Perceived Impact of the COVID-19 Pandemic on Orthodontic Practice in the Middle East.

BACKGROUND: With COVID-19 announced as a global pandemic, a countrywide lockdown was executed in many countries, including the Middle East. With no foregoing warning or expectation, orthodontic treatments were temporarily canceled as dental clinics and colleges were indefinitely closed. To the best of our knowledge, no study addresses the orthodontist perspective in such testing times, where they are entirely restricted to the confines of their homes. The study aims to assess the impact of the COVID-19-related lockdown on orthodontists and orthodontic postgraduate students' treatment and psychology.
MATERIALS AND METHODS: The survey participants consist of 315 orthodontists and orthodontic postgraduate residents from different Middle East countries. A pretested self-administered questionnaire was sent to the consenting participants through an online data collection platform (Google forms), covering participants' sociodemographics and participants' perceived impact of the COVID-19 pandemic.
RESULTS: A majority of the participants (87.61%) stated that the pandemic would permanently change their way of practicing orthodontics and also will lead to the reduction in the number of orthodontic patients in the future (78.73%), and a significant number of orthodontists (67.61%) has an opinion that the pandemic will not affect the viability of their profession. The majority of the respondents (88.57%) commented about the negative economic impact of COVID-19 on their income, and regarding the effect of COVID-19 on psychosocial well-being, 73.01% had experienced anxiety and depression, 88.25% were excited about the future of the profession, and 68.57% enjoyed the life with their family due to lockdown, and when asked about their social life with the family and friends, majority of the participants (66.34%) had an opinion that it has improved due to the increased free time.
CONCLUSIONS: Most of the respondents reported perceived economic, psychosocial, and social impacts due to the pandemic. Copyright:

INTRODUCTION

SARS-CoV-2, commonly as COVID-19, was initially notified in Wuhan, China, in December 2019, which then emerged as a pandemic infecting more than 110 million people.[123] Even though coronaviruses primarily infect animals, human contamination can occur if the animal-human species barrier is breached, and pangolins and snakes are considered the in-between hosts in the case of COVID-19.[1456] COVID-19 spreads from continent to continent due to widespread transportation modes, and the WHO declared COVID-19 a pandemic on March 11, 2020. COVID-19 can currently spread within towns through neighborhood spread from a carrier individual or community spread, where its origin is unknown. COVID-19 had been confirmed in more than 110,605,084 cases in 183 countries as of February 28, 2021, for more than 2,194,204 people died.[7] Despite ages, people are affected by COVID-19, reports recent studies. However, the risk of infection is high in those having close contact with positive cases and asymptomatic carriers also medical professionals and other hospitalized patients.[8]

Due to strict COVID-19 rules and public health interventions such as travel restriction and home isolation,[9] many dental workers opted for teleconferencing for patient interactions.[1011] Altogether, the above-said changes in job and living due to COVID-19 can significantly influence health professionals, including nonfrontline workers.[12] This research aimed to determine the impact of the COVID-19 pandemic on orthodontists and orthodontic postgraduate students, especially in terms of their current and future orthodontic practice as their financial, emotional, and social well-being.

MATERIALS AND METHODS

The consenting participants were received a self-assessed questionnaire through an online data collection platform (Google forms) between April and December 2020. The methodology adopted was purposive sampling. We included orthodontists and orthodontist residents (postgraduates) from different Middle East countries. A list of the participants was made first and was reached using the social media platform and through direct personal messages.

The questionnaire consisted of two parts, Part A comprised participants' sociodemographics, and part B documented participants' COVID-19 impact on their orthodontics treatment, particularly with reference to patients' seen during the pandemic, infection control training, and their perceptions on the longer-term viability of orthodontics as a specialty following the pandemic. Respondents were also asked if the pandemic would change the way, they currently practiced orthodontics and what changes they might be making if any. In addition, the questionnaire also assessed the perceived economic, psychosocial, and social impacts of the pandemic on the lives of respondents. A pilot study was done. The questionnaire was distributed to ten orthodontists and five orthodontic students to assess the validity of the instrument. These were not included within the overall samples used for the study. The ideal sample size computed for the study was 315, based on a confidence interval of 90%, a margin of error of 5%, and a study population of 350.

