Multifaceted impact of COVID-19 on dental practice: American dental care professionals prepared and ready during unprecedented challenges

BackgroundThe purpose of this study was to evaluate the multifaceted impact of the COVID-19 pandemic on dental practices and their readiness to resume dental practice during arduous circumstances.MethodsThe authors distributed an observational survey study approved by The University of Texas Health Science Center at San Antonio Institutional Review Board to dental care practitioners and their office staff members using Qualtrics XM software. The survey was completed anonymously. The authors analyzed the data using R statistical computing software, χ² test, and Wilcoxon rank sum test.ResultsNearly all participants (98%) felt prepared to resume dental practice and were confident of the safety precautions (96%). Only 21% of dentists felt the COVID-19 pandemic changed their dental treatment protocols, with at least two-thirds agreeing that precautions would influence their efficiency adversely. Although most participants were satisfied with the resources their dental practice provided for support during the pandemic (95%), most were concerned about the impact on their general health and safety (77%) and to their dental practice (90%), found working during the pandemic difficult (≈ 60%), and agreed there are challenges and long-term impacts on the dental profession (> 75%).ConclusionsDental care professionals, although affected by the COVID-19 pandemic and at high risk of developing COVID-19, were prepared to resume dental practice during most challenging circumstances.Practical ImplicationsThe pandemic has affected dental care practitioners substantially; thus, there is need to formulate psychological interventions and safety precautions to mitigate its impact. Further research should evaluate the long-term effects on dentistry and oral health and interceptive measures for better communication and programming around future challenges.     

Willingness and ability of oral health care workers to work during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic continues to disrupt dental practice in the United States. Oral health care workers play an integral role in societal health, yet little is known about their willingness and ability to work during a pandemic.MethodsOral health care workers completed a survey distributed on dental-specific Facebook groups during an 8-week period (May 1-June 30, 2020) about their willingness and ability to work during the COVID-19 pandemic, barriers to working, and willingness to receive a COVID-19 vaccine.ResultsFour hundred and fifty-nine surveys were returned. Only 53% of dentists, 33% of dental hygienists, 29% of dental assistants, and 48% of nonclinical staff members would be able to work a normal shift during the pandemic, and even fewer (50%, 18%, 17%, and 38%, respectively) would be willing to work a normal shift. Barriers included caring for family, a second job, and personal obligations, and these were faced by dental assistants and hygienists. Dentists were more likely than hygienists (P < .001), assistants (P < .001), and nonclinical staff members (P = .014) to receive a COVID-19 vaccine.ConclusionsOral health care workers have a decreased ability and willingness to report to work during a pandemic, and dentists are significantly more able and willing to work than hygienists and assistants. Dentists are more likely than staff to receive a COVID-19 vaccine.Practical ImplicationsThe results of this study may help inform future initiatives of dental workforce readiness during a pandemic. Dentists should be prepared to discuss alterations to standard operating procedures to allay staff members’ fears and improve retention rates during pandemics, allowing for improved access to oral health care.     

Resumption of Endodontic Practices in COVID-19 Hardest-Hit Area of China: A Web-based Survey

IntroductionThe purpose of this study was to investigate the resumption of endodontic practices in Hubei Province, China 1 month after the end of the lockdown.MethodsA Web-based survey was sent to 1069 active endodontic specialists and general dentists who provided endodontic care in Hubei Province from May 7 to May 9, 2020. The survey consisted of 18 questions on demographics, the current situation of endodontic practice for the participants, and concerns regarding contracting or spreading the virus in newly opened endodontic practices.ResultsA total of 322 participants completed the survey. Most respondents (62%) were from Wuhan. Almost 83% of the respondents have resumed their endodontic practice partially or fully. Most respondents in practice (99%) would take measures to screen patients before treatment including paid screening measures. More than 93% of the respondents reported having taken special measures for routine endodontic treatment at this stage, with the most common measure taken being wearing an N95 mask. The rubber dam was recognized as efficient in preventing infection by most respondents. Many respondents were concerned about contracting coronavirus disease 2019 (COVID-19) as a result of routine endodontic practice at this stage, and respondents with more than 11 years of endodontic experience were significantly less concerned about infection compared with those with fewer than 5 years of experience (P < .05).ConclusionsThere is a fear of contracting/spreading COVID-19 among endodontic clinicians, the fear is negatively associated with years of practice, and most clinicians believe that rubber dam isolation can protect them and their patients from COVID-19.     

