Impact of coronavirus pandemic in appointments and anxiety/concerns of patients regarding orthodontic treatment

The effect of dispositional resilience on the relationship between professional quality of life and psychological distress factors of nurses during the pandemic: A three-wave longitudinal study

BACKGROUND

COVID-19 overwhelmed all healthcare workers, especially nurses, who worked tirelessly in patient care in extremely stressful situations. Italy, with its hospital overcrowding and staff shortages, exacerbated these negative consequences.

DESIGN

A three-wave prospective longitudinal-design was adopted to use validated scales to examine the trend of stress, anxiety, depression and resilience on the professional quality of life of nurses who worked during the pandemic. During an 8-month period, a sample of 411 individuals was recruited and surveyed three times.

RESULTS

Resilience showed an increasing positive trend from the first to the third wave, increasing its effects on the outcomes and demonstrating its important protective role. The compassion fatigue showed progressively higher scores in the three waves, indicating greater workload perception and greater difficulty in managing the patients' perceived stress. Burnout increased in the first compared to second waves but decreased significantly in the third wave, due to the effect of resilience on burnout that was significantly stronger in the third wave.

CONCLUSION

Our findings align with the literature about the role of resilience and emphasize the importance of investing in strategies aimed at developing resilience in healthcare workers and providing prevention and assistance to them in terms of job demands and unsustainable stressors.

Changes in oral home care and smoking habits during COVID-19 pandemic: A cross-sectional study

OBJECTIVES

The coronavirus disease-19 (COVID-19) pandemic has caused disruption in the health behavior in many aspects of life. While hand hygiene was promoted as one of the precautionary measures to mitigate and contain COVID-19, oral health and smoking might have received less attention in the media campaigns. The aim of this study was to examine health behavioral changes in terms of oral home care habits, smoking, and perception of dental care during the COVID-19 pandemic.

MATERIAL AND METHODS

An online survey was designed to assess oral home care, smoking habits, and attitude toward dental services of participants aged 18 years and older. The data were collected between September and November 2021. The strength of association between changes in oral home care habits, smoking, and attitude toward invasive/long dental procedures and each variable was measured by χ2 analysis. Estimates of relative risk were also calculated for all variables. Predictors of avoiding dental procedures were estimated by a binary logistic regression.

RESULTS

A total of 532 participants, based in the United Arab Emirates, took part in this online survey with a response rate of 88.7%. The age of the participants ranged between 18 and 67 with mean age of 34.9 ± 9.0 years. The majority of the participants have adopted changes in their routine oral home care habits, with 82.1% of them changing the toothbrush more frequently. Participants who changed their oral home care habits were more likely to have received sufficient information on the importance of maintaining oral health. Likewise, the changes in smoking habits were significantly associated with receiving information on the relationship between smoking and the severity of the COVID-19 (p < 0.001).

CONCLUSIONS

The findings showed that positive behavior toward oral home care and smoking was noticed during the pandemic particularly when public receives sufficient and up-to-date information.

Orthodontic Patients with Poor Oral Health-Related Quality of Life are More Likely to Have Emotional Distress: A Cross-Sectional Study

OBJECTIVE

This study aims to investigate the relationship between oral health-related quality of life (OHRQoL) and emotional distress (ED), including anxiety and depression, in orthodontic patients.

METHODS

A cross-sectional study was conducted involving 603 orthodontic patients, consisting of 401 females (66.5%) with a mean age of 24.15 ± 7.72 and 202 males (33.5%) with a mean age of 24.16 ± 7.72. A questionnaire containing questions of demographic information, the Oral Health Impact Profile (OHIP-14) and the Huaxi emotional-distress index (HEI) was employed to assess OHRQoL and ED. According to the HEI score, the respondents were divided into ED group (HEI > 8) and non-ED group (HEI ≤ 8). Data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney test and logistic regression analysis with the significance level set at p < 0.05.

RESULTS

The prevalence of poor OHRQoL and ED of the study sample was 28.4% and 19.57%, respectively. There was a significantly higher prevalence of ED among poor OHRQoL patients (35.67%) compared to those with good OHRQoL (13.19%) (p < 0.001). Poor OHRQoL and risky drinking behavior addressed higher significant correlation with ED patients than non-ED patients (p < 0.05). There were no statistical differences in other factors such as gender, age, and appliance type (p > 0.05). Poor OHRQoL orthodontic patients were at a higher risk of suffering from anxiety and depression compared to those with good OHRQoL (age-risky drinking behavior-sex-adjusted: OR = 4.00; all p < 0.001).

CONCLUSION

Oral health-related quality of life (OHRQoL) is related to emotional stress. Namely, patients with poor OHRQoL are more likely to experience anxiety and depression. As a result, orthodontists should consistently assess the emotional well-being and OHROoL of patients over the treatment course for better treatment outcomes.

Technology-enhanced simulation-based learning in orthodontic education: A scoping review

INTRODUCTION

Technology-enhanced simulations seem to be effective in dentistry, as they can support dental students to improve competencies in simulated environments. However, implementation of this technology in orthodontic education has not been reviewed.

OBJECTIVE

This scoping review aimed to comprehensively summarize the use of technology-enhanced simulations in orthodontic practice.

METHODS

A systematic search was conducted to identify literature on technology-enhanced simulation-based learning in orthodontic education published from 2000 to 2021. The search was conducted up to September 2021 to identify articles from Scopus, Embase, PubMed, ProQuest Dissertations & Theses Global, Google Scholar and the reference lists of identified articles.

RESULTS

The search identified 177 articles. Following the inclusion and exclusion criteria, 16 articles of 14 digital simulators were included in this review. The findings demonstrated an increasing use of technology-enhanced simulations in orthodontic education. They were designed in several formats, including three-dimensional virtual format, augmented reality, virtual reality, automaton, haptic, and scenario-based simulations. These simulations were implemented in varied areas of orthodontics including diagnosis and treatment planning, bracket positioning, orthodontic procedures, facial landmark, removable appliance and cephalometric tracing. Most included articles demonstrated the development process without outcome evaluation. Six studies provided outcome evaluations at reaction or learning levels. None of them provide the evaluation at behaviour and results levels.

CONCLUSION

Insufficient evidence has been generated to demonstrate the effectiveness of technology-enhanced simulations in orthodontic education. However, high-fidelity computer-based simulations together with robust design research should be required to confirm educational impact in orthodontic education.

The Impact of the COVID-19 Pandemic on Pediatric Dentistry: Insights from an Italian Cross-Sectional Survey

BACKGROUND

The COVID-19 pandemic has had a significant impact on pediatric dentistry and also dental education. This study aimed to assess the observed changes in children's oral health by pediatric dentists and also served as an educational tool for dentistry students during the pandemic.

METHODS

Postgraduate students in pediatric dentistry prepared a survey addressed to Italian pediatric dentists. Over 5476 dentists were invited to participate, and collaboration among the students took place through virtual meetings and electronic platforms. The online questionnaire was composed of 29 questions focusing on the management of pediatric patients during and after the lockdown period. A descriptive statistic was used for data analysis, and chi-square tests were performed (p < 0.05).

RESULTS

A total of 1752 pediatric dentists participated in the survey. During the lockdown, 68.3% of dentists exclusively handled dental emergencies. In the subsequent semester, a significant decrease in the number of pediatric treatments was reported. Pediatric dentists also noted a decline in children's oral hygiene practices, a deterioration in dietary habits, and an increase in anxiety during dental procedures.

CONCLUSIONS

This survey shed light on the diverse effects of the pandemic on children's oral health and also provided valuable educational insights.

