key: cord-0736948-2eevbwgp authors: Kumar, Umesh; Gupta, Arpit; Goyal, Ashima; Gauba, K. title: Impact of covid-19 pandemic on characteristics of dental emergencies and treatment services at tertiary care centre date: 2021-06-06 journal: Saudi Dent J DOI: 10.1016/j.sdentj.2021.06.004 sha: 44325e5b0d2d295510f1aba98616451ed8bb3756 doc_id: 736948 cord_uid: 2eevbwgp To categorize and compare the dental emergencies along with status of health services received in the tertiary dental health care centre during the pre covid- 19 periods and period of the complete lockdown in COVID 19 pandemic. Methods: A retrospective cross-sectional observational survey was conducted. Four different groups period were studied on patients who visited for dental emergencies at tertiary care centre. April 14 to 13 May 2020 assigned and analyzed as a test period group or group IV. The control period group i.e. group III was 14 February 2020 to 17 March, pre lockdown COVID 19 month when there was no consideration of epidemic in India. Same as periods of group II and IV, group I and II from last year 2019 were also assigned and analyzed. The tertiary care centre provision of health services during this pandemic was also inquired and evaluated. The information was recorded regarding availability of health services like non-emergency dental treatments, emergency dental services, and online professional consultation. To compare four different time period of obtained data, Analysis of variance (ANOVA) and Chi square test were used. Results: The overall proportion and percentage of dental emergencies were raised. The reason for emergency visits to dental clinic were the main problem related with pulpal (46.0%) followed by abscess (16.6%), periapical lesions (15.0%), cellulitis (4.1%) or trauma (0.3%). In lockdown most of the dental emergencies 228(265) were endodontic related (86.1%) which managed mostly through ‘3A” approach(advise, analgesics and antibiotics) (60.1%) and remaining (26.0%) through extraction. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was initially identified in patients presenting with pneumonia of unknown origin in Wuhan, China, in December 2019 (Zhu et al., 2020) and was later established to be the causative agent of corona virus disease-2019 .On January 30, 2020,the World Health Organization (WHO) declared the spread of this disease as a public health emergency owing to the high mortality rate of 3.4% (Sohrabi et al., 2020., WHO, 2020) . Because of the rapidly transmissible nature of the disease, people were unwilling to go to public places, including hospitals (Harrel et al.,2004) .In this scenario, it is important to note that majority of dental procedures produce aerosols/droplets, and due to the exposure to saliva and blood, clinicians are at a high risk of the contagion (Peng et al., 2020).During dental procedures, transmission of SARS-CoV-2 from the infected individuals can occur through the inhalation of aerosols/droplets or by direct contact with the mucous membrane, oral fluids, and contaminated instruments and surfaces (Ali et al., 2020). Given the exposure risk for different professional categories, dental practitioners face the greatest threat. As dental treatments pose the highest risk during the pandemic, all routine procedures have been suspended worldwide, allowing only emergency care (Ather et al., 2020).Hence, when the pandemic is on the rise; it is challenging to respond to dental emergencies in terms of changes made by the institutions in the utilization of services. The public tertiary care centers play a key role in providing easily accessible, reliable and affordable health care services to patients belonging to all strata of the society (Guo et al., 2020). So the primary objective of this study was to analyze and compare the hospital records and categorize the dental emergency cases received in a tertiary dental health care center during the COVID-19 pre-lockdown period of February 2020 and the complete lockdown period of April 2020 and compare them with the corresponding periods in 2019. The secondary objective was to assess the status of health service provision in tertiary care hospitals during the COVID-19 pandemic. A retrospective cross-sectional observational survey was conducted at OPD clinic, Oral Health Science center, Post Graduate Institute of Medical Education and Research, a autonomous tertiary care hospital, Chandigarh, India, after obtaining ethical approval from the institution's ethics committee (No: INT/IEC/2020/SPL-745). Data regarding the total number of patients visited, percentage of new and old cases, and male and female patients were collected from the advanced hospital information system "e-sushrut." Four groups of different periods were studied with regard to the patients who visited the Oral Health Sciences Centre for dental emergencies. Groups I & II were assigned as periods from 2019. The control period group, i.e. group III, ranged from February 14, 2020 to March 17, 2020, which was assigned as the pre-lockdown month during which considerable spread of the epidemic had not happened in India. The period from April 14, 2020 to May 13, 2020 was assigned as the test period group or group IV. The records of patients who visited the dental emergency department were screened and reviewed. The inclusion criteria for the patients were: 1) presenting to dental emergency outpatient department (OPD). 2) age ≥16 years. If the same patient visited two or more times, it was counted as different as we were recording the data of per day emergency visit and the pandemic created the need to postpone elective care for emergency patients. Relevant information was extracted by trained and calibrated investigators under the supervision of a senior professor using a specially designed study proforma, and the kappa score was >0.8. The data were extracted independently by two researchers. Discrepancies, if any, were discussed in the presence of a third member to arrive at a consensus. A random sample comprising 5% of the extracted records was re-assessed to ensure the accuracy of the evaluated data. During this pandemic, information regarding the availability of health services such as non-emergency dental treatment, emergency dental service, and online professional consultation provided by the tertiary care center was assessed and recorded. General descriptive analysis was performed on the obtained data. Mean and standard deviation were used to present the continuous variables; frequency and proportion were used for the categorical variables. To compare the data obtained during four different time periods, analysis of variance (ANOVA) and Chi square test were used. Statistical significance was set at p< 0.05.All statistical analyses were performed with the SPSS 20.0 software (IBM Corp, Armonk, NY). A total of 8034 patients in group I, 8110 in group