Clinical activities suspended: How the COVID-19 affected the self-confidence of Italian dental students

Introduction

COVID-19 emergency caused several effects on the dental educational system, especially affecting courses including practical activities. The study aims to evaluate the impact of the suspension of dental clinical activities on the Italian dental students' self-confidence. Furthermore, the other purpose of the research is to find an integrative didactics solution to improve the clinical training of dentistry during the COVID-19 pandemic.

Materials and Methods

A questionnaire was administered to evaluate the impact of the suspension of clinical activities on dental students' self-confidence. A 67-questions survey tested the students' self-confidence in several dental disciplines (Conservative Dentistry, Endodontics, Oral Surgery and Dental Emergency). The study reached a sample of 193 dental students and the answers from 9 different Italian dental schools were analysed.

Results

The degree of students' self-confidence for all the dental disciplines investigated was found statistically different between the periods before and after the interruption of clinical activities. The students proposed, as a potential solution to improve their practice during the COVID-19 pandemic, to combinate the use of a video tutorials and dental simulators.

Conclusion

The interruption of the training in clinical practice significantly affected the educational career and the self-confidence of students. An alternative teaching method involving the use of video tutorials as support in teaching clinical procedures deserves to be considered.     

The impact of the COVID-19 pandemic on orofacial pain practice: Perceptions from a convenience sample of orofacial pain practitioners

BackgroundCOVID-19 has had a substantial impact on people’s lives. Increasing evidence indicates that patients with chronic pain particularly are being affected; however, few articles have examined how the pandemic has affected the care or clinical presentation of patients with orofacial pain. The aim of this study was to describe COVID-19–related changes in referral patterns and numbers, in patient demographics, in patients’ seeking treatment for problems, and in administrative procedures in 3 orofacial pain clinical settings.MethodsPractitioners participating in the American Academy of Orofacial Pain webinar titled “Practicing Orofacial Pain, Headache, and Sleep Care During the COVID-19 Pandemic” completed a voluntary anonymous online survey. Survey respondents completed general questions related to their orofacial pain practices and about perceptions of their patients’ symptoms. For statistical analysis, the authors calculated frequencies and used analysis of variance for continuous variables or Likert scale variables and the χ² test for dichotomous or categorical variables. Statistical significance was set at P value of .05 or below.ResultsPractitioners noted an increase in new patients with orofacial pain. Of the participants, 33% indicated the onset of their patients’ pain was often or extremely often related to COVID-19. The 5 most common symptoms that providers felt were aggravated in their patients were masticatory muscle myalgia, anxiety, tension-type headache, bruxism, and insomnia or fragmented sleep.ConclusionThe COVID-19 pandemic has resulted in a marked increase in the number of patients seeking consultation for orofacial pain and associated symptoms.Practical ImplicationsBecause of the COVID-19 pandemic, orofacial pain practitioners have noticed an increase in orofacial pain symptoms across practice settings.     

Impact of the Coronavirus on Providing Oral Health Care in the Netherlands

ObjectiveTransmission of SARS-CoV-2 during oral health care is potentially increased compared to regular social activities. Specific amendments to the Dutch national infection control guidelines were promulgated. This study aimed to map the impact of the coronavirus pandemic on providing oral health care during the first wave of the coronavirus pandemic in 2020 in the Netherlands.MethodsA cross-sectional web-based survey was sent via email to a representative sample of dental hygienists and dentists in the Netherlands.ResultsOf the 1700 oral health care practitioners approached, 440 (25.9%) responded to the survey. Patient access to oral health care was severely restricted during the lockdown in the spring of 2020. A total of 1.6% of the oral health care practitioners had laboratory-confirmed COVID-19 during the study period, although this is likely to be an underrepresentation due to limited access to testing at that time. Over half of the participants perceived an increased risk of virus transmission during aerosol-generating treatments in their practices. A large majority (65.0%–87.1%) of the oral health care practitioners followed the COVID-19-specific amendments to the national infection control guidelines. Compared to the pre-pandemic period, additional personal protective equipment and protocols were applied. Factors related with compliance with the additional recommendations were age, employment status, and occupation.ConclusionsThe pandemic had a profound impact on both the accessibility and practice of oral health care. This survey study found that most Dutch oral health care practitioners paid extra attention to hygiene and infection control. Also, a low number of COVID-19 infections detected amongst Dutch oral health care practitioners was reported in the Netherlands. These overall outcomes suggest that safe oral health care can be provided when following the current infection control recommendations.Key words: SARS-CoV-2, COVID-19, Dental infection control, Dental care, Dental practice management, Dentists     