Determining the Impact of the COVID-19 Pandemic on Dental Care in the Serbian Adult Population: An Online Questionnaire-Based Study

BACKGROUND Emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) could lead to an increase in dental anxiety, avoidance of dental visits, and general neglect of oral health. This online questionnaire-based study conducted in April and May of 2021 in Serbia aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on dental care. MATERIAL AND METHODS The study included 2060 adult citizens of the Republic of Serbia who participated in an anonymous online questionnaire based on a 5-point Likert scale. Data were collected on dental care routine prior to and during the pandemic, and the fear of negative consequences for oral health. The results were statistically analyzed using descriptive statistics, Pearson's correlation coefficient, ANOVA, and the paired t test. RESULTS Approximately one-fifth of the respondents postponed dental visits during the pandemic. Concern about postponing dental treatment was expressed by more than one-half of the respondents (57.1%), while 21.4% thought that they were already experiencing the consequences. Avoidance of preventive examinations and improvement of oral hygiene are more common among the elderly compared to younger respondents (P=.000). CONCLUSIONS The COVID-19 pandemic did not significantly affect the habit of avoiding dental interventions due to fear, but it did lead to part of the population completely avoiding even urgent dental interventions during the peak of the pandemic, and opting for tooth extraction rather than treatment. The strongest impact on dental care in the pandemic was among people over 64 years old.

Orthodontic emergencies and mental health of patients undergoing orthodontic treatment during COVID-19 pandemic: A questionnaire study

Objectives

To evaluate the impact of COVID-19 pandemic on orthodontic treatment and mental health of patients undergoing orthodontic treatment and to compare their mental health with the age-matched control group.

Materials and methods

484 orthodontic patients (245 males and 239 females) and 200 age-matched control subjects were divided into two age groups. Group 1 had 14-18 years of adolescents (N = 274) and 100 control participants (Group 2) and Group 3 comprised of 19 years above adults (N = 210) and 100 control participants (Group 4). Group 1 and 3 patients filled the 4 sections of the questionnaire related to orthodontic emergencies (Sections 1-3) and mental distress (Kessler Psychological Distress Scale-Section 4), while groups 2 and 4 were asked to fill only Section-4. The comparison of mental distress on high/low Kessler scores was made using the Chi-Square test/Fisher's exact test. The factors which came out to be significant were put to bivariate logistic regression analysis.

Results

The percentage of patients with high Kessler scores among Group 1 and Group 3 were 9.9% and 17.2% respectively, and their differences with age-matched control groups were non-significant. The mean differences of Kessler score were significantly higher for Group 3 compared to group 1. The higher Kessler score was associated with age, higher education, a feeling of concern for non-availability of appointments, increased treatment duration, its effect on the quality of treatment, and sabotaging of definitive future plans.

Conclusions

The orthodontic treatment and emergencies may not be a significant factor contributing to increased stress among patients during the lockdown.

The development of a novel Orthodontic Alignment Index and its use to evaluate the effect of residual overjet on the stability of the alignment of the maxillary anterior dentition

BACKGROUND

It is thought that achieving a normal overjet may help to stabilise the alignment of the maxillary anterior dentition. Little's Irregularity Index is limited in assessing discrete post-orthodontic changes, fails to account for reciprocal rotations and is not sensitive to dental changes in three planes. A more holistic tool for the assessment of post-treatment change is therefore required.

AIM

To compare the post-treatment stability of maxillary anterior dental alignment in subjects treated either to a Class I incisor relationship or an increased overjet (> 4 mm) following fixed appliance-based orthodontics using a novel measurement tool.

MATERIALS AND METHODS

The Orthodontic Alignment Index (OAI) was developed and validated using a panel of 63 raters. The new index accounts for a range of weighted features including contact point displacement, spacing, reciprocal rotations, inclination, angulation and vertical discrepancy. A retrospective cohort study was undertaken at the Institute of Dentistry, Queen Mary University of London. Recruitment took place over a 4-year period. All participants had removable retainers in the maxillary arch only. The stability of maxillary anterior teeth was assessed using Little's Irregularity Index (LII) and the OAI. Subjects were recruited at least 12 months following completion of dual-arch fixed appliance-based treatment.

RESULTS

Eighty-two participants were included with a positive correlation observed between LII and OAI at the 12-month post-treatment review with a 1-mm increase in LII associated with a 2-point increase in the OAI (P < 0.001). Limited relapse was observed in both groups: normal overjet group (OAI = 1.28; LII = 0.52); residual overjet group (OAI = 0.88; LII = 0.47). Median regression analysis failed to identify a significant association between an increased overjet at debond and the alignment of the maxillary anterior segment when assessed with OAI (P = 0.389) and LII (P = 0.577). Furthermore, age, gender, extraction protocols and retention regime were not predictive of post-treatment change.

CONCLUSIONS

Using a novel index (OAI) and LII, there was limited post-treatment relapse in alignment of the maxillary anterior dentition over a 12-month period. Based on this retrospective evaluation, achieving a normal overjet at the end of treatment may have little bearing on the post-treatment stability of maxillary anterior alignment at 12 months.

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

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

Impact of the COVID-19 pandemic on the self-reported competencies of dental graduates in a Malaysian setting

INTRODUCTION

COVID-19 pandemic has disrupted the clinical training of dental programmes worldwide. This study aimed to assess the self-reported competencies of dental graduates directly affected by the COVID-19 pandemic, as compared to the cohort before the year 2020.

MATERIALS AND METHODS

A questionnaire consisting of eight domains with 43 questions was sent to all the Universiti Kebangsaan Malaysia's (UKM) dental graduates of 2019 and 2020 cohorts. The domains were as follows: (A) gathering information at chairside, (B) diagnosis, (C) treatment planning, (D) treatment and prevention, (E) community-based, (F) management and administrative, (G) communication and (H) personal management and professional development. Three additional questions were included to assess satisfaction on clinical teaching and supervision, requirements and assessment and cross-infection control.

RESULTS

A total of 54 (91.5%) and 45 (100%) questionnaires were returned by the 2019 and 2020 cohorts, respectively. The 2019 cohort consistently perceived their competencies to be high across all the eight domains, and these responses were significantly higher than the 2020 cohort for seven out of the eight domains (p < .005). The 2019 cohort also consistently perceived their competencies higher compared to the 2020 cohort for 40 out of 43 skills. Eleven skills were deemed to have "poor ratings," and seven of these skills were rated significantly lower by the 2020 cohort than the other cohort (p < .005).

CONCLUSIONS

The findings of this study highlight the impact of the COVID-19 pandemic on the self-perceived competencies of dental graduates. The 2020 graduates reported lower percentages of competent responses, mainly for community-based skills and management and administrative skills, even though they were deemed competent and graduated. The loss of clinical time and the suspension of certain face-to-face activities significantly affected their perceived competencies.

Dynamics of Social Media Popularity of “Do It Yourself” Orthodontic Aligners: A YouTube Case Study

Objective

To have an understanding of the fact how the popularity of “do it yourself” (DIY) videos available on YouTube correlate with authorship, content, quality, reliability, and how they appeal to and influence the customers.

Materials and Methods

A new YouTube account was created, this was followed by a determination of the most commonly used keywords regarding DIY aligners by using “Google Trends.” The keywords were used to search the YouTube website. A total of 112 videos were assessed for various parameters, such as completeness of the content, reliability using a modified version of the DISCERN tool, and quality using a Global Quality Score (GQS). Out of 112 videos, 26 were rejected based on their relevance, duplication, videos without audio, and video language. Pearson’s correlation coefficient was used to study the relationship between the variables, authorship, popularity, and recommendations.

Results

The majority of the videos were uploaded by the laypeople (43%), followed by DIY aligner companies (38%), and dentists and orthodontists (16%). The content for most of the videos was poor (82%), with DISCERN reliability score of zero (65%), and GQS of 1 and 2 (poor to generally poor quality). The view of uploaded videos, view rate, and likes was in proportion to the quality of the videos, their popularity, and reliability. Further authors with a financial interest and poor quality, content, and less reliability of the videos usually recommended the DIY aligners. The reduced cost was one of the important factors for the customers to consider DIY aligner treatment.

Conclusion

YouTube videos on DIY aligners should not be considered a reliable source for the public in general who are looking for orthodontic treatment for correction of their dentofacial irregularities. The dental professional bodies and orthodontists should use social media platforms (YouTube) to increase awareness about the DIY aligners among the public.

The impact of COVID-19 pandemic on total treatment time of fixed appliances

BACKGROUND

Several aspects of the orthodontic routine seem to have been affected since the emergence of SARS-CoV-2. We aimed to evaluate the impact of the COVID-19 pandemic on the duration of fixed orthodontic treatment.

