Evaluation of access and attitudes of patients to dental treatments during COVID-19 pandemic

INTRODUCTION

In December 2019, a previously undetected coronavirus in humans was identified in Wuhan, China’s Hubei province [1]. The World Health Organization (WHO) has named this virus, which causes pneumonia of unknown origin in humans, as a new coronavirus (2019-nCoV). Later, due to its’ taxonomic similarity with the virus, which is the causative agent of severe acute respiratory syndrome (SARS), it was deemed appropriate to be named ‘SARS-CoV-2’ (COVID-19) [2]. Number of cases infected with this new coronavirus has increased rapidly since the first day of diagnosis and spread glo¬bally, and this coronavirus disease, briefly referred to as ‘COVID-19’, was declared as a pandemic disease by the WHO on March 11, 2020 [3]. With the increase in cases, studies examining the clinical and epidemiological features of the disease have gained momentum. Although clinical signs in people infected with SARS-CoV-2 are fever, dry cough, and malaise, these symptoms are not distinctive compared with other respiratory diseases. While most cases heal spontaneously, some develop fatal complications, including organ failure, pulmonary edema, severe pneumonia, and acute respiratory distress syndrome (ARDS) [4, 5]. Considering the contamination by droplets and aerosols, dentists constitute a high-risk group.
On March 10, it was reported that the first COVID-19 case was confirmed in Turkey. As of March 12, schools were suspended and online education was started, overseas assignments were postponed, and sports competitions were played without spectators. All events, where people would gather together, have been canceled. Subsequently, businesses, such as entertainment venues, restaurants, cafes, barbers, restaurants where people would come together and increase the risk of transmission of the virus, were closed to service. A restriction was imposed on citizens over the age of 65, and this ban was extended to include young people and children under the age of 20. Dentists working in public hospitals participated in PCR application for the diagnosis of COVID-19. In private practices and university hospitals, only emergency dental procedures were allowed. The fact that people could not go to hospitals due to restrictions, and that they did not go to hospitals due to the risk of COVID-19 contamination when the restrictions were over, caused an increase in dental problems.

OBJECTIVES

The current study evaluated the perceptions and attitudes of patients who applied to the dentistry faculty of our university during COVID-19.

MATERIAL AND METHODS

This study was approved by the Ministry of Health, Republic of Turkey (No: 2020-05-20T15_30_12). Ethical approval was received from the Non-Interventional Studies ethics committee of Pamukkale University (No: 60116787-020-106820/17).
All patients who applied to Pamukkale University, Faculty of Dentistry between September, 2021 and November, 2021 were invited to participate in the study. Participation in the survey was voluntary. Patients over 18 years were included, and no information was requested regarding identity information of participants (i.e., name, surname, or identification number). In this study, patients who applied to the faculty of dentistry during the COVID-19 period were requested to fill out a questionnaire consisting of questions, including reasons for their application, dental procedures they had during this period, and where these procedures have been performed (Table 1). Results were evaluated with Pearson’s 2 test, and p < 0.05 was taken as statistically significant. Data obtained from the study were presented as mean and frequency.

RESULTS

A total of 403 individuals participated in the study. 248 (61.5%) of the participants were females and 155 (38.2%) were males. Most of the participants (52.1%) were between the ages of 18-30 years. Considering the educational status of participants, the most people were high school (33.6%) and university graduates (35.8%). Most of the surveyors (62.7%) were unemployed. Details of the demographic data are shown in Table 1.
Toothache, abscess, or impacted tooth (27.8%) were the main reasons for the participants to apply to the hospital, followed by caries and filling (22.3%). Most surveyors (36.2%) preferred the university hospital as they thought that physicians were more interested and competent in their field. Most of the participants (52.5%) did not hesitate to go to the dentist, but 60.8% of them postponed their treatment during the pandemic. Two-third of the participants (65.9%) were vaccinated against COVID-19. Most of the participants (56.1%) thought that dental procedures were risky in terms of COVID-19 transmission. If the number of cases increases significantly, 44% of them stated to delay their treatment (Table 1).
Comparison of the questions by gender and age groups are presented in Table 2. Among those who hesitated to go to the dentist, women were statistically significantly higher than men (p < 0.05). In terms of age groups, the younger age group was less hesitant compared with middle ages (p < 0.05). In the period of delaying the treatment, while the middle age group (46.6%) waited for the pandemic to end, younger ages (31.9%) did not wait for it (p < 0.05). When vaccination statuses were examined, vaccination between the ages of 31-64 years was found to be statistically higher than in the age range of 18-30 years (p < 0.05).
Comparison of the questions by education status and working groups are shown in Table 3. Vaccination rates of university graduates were statistically higher than other education groups (p < 0.05). High school (65.7%) and university (58.7%) graduates thought that the risk of COVID-19 transmission from dental procedures was higher than reported in other groups. Most of the participants who waited for the pandemic process to pass for dental treatments were in the unemployed group (34.6%); however, the private sector employees (51.9%) had a higher ratio than the unemployed group (p < 0.05). In terms of not delaying treatment, no difference was found between sectors, in which people work or are unemployed (p > 0.05). According to working status, the highest vaccination rates were retirees (79.3%) and private sector employees (80.5%). Retirees stated that if the cases increase with a high-rate (62.1%), they will postpone their treatment as well as private sector employees (55.8%) and civil servants (43.8%). The unemployed group with a rate of 61.8% reported that they would not postpone their treatment.
It was found that vaccinated people were statistically more hesitant of going to the dentist than those who were not vaccinated (p < 0.05) (Table 4).