COVID-19–Related Factors Delaying Dental Visits of Workers in Japan

BackgroundThe aim of this research was to investigate the factors associated with postponing dental attendance amongst Japanese workers during the coronavirus disease 2019 (COVID-19) pandemic.MethodsWe conducted an internet-based survey in Japan from November 24 to 29, 2021. The participants were selected from people registered with an online research company. The inclusion criteria for this study were full-time or part-time workers aged 20 to 69 years. Participants filled out a questionnaire about their oral health, behaviour, and working conditions.ResultsA total of 1840 participants were included in the analysis. Three hundred ninety-eight participants (21.5%) answered that they postponed dental attendance due to COVID-19. Multiple logistic regression showed that women were more likely to postpone dental attendance (odds ratio [OR], 1.74; 95% confidence interval, 1.33–2.26). Moreover, employment status, household income, changes in income, working at home, interdental cleaning device use, regular dental attendance, awareness of untreated teeth, and dental pain were also associated with postponing dental attendance. The results of decision tree analysis showed that regular dental attenders with dental pain were the most likely to postpone dental attendance.ConclusionsThe characteristics of postponed dental visits for Japanese workers differ depending on whether one is a regular dental attender or not. Amongst regular dental attenders, worsening oral health due to interruptions in dental attendance is concerning. Meanwhile, untreated teeth might be neglected amongst nonregular dental attenders. Preventing patients from refraining from dental attendance, regardless of whether or not they are regular dental attenders, is important during the COVID-19 pandemic.Key words: COVID-19, Postponed dental attendance, Dental visits, Regular checkups     

Methods Helping Dentists to Detect Dental Fear

ObjectivesDental fear is common and yet often remains unrecognised. COVID-19 has challenged health care since 2020. This study aimed to evaluate patients’ self-reported dental fear and detection of dental fear by the dentists. Another aim was to validate a colour code instrument for estimating dental fear. The influence of COVID-19 on fear and attendance was assessed.MethodsA cross-sectional survey was conducted in the primary urgent dental care of Oulu, Finland, in spring 2020 and 2021 after the first (T1) and third waves (T2) of the pandemic. Data were obtained for analyses using the Modified Dental Anxiety Scale (MDAS), Facial Image Scale (FIS), and a new “traffic light” colour code for dental fear (CCF). The influence of COVID-19 on dental fear and attendance was assessed with structured and open-ended questions. The questionnaires were completed by 273 anonymous participants.ResultsOf the participants, 167 (61.2%) visited dental care during T1 and 106 (38.8%) during T2. Their mean age was 45.1 years. An MDAS score of 19 or above, indicating severe fear, was reported by 10.6% of the participants. Of those with severe dental fear, 87% chose the red colour in the CCF “traffic light” system. The association between dentists’ and participants’ estimation of dental fear was weak (P < .001) and agreement with the red code was nonexistent (Cohen's kappa value = −0.035). MDAS scores of the younger participants were higher than those of the older ones after the first wave (T1) (P = .021). COVID-19 had the strongest influence on dental attendance and dental fear of those having the most severe self-reported dental fear as measured by the MDAS.ConclusionsColour-coded traffic lights seem valid for screening severe dental fear and are easy and quick to use. They could be useful tools especially since recognising dental fear seems difficult for dentists. The COVID-19 pandemic has complicated dental care for the most fearful individuals.     