METHODS

This retrospective study evaluated consecutive cases of patients undergoing fixed orthodontic treatment that completed treatment before (n = 37) or during (n = 26) the COVID-19 pandemic. The impact of the pandemic on treatment time was adjusted for the patient's initial age, sex, number of debonds/breakages, number of missing teeth, initial PAR (Peer Assessment Rating) index (T0) and operator (n = 2), through multiple linear regression. The impact generated by months of treatment conducted during the pandemic period was also examined. Seven poorly finished cases were previously excluded, including five finished during the pandemic.

RESULTS

Although the number of absences/missed appointments of patients treated during the pandemic was four months more than those treated in the previous period (p < 0.001), there was no significant effect of the pandemic on total orthodontic treatment time for both operators. There was also an effect of operator (β = 10.42, p < 0.001) and gender, which was lower in females (β = 4.77, p = 0.03), on treatment time (R2 = 0.27). The other variables showed no significant association (p > 0.05).

CONCLUSION

The COVID-19 pandemic did not have a significant effect on total orthodontic treatment time, although a greater number of absences/missed appointments were observed.

Knowledge, attitude, and behaviour of dentists working during the COVID-19 pandemic: A cross-sectional survey

BACKGROUND: The coronavirus disease 2019 (COVID-19) has immensely affected the world’s population at physical and psychosocial levels. Dentists are no different from other healthcare providers, as they are equally if not more exposed to the threat of getting infected. OBJECTIVE: To assess the experience and behavior of public and private sector dentists practicing during the COVID-19 pandemic and their knowledge about it. METHODS: A cross-sectional survey was conducted online by sharing google forms through email, WhatsApp, and Facebook. The survey included questions on the knowledge, attitude, and behavior of dentists practicing during COVID-19. The data was interpreted by SPSS 24 using a chi-square test, and a value of p < 0.05 was considered significant. RESULTS: A considerable number of general dentists (26.9%) and specialists (39.4%) adopted partial suspension of clinics. Restriction’s ease allowed 50.2% of the clinicians to resume their duties. 67.9% of the patients were medicated online during the lockdown phase. There was no significant difference regarding years of experience and willingness to treat/care (p-value 0.648). Personal protective equipment (PPE) was readily available for use in public or private practices, and the respondents agreed with its efficacy in protecting the operators. Compliance with PPE wear was 50% in all the respondents. CONCLUSION: The psychosocial repercussion of the pandemic continues to affect dental practices. Our attitude needs to improve as far as PPE is concerned, with regular training workshops and continuous updates of the developing Knowledge on COVID-19.

Dental Service and Resource Needs during COVID-19 among Underserved Populations

Introduction:

In response to the coronavirus disease 2019 (COVID-19) outbreak, dental services in British Columbia, Canada, were restricted to urgent and emergency cases between March 16 and May 18, 2020. It is unclear how the curtailment of oral health services has affected underserved populations who already often have limited access to dental care due to cost, fear, stigma, and discrimination.

Objectives:

To explore the experiences of underserved populations and their community organizations when accessing oral health services and information in British Columbia and identify their coping mechanisms employed during the curtailment of oral health care services.

Methods:

Semistructured, remote interviews were conducted with 13 staff and 18 members from 6 community-based organizations. These organizations serve men and women with a history of incarceration and/or experiencing poverty and homelessness, persons living with human immunodeficiency virus/AIDS, adults living with mental illness, and older adults in long-term care facilities. The interviews were audio-recorded, transcribed verbatim, and coded for emerging themes using NVivo 12 software. Thematic analysis was performed.

Results:

The pandemic raised concerns and hesitancy among underserved populations and further reduced access to care. In turn, those with unmet dental needs resorted to coping mechanisms, including turning to community support or medical services, self-management of dental issues, and not dealing with dental issues altogether. Community organizers and members outlined needed resources such as assistance navigating the dental care system, having a contact for dental-related questions, and member preparation for dental service changes, while emphasizing the importance of positive relationships with dental providers.

Conclusion:

Underserved populations who already face barriers to oral health care services experienced increased difficulty in addressing their oral health needs and concerns during the beginning of the COVID-19 pandemic. Strategies aimed at reaching out to this population and those who support them are needed to help mitigate negative coping strategies and increased oral health disparities.

Knowledge Transfer Statement:

This study depicts ways of addressing unmet oral health–related issues during the COVID-19 pandemic for underserved populations and their community organizations with policy implications as well as practical strategies.

Do Specific Craniomaxillofacial Features Correlate with Psychological Distress in Adult Pretreatment Orthodontic Patients? A Cephalometric Study

Purpose

To explore the relationship between craniomaxillofacial features and psychological distress among adult pretreatment orthodontic patients.

Methods

A group of 190 patients (95 males and 95 females) was included. Questionnaires including the Kessler psychological distress scale (K10) were sent to patients, and cephalograms were collected. Patients were divided into two groups according to K10 score: psychological distress group (score ≥ 20) and no psychological distress group (score < 20). Nineteen hard tissue and thirteen soft tissue parameters were traced on cephalograms to characterize the craniomaxillofacial features.

Results

There was no significant difference in gender or age distribution between the two groups. Male patients with psychological distress showed statistically significantly larger anterior facial height (AFH) (126.62 mm vs. 120.97 mm), upper lip length (25.11 mm vs. 23.26 mm), and smaller overbite (1.21 mm vs. 2.75 mm) than patients without psychological distress. Male patients with hyperdivergent pattern and open bite were more likely to have psychological distress. None of the parameters showed statistical differences across groups in females. Frankfort-mandibular plane angle (r = 0.235), Bjork's sum (r = 0.311), AFH (r = 0.322), overbite (r = −0.238), AFH/posterior facial height (r = 0.251), and upper anterior facial height (UAFH)/lower anterior facial height (LAFH) (r = −0.230) were correlated with K10 score in males. After adjusting gender and age, the AFH (B = 0.147) and UAFH/LAFH (B = −14.923) were significantly related with the K10 score.

Conclusion

Psychological distress was mainly correlated with hyperdivergent pattern, open bite, and larger lower anterior facial height proportion in pretreatment orthodontic patients. Orthodontists should be aware of the possible underlying psychological distress in patients with specific craniomaxillofacial features. Clinical assessment of psychological distress may need to take into account gender differences in patients.

COVID-19: The Patients' Perceived Impact on Dental Care

OBJECTIVES

 The present study aims to investigate the effect of the COVID-19 pandemic on people's mental and physical balance, oral hygiene habits, type of diet, perceived safety of returning to the dentist, and aesthetics with the use of masks.

MATERIALS AND METHODS

 An online questionnaire was submitted to the Italian population between December 2020 and January 2021. It was sent via online platforms and included 21 questions.

STATISTICAL ANALYSIS

 Differences in rates were calculated by using the Chi-square test. The level of significance was set at p <0.05.

RESULTS

 A total of 1,008 individuals completed the questionnaire. About 72% of participants were not concerned about returning to the dentist. Approximately 45% of the individuals intensified their oral hygiene and preventive rules. About 38% of participants increased their carbohydrate intake, while 28% increased their fat consumption. Furthermore, 75% of the participants felt that the mask did not diminish the beauty of their smile.

CONCLUSIONS

 Most participants felt comfortable returning to the dentist but only for more urgent treatment. However, most people reported that they had not stepped up their home oral hygiene measures. The biggest changes in the population's eating habits involved increased carbohydrate and fat consumption. Finally, most participants responded that mask use did not compromise their aesthetics.

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

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

Influence of knowledge on Brazilian student's perception of life and clinical classes during COVID-19

BACKGROUND

The current pandemic associated with SARS-CoV-2 has negatively influenced several activities, including teaching in Operative Dentistry. The aim of this study was to evaluate the influence of knowledge in Operative Dentistry on undergraduate students' perception related to personal life and return to clinical practices classes during pandemic.

MATERIALS AND METHODS

The present research was a cross-sectional, observational, and qualitative survey. The 16-item based questionnaire was sent to undergraduate students in 2020, which were divided into two groups, according to the Operative Dentistry knowledge: G1-not started clinical practice; G2-already started or completed clinical practice. Questions were focused on the impact of the pandemic in relation to their personal lives and return to clinical practice classes. Chi-square association test was performed using the SigmaPlot 12.0 software (P ≤ 0.05).

