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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 19-23

Descriptive study of dental diseases among patients visiting for dental care in a tertiary care center during COVID-19 pandemic


1 Department of Dentistry, PDU Medical College, Churu, Rajasthan, India
2 Department of 1Community Medicine, PDU Medical College, Churu, Rajasthan, India
3 Department of Biostatistics, PDU Medical College, Churu, Rajasthan, India

Date of Submission25-Sep-2021
Date of Decision17-Oct-2021
Date of Acceptance29-Oct-2021
Date of Web Publication06-Apr-2022

Correspondence Address:
Rajesh Kumar Singh
Department of Community Medicine, PDU Medical College, Churu, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_159_21

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  Abstract 


Background: Recently, coronavirus disease 2019 (COVID-19) has affected all aspects of life globally. The COVID-19 pandemic is an extremely testing time for dental health professionals dealing with a high oral disease burden and being at higher risk of COVID-19. The aim of this study was to report the pattern of dental diseases among patients visiting the Department of Dentistry at a tertiary care center in Rajasthan, India. Methodology: A descriptive analysis of dental outpatient department (OPD) records of a tertiary care center during COVID-19 epidemic lockdown duration in India for demographics, diagnosis, the severity of pain, and triage for the urgency of treatment need was carried out. Data were analyzed using Epi info 7 software. Results: The majority of the patients (30%) were in the age group of 31–45 years and 14.47% of patients were >60 years. The triage of patients according to the need of procedures revealed the majority (77.76%) were in the urgent category, while 4.82% were in the emergency category. The majority of patients (67.22%) visited for endodontic treatment, with the main diagnosis of symptomatic apical periodontitis. The majority of diseases had moderate-to-severe pain at presentation. Conclusion: The majority of dental OPD patients reported moderate-to-severe pain of dental origin and required urgent care. The main endodontic diagnosis was symptomatic apical periodontitis.

Keywords: Coronavirus disease 2019, dental care, dentistry, health professionals, infection risk, severe acute respiratory syndrome-CoV2


How to cite this article:
Mittal HC, Singh RK, Pant A, Singhal P. Descriptive study of dental diseases among patients visiting for dental care in a tertiary care center during COVID-19 pandemic. J Dent Res Rev 2022;9:19-23

How to cite this URL:
Mittal HC, Singh RK, Pant A, Singhal P. Descriptive study of dental diseases among patients visiting for dental care in a tertiary care center during COVID-19 pandemic. J Dent Res Rev [serial online] 2022 [cited 2022 May 23];9:19-23. Available from: https://www.jdrr.org/text.asp?2022/9/1/19/342701




  Introduction Top


Recently, coronavirus disease 2019 (COVID-19) has affected all aspects of life globally. Despite the low mortality rate of COVID-19 compared to severe acute respiratory syndrome and Middle East respiratory syndrome, its high infectivity and transmissibility placed the world in a standstill and distressing stage.[1],[2],[3],[4]

Dental health professionals (DHP) are at higher risk of COVID-19 due to factors such as close face-to-face contact of >15 min; intra-oral instrumentation generating aerosols mixed with saliva; relatively enclosed dental clinic environment; and saliva contamination of surfaces.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Saliva is found to have a consistent nCoV-19 virus comparable to nasopharyngeal samples.[11] The oral cavity with an abundance of Angiotensin-Converting Enzyme 2 receptors and eye exposure provide an effective route beside the prominent route of transmission of nCoV-19 virus via respiratory droplets produced during coughing, talking and sneezing, etc.[2],[5] Recently, airborne transmission via aerosols has also been demonstrated as highly virulent and the dominant route for the spread of COVID-19.3 Recently, on August 3, 2020, WH O also highlighted risk in dentistry with no differentiation of dental or medical aerosol procedures.[12]

The COVID-19 pandemic is an extremely testing time for health professions especially DHPs in providing care with challenges of high oral disease burden, shortage of personal protective equipment worldwide, limited evidence-based information, inadequate preparedness in terms of training, infrastructure, and manpower for respiratory infections, rapidly changing guidelines to be followed in the dental setting and different opinion about aerosols.[13],[14],[15]

Due to the unprecedented nature and unknown length of the pandemic, understanding the present situation from a dental perspective is helpful in terms of predicting future dental needs. The current descriptive analysis aimed to report the pattern of dental diseases of patients visiting the Department of Dentistry at a tertiary care center in Rajasthan, India. This would provide important information to policymakers to understand the requirements for providing care during the possible future increase in cases of disease and would aid in planning for adequate preventive measures according to the burden of diseases while delivering the health care services.


