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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 39-43

Dental Problems and Awareness of Patients for Oral Health in COVID-19 Pandemic during Lockdown and Postlockdown Period

1 Department of Oral Medicine and Radiology, People's College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh, India
2 Department of Public Health Dentistry, People's College of Dental Sciences and Research Center, Bhopal, Madhya Pradesh, India
3 Department of Anatomy, GMC, Datia, Madhya Pradesh, India

Date of Submission29-Oct-2021
Date of Acceptance25-Dec-2021
Date of Web Publication06-Apr-2022

Correspondence Address:
Rashmi Deshpande Sathe
Department of Oral Medicine and Radiology, People's College of Dental Sciences and Research Center, Bhanpur, Bhopal, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_171_21

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Introduction: Due to the COVID-19 pandemic lockdown was imposed largely to control the rapid spread of this virus and get our health machinery ready to fight the disease. The dental services were restricted to urgent and emergency procedures. The aims and objectives of present study were assessment of dental problems faced by the patients during and after the lockdown, awareness of the patients regarding the oral health during this period and evaluation of current status of the dental problems. Materials and Methods: After taking informed consent of patients, cross sectional study was designed in form of online survey in month of February 2021. A link was shared to all the patients visiting dental outpatient department. There was no exclusion criterion for study. The responses were subjected to statistical analysis-using Chi-square test with significance value P < 0.05. Results: Total 506 responses (age range 5–68 years) of both the sexes were recorded. Out of them 269 (60.3%) did not have any dental problem whereas 177 (39.7%) had dental problem during the lockdown. Out of 177 responses, 62 patients faced multiple dental problems, highest being dentinal sensitivity/dental pain (50.2%).35.2% patients resorted to home remedies, 9.4% patients to teledentistry. Use of teledentistry was statistically significant for the dental problems of patients during lockdown (P < 0.05). Conclusion: Patients faced multiple problems Dental pain being the commonest. The current study has shown us the path for teledentistry and need for emergency dental services to tackle further such outbreaks.

Keywords: COVID-19 lockdown, dental problems, oral health awareness, teledendistry

How to cite this article:
Sathe RD, Bhambal AM, Channaiah SG, Singh TP, Sathe SV. Dental Problems and Awareness of Patients for Oral Health in COVID-19 Pandemic during Lockdown and Postlockdown Period. J Dent Res Rev 2022;9:39-43

How to cite this URL:
Sathe RD, Bhambal AM, Channaiah SG, Singh TP, Sathe SV. Dental Problems and Awareness of Patients for Oral Health in COVID-19 Pandemic during Lockdown and Postlockdown Period. J Dent Res Rev [serial online] 2022 [cited 2022 May 26];9:39-43. Available from: https://www.jdrr.org/text.asp?2022/9/1/39/342704

  Introduction Top

The novel corona virus pandemic has largely changed the scenario of treatment protocols in all the health care fraternity and dental treatment is no exception to it. After the declaration of spread of COVID-19 pandemic a lockdown was imposed largely to control the rapid spread of this virus and get our health machinery ready to fight the disease. The dental services were restricted to urgent and emergency procedures with suspension of routine dental care.[1],[2]

The transmission of COVID-19 is mainly by direct contact, respiratory aerosols or droplets of infected persons.[3],[4] Dentists belong to the high risk group and dental clinics could be a place for the possible viral transmission if proper protocols are not followed. Scientific evidence has proven SARS-CoV-2 may be present in saliva, thus it can act as a potential source of transmission.[5],[6],[7]

Sudden announcement of lockdown had largely created confusion and panic among the general population and the dental patients were worst affected due to incomplete treatment and perpetual oral ailments. Many patients either missed their routine dental check-ups or neglected their oral conditions. Due to the hesitation of the patients to go to a dental surgeon or any dental hospital many resorted to home remedies or took over the counter medications from the pharmacy. Some Patients also took the help of newer consultation methods such as telephonic and internet consultation services.[8]

The present study was conducted in Central India in Madhya Pradesh, Bhopal, with an aim to assess the dental problems faced by patients during the lockdown and their current dental condition. The study was conducted between the imposition of first and second lockdown. Phase I lockdown was between March 25, and April 14, 2020 and phase 2 lockdown was between April 15 and May 3 which was further extended till 1st week of June. During this period the routine dental services were restricted only for emergency treatment.