RESULTS

The response rate was 55.5% for G1 and 44.4% for G2. Regarding the questions related to personal life, G1 demonstrated higher percentages of fear of contracting the virus during theoretical classes. Same observations were found when students answered about their fear of contracting coronavirus during the clinical practice classes. However, G2 presented the highest agreement responses for the preparedness feeling to return to theoretical classroom, clinical practice classes, and the possibility of applying online learning.

CONCLUSIONS

In general, students' knowledge had little influence on perception of personal life. However, students who have more knowledge in operative dentistry presented more security about returning to clinical classes.

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.

The Attitude, Perception, and Mental Health of Patients Receiving Orthodontic Treatment During the COVID-19 Pandemic in Saudi Arabia

PURPOSE

The COVID-19 pandemic has forced dental clinics to shut down indefinitely, leaving thousands of orthodontic patients in unending fear and dismay. The study aimed to assess the attitude, perceptions and mental health status of patients undergoing orthodontic treatment in Saudi Arabia during the lockdown.

PATIENTS AND METHODS

A cross-sectional study was conducted among orthodontic patients of different clinics across Saudi Arabia and selected using two-stage clustered sampling. A validated Arabic questionnaire comprising four sections including demographic data, patients' interactions, attitude and perception, and Kessler Psychological Distress Scale was sent via digital means. Descriptive and inferential statistics were applied with the level of significance set to p<0.05.

RESULTS

A total of 512 orthodontic patients voluntarily participated in the study. Eighty-four percent of the patients contacted their orthodontist once or twice during this period, 22% percent did not receive any communication from their orthodontist, 18% were very worried about not being able to continue their treatment, 72% were concerned about the treatment duration increasing post lockdown, 18% suffered cuts or lacerations due to their appliance, and 32% had poking wires. Seventy-six percent of patients were willing to visit a clinic post lockdown only with proper preventive measures in place. A mild level of mental distress (22.76 ± 8.69) was reported using the Kessler Psychological Distress Scale. Female orthodontic patients >25 years of age with >1 year of ongoing treatment were associated with higher levels of mental distress.

CONCLUSION

The current pandemic has impacted the mental health status of orthodontic patients in some form or another. Older females with longer treatment times were more affected by the lockdown. The lack of effective communication from the orthodontist led to some negative perceptions about their treatment.

Psychological and financial impact of the COVID-19 pandemic during the first stages of the pandemic: Brazilian orthodontists´ perspective

Introduction:

Brazil faced a catastrophic situation in the coronavirus pandemic. Due to the high risk of contamination and spread of COVID-19, dentist have been attending only urgency and emergency services in Brazil at the beginning of the pandemic.

Objective:

This research aimed to evaluate the psychological and financial impacts caused by the coronavirus pandemic in Brazilian orthodontists.

Methods:

This population-based cross-sectional study collected demographic data and mental health measurements from 404 orthodontists. Depression, anxiety, insomnia, and distress were evaluated through Brazilian versions of the 9-item Patient Health Questionnaire (9-PHQ), the 7-item Generalized Anxiety Disorder scale and Mini-Tracking (GAD), the 7-item Insomnia Severity Index (ISI), and the 22-item Impact of Event Scale-Revised (IES-R), respectively. The demographic data of the sample was described using descriptive statistics. The data was analyzed according to sex, professional status, and economic income. Comparisons were performed using Chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis followed by post-hoc tests.

Results:

Females, graduate students, and lower incomes subgroups showed higher levels of depression, anxiety, insomnia, and distress. Most orthodontists showed moderate to extreme financial and professional concerns during the pandemic.

Conclusion:

The coronavirus pandemic negatively affected the psychological health and increased the financial concerns of the Brazilian orthodontists, mainly female, graduate students, and with income below 10k participants.

Attitudes, stressors and work outcomes related to the COVID-19 pandemic among dental assistants in Germany: a cross-sectional study

OBJECTIVES

The COVID-19 pandemic has posed great challenges to medical professionals worldwide. Dental assistants (DAs) are at exceptionally high risk of infection with SARS-CoV-2 due to frequent and close patient contact and involvement in various high-risk dental procedures. This study aimed to investigate attitudes, stressors and work outcomes among DAs from all over Germany at the peak of cases in spring 2020.

DESIGN

Cross-sectional study. Descriptive analysis and logistic regression.

SETTING

Dental, maxillofacial surgery and orthodontic practices across Germany, April 2020.

PARTICIPANTS

Participants aged 18 years and above and currently working as DAs in Germany.

PRIMARY AND SECONDARY OUTCOME MEASURES

A self-devised online questionnaire was employed comprising questions on SARS-CoV-2-related attitudes, stressors and work outcomes. Validated scales assessed symptoms of depression and anxiety.

RESULTS

Among 1481 participating DAs (median age 35 years, 98.4% female, 91.8% working in dental practices), major stressors were uncertainty about the pandemic's temporal scope (97.9% agreement, n=1450), uncertainty about one's financial situation (87.8%, n=1301), uncertainty about how to act correctly (87.6%, n=1298) and thoughts about a possible infection during work (83.8%, n=1241). Forty-two per cent of DAs (n=622) felt sufficiently prepared for dealing with patients with SARS-CoV-2. Only 17.5% (n=259) agreed that material for personal protection was sufficiently available. Multivariable logistic regression analyses suggested that working in a dental practice, compared with orthodontic and maxillofacial surgery practices, was significantly associated with uncertainty about one's financial situation (OR 2.13 (95% CI 1.33 to 3.44)) and with the reported availability of personal protective equipment (PPE) (0.55 (0.36 to 0.84)).

CONCLUSIONS

Training about correct behaviour of DAs during future infectious disease outbreaks is needed, especially for DAs working in dental practices. In the future, it will also be necessary to strengthen supply chains to ensure that PPE is sufficiently available in a timely manner.

What has changed in orthodontic patient care between the two surges of the COVID-19 pandemic? A thematic analysis

BACKGROUND AND AIM

The coronavirus disease 2019 (COVID-19) has brought new challenges to every specialty and orthodontics is no exception. Currently, there seems no way other than to mitigate the risk and proceed with routine orthodontic treatment. The aim of the present study was to conduct a qualitative inquiry into the coping strategies, perceptions and anticipations of orthodontic patients and the challenges faced by orthodontists.

METHODS

An in-depth telephone interview of 30 patients and/or their parents and orthodontists belonging to an Academic-based Residency Program and Private Practice was conducted regarding the challenges, opportunities and futuristic ways of coping with COVID-19. Inputs were recorded, transcripts were prepared and anonymised, and a thematic analysis was performed.

RESULTS

Six themes and several sub-themes emerged from the detailed interviews and their transcripts. The initial fearful situation due to COVID-19 has gradually transformed into a certain 'new normal' in the lives of patients and caregivers, explaining why patients started seeking orthodontic treatment as usual or even preferring to begin treatment during this period. Orthodontists in the midst of uncertainty are delivering quality care and expecting future innovations and changes to combat such pandemics.

CONCLUSION

Humans can adapt to any crisis that runs over a period of time. The new insights obtained will help to plan treatment and set up practice to cope with pandemics and crises that can affect orthodontic treatment in the future.

Effects of the COVID-19 pandemic on new patient visits for orthodontic treatment: A comparison of 2020 and the previous 3 years

BACKGROUND

Coronavirus disease (COVID-19) has led to unprecedented challenges in the arts, sports, education, finance, and healthcare. The aim of this study was to compare demographic characteristics of new-patient visits for orthodontic treatment in the pandemic year (2020) versus previous years.

METHODS

The retrospective study included patients who sought care at a tertiary orthodontic referral center between January 1, 2016 and December 31, 2020. Clinical and demographic characteristics, including age, age group (child, young adult, adult), gender, and numbers of monthly and annual new-patient visits were compared between the pre-pandemic (2017-2020) and post-pandemic (2020) periods. The daily average numbers of appointments were compared for 2019 versus 2020.

