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

Abstract

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.

COVID-19: Another Cause of Dental Anxiety?

“…According to Cotrin et al, for 78% of orthodontic patients, it was important to avoid other people at the reception desk, while the availability of protective equipment for the patients was deemed important by 35% [ 18 ]. Similar results were published by Alassiry and Hakami, who reported that 76% of the respondents were not afraid to visit their dentist, under the condition that adequate preventive measures were followed [ 20 ].…”

“…The first studies in the field of dentistry that appeared after the outbreak of the pandemic were aimed at infection control under the new conditions [ 11 , 12 , 14 ]. Patient concern (for outcomes and duration of the treatment) was the topic of mostly orthodontic studies [ 18 – 20 ]. A few studies that emerged later provided data on the fear of dental patients during a pandemic, in addition to other information [ 21 – 24 ].…”

“…These findings agree with previously published results of other authors who also noted the negative impact of COVID-19 on the “flow” of dental patients and their willingness to complete their treatment [ 19 , 25 ]. The fear of transmitting the infection in the dental environment has been reflected in the increase in the number of canceled visits and the reduced number of first examinations and new patients [ 20 , 22 ]. Oshima et al noted that the number of patients attending regular dental check-ups due to the pandemic was reduced by 30% [ 24 ].…”

“…An increase in the number of calls from patients was reported by 38% of dentists in the study by Ahmadi et al [ 15 ]. Patients who contacted their dentist by telephone or text message felt less concerned about treatment [ 19 , 20 ]. About 40% of dentists use some form of teledentistry (most often teleconsultation and emergency calls), but nevertheless most admit that they do not know the regulations of teledentistry and that they need education [ 31 ].…”

Effects of COVID-19 pandemic on orthodontic practice

“…Only with sufficient preventive precautions in place 76% of patients were willing to see a clinic after the lockdown. 18 Guo et al stated that most orthodontic appointments and problems were judged non-emergent during the outbreak, so most orthodontic departments and clinics were closed. Many orthodontists and patients were at home throughout the orthodontic practice suspension and home quarantine, communicating via smartphones or online telemedicine services.…”