Dentists’ knowledge,attitudes, and professional behavior toward the COVID-19 pandemic: A multisite survey of dentists’ perspectives

BackgroundCOVID-19 continues to affect the dental community worldwide. The authors conducted a cross-sectional electronic study using a multisite survey to examine dentists’ knowledge, attitudes, and professional behavior toward COVID-19 and the affect on their livelihood.MethodsA questionnaire was circulated via e-mail and social media platforms to dentists in North America, Europe, Eastern Mediterranean, and Western Pacific regions. It covered demographic characteristics and questions about the COVID-19 outbreak related to dentists’ levels of comfort for preventive and safety measures, provision of treatment, affect on work, and financial implications. Responses were tabulated and analyzed by means of χ² or Fisher exact test. Mann-Whitney and Kruskal-Wallis tests were used to compare means. P < .05 was considered significant.ResultsA total of 1,251 dentists responded. General dentists represented 63.9% of the respondents and 62.5% worked in private practice. The global score for level of comfort with the preventive measures and provisions of treatment during the COVID-19 pandemic was low (14 of 30), and differences between regions were significant (P < .01); dentists working in private practice and general dental practitioners were less comfortable (P < .01).Conclusions and Practical ImplicationsThe respondents reported a lack of preparedness to confront a highly infectious respiratory disease. A new level of protective armamentarium in the dental operatory and updated operational guidance and policies are required, necessitating educators and regulators to ensure the delivery of knowledge and skills to oral health care providers. Dentists need to address the sustainability of their practices and have a robust business plan.     

COVID-19–Related Factors Delaying Dental Visits of Workers in Japan

BackgroundThe aim of this research was to investigate the factors associated with postponing dental attendance amongst Japanese workers during the coronavirus disease 2019 (COVID-19) pandemic.MethodsWe conducted an internet-based survey in Japan from November 24 to 29, 2021. The participants were selected from people registered with an online research company. The inclusion criteria for this study were full-time or part-time workers aged 20 to 69 years. Participants filled out a questionnaire about their oral health, behaviour, and working conditions.ResultsA total of 1840 participants were included in the analysis. Three hundred ninety-eight participants (21.5%) answered that they postponed dental attendance due to COVID-19. Multiple logistic regression showed that women were more likely to postpone dental attendance (odds ratio [OR], 1.74; 95% confidence interval, 1.33–2.26). Moreover, employment status, household income, changes in income, working at home, interdental cleaning device use, regular dental attendance, awareness of untreated teeth, and dental pain were also associated with postponing dental attendance. The results of decision tree analysis showed that regular dental attenders with dental pain were the most likely to postpone dental attendance.ConclusionsThe characteristics of postponed dental visits for Japanese workers differ depending on whether one is a regular dental attender or not. Amongst regular dental attenders, worsening oral health due to interruptions in dental attendance is concerning. Meanwhile, untreated teeth might be neglected amongst nonregular dental attenders. Preventing patients from refraining from dental attendance, regardless of whether or not they are regular dental attenders, is important during the COVID-19 pandemic.     

An update on the current training situation of German interns in oral and maxillofacial surgery at special times in 2021

The aim of this study was to evaluate the current state of training of German interns in oral and maxillofacial surgery (OMFS) under the influence of the COVID-19 pandemic in 2021.A previously tested questionnaire consisting of 53 questions was sent to interns in German OMFS (non-) university hospitals and private practices as an online survey. The questionnaire was adapted to current topics, such as the ongoing COVID-19 pandemic, aspects concerning nighttime and weekend services, overtime hours, surgical logbooks, benefits of academic degrees and support for scientific activities, part-time employment, parental leave and childcare. Next, results of questions from before the COVID-19 pandemic were re-evaluated.The COVID-19 pandemic influenced the clinical work (71.83%) and the current state of training (68.64%) in OMFS of most participants. Nighttime and weekend services are possible for employees in possession of only one degree (87.93% with a medical degree) in most hospitals. Not having one or both doctorate degrees was considered to be a disadvantage by 54.95%. In all, 42.11% of the participants attested to a positive influence of research on their training situation, and 50% reported financial or non-financial research support from the employer. Part-time employment was possible for 78.81% of the participants. The course of training was interrupted more often for women due to parental or maternity leave (10.53% of men and 30.95% of women). A total of 40.71% of the participants reported that childcare was available at the hospital, theoretically.The state of OMFS training in Germany can be referred to as positive. Current and future challenges are diverse, including aspects originating from the ongoing COVID-19 pandemic, gender aspects, reconciliation of family and work, and flexible working hours. Addressing these topics will ensure OMFS training at the highest surgical level and further increase interns’ satisfaction, preserving the specialty’s popularity and reception.     