RESULTS

The average number of monthly new-patient visits was 240.69 ± 81.48 in the pre-pandemic period, as opposed to 113.75 ± 88.89 in the year 2020 (P < 0.001). The average number of monthly new-patient visits decreased by 48.3% in 2020 compared to 2019, while the average number of daily new-patient visits in 2020 decreased significantly in all months (P < 0.05), except for January (P = 0.613) compared to the monthly numbers from the previous year. No significant difference was found between the pre-pandemic period and 2020 with regard to gender (P = 0.410). In all years, the numbers of new-patient visits were higher for women, compared with men, and for children, compared with adults.

CONCLUSIONS

The results indicated a sharp decrease in the number of new-patient visits for orthodontic treatment in the pandemic year (2020) compared to previous years.

Aerosol generating procedural risks and concomitant mitigation strategies in orthodontics amid COVID-19 pandemic - An updated evidence-based review

IMPORTANCE

The ongoing COVID-19 pandemic has posed unique challenges to orthodontic profession by adversely impacting provision of in-office orthodontic care due to prevailing uncertainty around risks pertaining to splatter and 'aerosol-generating procedures' (AGPs). This review aims to provide an insight into the prevailing and emerging evidence informing potential risks related to splatter and AGPs, and risk mitigation strategies employed for reducing the potential risk of SARS-CoV-2 transmission from dental bioaerosols.

METHODS

PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, LILACS, WHO COVID-19 databases and preprint databases were searched for eligible English language publications. Citation chasing was undertaken up until the review date of 4 January 2021. Study selection, data extraction and risk of bias assessment was undertaken independently in duplicate, or else by consultation with a third author.

RESULTS

Following filter application and duplicates removed, a total of 13 articles assessing procedural mitigation measures were included. Seven included studies revealed overall low-risk of bias. The overall risk varied from unclear to high for rest of the studies, with the most concerning domains being blinding of the participants and the personnel and blinding of the outcome assessors. Accumulated consensual evidence points towards the use of dental suction devices with wide bore aspirating tips as effective procedural mitigation strategies. Variations in the literature can be observed concerning aerosol transmission associated with water spray use during debonding. Emerging direct evidence consistently supports adjunctive use of pre-procedural povidone-iodine mouthrinse to mitigate direct transmission risk in the orthodontic practice.

CONCLUSIONS

A thorough risk assessment concerning AGPs and implementation of consistent and evidence-based procedural mitigation strategies may play an indispensable role in navigating optimal orthodontic practice through unforeseen similar pandemic threats. High-quality robust research focussing on more biologically relevant models of dental bioaerosols in orthodontic settings is warranted.

A two-centre study assessing the impact of the COVID-19 pandemic on orthodontic patients in secondary care

OBJECTIVE

To evaluate the impact of the coronavirus pandemic on patients in active orthodontic treatment.

DESIGN

Digital online survey.

SETTING

Two secondary care orthodontic departments in the United Kingdom.

PARTICIPANTS

A prospective convenience sample of 103 patients in active orthodontic treatment.

METHODS

A 12-item questionnaire developed using the platform SurveyMonkey was used to assess the following: (1) patient's feelings towards attending their orthodontic appointments; (2) their desire to continue with their treatment; (3) how many patients encountered problems with their appliance during the lockdown; (4) how patients sought help during the first national lockdown period; and (5) any other concerns regarding impact on their orthodontic treatment.

RESULTS

A total of 103 participants responses were collected over a four-week period across two departments. Of them, 45% required a face-to-face appointment to solve a problem with their appliance; 45% of patients who had problems with their orthodontic appliance were able to resolve the issue through digital means either via telephone/email advice from their provider or from accessing help via the Internet; and 99% of patients wanted to continue with their orthodontic treatment.

CONCLUSION

Our study has shown that a significantly higher percentage of patients are more concerned regarding attending face-to-face appointments after the first national lockdown due to the coronavirus pandemic. Providers of orthodontic care should ensure they support their patients by providing digital support and adopt virtual means of managing emergency cases patients in the event of any further imposed national or local lockdowns. Furthermore, access and availability of emergency face-to-face orthodontic care is necessary for many patients in active orthodontic treatment.

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

OBJECTIVE

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

DESIGN

Two-phase multicentre service evaluation.

SETTING

Secondary care orthodontic departments in the South West of England.

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Patients' perceptions of orthodontic treatment experiences during COVID-19: a cross-sectional study

BACKGROUND

COVID-19 has impacted the care of patients undergoing orthodontic treatment. We aimed to provide an overall view of patients' perspectives, concerns, and expectations towards their treatment throughout the clinic lockdown during the pandemic; and to assess patients' levels of mental distress and its association with their confidence in resuming care.

METHODS

An anonymous, validated, in-person paper questionnaire was distributed to adult orthodontic patients' post-lockdown at an academic institution. The survey focused on the clinical aspects and patients' perspectives regarding orthodontic treatment during the pandemic. The Kessler Mental Distress Scale (K10) was used to evaluate their psychological status. Survey responses were descriptively summarized and confidence in resuming care was compared between normal patients and patients with mental distress using Mann-Whitney tests.

RESULTS

One hundred fifty-four patients were surveyed from July to October 2020. Mean age of the participants was 29.30 (SD = 12.01) years and 62% were females. Emergencies during the closure (21%, 32/154) involved primarily irritation with protruding wires. Patients were neutral regarding tele-dentistry and preferred their current fixed appliances over clear aligners. Upon resuming care, 80.51% were extremely pleased with the restrictive protocols and with high level of confidence in resuming treatment. The average level of anxiety was low, and a modest association was found between mental distress and reduced confidence in resuming treatment.

CONCLUSIONS

Few numbers of minor emergencies occurred during the clinic closure. Despite the rising interest in tele-dentistry, patients were neutral on considering this option to monitor treatment and were content with fixed appliances. Patients had high confidence levels to resume their care based on the protocols established upon reopening. The association of mental distress and confidence in resuming care is suggestive and needs further investigation.

Evidence mapping and quality analysis of published dental literature on COVID-19 - A systematic review

A large number of scientific articles have been published regarding impact of COVID-19 infection on dental practice, dental professionals, and the mode of spread of infection via dental procedures. The present systematic review was planned with an aim of evidence mapping and quality analysis of published research on the dental aspects of COVID-19 infection. The protocol was registered at https://share.osf.io/registration/46221-C87-BA8. The search was performed in Scopus, PubMed, Cochrane, and Embase databases till 15th July 2020. There was no restriction of year of publication and language. All types of published articles related to Dentistry, Dentist, Dental practice, and Oral health education on COVID-19 were included. The Joanna Briggs Institute's (JBI) Critical Appraisal Tools were used for the risk of bias analysis of included studies. A total of 393 articles were short-listed and were checked for eligibility and finally, 380 articles were included. Among the 380 research articles published (till July 15, 2020), the majority of the included articles belonged to the lowermost strata of the evidence pyramid. There were 54 original research articles with no randomized clinical trial, systematic review or, meta-analysis pertaining to the dental perspective of COVID-19 infection. The level of available evidence about dentistry and COVID-19 infection is very low with a lack of researches of highest quality. The guidelines/recommendations for dental professionals, proposed by the different scientific organizations/societies regarding COVID-19 infection are only consensus-based necessitating the need to formulate evidence-based guidelines. There is a need to identify essential research questions and strengthen the study designs in most of the aspects related to the dentistry and COVID-19 pandemic.

The perception of COVID-19 among Italian dental patients: an orthodontic point of view

BACKGROUND

The present study aimed to investigate the patients' perception of the dental practice during the COVID-19 outbreak, and whether the pandemic will affect the attendance of orthodontic patients at the dental practice. An online questionnaire, including the Patient Health Questionnaire-4 (PHQ-4), was submitted to Italian dental patients with items about their perceived risks when going to the dentist, concerns about continuing orthodontic treatment, and the onset of temporomandibular disorders (TMD). Data were analyzed with a chi-square test and logistic regression analysis. The level of significance was set at P < 0.05.

