PsycInfo, CINAHL, and ERIC to identify peer reviewed publications published globally since the onset of the COVID-19 pandemic in March 2020 until June 22, 2021. Manual search was also performed on Google scholar. Eligible studies were selected based on the predetermined set of criteria and focused specifically on mental health issues experienced by undergraduate dental students in the context of COVID-19.

RESULTS

Fifty-five publications were retained. Fifty-one reported stress, anxiety, or depression experienced by undergraduate dental students during the pandemic. Twenty-five studies employed validated psychometric instruments to explore mental health status among the same students. A total of 28 publications reported that the predominant concern for students was fear of infection, especially during patient interaction. Adapting to virtual learning, clinical skill deficit due to lack of/limited practical training and social isolation were other majorly reported stressors.

CONCLUSIONS

Many mental health issues and stressors related to the COVID-19 pandemic have been identified. Mitigation of COVID-19-related stressors on dental students' mental health should be a priority across all dental academic institutions. Continued efforts should be made to create a supportive learning environment.

Influence of the Sanitary, Economic, and Social Crisis of COVID-19 on the Emotional State of Dentistry in Galicia (Spain)

The main objective of this research was to analyze the economic, social, and emotional repercussions among Galician dentists (Spain) as a consequence of the COVID-19 pandemic. A survey was filled out by 347 professionals. After verifying the survey's reliability using Cronbach's alpha = 0.84, the professional activity and emotional state of the participants were assessed based on aspects related to their personal and family data. The economic impact of the pandemic was considerable, and all participants experienced a decrease in income. In total, 72% of the participants considered that working with personal protective equipment (PPE) made their clinical activities difficult, and 60% expressed concern about being infected during their professional practice. Among the professionals, women (p = 0.005), and separated, divorced, or single professionals (p = 0.003) were the most strongly affected. Separated or divorced professionals were the group that most frequently raised the need to make a radical change in their lives. Finally, it was observed that the emotional consequences varied substantially in the lives of these professionals, mainly among female dentists (p = 0.010), separated and divorced men (p = 0.000), and those with fewer years of professional practice (p = 0.021). The COVID-19 pandemic had an economic impact, due to the decrease in the number of patients and hours of attention, as well as an emotional impact, mostly expressed in the form of sleep disorders and stress. The most vulnerable professionals were women and professionals with fewer years of experience.

Applicable of teledentistry and digital platforms during the COVID-19 pandemic among dentists in Fiji: A qualitative study

Objectives

This research aims to explore the perception of dental officers (DOs) and dental managers (DMs) on the use of teledentistry and digital platforms during the COVID-19 pandemic in Fiji.

Methods

This qualitative study was conducted among 30 DOs and 17 DMs. The study was conducted in private dental clinics, government dental clinics and the School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji that were selected randomly. The participants were selected using the purposive sampling method using the inclusion and exclusion criteria. Data was collected through in-depth interviews via zoom using a self-developed semi-structure open-ended interview questionnaire. Manual thematic analysis of the data was conducted.

Results

Five themes emerged from data analysis: utilization of teledentistry and media during the pandemic, usefulness of teledentistry, confidence with teledentistry and digital platforms-associated risks, digital platforms for record keeping, and teledentistry promotion and training. Teledentistry was mostly utilized by private practitioners and the oral surgery department. Practitioners were not in favour of teledentistry as they thought it was putting them at risk.

Conclusion

Majority of DOs and DMs were not utilizing teledentistry except for a few private dental practitioners and the oral surgery department. Future research can be conducted in other divisions and include other healthcare professionals.

Psychological Impact of the COVID-19 Pandemic on Dentists in Latin America's Epicenter: São Paulo, Brazil

The present study aimed to assess the prevalence and associated factors of stress and anxiety symptoms among dentists during the COVID-19 pandemic in the state of São Paulo, Brazil. A structured questionnaire was sent electronically to 93,280 dentists with active registration in the Dental Council of São Paulo, Brazil, enquiring about information regarding the first-wave peak period in Brazil. Descriptive analyses of background characteristics, perceptions of preparedness, and psychological impact were calculated. Multiple logistic regression analysis was performed, and independent variables that showed p < 0.20 were used in the adjusted logistic regression model to compare the psychological impact on dental professionals. Among the 2113 respondents, female participants had 63% lower chance of reporting anxiety than males. Older dentists had a lower likelihood of reporting anxiety compared to 21-30-year-old dentists (p ≤ 0.05). Dentists working in the public health service were 1.78 times more likely to report anxiety than those who worked in private practice. Finally, dentists in the COVID-19 high-risk group and those with a family or team member with a positive COVID-19 diagnosis were more likely to have anxiety. This study can help dental and other healthcare professionals to better understand the consequences of COVID-19 in terms of mental health.