DISCUSSION

The current COVID-19 outbreak is a worldwide emergency, as its’ rapid spread and high mortality rate have caused severe disruptions. As in many developed countries, many scientific and legal regulations have been made in Turkey, and at the beginning of the pandemic process, in line with the recommendations of the Ministry of Health Coronavirus Scientific Advisory Board, a circular was issued by the Ministry of Health, General Directorate of Health Services, on March 17, 2020, allowing emergency and compulsory dental treatments only and postponing elective procedures. Following the publication of the “Guide to Work in Health Institutions during the normalization period in the COVID-19 pandemic” issued by the Ministry of Health on June 1, 2020, the previously postponed elective treatments started to be carried out again, with priority in the provision of emergency and mandatory services, in line with working principles in this guide. These decisions led to the patients not being able to meet their treatment needs other than emergency dental treatments. The purpose of our survey study was to evaluate the dental treatment processes of patients and the effects of these processes on their oral health from the patients’ perspectives. The COVID-19 pandemic is affecting lives of many people, causing an increase feeling of uncertainty and anxiety in people [6]. The survey results in this study revealed that most patients postponed their dental treatment in the pandemic and normalization process, and because of this situation, 71.5% of the patients believed that their oral health worsened. Patients were largely aware of the seriousness of the COVID-19 pandemic and reported concerns. In addition to postponing their dental treatments, the patients postponed follow-up of their potentially fatal diseases, either because of the limited number of health personnel or the fear of disease transmission [7]. In our study, 56% of the patients stated that they would not delay their treatment if there was a pandemic again. Peleso et al. [8] found that 38.3% of the patients stated they would go for a dental appointment if the dentist/staff called to schedule, 44.2% said they would go only in case of an emergency, and 17.5% said they would not go for any reason. Although there was no difference between men and women in terms of delaying treatment in our study, women (57%) and the middle age group (62.3%) seem to be more hesitant about going to dental treatment. The literature suggests that women are more amenable to dental treatment than men in normal situations [9]. However, in studies conducted during the pandemic, it was found that the pandemic increased the stress level in women more than in men [10]. Probably, women felt safer to stay at home or just go to the dentist in case of emergency. Due to many underlying biological mechanisms, women may be more prone to depression and anxiety disorders [11], and may be particularly affected by stressful events [12].
To combat the coronavirus disease, many researchers have focused on developing effective vaccine. According to the survey results, the vaccination rate of women (62.2%) was found to be lower than that of men (70.8%). Inconsistent with our study, a study [13] reported that women in Turkey were more hesitant about the COVID-19 vaccination. This may be because they are more likely to come across anti-vaccine data in their online research on vaccines, as women are usually caring for children or they may not need to be vaccinated since women do not take as active roles as men in social life in Turkey. Among the education group, university graduates (81.8%) presented the highest vaccination rate in contrast with a survey performed in Turkey, which resulted in low educational level cases who were more willing to get vaccinated [14]. The lowest vaccination rate was found in the unemployed group (57.0%), and the highest vaccination rate was found in the private sector group (80.5%). According to the results found in studies, from 31% to 43% of people are hesitant to be vaccinated [14, 15]. Currently, there is no vaccination requirement for government employees in Turkey, but there is unofficial pressure on private sector employees to be vaccinated. Here, those who cannot work may not have preferred to be vaccinated because they do not have concerns about losing their jobs. Although, 58.7% of those who were vaccinated hesitated to go to dental treatments. The reason for this may be due to the low confidence of people in the effects of the vaccine, adverse effects, or considering that coronavirus is a virus of laboratory origin despite being vaccinated [16].

CONCLUSIONS

The results of the present study showed that toothache, abscess, and impacted tooth were the first reasons for applying to the dental hospital. Most of the patients stated that they hesitated to go to the dentist and postponed their treatments during the COVID-19 pande¬mic. Patients with higher education levels had a higher rate of vaccination. Vaccinated patients were statistically more hesitant of going to the dentist than unvaccinated.

CONFLICT OF INTEREST

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References