RESULTS

A total of 1566 subjects completed the survey, including 486 who were under orthodontic treatment or who had a child in orthodontic treatment. A total of 866 participants (55.3%) thought the risk of contracting the COVID-19 infection was higher in a dental practice; this perception was associated with gender (women more than man), age (over 60 years old) and high levels of distress (P<0.001). However, 894 patients (57.1%) felt comfortable going back to the dentist. Most of the orthodontic patients (84%) would continue their treatment. After the lockdown, there was a slight increase in the frequency of TMD pain (356 versus 334).

CONCLUSIONS

Most of the participants believed that the dental practice is a place at greater risk of contracting COVID-19, even if they continue to go to the dentist. Gender, age, and the level of distress were associated with the increase in the fear of going to the dentist due to COVID-19. Because of the pandemic, 16% of patients undergoing orthodontic treatment would not return to the dental practice to continue their orthodontic treatment after the lockdown. The prevalence of TMD pain in the population increased due to the pandemic.

Does the use of face masks during the COVID-19 pandemic impact on oral hygiene habits, oral conditions, reasons to seek dental care and esthetic concerns?

BACKGROUND

To evaluate the impact of the use of face masks on oral hygiene habits; oral conditions self-perception; reasons to seek dental treatment; and esthetic concerns.

MATERIAL AND METHODS

1346 participants answered a web-based survey with questions related to the aims of the study. Descriptive statistic was performed and the responses were analyzed with chi-square test and regression analysis.

RESULTS

With the use of masks, toothbrushing frequency decreased significantly, and people are significantly less concerned about oral hygiene. The number of subjects that reported to have halitosis increased significantly and this was associated with a decrease in toothbrushing frequency. The greatest complaints of subjects were teeth color and alignment. The prevalence of bruxism increased significantly. Overall, 94.1% considered that esthetics is important to seek dental care even with the use of masks, and 84.2% are maintaining usual periodic dental care. People are significantly less concerned with their smile and dental esthetics with the use of masks.

CONCLUSIONS

With the use of face mask, people must be motivated regarding maintaining oral hygiene habits. Some respondents will seek dental care only when masks were no longer necessary, therefore dentists must be aware of a reduction in the volume of patients. Key words:Dental health surveys, esthetics, oral hygiene, dental care, COVID-19, behavior.

COVID-19 and Orthodontics: An Approach for Monitoring Patients at Home

Aim:

The aim of this study was to test an experimental approach involving the remote monitoring of orthodontic patients through the use of their smartphones.

Background:

Due to the COVID-19 emergency, dental offices were asked to stop elective treatments; suddenly orthodontic patients found themselves isolated at home, without the possibility of monitoring by their orthodontists. The use of telemonitoring via smartphones can be a quick way to recover the orthodontist-patient relationship, monitor and continue the treatment.

Objective:

The purpose of this study was to propose an innovative, simple and reliable approach for the remote management of orthodontic patients.

Methods:

137 patients were contacted verbally by phone and via WhatsApp®; they were asked to send a set of photographs taken with their smartphone. They were asked to complete a questionnaire to evaluate the effectiveness of the approach. Descriptive statistics (frequency with percent) of questionnaire results and the presence of procedural errors while taking pictures were calculated. Correlations between different questionnaire answers were analyzed with the Chi-Square test. Variables with p < 0:05 were declared as significant.

Results:

The majority of patients considered that this approach was positive and they did not feel abandoned. Difficulties emerged from a technical point of view, that is, in terms of photoshoot, and part of the patients expressed perplexity regarding the fact that telemonitoring can replace completely an outpatient visit.

Conclusion:

The use of telemonitoring managed to recreate a relationship with the orthodontist, especially in emergency periods.

Orthodontic treatment in times of Covid-19

During the first two months of the Coronavirus Disease 2019 (Covid-19) pandemic, Romania was in lockdown, and all dental practices were closed, so orthodontic patients had to postpone their check-ups for at least eight weeks. This led not only to a delayed end of treatment but also to accidents and complications. The present study tried to evaluate the orthodontic situation both from the patient's and orthodontist's point of view, so the patients were given a few questions to answer, and the orthodontist analyzed each treatment before and after the two-month lockdown and decided if it was mildly or severely affected by the absence of check-ups. The study group consisted of 105 patients evaluated by three orthodontists in the same private practice. Patients that have gotten worse after the lockdown or who had problems were included in the study. Also, all the patients were given a 7-question form in order to find out their opinion. After two months without check-ups, our orthodontists found that 9.52% got worse because of the lack of intermaxillary elastics, broken brackets, broken removable orthodontic appliances, and others. Most of the patients believe that their treatment was delayed by the Covid-19 pandemic, but none of the patients felt unsafe when visiting the clinic. The Covid-19 pandemic had severe effects on orthodontic treatments. Orthodontists noticed a delay for about one-third of their patients. However, from the patient's point of view, half believe that their treatment was negatively affected by the Covid-19 pandemic in different degrees.

Impact of the coronavirus disease 2019 pandemic on orthodontic patients and their attitude to orthodontic treatment

INTRODUCTION

This study aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on the orthodontic patient. It also assessed the knowledge and attitude of patients to the COVID-19 infection and the willingness to carry out specific precautionary measures in the orthodontic clinics to mitigate the spread of the virus.

METHODS

It was a cross-sectional descriptive study. Questionnaires were distributed to orthodontic patients via Google forms. The questionnaire assessed participants' knowledge, attitude, the impact of the COVID-19 pandemic on orthodontic treatment, and willingness to carry out infection control precautionary measures in the orthodontic clinic.

RESULTS

A total of 304 responses were obtained; 83 males (27.3%), 221 females (72.7%) with a mean age of 35.6 years. Subjects demonstrated good knowledge of COVID-19 infection (94.7%). Most respondents (95%) considered the infection as dangerous and believed the orthodontic patient was at risk of contracting the disease but were willing regardless to carry on with their orthodontic treatment during the pandemic. Fear of contracting the COVID-19 virus during orthodontic appointments and missed orthodontic appointments (74%), and increased treatment time (50%) were the immediate and long-term concerns, respectively. A high acceptance rate of compliance to precautionary measures to mitigate virus spread in the clinic was observed.

CONCLUSIONS

The COVID-19 pandemic has had a negative impact on the orthodontic treatment and the financial and emotional wellbeing of orthodontic patients. Patients were willing to continue with orthodontic management during the pandemic while complying with precautionary measures to prevent disease spread in the orthodontic practice setting.

Appointment impact and orthodontic emergency occurrence during the coronavirus disease 2019 pandemic: A retrospective study

Introduction

This retrospective study aimed to quantify the impact of coronavirus disease 2019 (COVID-19) on the orthodontic appointment and make an analysis of orthodontic emergencies (OEs) that occurred during the pandemic.

Methods

A total of 628 patients were randomly sampled from 3489 subjects who were undergoing active orthodontic treatment with fixed appliances, and the medical records were reviewed. OE occurrence was analyzed from 617 patients who had explicit return-visit records after the COVID-19 outbreak. Wilcoxon signed rank tests, chi-square tests, and a binary logistic regression were performed.

Results

The return-visit of 98.6% of the patients was delayed significantly with an increase over 8.98 ± 4.76 weeks (P <0.001). In general, 32.3% of the patients suffered from various OEs while waiting for their first return-visit, and bracket or band debonding was the most frequently reported category. Most OEs did not receive timely treatments because of the lockdown. The incidence was nearly 2 times higher than that of the normal appointment times. No correlation was found between OE occurrence and different demographic and clinical characteristics of patients. The therapeutic progress of patients, especially those in stage 3, was postponed because of the occurrence of OEs.

Conclusions

Regardless of the limitations, our study suggested that it is highly possible that the COVID-19 pandemic has delayed appointments of fixed orthodontic patients. OEs did bother a minority of patients and could not be settled in time during the lockdown, which had a negative impact on the near-term treatment progress and should have been prevented. Further studies are required to investigate the long-dated influence of COVID-19 on orthodontic practices.