Influence of Country Digitization Level on Digital Pandemic Stress

A quick and effective solution to address the immediate change in teaching methods after the COVID-19 pandemic was digital learning environments (DLEs). The way in which this process of change towards DLEs was tackled was different around the world, depending on multiple factors, including the level of digitization, technology, and innovation. This paper conducts quantitative research on the influence of the COVID-19 pandemic on the adaptation of university professors to DLEs. In order to achieve this objective, a sample of 723 university professors from 15 countries in Latin America and the Caribbean was taken. The participants’ self-perception of the stress generated and their levels of digital competence during the COVID-19 pandemic were studied according to the Global Innovation Index (GII) of their country of origin. The results show that professors have an intermediate–high self-perception of both their digital competence and their ability to adapt to DLEs. It is also shown that neither the professors’ level of digital competence nor the GII of the country of origin fully explain the level of pandemic stress regarding the use of DLEs. This fact suggests that there must be other influential factors to consider, thus opening new lines of future research.

General Labor Well-Being in Latin American Dentists during the COVID-19 Pandemic

This study aimed to determine the general labor well-being of Latin American dentists according to sociodemographic characteristics during the COVID-19 pandemic. A cross-sectional study was conducted in a final sample of 2214 participants from 11 countries. A validated online questionnaire on general work well-being was used (data collection period from 1 June to 10 July 2021), containing two dimensions: psychosocial well-being and collateral effects. The sociodemographic characteristics of the dentists and their perception of the economic impact of the pandemic were also recorded. A multivariate linear regression analysis was performed (hierarchical regression model) to evaluate the joint effect of the explanatory variables on labor well-being and the changes in the variance between each model. A score of psychosocial well-being of 233.6 + 40.2 and collateral effects of 45 + 20.1 was found. Psychosocial well-being was associated with sex, country of origin, academic training achieved, type of dental activity, and perceived impact during the pandemic (p < 0.05). Somatization was frequently manifested through back pain (88.2%) and muscular tensions (87.2%). Women, those who worked 41 or more hours and had between 1 to 15 years of professional experience presented a greater collateral effect (p < 0.001). The impact of the COVID-19 pandemic a year and a half after it began on the labor well-being of Latin American dentists was evidenced with important interactions with social characteristics.

Behavioral Preventative Strategies Undertaken by Dental Clinics in Fiji during COVID-19 Pandemic

Introduction:

COVID-19 has created a significant impact on dentists and oral health professionals. This research aimed to explore the perspective of dental officers (DOs) and dental managers (DMs) on behavioral preventative strategies and recommendations for preventing the virus transmission in the dental clinics in Fiji.

Materials and Methods:

This qualitative study was conducted among DOs and DMs who worked in nine private dental clinics, eight government dental clinics, and one School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji between August 9 and September 12, 2021. The participants were selected using purposive sampling method using the inclusion and exclusion criteria. Self-developed semi-structured open-ended questionnaires were used for data collection through in-depth interviews via zoom. Manual thematic analysis of the data was conducted.

Results:

Thirty DOs and 17 DMs participated in this study. Seven themes emerged from data analysis: Risk perception-COVID-19 versus dentistry; Staff safety, satisfaction, and motivation; Breaking the chain of infection transmission; Adaptability, and acceptance; Shared responsibility; Roles and knowledge; and Importance of good planning. Majority of participants felt that dental professionals are at high risk, and hence, need to take extra precautionary measures. Participants also stated that more care should be provided to patients by accepting the situation and moving forward.

Conclusion:

This study highlighted the importance of dentists in preventing disease transmission in a dental setting. Continuation with the protocols and strategies gave the participants more sense of protection. The importance of good planning, accepting the situation, and moving forward was highlighted. Future research is recommended in other divisions and other health-care professionals can be included.

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.

