Dental professionals are at higher risk of being infected by SARS-CoV-2, exposing to blood, saliva, and aerosol/droplet generation during dental procedures (9, 10). Previous investigations considered that dentists are the highest risk group of health-care workers for contracting COVID-19 (11). Several recommendations have been proposed since the beginning of the outbreak, including infection control protocols and triage of patients to reduce the risk of nosocomial infection in dental settings. Although, the patients who are carrying the novel virus can be asymptomatic, and the routine triage might not detect them. The nosocomial transmission of SARS-CoV-2 has been a concern for dental practitioners, as it could put both patients and dentists at the risk of contagion.
The results of our study showed that about 7% of the contributors had experienced the symptoms of COVID-19, and nearly 1% of them had a positive COVID-19 test. Besides, the workers in dental clinics are also at considerable risk of contagion, as our investigation showed that 3% of the contributors’ assistants had the symptoms mentioned above. This indicates that dental practice should be done even with more infection control cautionary, and the non-emergency treatments should be delayed until the end of the pandemic.
Occupational Safety and Health Administration has mentioned that using remote dental consultations should be considered for the non-emergent cases during the pandemic (12). Additionally, before the current pandemic, remote consultation was found to have sufficient quality for oral treatments (13). The telehealth-based delivery of dental services seems to be an attractive and flexible concept, especially during these unprecedented times (14).
Consistently, the majority of the participants of the present study also reported a tremendous increase in the demand for remote dental consultations. However, they did not consider remote consultation as an effective way of delivering dental services. We believe these controversial results could be because of the characteristics of dental procedures and the lack of appropriate infrastructure. Future studies must be conducted to hypothesize and design advanced technologies that can virtually deliver dental services.
In response to the current pandemic, several organizations such as the Centers for Disease Control and Prevention (CDC), (ADA), British Dental Association, and National Health Service have designed and developed response groups, and guidance for dental settings. In the early days of the pandemic, the guidelines recommended that dental care procedures should be done for urgent and emergency diagnosis while providing appropriate PPE and patient care supplies. However, as the pandemic continued, it has been proposed that dental settings can deliver non-emergency treatments. A survey led by the ADA Health Policy Institute demonstrated that over 90% of dental clinics are now open for elective care services (15). CDC has designed a standard for health-care systems and health-care workers for the delivery of non-emergent services to minimize the risk of the contagion (16).
Most of the contributors mentioned that they follow and implement the latest guidelines for dental settings. More than half of them believed that the standards in that regard must be reformed. The guidelines may differ in different regions of the world according to their facilities and supplies. Though, we believe that a comprehensive worldwide instruction must be provided for dental settings to minimize the risk of infection effectively. A significant number of participants mentioned that they do not perform any non-emergency procedures, and they have lowered their work hours to minimize the spread of the virus. In our study, several suggestions have been made regarding dental practice guidelines such as reducing the treatment sessions, emphasis on preventive care, triaging patients for the related symptoms, conducting COVID-19 tests for the referred patients, and proper use of PPE. Some participants considered that the reopening of the dental clinics for non-emergency cases might increase COVID-19 incidence, and the offices should be closed until the end of the pandemic.
The global health care systems have already been overwhelmed with infectious and potentially infectious patients. Effective use of PPE, including gowns, gloves, face shields, goggles, and face masks, is an essential regulation for preventing the spread of the virus to and from health-care providers and patients. While the rapid enhance of demand for PPE resulted in the shortage of these supplies all around the world (17).
The majority of the participants have asserted that the consumption of PPE had been significantly raised, and more than half of them had trouble finding facemask since the COVID-19 outbreak. Furthermore, they reported that the price of personal protective equipment (PPE) had been significantly raised, which could be a sign of shortage. No public organization did not help the participants to provide this equipment due to the lack of support from insurance companies.
A significant number of the participants had financial problems caused by their lowered work hours and restricted dental procedures. More than half of them have been expending their saves for daily expenditure. Still, a small number of them have received financial help from public organizations. These results indicate that the related organizations must increase their efforts to fund the dentists and their assistants during these unprecedented times. Should not providing the support funds for the dental care workers, by persisting the COVID-19 pandemic, the number of workers that encounter financial problems will increase.
It has been noted that the health-care workers are encountering far more emotional stress comparing to the general population, during the COVID-19 pandemic (18, 19). Increased workload, fear of being infected with the disease, working with repeatedly changing protocols, usingPPE, and caring deteriorating patients are found to be the main concerns among the medical staff during the pandemics. Moreover, difficult decisions should be made by the workers during the pandemics as the resources are limited. Our study also showed that about half of the participants had symptoms of depression and anxiety. They also mentioned that they need to consult with a psychiatrist or a therapist.