22 November, 2021
Dental Economics During COVID-19: An insight into factors that tipped the balance
Panic buttons have been pressed at all levels since the day COVID-19 was declared a pandemic by the World Health Organization. Like all other healthcare sectors, dentistry has also been severely affected due to various factors, including the highly contagious nature of the SARS-CoV2 infection that is feared to spread through the aerosols generated during dental procedures. This has left a catastrophic impact on financial and social security and the mental and physical health of the practitioners, patients, dental auxiliaries, students, and researchers in dentistry due to the closure of dental clinics, colossal revenue, and job loss that led to economic instability.
Did the pandemic affect the Dental Practice?
An evidence-based approach about the impact of COVID-19 on finances and employments offers a worrisome picture. There is an alarming situation due to reduced patient inflow and financial collections while overheads increased due to the professional protective equipment (PPE) and other infection control materials. Studies show that more than 75% of dental practices in many geographical regions had a drastic decrease in their usual patient volume, with incomes falling, hitting rock bottom in over 82% of dental practices.
This depletion of income and revenue directly affects dental clinic owners' capability to pay the regular salary of their employees. The period from March 2020 to August 2020 was the worst effect as more than half of dentists in many parts of the world could afford only partial salary payment while around a quarter of them could not pay their staff during this period. Research shows that just about 27% of dental practice owners provided full pay to their employees. This has been the situation globally because almost all dental practices have been shut either voluntarily or by governmental orders.
Most dental clinics report to have followed the COVID- 19 infection control protocol strictly, but very few have the regular patient inflow. It was reported that only emergency cases were reported to the clinics during COVID-19 times. Surveys by The American Dental Association (ADA) showed that most of the dental professionals (>11,000) were dealing with mental stress and uncertainties, wondering if the dental professional has lost the charm of yesteryears. In light of these observations and the tremendous concerns of the COVID-19 impact on the profession of dentistry, there is a need to elaborate upon the economic and social impact of this worldwide crisis.
Effect on Dental Education
Dental schools all around the world have been devasted as a result of indefinite lockdown. COVID-19 pandemic outbreak greatly restricted the opportunity for clinical training that also adversely affected patients treated at the dental clinics of these educational institutions. For nearly ten months, dental schools' closure has resulted in losses of revenue to the tune of millions of dollars, the abrupt ending of several ongoing research, the suspension of many preplanned educational programs and activities.
COVID-19 also stopped/stalled recruitments in dental clinics and academic institutions, devastating job seekers globally. Based on the national guidelines and policies of the particular country and the severity of COVID-19 spread, every dental school worldwide has suffered from these unfortunate incidences.
Only Emergency Cases Prioritized
Dentistry is a specialty that hugely depends on dental procedures like tooth extraction, routine scaling and root planning, denture and implant placement, root canal treatment, periodontal surgeries, orthodontic correction, etc., patients' complaints. Many dental schools discontinued their clinical services during the lockdown except for treating dental emergencies such as an acute toothache or uncontrolled bleeding from an extraction socket. Since many patients were deprived of a routine checkup and primary dental care, it is expected that there will be an increase in the prevalence of many oral diseases in the months to come. Statistics show that senior faculty (96%) and postgraduates (30%) treated the patients who reported attended emergency clinics during the pandemic.
Advent of Virtual Learning
In the initial months of the pandemic, teaching was entirely shifted to online platforms. Without sufficient resources, virtual reality devices, haptic technologies, and human resources, many dental schools had to cut down a lot on the existing curriculum. Being a clinical specialty, evaluating dental students' clinical competency, including manual dexterity and fine motor skills, is a mandatory step. Many universities skipped this aspect due to the pandemic lockdown, and instead, students were evaluated only based on their theoretical knowledge to maintain the academic year's continuity.