The information was coded, entered, and analyzed utilizing SPSS 23.0 version (IBM Corp., Armonk, NY, USA). Descriptive statistics, frequencies, and percentages were utilized to sum-up, information. Descriptive analysis was carried out by frequency and proportion for categorical variables. Categorical outcomes were compared between study groups using the Chi-square test/Fisher's exact test. P < 0.05 was considered statistically significant. IBM SPSS version 23 was used for statistical analysis by an independent biostatistician.

RESULTS

A total number of 315 orthodontists and orthodontic residents in the state taken part in the survey, made up of 205 (65%) males and 110 (35%) females with the majority in the age group 31–40 years. We had participants from Saudi Arabia (49.2%), United Arab Emirates (17.8%), Oman (14.3%), Kuwait (12.1%), and Qatar (6.7%). Most of them, 144 (45.71%), were consultant orthodontists, while 101 (32.06%) of them were orthodontic residents. A total of 133 (42.22%) completely resumed their orthodontic practice after the lockdown and 52 (16.50%) reported that they have not resumed their practice yet [Table 1]. As shown in Table 2, majority of the participants (85%) stated that they have got instruction on infection control in dentistry but not regarding COVID-19 (55%). Furthermore, a majority of them (87.61%) stated that the COVID-19 will perpetual change in their way of practicing orthodontics and also will lead to decrease in the number of orthodontic patients in the future (78.73%), and a significant number of orthodontists (67.61%) has an opinion that the pandemic will not affect the viability of their profession. When we assessed the relationship of these effects with the country of practice, it was found that there was no statistically significant association except that 80% (n = 124) of participants from Saudi Arabia, and 75.5% (n = 34) from Oman believed that COVID-19 would lead to the decrease in the number of orthodontic patients in the future more than other countries (P = 0.018).

Table 1

Baseline characteristics of the participants (n=315)

	Male, n (%)	Female, n (%)	Total, n (%)
Age
Below 30	42 (20.48)	29 (26.36)	71 (22.53)
31-40	62 (30.24)	32 (29.09)	94 (29.84)
41-50	39 (19.02)	17 (15.45)	56 (17.77)
51-60	47 (22.92)	16 (14.54)	63 (20)
61-70	15 (7.31)	16 (14.54)	31 (9.84)
Total	205 (100)	110 (100)	315 (100)
Country
Saudi Arabia	85 (54.8)	70 (60.9)	155 (49.2)
United Arab Emirates	35 (62.5)	21 (37.5)	56 (17.8)
Oman	39 (86.7)	6 (13.3)	45 (14.3)
Kuwait	31 (81.6)	7 (18.4)	38 (12.1)
Qatar	15 (71.4)	6 (28.6)	21 (6.7)
Total	205 (100)	122 (100)	315 (100)
Number of years after graduation
1-10	153 (74.63)	88 (80)	241 (76.50)
11-20	52 (25.36)	22 (20)	74 (23.49)
Total	205 (100)	110 (100)	315 (100)
Current status of practice
Postgraduate student	38 (18.53)	63 (57.27)	101 (32.06)
Orthodontic consultant	105 (51.21)	39 (35.45)	144 (45.71)
Own clinical practice	62 (30.24)	8 (7.2)	70 (22.22)
Total	205 (100)	110 (100)	52 (16.50)
Current status of orthodontic practice
Not resumed yet	33 (16.09)	19 (17.27)	52 (16.50)
Partially resumed	67 (32.68)	33 (30)	100 (31.74)
Completely resumed	86 (41.95)	47 (42.72)	133 (42.22)
No suspension	19 (9.26)	11 (10)	30 (9.52)
Total	205 (100)	110 (100)	315 (100)