COVID-19 among dentists in the United States: A 6-month longitudinal report of accumulative prevalence and incidence

BackgroundIn 2020, the Centers for Disease Control and Prevention and the American Dental Association released COVID-19 infection control interim guidance for US dentists, advising the use of optimal personal protection equipment during aerosol-generating procedures. The aim of this longitudinal study was to determine the cumulative prevalence and incidence rates of COVID-19 among dentists and to assess their level of engagement in specific infection control practices.MethodsUS dentists were invited to participate in a monthly web-based survey from June through November 2020. Approximately one-third of initial respondents (n = 785) participated in all 6 surveys, and they were asked about COVID-19 testing received, symptoms experienced, and infection prevention procedures followed in their primary practice.ResultsOver a 6-month period, the cumulative COVID-19 infection prevalence rate was 2.6%, representing 57 dentists who ever received a diagnosis of COVID-19. The incidence rates ranged from 0.2% through 1.1% each month. The proportion of dentists tested for COVID-19 increased over time, as did the rate of dentists performing aerosol-generating procedures. Enhanced infection prevention and control strategies in the dental practice were reported by nearly every participant monthly, and rates of personal protection equipment optimization, such as changing masks after each patient, dropped over time.ConclusionsUS dentists continue to show a high level of adherence to enhanced infection control procedures in response to the ongoing pandemic, resulting in low rates of cumulative prevalence of COVID-19. Dentists are showing adherence to a strict protocol for enhanced infection control, which should help protect their patients, their dental team members, and themselves.Practical ImplicationsCOVID-19 infections among practicing dentists will likely remain low if dentists continue to adhere to guidance.     

Dental trainees’ mental health and intention to leave their programs during the COVID-19 pandemic

BackgroundDental trainees (dental students, graduate students, and postdoctoral residents) are at increased risk of experiencing poor mental health, which can lead to intentions to leave their program, especially during the COVID-19 pandemic.MethodsThe authors invited 355 dental trainees at the University of Washington School of Dentistry to complete an 83-item questionnaire in August and September 2020. The outcome analyzed was intention to leave their programs. There were 4 self-reported predictors: anxiety, burnout, depression, and COVID-19 impact on overall mental health. The authors ran multiple variable logistic regression models to evaluate relationships between each predictor and outcome (α = .05) and reported odds ratios (ORs) and 95% CIs.ResultsThe survey response rate was 35.5%. Overall, 12.7% of participants reported any intention to leave. In total, 22.2% and 16.7% of participants endorsed clinically significant anxiety or depression symptomatology, respectively; 28.6% reported 1 or more burnout symptoms; and 69.0% reported that COVID-19 affected their overall mental health. Participants reporting anxiety (OR, 8.87; 95% CI, 1.80 to 43.57; P = .007), depression (OR, 11.18; 95% CI, 1.84 to 67.74; P = .009), or burnout (OR, 8.14; 95% CI, 1.73 to 38.23; P = .008) were significantly more likely to report intention to leave than those not reporting mental health problems. All participants reporting that the COVID-19 pandemic impacted their mental health expressed intention to leave.ConclusionsPoor mental health is common among dental trainees and is associated with intention to leave their program.Practical ImplicationsCOVID-19 has exacerbated the prevalence and consequences of poor mental health among dental students, highlighting the importance of providing wellness resources.     

Regenerative Endodontic Procedures among Endodontists: A Web-based Survey

Introduction

The protocols that endodontists implement for regenerative endodontic procedures (REPs) are unknown. The aim of this study was to examine current REP protocols among practicing endodontists in the United States.