The objectives of present study were to assess the awareness of patients to oral health and whether the patients have started paying more attention to the oral health since the lockdown. Also because of sudden surge of pandemic and inability of patients to visit dental set ups, have they taken help of latest consultation methods like telecommunication applications and internet services regarding their dental problems.

  Materials and Methods Top

After getting the ethical clearance from the institute (IEC number-EC202044, Date February 1, 2021) an online cross-sectional survey was designed and conducted in the month of February 2021. Objective based questionnaires were created on Google platform. The consent of each patient who was willing to be a part of the survey was mentioned within the questionnaire. The link was shared to all the patients and their relatives through the Whats App application who were visiting the Outpatient Department of Dental College in Bhopal, Central India during this tenure. The survey was designed in such a way that it could be easily completed using a smart phone or tablet. The questionnaires were structured both in English and Hindi and were kept short and precise for easy understanding of the patients. The age range was between 5 and 70 years, subjects who were unable to use smartphones, the response sheet was filled with help of their relatives. A total of 10 questions were given of which the first question was about the demographic data, next 3 were pertaining to the dental problems faced during lockdown, remedies taken and the treatment received. The 5th and the 6th questions dealt with the current status of the dental problems and the ongoing treatment. The 7th question was based on the usage of telecommunication and internet based applications used by the patients for their dental problems. 8th and 9th questions were about the awareness of patients pertaining to their oral hygiene during the lockdown period. The last question was based on the awareness of patients about the COVID-19 protocol to be followed during the dental treatment. All the questions were closed ended questions with multiple choice given. There was no exclusion criteria in the survey all the patients and relatives willing to participate were included in the study.[9]

Statistical method

The collected responses were stored in Google spread sheets in excel format and were subjected to statistical analysis-IBM SPSS Statistics version 20 (SPSS Inc. Chicago,USA). Descriptive analysis and Chi-square test of significance were used with significance value set at P < 0.05.Analysis with Chi-square test was done deriving the frequencies of the response of each question and significance between dependent and independent variables.

  Results Top

The link was shared with 580 subjects out of them 506 responded to the questionnaire, with a response rate of 88%. A total of 506 responses were collected with an age range of 5 years to 70 years.

Out of these, 446 responded to the first question, 269 (60.3%) did not have any dental problem during the lockdown period whereas 177 (39.7%) did face dental problems during the lockdown period.

Out of 177 responses, 62 patients faced multiple dental problems. The highest response was of dentinal sensitivity or dental pain i.e., 120 patients (50.2%), which was followed by bleeding gums (17.2%), food lodgment (15.5%), swelling in gums or face (10.5%), halitosis (10.9%) and dislodged restoration (7.9%). Other dental problems were <1% [Figure 1].
Figure 1: List of dental problems faced by the patients during the lockdown

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Various measures taken by the patients to relieve their dental problems were as follows: 35.2% patients resorted to home remedies, 11.1% patients took self-medication in form of over-the-counter analgesics and antibiotics from the medical stores, while 23.3% patients tried to visit dental institutions. 17.8% patients contacted their regular dentist either personally or on phone whereas 12.5% patients visited other dentists [Figure 2].
Figure 2: Various measures taken by the patients to relieve their dental problems

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On enquiring about the current status of dental problems, it was observed that in 45.1% patients dental problem was still persistent whereas in 20.9% patients it was resolved. 56.7% patients were undergoing symptom based treatment for their dental problems and 8.6% patients had to undergo emergency dental treatment due to extreme dental pain or severe infection [Figure 3].
Figure 3: Shows the status of current treatment the patient is undergoing

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Only 9.4% patients tried the telecommunication methods regarding the dental problems and the rest 90.6% patients were unaware of such applications.[10] Use of telecommunication was found to be statistically significant for the dental problems faced by patients during lockdown (P < 0.05).