II, 8045 in group III, and 521 in group IV visited the dental OPD of the tertiary care center. General descriptive analysis of the groups was performed. During the period ranging from February 14 to March 17, 2019 (group I), a total of 8034 patients visited the department, of which 4242(52.8%) were men and 3789(47.2%) were women. In group II, 8110 patients visited, of which 4156(51.2%) were men and3954 (58.8%) were women. In the control group or group III, a total of 8045 patients visited, of which 4255 (52.8%) were men and 3786(47.2%) were women. In the test group, i.e. group IV, 521 patients visited, of which 306 (58.7%) were men and 215 (41.3%) were women. No statistically significant difference was seen in age and gender among the four analyzed time periods or groups ( Table 1 ). The largest age range was 31-45 years (66.8%) in all groups. Upon comparing the four groups of dental emergency visits, the number of visits identified in group I, group II, and group III were 395 (4.9%), 406 (5%), and 387 (4.8%), respectively. In the test group period, the number of visits was 265(51.7%), which was significantly different from the other three groups ( Table 2 ). The overall proportion and percentage of dental emergencies had increased, and a significant difference was seen between the test and control groups as well as between 2020 and the same periods of the preceding year (groups I and group II). Upon comparing other categorical variables of dental emergencies, no statistically significant differences were seen among all the groups (Table 2 ). There were fewer male patients than female patients in group I, II, and IV. However, during the prelockdown period of the COVID-19 epidemic (p< 0.001), i.e. in group III, the situation was reversed. The main reason for emergency visits to the dental clinic in group IV was pulpal (46.0%), which was followed by abscess (16.6%), periapical lesions (15.0%), cellulitis (4.1%), and trauma (0.3%)( Table 3) . Although the total numbers and patients per type declined owing to the fear of COVID-19, the distribution of dental problems had increased significantly after the pandemic. For instance, there was a hike in dental trauma cases from0.3% to 2.2%. ( Figure 1 ). There was a significant reduction in the number of patients seen from 8045 to 521 during the pre-lockdown period of COVID 19, especially during the early weeks of the lockdown. Upon comparing the activity of dental health services between the lockdown month and the same period in 2019, there was a drastic change. The hospital suspended all routine dental procedures and the main focus was to provide treatment for acute tooth ache, oral and maxillofacial trauma, cellulitis, and abscess. The change in dental health services offered was notified to the public through official web-based and mobile networks. During the lockdown, most of the dental emergencies (228/265) were related to endodontics (86.1%), which were managed mostly through the "3A" approach (advise, analgesics, and antibiotics) (60.1%) and the remaining (26.0%) through extraction. In response to the COVID-19 outbreak, the Government of India (GOI) announced a series of measures (including lockdown) on March 22, 2020 to curb the spread of the virus and sustain the capacity of the national health services. During this period, there has been a substantial decrease in the emergency visits to tertiary care hospitals and the treatment services offered (MoH&FW, GOI, 2020).We retrospectively reviewed the characteristics of dental emergencies and their immediate effects on treatment services in a tertiary care center during the lockdown period. Furthermore, we described and compared the activity over the same period (April 14-May 13, 2020) with the pre-lockdown period of COVID-19 (February 14-March17, 2020 ) and corresponding period of 2019. In our study, the total number of patients who visited the dental OPD during the During the pandemic period, routine dental care was mostly suspended and only emergency cases were seen. This was the main reason behind the reduced count of the overall dental emergency patients. Upon comparing the dental emergency visits among the groups, the overall percentage of emergency visits was 4.9% (345/8034) in group I, 5% (406/8110) in group II,4.8% (387/8045) in group III, and only 51.7% (265/521) in group IV. However, no significant difference in gender was seen among the groups. In the present study, nearly the same ratio of new-to-old cases and referred-to- were reluctant to venture out and report to hospitals. One concern in the present study was the increase in the overall number of patients with acute dental infections visiting the center for treatment during the lockdown period when compared with the pre-lockdown period and the corresponding periods of 2019. The treatment service of dental emergencies was challenging during the COVID-19 pandemic owing to potential exposure to the virus, making it a high risk ., 2020) . The present study speculates that the requirement for dental services might grow explosively in the post-COVID-19 period. Retrospective observational study design, sample size of the test group, and choosing a single tertiary care center are among the limitations of this study. The universal validity of the study regarding the dental emergency characteristics are subject to the risk of referral bias, which might have affected the outcome. Within the limitations of this study, our results suggest that the COVID-19 pandemic had a strong influence on the number of emergency dental visits and the overall number of visitors reduced significantly. Health service provision was also considerably disrupted during the pandemic. The utilization of telehealth was significantly higher during the lockdown than during the pre-lockdown period as it helped in lowering the risk of SARS-CoV-2 transmission by reducing the exposure and limiting the treatment time. conceptualisation, design of work, data acquisition, validation, drafting the work or revising it critically. All the authors have read and approved the final version of the manuscript and agreed to be accountable for all aspects presented in the article. 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Patient consent for publication Acknowledgments; All the authors made substantial contributions to the Acknowledgments All the authors made substantial contributions to the Manuscript ID-SDENTJ-D-20-00490Manuscript title:Impact of covid-19 pandemic on characteristics of dental emergencies and treatment services at tertiary care centre.All the authors made substantial contributions to the conceptualization, design of work, data acquisition, validation, drafting the work or revising it critically. All the authors have read and approved the final version of the manuscript and agreed to be accountable for all aspects presented in the article.