The results of our study showed that about 7% of Iranian dentists 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 (16).
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 (17). As previous studies also mentioned that dental practitioners are at higher risk of being infected by SARS-CoV-2 (18-21).
The majority of the participants of the present study 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 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 (22).
Occupational Safety and Health Administration has mentioned that using remote dental consultations should be considered for the non-emergent cases during the pandemic (23). Additionally, before the current pandemic, remote consultation was found to have sufficient quality for oral treatments (24). The telehealth-based delivery of dental services seems to be an attractive and flexible concept, especially during these unprecedented times (25). Despite this, most clinics do not have the proper equipment such as network infrastructures and adequately trained staff to provide the telehealth services (21).
A significant number of the 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. They also declared that they follow and implement the latest national and international COVID-19 guidelines for dental practice. However, more than half of them believed that the standards in that regard must be reformed by the local authorities. We believe that a comprehensive worldwide instruction must be provided for dental settings to minimize the risk of infection, effectively.
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 (26-28). These instructions emphasized on closely examining the patients considering the clinical symptoms and epidemiological history (21). In the early days of the pandemic, the guidelines also recommended that dental care procedures should be done for urgent and emergency diagnosis while providing appropriate PPE and patient care supplies (4).
In our study, several suggestions have been made to decrease the risk of infection 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 believed 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 public organizations suggested that the general population should increase their oral hygiene and implement preventive care to reduce the need for dental procedures, during the pandemic (21). As most of the dental clinics only provide low-risk procedures such as tooth-extraction, which could increase the demand for removable prosthetic treatments in the future (29). However, as the pandemic continued, it has been proposed that dental settings can deliver non-emergency treatments as well. A survey led by the ADA Health Policy Institute demonstrated that over 90% of dental clinics are now open for elective care services (30). CDC has also 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 (31).
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 (32, 33). While the rapid enhance of demand for PPE resulted in the shortage of these supplies all around the world (34). The majority of the participants of the present study 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 PPE had been significantly raised, which could be a sign of shortage. This increasing price of PPE might also lead to the rise of dental treatment costs (21). Although, public organizations did not help the participants to provide this equipment.
A significant number of the participants had financial problems caused by their lowered work hours and restricted dental procedures. Consistently, a study revealed that the COVID-19 pandemic imposed financial distress on dental offices (35). More than half of the Iranian dentists 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 (21).
Our study also showed that about half of the participants had symptoms of depression and anxiety. It has been noted that the health-care workers are encountering far more emotional stress compare with the general population, during the COVID-19 pandemic (36, 37). Increased workload, working with repeatedly changing protocols, using PPE, social-distancing, self-isolation, and caring deteriorating patients are found to be the main concerns among the medical staff during the pandemics (38, 39). Moreover, difficult decisions should be made by the workers during the pandemics as the resources are limited (40). The dentists who participated in the present study also mentioned that they need to consult with a psychiatrist or a therapist.
Our study has some limitations. One of the most important weaknesses of our study is the sampling method. Although chain-referral sampling is an easy and quick method to find participants, people may refuse to participate in the study after the invitation. Furthermore, participants may recommend the dentist whom they know with a similar age range. Our investigation is a descriptive study that focuses on descriptive analysis of the situation and objects, therefore it was unable to test or verify the causal relationship. Another weakness of our study is that we had a limited time frame to conduct the questionnaires to be more up to date.