The responses on oral health awareness showed that 60.4% patients brushed once a day, 38.2% patients brushed twice a day, i.e., had a night brushing habit. Frequency of brushing was found to be statistically significant for the subjects who had dental problems during lockdown. 56.1% patients started paying more attention to their oral health during lockdown by using mouth washes, interdental cleaning agents and resorting to night brushing habit. Subjects paying increased attention to oral health were found to be statistically significant with the dental problems encountered by subjects during lockdown. 28.6%patients did not change their oral hygiene habits. However 15.2% patients were not sure about their answer [Figure 4].
Figure 4: Shows the distribution of patients who started paying more attention to the oral hygiene

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Most of the patients (73.6%) patients were aware of the COVID-19 protocol to be followed during dental treatment whereas 26.4% patients were unaware of any such precautions to be followed during COVID-19 pandemic.

  Discussion Top

The unprecedented pandemic has put the whole world in state of emergency and India is no exception to it. Ignoring regular dental checkups may lead to worsening of the dental problems and may affect the overall oral health of the society.[11] These can further lead to dental emergencies which may exacerbate within a short period of time which will overburden the dental health care emergency services, leading to more chaos and mismanagement.[12]

According to this study, 60.3% patients faced dental problems during the lockdown. Out of this half of them had pain/sensitivity in teeth or swelling in the face or gums. 8.6% patients had to undergo emergency dental care.

Many patients resorted to home remedies or took over the counter medications in form of analgesics and antibiotics due to limited access to dental facilities during lockdown. Overuse of medications without proper medical advice can lead to serious issues like antibiotic resistance and sometimes toxicity.[13]

The authors observed that many patients enhanced their oral hygiene routine by increasing the frequency of brushing, use of mouthwashes and interdental cleaning agents during the lockdown period. This showed the willingness and awareness of the patients for oral health.[14]

(73.6%) Patients were aware of the COVID-19 protocol in form of usage of mask, social distancing and awareness about the cross infection during dental treatment. Whereas 26.4% patients were completely unaware about the COVID appropriate behavior.

It was observed that only 9.4% patients in the study took the help of telecommunication application for their dental problems. Petcu R et al. in his study about patients perception on teledentistry found a positive approach regarding teledentistry when used for cognitively impaired subjects.[15] Similar results were also found by study conducted by Estai et al. and Obeid Watfa et al. which showed a high satisfaction rate and acceptance for newer technology among the patients.[16],[17]

Most of the Indian population have access to the smart phones, tablets and computers, appropriate use of teledentistry can serve as a boon to both dentist and patients in managing dental emergencies in lock down.[18] These applications must be designed in such a way so that it can be used easily by a common man, which will greatly facilitate the oral health care system. Teledentistry needs to be advertised and promoted as it is practical, cost effective and efficient in this pandemic situation.[19] AIIMS New Delhi has taken initiative of providing tele-consultation, tele-diagnosis, tele-education to several medical colleges and hospitals in North-Central India in form of Collaborative Digital diagnosis system (Collab DDS). The major challenges faced by Tele-dentistry today in the Indian scenario include absence of government schemes, data protection laws, lack of orientation among doctors and patients, diversity of language, patients trust and unfamiliarity with the latest technology.[20]

Few limitations of this survey were limited sample size and study population limited to Bhopal population. Larger studies need to be conducted to study about the difficulties faced by patients during lockdown in other parts of the country.

Our dental offices and staff have to be well equipped to handle emergency dental treatment and should undergo proper training so as to get prepared for future outbreaks.[21] Complete sterilization protocols and guidelines should be followed as laid down by Centers for Disease Control and Prevention and WHO in the Dental set up so that the patients are less apprehensive for the treatment.[22] Topmost care should be taken to avoid cross infection for the safety of dental staff as well as patients.

  Conclusion Top

Very few studies have been conducted highlighting the dental problems faced by patients during and after lockdown. Such studies have helped us to evolve through this pandemic situation, so that we can learn, adapt and become better equipped so as to provide optimal oral health care to the society. There is a need to educate and update the use of internet and teledentistry for patients as well as dental surgeons so that we become future ready for any such outbreaks. The dental surgeons as well as the dental staff should be adequately trained to handle the emergency dental treatment during such outbreaks.