The Impact of the COVID-19 Epidemic on Orthodontic Patients in China: An Analysis of Posts on Weibo

Background: During the COVID-19 pandemic, many dental care services including orthodontic practice were suspended. Orthodontic patients turned to social media platforms to communicate, share experiences, and look for solutions. Our study aimed to investigate the attitudes and perspectives of orthodontic patients during the COVID-19 epidemic in China by analyzing orthodontics-related posts on Sina Weibo (a Chinese counterpart of Twitter). Materials and Methods: Potentially eligible posts on Sina Weibo platform were collected between December 30, 2019, and April 18, 2020. Posts related to both orthodontics and COVID-19 were included and then coded and classified into specific appliances and themes. Geographic and temporal distributions of the included posts were analyzed. In addition, time-lagged cross correlation was performed to explore the association between the number of daily posts and daily new COVID-19 cases/deaths in China. Chi-square tests were employed to compare the differences between fixed appliances and aligners in problems/difficulties and feelings during the epidemic. Results: Of the 28,911 posts identified, 4,484 were included in the analysis. The most frequently mentioned themes were appointments (n = 2,621, 58.5%), negative feelings (n = 2,189, 48.8%), and problems/difficulties (n = 1,155, 25.8%). A majority of posts were tweeted in regions with high levels of economic development and population density in eastern China and from February to March. The number of daily posts had a significantly positive correlation with daily new COVID-19 cases/deaths in China (P < 0.05). Compared with clear aligners, patients with fixed appliances reported more problems/difficulties (P < 0.001) and negative feelings (P < 0.001), but fewer positive feelings (P < 0.001). Conclusions: The analysis of Weibo posts provided a timely understanding of the impact of COVID-19 on orthodontic patients. Delayed appointments were their greatest concern, and negative feelings and untreated orthodontic problems increased during the suspension of dental care services. However, patients with clear aligners reported fewer negative feelings and problems than those with fixed appliances. The findings highlighted the need to consider both treatment- and psychology-related issues of orthodontic patients and how to handle them appropriately during the epidemic.

COVID-19 pandemic and pediatric dentistry: Fear, eating habits and parent's oral health perceptions

BACKGROUND

Severe measures have been implemented around the world to reduce COVID-19 spread with a significant impact on family dynamics.

AIM

To assess the impact of the pandemic on fear, dietary choices and oral health perceptions of parents.

DESIGN

questionnaire containing 19 questions was remotely applied to 1003 parents of children aged 0-12 years. The questions addressed topics regarding changes in daily routine, dietary habits, fear level, oral health, and variation of income during the pandemic. Data analysis included the description of the relative and absolute frequencies of the variables. Association tests were performed using Fisher's exact and Kruskal-Wallis tests.

RESULTS

73% of respondents reported income loss. Five hundred sixty-eight people denied seeking medical or dental care. 61.5% of respondents revealed changes in the dietary pattern; most of them mentioned an increase in food intake. Most parents (66.6%) would only seek urgent dental care. There was an association between parents' willingness to take their children to dental appointments with the fear level (p < 0.001).

CONCLUSIONS

Most families have experienced changes in daily routine and eating habits during the pandemic. Parents fear COVID-19 and it impacts their behavior regarding seeking dental care for their children.

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

Background

The spread of Coronavirus Disease 2019 (COVID-19) has led to a major public health issue; most dental clinics were closed and millions of orthodontic patients were unable to complete their treatment. This study aimed to assess the challenges faced by patients receiving orthodontic treatment and their preferred solutions to overcoming these challenges during this pandemic.

Methods

An online questionnaire was developed and sent to patients receiving orthodontic treatment at a public or private clinic.

Results

A total of 388 responses were analyzed: mean age 20.4 ± 4 years, 75% (291) female, and 58% (226) received their treatment at a public clinic. Of all participants, 27.3% (106) were still unable to attend their appointments and 69% (244) stated that closing of the clinic was the main reason for missing their appointments. Depending on their type of appliance, the patients faced different problems and chose multiple ways to deal with them. Most participants had fixed appliances, 84% (327), and only 21% (64) of them stated that they had no problem compared with 39% (11) and 36% (8) for removable appliance and clear aligner groups, respectively.

Conclusion

The COVID-19 pandemic has had a significant impact on orthodontic treatments. Almost every orthodontic patient had to stop attending their appointments, which put them in complicated situations and in fear of delayed treatment. Patients from a public clinic and patients with fixed appliances reported more problems than others. More attention should be giving to teleorthodontics; also orthodontists should prepare their patients to deal with some of the problems related to their appliances when possible.

The Use of Facemasks During the COVID-19 Pandemic by the Brazilian Population

Objective

To evaluate the use of facemasks by the Brazilian population during the COVID-19 pandemic.

Materials and Methods

This cross-sectional study involved 1277 participants who answered a web-based open survey with questions about the use of facemasks during the COVID-19 pandemic. Descriptive statistics with percentages was performed, and the responses were analyzed with chi-square and independent t-tests.

Results

A total of 1277 answered the questionnaire, and most participants were female (81.8%). Almost all the participants (99.1%) reported wearing facemasks, and 34.2% are wearing just because it is mandatory; 65.8% would continue to wear masks even if it was not mandatory. Most subjects (50.4%) believe that masks' use effectively prevents infection by the novel coronavirus. Reusable fabric facemasks are the most used by the participants (49.5%). Almost all subjects were wearing masks to go to crowded and public places. Most respondents (67.3%) are bothered with the use of facemasks, and the most cited reason for the discomfort was feeling trapped or suffocated (58.9%).

Discussion

The use of facemasks can help prevent the COVID-19, but it is most effective at reducing the spread of the virus when the general population's compliance is high. Some factors that limit the population's compliance with the use of masks are discomfort and a sense of embarrassment. Media campaigns and public health promotion activities supported by governmental agencies can increase the use of facemasks by the population.

Conclusion

The mean level of anxiety with the COVID-19 pandemic was 6.18. Almost all the participants were wearing facemasks, and they believe that its use effectively prevents infection by the novel coronavirus. Reusable fabric facemasks are the most used by the participants. Almost all subjects were wearing masks to go to crowded and public places. The great majority of the participants feel more protected with the use of facemasks.

Psychological Functioning of Patients Undergoing Oral Surgery Procedures during the Regime Related with SARS-CoV-2 Pandemic

The coronavirus pandemic has become a huge global challenge medically, economically and psychologically. The COVID-19 pandemic shows that the population can experience general psychological distress. The sanitary regime in dental offices and lack of vaccine for coronavirus may have an impact on the level of dental anxiety among patients undergoing oral surgery procedures. A clinical study was conducted between November 2019 and September 2020. A total of 175 patients (n = 175) were enrolled in the research. The aim of the study was to assess the attitude of patients towards the new situation related to the reduced availability of dental offices providing oral surgery procedures. The level of anxiety associated with surgical intervention was measured using a self-made COVID-19 questionnaire and the MDAS scale. The ED-5Q questionnaire and EQ-VAS scale were also used in this research. The study showed that 21.9% of respondents presented with increased anxiety about a dental visit compared with the time before the pandemic. This epidemiological situation has led to an overwhelming increase in moderate dental anxiety (M: 11.4) among patients undergoing oral surgery procedures. The quality of patients’ health (EQ-VAS) related to the impact of the coronavirus pandemic and the quarantine decreased by 10 percentage points. Oral surgeons should be prepared for more anxious patients in dental offices during the pandemic.

Appropriate orthodontic appliances during the COVID-19 pandemic: A scoping review

INTRODUCTION

The esoteric Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection or COVID-19 has been an unusual plummet in dental/orthodontic practice. Based on current recommendations for various amendments in an orthodontic practice, this scoping review aims to identify orthodontic appliances that are most appropriate to us during this on-going pandemic.

METHODS

Electronic databases (PubMed, Scopus, Web of Science, Science Direct, and Google Scholar) were searched up until August 11, 2020. Full-text articles in English with keywords "COVID-19 and Orthodontics" and related search terms were included.

RESULTS

Out of 17 retracted articles, only 4 articles were found to be brief the choice for orthodontic appliances in pandemic times speculating clear aligner therapy (CAT) to be a pragmatic solution. The remaining articles were also thoroughly studied and the new norms set by the pandemic were determined. Criteria for orthodontic appliance selection included careful patient screening and collection of records, minimal physical visits, efficient use of technology, virtual consultations but the use of PPE for physical appointments; and lesser AGPs with a lesser risk of airborne transmission.

