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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 88-92

Psychosocial impact of novel COVID-19 on dental professionals – Current analysis and scoping review


1 Department of Pedodontics and Preventive Dentistry, Daswani Dental College and Research Centre, Kota, Rajasthan, India
2 Department of Oral Medicine and Radiology, Daswani Dental College and Research Centre, Kota, Rajasthan, India
3 Department of Periodontology, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India

Date of Submission03-Sep-2020
Date of Decision19-Sep-2020
Date of Acceptance23-Sep-2020
Date of Web Publication28-Jan-2021

Correspondence Address:
Dr. Srinandan Pradhan
Senior Lecturer, Daswani Dental College and Research Centre, Kota, Rajasthan - 325 003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sidj.sidj_38_20

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  Abstract 

The human civilization of the world is probably going through the most important turning point of this millennium, in which the existence of humans is being challenged by the emergence of a severe respiratory syndrome novel coronavirus-19 (nCov-19), which can be seen in new areas around the world attempting to encroach and destroy. nCoV-19 pandemic has created a challenge for scientists and doctors from worldwide how to treat infected patients while protecting themselves from this infection, and the significant effect of this pandemic is on treating eye and dental diseases. The novel coronavirus disease 2019 (nCOVID-19) transmission through contact with droplets and aerosols generated during dental clinical procedures is expected. Hence, especially for dentists and health-care professionals that perform aerosol-generating procedures are restricted. As a result, severe financial implications being faced by dentists and health-care workers. Like other pandemics and emerging disease outbreaks, nCOVID-19 is creating immense psychosocial disturbances. The collective fear of nCOVID-19, which can be felt among working dental professionals in institutions, may be called “Dento-Coronophobia,” has led to an excess of psychotherapeutic manifestations at various levels of society. Therefore, this review has been done to define the psychological effect of nCOVID-19 on dental practitioners.

Keywords: Coronavirus, COVID-19, dentistry, psychosocial impact


How to cite this article:
Pradhan S, Upadhyay P, Gupta D, Chavan S, Kumar P, Yadav N. Psychosocial impact of novel COVID-19 on dental professionals – Current analysis and scoping review. Saint Int Dent J 2020;4:88-92

How to cite this URL:
Pradhan S, Upadhyay P, Gupta D, Chavan S, Kumar P, Yadav N. Psychosocial impact of novel COVID-19 on dental professionals – Current analysis and scoping review. Saint Int Dent J [serial online] 2020 [cited 2021 Apr 19];4:88-92. Available from: https://www.sidj.org/text.asp?2020/4/2/88/308177


  Introduction Top


Coronavirus disease 2019, additionally known as nCOVID-19, is the contemporary infectious disease that is swiftly spreading worldwide with an etiology of the severe acute respiratory syndrome:[1] The 2019 coronavirus is not like severe respiratory syndrome coronavirus (SARS-CoV), however, it has the identical host receptor of SARS, i.e.,: human angiotensin-converting enzyme 2 (ACE2). SARS-nCoV-2 became provisionally first identified in 2019 in Wuhan city, China, unfortunately spreading globally, ensuing in the 2019–2020 pandemic.[2]

The COVID-19 transition commenced in Asian countries, however, it has now extended quickly to other countries around the world as reported by the World Health Organization (WHO) and the Public Health Emergency of International Concerns: According to the WHO, this new kind of epidemic is spreading due to novel CoV-2019. Nearly every country in the world, along with India, had announced a nationwide lockdown of at least 3 to 4 weeks, citing a necessary and effective measure to break and reduce the nCOVID-19 transition cycle. Social isolation, mouth mask, and hand washing are effective methods of breaking the process of nCOVID-19 infection, according to the World Health Organization. All medical and dental practices are currently restricted to the provision of emergency care. Hence, dentists and health-care professionals are facing psychological and financial challenges in this difficult time. Protracted and dynamic pandemic conditions will draw out the anxiety.[1] Fears of economic and stagnation in dental professionals, including uncertainty, the increasing nCOVID-19 has triggered depression and anxiety as a global crisis. Humans are observing a tough time fighting against an invisible enemy, the novel COVID-19 CoV.