COVID-19 vaccine hesitancy and reasons for or against adherence among dentists

BackgroundCOVID-19 has spread widely among health care workers. Oral health care workers have an increased risk of being infected owing to dental practice characteristics. New, effective vaccines against COVID-19 have been approved for use. The authors aim was to evaluate intentions to be vaccinated against COVID-19 in a population of dentists and identify factors associated with their intentions.MethodsThe authors conducted an anonymous online survey among 761 dentists enrolled at the Board of Physicians and Dentists of the District of Monza Brianza, Monza, Italy. The authors collected data on demographic characteristics, influenza vaccine uptake, COVID-19 history, vaccine attitudes, and specific reasons for their intentions to be vaccinated against COVID-19 or not.ResultsOverall, 421 dentists completed the survey. More than 82% of the participants declared their intention to be vaccinated against COVID-19. The multivariate logistic regression model reported a positive association with receiving the influenza vaccine in the 2020-2021 influenza season (odds ratio, 5.15; 95% CI, 2.14 to 12.39) and a negative association with receiving a diagnosis of COVID-19 previously (odds ratio, 0.32; 95% CI, 0.15 to 0.66). The participants’ main reason for supporting vaccination was to protect their family and friends (87%) and their main reason for opposing vaccination was the lack of information (39%).ConclusionsIt is fundamental to consider vaccine hesitancy in health care workers and address it properly because they must provide recommendations to patients and promote adherence to vaccination programs.Practical ImplicationsThe vaccination of dental practitioners should be prioritized owing to the high risk related to dental practice.     

Reopening Dental Offices for Routine Care Amid the COVID-19 Pandemic: Report From Palestine

ObjectivesThis study reports on the readiness of Palestinian dentists to reopen their practices for routine care during the current coronavirus disease 2019 (COVID-19) pandemic.MethodsA cross-sectional study targeted dentists in the West Bank area of Palestine using an online survey during the first 2 weeks of May 2020. Questions mainly asked about dentists’ perception of the risks of COVID-19, readiness to reopen their clinics for routine care, and the level of confidence in dealing with patients suspected of having COVID-19.ResultsA total of 488 dentists completed the survey. Almost 60% believed that they were not ready to reopen their practices. Almost 13% had “no confidence” in dealing with patients with COVID-19, while 64% had “little to moderate” confidence. Confidence was correlated negatively with increased fear of becoming infected (ρ = -0.317, P < .0001) and positively with years of practice (ρ = 1.7, P < .0001). Dentists who received updated training on infection control or on COVID-19 reported higher levels of confidence (χ² = 53.8, P < .0001, χ² = 26.8, P < .0001, respectively). Although 88% preferred not to treat patients with COVID-19, 40% were willing to provide care to them. Almost 75% reported that they were already facing financial hardships and could not survive financially until the end of the current month.ConclusionsEthical and financial reasons were the main drivers for dentists in this sample to reopen their practices for routine care. Data from this study highlights the fragility of private dental practice in emergency situations. Ethical, health, and financial challenges that emerged during COVID-19 require dentists to adapt and be better prepared to face future crises.     

Opinions and attitudes of endodontists and general dental practitioners in the UK towards the intracanal fracture of endodontic instruments: part 1

Aim  To investigate the attitudes and opinions of general dental practitioners (GDPs) and endodontists in the UK towards fracture of endodontic instruments. It was hypothesized that there would be no significant difference between GDPs and endodontists regarding their experience of fracture of endodontic instruments.
Methodology  A pilot questionnaire was carried out on 20 postgraduate dental students to ensure that the questions were easily understood. This was followed by a further pilot survey on a group of GDPs and endodontists (50) to facilitate sample size calculation. The sample size comprised 330 systematically selected GDPs, and all endodontic specialists working in the UK (170). The questionnaire comprised both close-ended and partially close-ended questions in four categories: demographics; pattern of practice and experience of instrument fracture; management of fractured instruments; and unsuccessful management of fractured instruments. Nonrespondents were sent another two mailings (first and second reminders). After collecting the responses, data were analysed using chi-square and Linear-by-Linear Association tests at the 0.05 level of significance.
Results  The overall response rate was 75% (82.82% for endodontists and 70.92% for GDPs). Overall, 88.8% of respondents had experienced fractured instruments with a significantly higher proportion of endodontists (94.8%) compared with that of GDPs (85.1%).
Conclusion  Both endodontists and GDPs were aware of most factors contributing to endodontic instrument fracture. With experience and knowledge, fracture of endodontic instruments was associated with the number of root canal treatments performed.