CONCLUSIONS

Subject to regional demands, CAT can be considered as the relatively safer modality-predictable and effective apposite to fixed orthodontic appliances in these unprecedented times.

Italian Response to Coronavirus Pandemic in Dental Care Access: The DeCADE Study

The aim of the study was to evaluate the impact of the coronavirus pandemic on the willingness, anxiety and concerns of Italian people on undergoing dental appointments. An anonymous survey was posted online on social media on 11 May 2020 and was completed by 1003 respondents in one week. Multiple correspondence analysis and multiple logistic regression were used to evaluate the association between socio-demographic characteristics, dental care access, contagion fear of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), trust in dentists regarding sanitization procedures and perception of the impact of the risk of contagion on dental care. Subjects with a high level of education, attending public dental offices and that are used to go to dental offices for urgent care would not feel comfortable in undergoing a dental appointment and would prefer to postpone or cancel dental visits, waiting for a decrease in the number of the contagions. Moreover, the risk of canceling or postponing the appointment at the dentist was 1.59 times greater in those who claimed to be strongly influenced by SARS-CoV-2. Fear of coronavirus disease (COVID-19), new cases decrease and the not urgent nature of dental visits influenced more than the lowered income household on upcoming or resuming dental appointments. In the next months, despite the forecasted economic crisis caused by coronavirus pandemic, fear and anxiety generated by the spread of the virus will impact more than the lowered familiar income with regards to access to dental care.

Urgencies and emergencies in orthodontics during the coronavirus disease 2019 pandemic: Brazilian orthodontists' experience

Introduction

The present study aimed to evaluate the most common urgencies and emergencies in orthodontics during the coronavirus disease 2019 (COVID-19) pandemic and to assess how orthodontists in Brazil were dealing with patients and challenges.

Methods

Early in 2020, as the COVID-19 pandemic spread around the world, routine dental care was suspended in many countries, and only patients needing urgent or emergency care could be seen. During this period, orthodontists in Brazil were invited to participate in an anonymous online survey. Over 48 hours (May 1-3, 2020), 395 orthodontists (specialists, MScs, and PhDs) responded. They answered questions regarding dental office and appointments during the pandemic, the type of urgency or emergency care provided, the type of appliance and urgencies, etc. The level of concern about the impact of the pandemic on patients' orthodontic treatments and the financial impact on the dental office was also evaluated. Descriptive statistics were performed with percentages, and responses were compared between specialists, MScs, and PhDs, using chi-square tests.

Results

Specialists were the majority of respondents. Most orthodontists were handling only emergencies or urgencies. The most frequent urgencies were bracket breakage, archwire breakage, and breakage of molar tubes and/or bands. Stainless steel fixed appliances were the most common type of appliance related to unscheduled appointments. The majority of patients got in touch with the orthodontist using the professional WhatsApp messenger (WhatsApp Inc, Menlo Park, Calif). Orthodontists were more concerned with the financial impact of the pandemic than with the orthodontic treatment itself.

Conclusions

Breakage of brackets, archwires, or tubes and/or bands were the most common causes of urgency and/or emergency appointments during the pandemic. The level of concern about the financial impact of the stay-at-home orders and the COVID-19 pandemic was significantly greater for specialists and MScs than for PhDs.

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We surveyed orthodontists in Brazil during the coronavirus disease 2019 pandemic.

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Most frequent urgencies were breakages of brackets, archwires, molar tubes, or bands.

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Stainless steel fixed appliances were the type most related to unscheduled appointments.

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Most patients contacted the orthodontist using the professional WhatsApp messenger.

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Orthodontic specialists and MScs were more concerned than PhDs about financial impacts.

COVID-19 Related Experience, Knowledge, Attitude, and Behaviors Among 2,669 Orthodontists, Orthodontic Residents, and Nurses in China: A Cross-Sectional Survey

Objectives: To assess the current COVID-19 related experiences, knowledge, attitudes, and behaviors among orthodontists, orthodontic residents, and orthodontic nurses in China, and to identify factors associated with their self-perceived and actual level of knowledge, as well as their willingness to treat/care for COVID-19 patients.

Materials and Methods: A cross-sectional online survey was conducted in China using a 37-item questionnaire developed based on previous research. A professional online survey tool (www.wjx.cn) and a social media platform (WeChat) were used to display and distribute the questionnaire. Data were collected during April 11 to 13, 2020, when most regions of China had resumed dental practice except for high-risk regions such as Wuhan. Then the data were analyzed with multivariable generalized estimating equations.

Results: A total of 2,669 valid questionnaires were collected. Orthodontic services were suspended for nearly all respondents (97.8%) during the epidemic, and 68.0% had resumed work by the time they completed the questionnaire. The majority of respondents (80.2%) were confident that they understood COVID-19 related knowledge, but most of them only correctly answered less than half of the questions testing their actual level of knowledge. About two-thirds (64.1%) were willing to treat/care for patients with confirmed or suspected COVID-19. The completion of relevant training programs was significantly associated with more confidence in knowledge mastery (P < 0.001) and a higher actual level of knowledge (P < 0.001), but did not increase their willingness to treat/care for patients with COVID-19 (P = 0.235).

Conclusions: Before work resumption, COVID-19-related training programs are essential for the improvement of knowledge, confidence, and preparedness of orthodontic professionals. Sufficient and proper protection should also be provided to ensure safety and reduce the psychological burden on them.

Clinical Relevance: The findings can provide evidence for policy-making related to the resumption of elective dental services.

How does the quarantine resulting from COVID-19 impact dental appointments and patient anxiety levels?

The present study sought to evaluate the impact of quarantine resulting from the coronavirus disease 2019 (COVID-19) pandemic on dental appointments and patients' positions and concerns regarding their ongoing dental treatment. Patients from private dental clinics answered an online questionnaire anonymously regarding their treatment, availability and willingness to attend dental appointments, and concerns about contamination. Descriptive statistics of the responses were performed with percentages and responses were compared between sexes, regions, and other aspects using the chi-squared test. Five hundred ninety-five patients (412 females and 183 males; mean age: 38.21 years) answered the questionnaire. Most patients reported they were receiving dental treatment (orthodontics) and would attend to a dental appointment; meanwhile, those patients not receiving treatment would not attend or would visit only in the case of an emergency. Males reported to be calmer than females, who were more anxious and afraid; as such, males reported more willing to go a dental appointment while, in general, females were not worried about how quarantine could affect dental treatment. Patients actively undergoing treatment and orthodontic patients were more concerned about a delay in treatment. There was a significant association between feelings about the COVID-19 pandemic and the level of willingness to attend a dental appointment. The quarantine recommended due to the COVID-19 pandemic was shown to have an impact on dental appointments and the anxiety levels of patients, since there was a significant association between patients' feelings and their willingness to attend a dental appointment. Overall, patients undergoing dental treatment and orthodontics were more willing to attend an appointment and were more concerned about an increase in treatment duration.

Healthcare Workers in Brazil during the COVID-19 Pandemic: A Cross-Sectional Online Survey

Brazil is in a critical situation due to the COVID-19 pandemic. Healthcare workers that are in the front line face challenges with a shortage of personal protective equipment, high risk of contamination, low adherence to the social distancing measures by the population, low coronavirus testing with underestimation of cases, and also financial concerns due to the economic crisis in a developing country. This study compared the impact of COVID-19 pandemic among three categories of healthcare workers in Brazil: physicians, nurses, and dentists, about workload, income, protection, training, feelings, behavior, and level of concern and anxiety. The sample was randomly selected and a Google Forms questionnaire was sent by WhatsApp messenger. The survey comprised questions about jobs, income, workload, PPE, training for COVID-19 patient care, behavior and feelings during the pandemic. The number of jobs reduced for all healthcare workers in Brazil during the pandemic, but significantly more for dentists. The workload and income reduced to all healthcare workers. Most healthcare workers did not receive proper training for treating COVID-19 infected patients. Physicians and nurses were feeling more tired than usual. Most of the healthcare workers in all groups reported difficulties in sleeping during the pandemic. The healthcare workers reported a significant impact of COVID-19 pandemic in their income, workload and anxiety, with differences among physicians, nurses and dentists.