Key messages

It is very important for the dentist to have complete knowledge of prevention from this epidemic; people in quarantine who require emergency dental care should address their condition to dentists through Wireless medium.

Strategies of literature search

We searched PubMed, Medline, SCOPUS, EMBASE, Science Direct, and Google Scholar for relevant articles on psycosociology of nCOVID19 and its impact from July to August 2020. Medical subject headings (MeSH) were searched using Boolean operators “OR/AND.” Search terms were: (“psycosocial impact, 2019-nCoV” or “novel coronavirus” or “nCOVID-19” or “nCoV-19)” and (“dentist, oral health-care workers”).

Inclusion criteria

Studies that explain social and economical impact of nCOVID-19 either observational, original research, editorials, case report, case series, literature reviews, or opinion-based comments.

Exclusion criteria

Studies performed on other points except social impact of COVID-19 like clinical outcome, clinical trials.

Novel COVID-19 – A mark of disgrace

In recent times, researchers throughout the world have been focusing on a clean and complete treatment of potential nCOVID-19 and also highlighting how social support can affect such remarkable health outcomes. One threat to the nCOVID-19 response in India is the propagation of misinformation through social media to dental professionals as well as other health-care workers practicing in non-COVID-19 accredited centers. Due to the nCOVID-19 epidemic, non-COVID-19 workers have been asked to stay at home (self-isolation) for personal safety and protection, which has culminated in elevated rates of domestic violence and stress.[1]

Distress level of novel COVID-19 in dental professionals

Studies carried out on nCOVID-19 patients worldwide have investigated their level of anxiety and quality of life (QL). Even dental professionals practicing worldwide are also not untouched by this nCOVID-19 epidemic and are suffering from Dental stress and nCOVID-19 Phobia.[2],[3] Today's nCOVID-19 epidemic has led to many changes in a broad spectrum of QL issues, including physical, social, cognitive, spiritual, interpersonal, and role work, coupled with psychological impairment, pain, and another general lifestyle. nCOVID-19 has given rise to psychological issues in dental professionals such as dissatisfaction, embarrassment, self-consciousness, lack of self-confidence, and social dysfunction such as decreased social interaction with peers/avoidance, fewer employment opportunities have been documented during this pandemic.


  Impact on Healthcare Top


The nCOVID-19 pandemic has created a global crisis and unprecedented challenge for healthcare systems. In particular, healthcare workers' risk is one of the most significant vulnerabilities of health-care systems worldwide. It was more interesting to understand that, despite the high level of knowledge, dentists around the world are contributing to routine casual dental treatments even in the face of persistent fear of acquiring epidemics nCOVID-19. High health-care costs, shortages of protective equipment, including N95 face masks and low medical capacity, ICU beds, and ventilators, have ultimately exposed weaknesses in the delivery of patient care. Unfortunately, the outbreak of nCOVID-19 has resulted in severe financial pressures being put on hospitals and health-care workers as they fight this pandemic.[4]