Table 2

Infection control training and impacts on orthodontic practice

	Responses		P* (country of practice)
	Yes, n (%)	No, n (%)
Concerning COVID-19 and infection control
Have you had any training on infection control?	268 (85)	47 (15)	0.292
Have you had any training regarding control for COVID-19?	142 (45)	173 (55)	0.182
Impact of the pandemic on orthodontic practice
Do you think such pandemics will lead to the reduction in the number of orthodontic patients in the future?	248 (78.73)	67 (21.26)	0.018
Do you think it will affect the feasibility of orthodontics as a profession?	102 (32.38)	213 (67.61)	0.342
Do you think COVID-19 will change the way you practice orthodontics?	276 (87.61)	39 (12.38)	0.812

*P for Chi-square test

As shown in Table 3, majority of the respondents (88.57%) commented about the negative economic effect of COVID-19 on their income, and regarding the effect of COVID-19 on psychosocial well-being, 73.01% had experienced anxiety and depression, 88.25% were excited about the future of the profession, and 68.57% enjoyed the life with their family due to lockdown and when asked about their social life with the family and friends, majority of the participants (66.34%) had an opinion that it has improved due to the increased free time. Participants from Oman (84.4%, n = 38) and Saudi Arabia (76.1%, n = 118) reported that COVID-19 improved their social life with family and friends that showed statistical differences when compared to responses from other countries (P = 0.019).

Table 3

Impact of the COVID-19 on economics, psychosocial well-being, and social life of orthodontists and orthodontic residents

	Responses		P* (country of practice)
	Yes, n (%)	No, n (%)
Impact of COVID-19 on practice
Negative economic impact of COVID-19 on income	279 (88.57)	36 (11.42)	0.042
Impact of COVID-19 on psychosocial well-being
Anxiety and depression	230 (73.01)	85 (26.98)	0.181
Feeling happy with family due to lockdown	216 (68.57)	99 (31.42)	0.311
Excited about the profession	278 (88.25)	37 (11.74)	0.275
Impact of COVID-19 on social life
Improved my social life with family and friends	209 (66.34)	106 (33.65)	0.019

*P for Chi-square test

DISCUSSION

Dentistry, including orthodontics, needs patients' close interaction for treatment. The COVID-19 protocol recommends avoiding direct human contact and maintains a 1–2 meter social distancing.[13] These suggestions disturbed the orthodontic setup for the treatment's nature because the doctor and the assistant topped the risk category. Thus, there has been a remarkable struggle to instituting quality treatment by dental professionals during this phase. The pandemic thus bangs orthodontic care.[1415] Thus, assessing the pandemic's economic and psychosocial impact on orthodontists and orthodontic treatment in particular, with a view of palliating these impacts, is important. It is important to have orthodontists' and orthodontic residents' perspectives on it as it impacts both their personal lives and the treatment they provide.

The specialists had undergone previous training in infection control, which is quite satisfactory during their medical studies. According to the study, COVID-19 infection control training had attended only 45%. This shows the importance of orthodontists to gain infection control training against COVID-19. The economic outcomes had a negative impact due to the lockdown worldwide. Likewise, dentistry also had adverse effects during a lockdown. Thus, about 88.57% say that dental practitioners had an immensely negative effect on their income. The high impact on financial status has affected respondents' social life. About 73.01% experienced anxiety and depression and 88.25% were excited about the future of their profession. However, greater time spent with their families due to the lockdown for almost 2 months improved their quality time with family and friends (66.34%). Similar findings have also been found in another report.[16]

Despite receiving all the suitable strides to decrease bias, the investigation was susceptible to certain restrictions. The significant impediment was the short duration for data collection, which might have brought about a smaller than expected example. Utilizing web-based media for information collection would have disposed of the inexperienced professionals with online media or the individuals who were busy dealing with personal affairs. A few provinces or districts across the different countries were more affected than others, which may impact the administration and health-care preventive measures executed by a specific region that could likewise impact this study's after effect. Furthermore, the observation recorded was purely personalized. The significant limitation was the use of validated scales on assessing the social and psychosocial effects.

CONCLUSIONS

In short, SARS-CoV-2 is the first highly communicable pandemic of this era. Even though cross infection within any dental setting has not been identified, dental specialists in all specialties, including orthodontists, have to be continually attentive to the rising infectious hazards and acquainted with updates in infection control protocols.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.