Ethical clearance

Ethical Clearance no-IEC number EC202044, Date February 1, 2021.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Alharbi A, Alharbi S, Alqaidi S. Guidelines for dental care provision during the COVID-19 pandemic. Saudi Dent J 2020;32:181-6.  Back to cited text no. 1
Guidance for Dental Settings. Centers for Disease Control and Prevention; 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. [Last accessed on 2020 Jun 27].  Back to cited text no. 2
Galbadage T, Peterson BM, Gunasekera RS. Does COVID-19 spread through droplets alone? Front Public Health 2020;8:163.  Back to cited text no. 3
WHO. How Does COVID-19 Spread? World Health Organization; 2020. Available from: https://www.who.int/publications-detail/global-surveillance-for-covid-19-caused-by-human-infection-with-covid-19-virus-interim-guidance [Last accessed on 2020 Jul 02].  Back to cited text no. 4
Fini MB. What dentists need to know about COVID-19. Oral Oncol 2020;105:104741.  Back to cited text no. 5
Li Y, Ren B, Peng X, Hu T, Li J, Gong T, et al. Saliva is a nonnegligible factor in the spread of COVID-19. Mol Oral Microbiol 2020;35:141-5.  Back to cited text no. 6
Schwendicke F. Saliva is a potential source of Covid-19, and appropriate protection measures should be applied in dental practice. Evid Based Dent 2020;21:62.  Back to cited text no. 7
Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus disease 19 (COVID-19): Implications for clinical dental care. J Endod 2020;46:584-95.  Back to cited text no. 8
Singh S, Rana A, Jain V, Sybil D, Khatter H. Effect of COVID-19 lockdown on dental care of patients: A survey analysis. Int J Res Rev 2020;7:1-8.  Back to cited text no. 9
Kopycka-Kedzierawski DT, McLaren SW, Billings RJ. Advancement of Teledentistry at the University of Rochester's Eastman Institute for oral health. Health Aff (Millwood) 2018;37:1960-6.  Back to cited text no. 10
Gambhir RS, Gupta T. Need for oral health policy in India. Ann Med Health Sci Res 2016;6:50-5.  Back to cited text no. 11
[PUBMED]  [Full text]  
Meisha DE, Alsolami AM, Alharbi GM. Social determinants of seeking emergency and routine dental care in Saudi Arabia during the COVID-19 pandemic. BMC Oral Health 2021;21:212.  Back to cited text no. 12
Dana R, Azarpazhooh A, Laghapour N, Suda KJ, Okunseri C. Role of dentists in prescribing opioid analgesics and antibiotics: An overview. Dent Clin North Am 2018;62:279-94.  Back to cited text no. 13
Gambhir RS, Dhaliwal JS, Aggarwal A, Anand S, Anand V, Bhangu AK. Covid-19: A survey on knowledge, awareness and hygiene practices among dental health professionals in an Indian scenario. Rocz Państw Zakł Hig 2020;71:223-9.  Back to cited text no. 14
Petcu R, Kimble C, Ologeanu-Taddei R, Bourdon I, Giraudeau N. Assessing patient's perception of oral teleconsultation. Int J Technol Assess Health Care 2017;33:147-54.  Back to cited text no. 15
Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Bunt S, Kruger E, et al. End-user acceptance of a cloud-based teledentistry system and Android phone app for remote screening for oral diseases. J Telemed Telecare 2017;23:44-52.  Back to cited text no. 16
Obeid Watfa M, Bernfeld NM, Oren D, Shani T,Zigron A, Sela E, et al. Rapid implementation of teledentistry during the covid-19 lockdown. Adv Oral Maxillofac Surg 2021;2:100031.  Back to cited text no. 17
Deshpande S, Patil D, Dhokar A, Bhanushali P, Katge F. Teledentistry: A boon amidst COVID 19 lockdown – A narrative review. Int J Telemed Appl 2021;2021:1-6.  Back to cited text no. 18
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