  Challenges and Impact on Dentistry Top


Despite SARS-CoV-2 worldwide transmission, health-care providers are at increased risk of experiencing an infection and becoming potential carriers of this epidemic. Dentists are often the first line of diagnosis, as they work in close contact with patients. According to the Occupational Safety and Health Administration, dental health-care personnel are placed at greater risk as a result of work in proximity to the patient's oral cavity. Dentistry is experiencing its toughest hour Due to the growth and spread of the novel coronavirus 2019 (nCov-19) epidemic. According to several printed articles, dental surgeons are at greatest risk of contraction and infection of nCoVs, along with paramedics, nurses, and other health-care workers. Dentistry is a profession where the dentist operates near the patient's mouth, and many procedures are performed in which aerosols are produced, which is a mixture of water (from a dental instrument like high-speed handpiece) and the patient's saliva or blood.[5] These aerosols could result in the spread of infection and diseases, including nCOVID-19.[6] On March 15, 2020, the New York Times published an article entitled “the workers Who Face the Greatest Coronavirus Risk,” in which an outstanding schematic figure described and identified that oral health care workers are most exposed and vulnerable to the risk of being affected by nCOVID-19, much more than nurses and general physicians.[6] Due to this epidemic, dentists are at risk and more prone to being affected; several health regulatory bodies have released general guidelines for registered general dental practitioners to perform only emergency dental procedures with instructions to avoid all elective treatments such as restoration and extraction of asymptomatic teeth, esthetic dental procedures, orthodontic follow-up and adjustments, and routine radiographs.[7] General dental practices are currently suffering substantial financial losses as they can provide only emergency dental care. It is highly recommended that the competent authorities of the country should step up and support dental practices that are on the verge of closure due to financial losses inflicted by the nCOVID-19 pandemic. nCOVID-19 has shown a disastrous impact on the dental education as well as on dental oral health-care professionals and is still upward on the epidemic development curve, and the extent and severity of its long-term effects are difficult to ascertain at this stage.[8],[9]

Need for creating awareness in dentistry - New ways of communication

In the era of this epidemic, the use of communication technology has become very important in the medical and dental field in the age of information overload from various sources. This epidemic has also proved dentistry to be a required field of medicine, but it is still isolated from traditional medical science and research. Before specializing in dentistry, governing bodies of the country should create basic guidelines so that dentists can understand and recognize its importance by not only earning a primary degree but also making all the dentist necessary to equip with all types of essential therapies to cope and better deal with such kind of epidemic emergencies. In the time of this spreading epidemic, dentists need to find the right knowledge and the correct way to artificialize information and to make patients aware of it, to reduce patient anxiety and harassment among patients, and create awareness by being honest and transparent.[10]

Comorbidity with novel COVID-19 – Dentist overview

The overall burden of nCOVID19 is affected in part by high comorbidity of other medical and psychological disorders. In general, the articles regarding the nCOVID-19 epidemic are still incomplete and are being studied worldwide; based on the information received so far, diabetes, blood pressure, respiratory diseases, and their susceptibility condition is thought to be linked with comorbidity of nCOVID-19.[10]

The people with hypertension, diabetes, respiratory system disease, and cardiovascular disease should be included in influenza and future SARS-CoV-2 vaccination recommendations. Further significant experiments should be conducted to consider the yet published weak data related to cover-19 and to confirm the correlation. The prevalence and incurable epidemics of chronic diseases are increasing year-by-year, and targeted public health vaccination interventions should be adopted to better protect against chronic diseases caused by infection with viruses and incurable epidemics such as SARS-CoV-2. There is a need for a cultural shift in the approach to dentistry, adopt telementoring, and shift focus to preventive dental care. Preventive procedures can curb the risk of cross-infection from aerosols, and the splatter, which poses a severe health risk to dental practitioners even under regular circumstances.[11]


  Psychological Impact on Dental Professionals in India Top


nCOVID-19 pandemic has caused fear and devastation across the world. India is also going through a daunting situation due to this epidemic as the number of infected/positive cases is continuously rising. Along with strict preventive measures and restrictions by the Indian Government in the form of nationwide lockdown, the Indian citizens are undergoing through a range of psychological and emotional reactions, one of which is fear and uncertainty. In India, the first and foremost important response to the COVID-19 has been feeling of palpable fear and a sense of clear and imminent danger. Social disturbances and lockdowns have led to many changes in the day-to-day activities of a normal citizen as well as the dentist, such as redistribution of household chores, working from home and spending more and more time with the occupants.[12]

Impact and change in strategy of dental education

The COVID 19 epidemic has adversely affected students learning dentistry, in which they look to an uncertain future due to undergraduate and postgraduate students not getting dental education due to the total lockdown of dental colleges. Dentistry is a medical branch devoted to the study of oral and maxillofacial knowledge and related diseases. It is a profession that requires oral communication, attention to detail patient grace, clear conception to solve problems, and most excellent manual dexterity. Have you ever thought about why hand skills are so important in dentistry and how much the students of dental practice have suffered because of this epidemic? The effective and correct combination of manual dexterity helps the dentist to complete his or her dental surgeries in a very short time; but due to the impact of this epidemic, the dental universities are closed as a consequence of which the dentist has lost the choice to improve their manual dexterity.