The Impact of the COVID-19 Pandemic on Israeli Orthodontic Practice: A Clinic's Activity and Patients' Attitudes

The current study aimed to characterize the activity in orthodontic clinics during the COVID-19-induced lockdown and the inter-lockdown periods, as well as to evaluate patients’ perspectives with respect to their fears, their extent of cooperation with treatment, and their emergency needs during the lockdown. The data were gathered from 11 private orthodontic clinics from 1 January 2020 to 8 March 2021, which included three lockdowns and inter-lockdowns. Information specifying the number of admissions, missed appointments, and emergency visits was gathered. Four hundred and twenty-nine orthodontic patients treated in those clinics agreed to complete a questionnaire that evaluated their concerns and expectations, the treatment emergency issues, implementation of the orthodontist’s instructions, and contact with the clinical staff during lockdowns. There was a significant increase in the number of scheduled appointments during the inter-lockdown periods, compared with the pre-pandemic period (p = 0.001). No difference in the number of missed/canceled or emergency appointments was found between the different periods (p > 0.420). The majority (89.6%) of the emergency visits involved issues with appliances; 68.7% of the subjects were advised to present themselves at clinics. During the peaks of the waves of the COVID-19 pandemic, a sharp rise in the number of missed and urgent appointments was not found. Reducing the number of orthodontic emergencies may assist in reducing patient fears.

Knowledge, Attitude, and Practices of Dentists in Caribbean Countries during the COVID-19 Pandemic: A Multicenter Cross-Sectional Study

Background: The COVID-19 pandemic has affected dentists globally, both financially and mentally. This study aimed to determine the knowledge, attitude, and practices of dentists in Caribbean countries during the COVID-19 pandemic. Methods: A non-probability sample was obtained from dentists in more than ten different Caribbean countries. They were invited to complete a self-reported questionnaire, which was conducted from December 2020 to March 2021. Ethics approval was sought and an exemption was received from the UWI ethics committee. Results: One hundred and fifty-two dentists responded. More than one-third (38.8%) were in the >35–45 age group, and 58.6% were females. Most (84.9%) were general dentists and 75% were stressed by the COVID-19 situation with 80.9% being affected financially. The majority, 94.7%, believed that the highest risk of transmission of COVID-19 was via aerosol-generating procedures and 87.5% were worried about contracting it clinically. The majority (69.1%) were willing to receive the vaccine, the main reason reported for vaccine hesitancy was due to the possible side effects (35.3%). Most (75%) consumed alcohol. When the locus of control was determined, 54.6% felt they were in control of protecting themselves while 52% felt that external factors controlled their lives. Conclusions: The findings suggest that most dentists in the Caribbean were knowledgeable about COVID-19 and followed current guidelines in their practice and were willing to receive the vaccine.

Revealing Distress and Perceived Stress among Dentists at the Outset of the COVID-19 Pandemic: A Cross-Sectional Factor Analytic Study

Dentists' perceptions about the stressfulness of clinical practice are well-documented, but literature on perceived stress and psychological distress experienced during the COVID-19 pandemic is scarce. This study aims to explore the emotions and attitudes, and the socio-demographic, dental, and COVID-related factors that are associated with the emergence of perceived stress and psychological distress that have been experienced by dentists during the COVID-19 pandemic. General demographic and dental-related data, and specific questions measuring the potential factors regarding dental professionals' concerns and opinions about their professional circumstances during the pandemic, were electronically collected from 182 dental practitioners. Exploratory and confirmatory factor analyses were used to assess whether dentists' emotions and attitudes during the pandemic measure the same construct: psychological distress, while linear regression models were built on the exploration of the effects of COVID-related factors on perceived stress and psychological distress. Facets of impulsiveness, lack of interest in social connections, emotional disengagement, mood swings, and acknowledgment of emotional exhaustion due to the pandemic, were measurements of the same construct and manifested in a singular factor: psychological distress. Two aspects, the fear of aerosol propagation and insecurities of financial status, increased the likelihood of the emergence of heightened levels of perceived stress and distress, while years spent in dental practice and age seemed to be protective factors against perceived stress and distress.

Extreme Situation Experienced by Dental Students of the Medical University of Silesia Due to the SARS-CoV-2 Epidemic during the First Lockdown

The pandemic declared in many countries in 2020 due to COVID-19 led to the freezing of economies and the introduction of distance learning in both schools and universities. This unusual situation has affected the mental state of citizens, which has the potential to lead to the development of post-traumatic stress and depression. This study aimed to assess the level of stress in dental students in the context of the outbreak of the SARS-CoV-2 virus pandemic. A survey on the PSS-10 scale was prepared to measure the level of perceived stress. The study included 164 dental students at the Faculty of Medical Sciences of the Medical University of Silesia in Katowice, Poland. The results showed the impact of COVID-19 on the stress of students, with 67.7% reporting high levels of stress. The study also revealed that stress was higher among older female students. This paper recommends that the university provide more intensive psychological care as psychological first aid strategies in epidemics or natural disasters and to consider telemedicine in order to deliver services due to the limitations of the pandemic.