Change In Student Evaluation Pattern
The pandemic has, however, changed many academic strategies within the faculty of dentistry. Due to the profession's clinical nature, strategies in online- and e-learning practices and clinical skill enhancement involving augmented reality/virtual reality need to be available for universities globally. The lockdown also halted the traditional teaching and hands-on laboratory/clinical training under direct supervision and necessitated alternative teaching methods and assessing through online exams, problem-solving clinical scenarios, and webinars. Virtual meetings between faculty and students and telecommuting became an alternative for better communication. Although virtual sessions help to continue online classes, nothing could replicate the actual clinical experience and extramural rotations as part of the curriculum in many colleges.
The Mental Health Of Dentists And Dental Students
Depression, anxiety, and panic attacks have been reported to be on the rise during this crisis. Being in the frontline increased the risk of exposure to the SARS-CoV2 infection, which led to many dentists contracting COVID-19 and losing their lives. Some students even worried about the missed clinical training, ongoing research, evaluation criteria, and even lack of direct faculty supervision during the lockdown period. Many countries and governments took the initiative to address this issue by providing psychological support, counseling facilities, and emergency helplines.
Effect On Dental Research
One of the largest conclaves of international dental researchers, the International Association of Dental Research (IADR), which was planned to be held in March 2020 in Washington DC, USA, was canceled. Furthermore, to maintain social distancing and comply with government rules, most of the research projects were abruptly stopped, resulting in huge losses of money, time, and hard work invested. Subsequently, many studies were converted to off-campus and web-based studies such as literature reviews and online surveys.
The Silver Lining
The COVID-19 has impacted every aspect of Dentistry. But every cloud has a silver lining. Despite all the unfortunate losses during the pandemic, there are some positive changes too. One of the positive changes that happened during the pandemic is the boom of Teledentistry. Dental patients were able to seek online dental consultations and treatment planning for their ailments without visiting hospitals and exposure to infection. Patients could send clinical pictures and information to a doctor who was at a distant place. Remote screening and triaging were made possible Teledentistry, which was helpful for primary health centers, dental clinics, and hospitals to assist patients with initial management. Other than regular patients, children, pregnant women, elderly, and medically compromised patients were among the ones mostly benefitted.
Real-time virtual consultation, ease of data storage, and remote consultation proved Teledentistry an ideal tool for the post-pandemic practice. Similarly, handwashing and the use of professional protection equipment PPE have been made mandatory by many governments. These initiatives will ensure that dental clinics to be a lot safer place to visit. There is also an exponential growth in the number of online courses and educational content to learn from. During the lockdown, many dental students and clinicians utilized the time and opportunity to improve their knowledge and expertise through the available e-learning platforms.
In the final analysis, the COVID-19 pandemic has impacted every aspect of dentistry. One has to incorporate smart techniques to benefit dental practice and the patient. We all must be geared to enter the post-pandemic world with utmost preparedness. While the dental practice seems to be slowly recovering, there is a need to engage in constructive discussions to face today's challenges and prevent a second wave from thwarting our tomorrows.
Barabari, P. and Moharamzadeh, K., 2020. Novel coronavirus (COVID-19) and dentistry–A comprehensive review of literature. Dentistry journal, 8(2), p.53.
Meng, L., Hua, F. and Bian, Z., 2020. Coronavirus disease 2019 (COVID-19): emerging and future challenges for dental and oral medicine. Journal of dental research, 99(5), pp.481-487.
Emami, E., 2020. COVID-19: perspective of a dean of dentistry. JDR Clinical & Translational Research, 5(3), pp.211-213.
Quinn, B., Field, J., Gorter, R., Akota, I., Manzanares, M.C., Paganelli, C., Davies, J., Dixon, J., Gabor, G., Amaral Mendes, R. and Hahn, P., 2020. COVID‐19: The immediate response of european academic dental institutions and future implications for dental education. European Journal of Dental Education, 24(4), pp.811-814.
Desai, B.K., 2020. Clinical implications of the COVID‐19 pandemic on dental education. Journal of dental education, 84(5), p.512.
Ghai, S., 2020. Are dental schools adequately preparing dental students to face outbreaks of infectious diseases such as COVID‐19?.
Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J. and Zheng, J., 2020. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry research, 287, p.112934.