The epidemic has progressively forced online learning for students studying in universities around the world, which has generally led to unexpected expenses at universities. They had to raise funds to continue paying their workers as well as deep cleaning facilities and research programs mothballing. Nevertheless, they can easily overshadow expectations for next year as high as a loss for the current academic year. Sometime in the 2nd week of March, governments around the world began temporarily closing down schools and colleges, with India also taking a swift decision to close its international borders and enforce immediate lockdown as it was a mere temporary measure to stop the spread of the nCoV. The shutdown from March to till now, and there is uncertainty when they will reopen. This is a crucial time for dental education and another education sector - board examinations, nursery school admissions, entrance examinations of various universities, and competitive examinations, among others, are all conducted during this period. Apart from the missed opportunities at the time of this epidemic, the students of dentistry are not able to learn from experienced facilities, as well as opportunity for students to treat oral disorders of the patients are minimized due to closure of the dental institutions giving rise to economic and social stress. The pandemic has also disrupted the higher education sector, which is an essential determinant of the country's economic future. However, a matter of great concern in everyone's mind is the impact of the employment rate caused by this epidemic.[10],[11] In India, all universities are required to finish the complete course and examinations in a fixed time. Due to this epidemic, this year, the Government of India has issued some protocols and guidelines to minimize face to face teachings and to conduct examinations on semester 2019–2020 which all institutions have to follow, so that the teachings and examinations can be done on their own time. Few points are as:

  • 25% course teaching should be done online mode and rest through physical attendance at institute
  • Extension of approximately 6 months' period for post graduate and super specialties courses
  • Examination can conduct by reducing time from 3 h to 2 h through online/offline mode.


Future dentistry – Adapting new world a thought

There should be an effort to connect dentistry, medicine, pharma, and IT in the world, which will have a positive impact on providing essential, acute dentistry emergency and emergency services to the ordinary people in the times ahead. Practitioners are globally embracing the idea of teledentistry, which can be immensely helpful for triaging and can also minimize unnecessary face-to-face time with patients. However, this suggestion needs to be regulated as well as remuneration. This model, if implemented globally, can help save time, effort, and money in times of epidemics-emergency dentistry can be provided to the public even in such difficult times.[12]


  Conclusion Top


In order to better deal with these psychosocial issues in different fields of dentistry, the model of psychosocial crisis prevention and intervention should be formulated and developed immediately with the assistance of government and health-care staff. The appropriate application of modern Internet services, technology, and social media should strive to curb both such epidemics and infodemic and make the dentist aware so that its necessary information can reach every healthcare professional. With the fear of a new recession and financial losses, flexible and substantial leadership in health care, business, government, and wider society needs to implement immediate relief measures and adjust for those who may fall through the rift. How to revive and reactivate the economy after this crisis requires medium and long-term planning. This situation worldwide is appalling and urgently requires financial support to deal with this epidemic so that hospitals and all health workers can face continuous loss and meet all their immediate needs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatr 2009;54:302-11.  Back to cited text no. 5
    
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Pulla P. Covid-19: India imposes lockdown for 21 days and cases rise. BMJ 2020;368:m1251.  Back to cited text no. 7
    
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Chua SE, Cheung V, McAlonan GM, Cheung C, Wong JW, Cheung EP, et al. Stress and psychological impact on SARS patients during the outbreak. Can J Psychiatry 2004;49:385-90.  Back to cited text no. 8
    
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Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. 2020 Feb 26.  Back to cited text no. 9
    
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