  Methodology Top


A descriptive cross-sectional record-based study was conducted during COVID-19 lockdown in India when regular services were suspended. The present study was conducted in the outpatient department (OPD) of dentistry at the only government tertiary care institute in the Churu district of Rajasthan, India. The Churu district of Rajasthan is situated in the Thar Desert region of Rajasthan and this institute provides specialized dental care. The institute maintains the digital demographic records of the patient through unique health identities allocated to them at registration. During the COVID-19 pandemic, all patients visiting the dental department were screened for COVID-19 symptoms and travel history. The suspected patients were referred for COVID-19 testing.

Prior permission from the head of the department of dentistry and in-charge of the hospital attached to the tertiary care institute was taken to access the medical records of the patients. The records of patients visiting dental OPD from March 25 to May 31, 2020, were reviewed by two investigators for demographics, diagnosis, the severity of pain, categorization according to the urgency of the procedure. Incomplete records with respect to diagnosis and treatment, and those with illegible information, were excluded. The triage of patients visited for dental care was carried out according to Government of India (GOI) criteria for classification into emergency (clinical conditions of dental origin which increase the risk of death of a patient) or urgent category (clinical conditions of dental origin which require priority care but do not increase the risk of death of a patient).[16] The patient's primary diagnoses were also classified according to the requirement of endodontic or nonendodontic dental treatment. The severity of pain was assessed from the patient's record based on the dose of analgesic/day prescribed according to the age of the patient. The patients with the lowest dose of analgesic were considered to have mild pain and the patients receiving more than the lowest dose were considered to have moderate to severe pain.

Statistical analysis

Data were entered and cleaned in MS Excel which was later analyzed using EPI Info 7 software. The summary statistics such as mean, frequency, and percentages were calculated. The Chi-square test was used to analyze the difference in proportions and a P < 0.05 was taken as statistically significant.


  Results Top


A total of 1156 patients visited for dental treatment from March 25 to May 31, 2020 period. Out of the total records identified, 140 incomplete records in terms of diagnosis, treatment, and socio-demographic information were excluded for homogeneity of data and thus, 1016 records were included in the final analysis.

The demographic characteristics are listed in [Table 1]. The age range of the patients was 1–90 years and the mean standard deviation was 41.62 (17.16) years with the majority of the patients (29.82%) in the age group of 31–45 years. There were 147 (14.47%) patients in the elderly group (>60 years). There were 517 males (50.9%) and 499 females (49.1%) with a male-to-female ratio of 1.04:1.
Table 1: Age and sex distribution of patients

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As shown in [Figure 1], the majority (77.76%) of patients visited the hospital for urgent dental care while emergency dental visits accounted for only 4.82%. The rest 17.42% were nonurgent category when triaged according to the need of the procedure. The majority of urgent category patients had an endodontic diagnosis (Irreversible pulpitis, symptomatic apical periodontitis, endo-perio lesions, dental abscess). The pain severity profile of patients revealed that the majority of patients (75%) reported moderate-to-severe pain at the time of presentation and the endodontic procedures were required in 67.22% of patients.
Figure 1: Distribution of patients according to the type of visit, pain severity, and procedure required

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[Table 2] shows the categorization of the patient according to dental diseases with the gender-specific distribution of diseases. The patients with symptomatic apical periodontitis were found to be most common accounting for 48.33% and 16% of patients presented with endo-perio origin or periodontal abscess. The pericoronitis in 6.10%, maxilla-facial or dental trauma in 2.56% and irreversible pulpitis in 2.46% were other diagnoses among patients who visited during COVID-19 lockdown duration.
Table 2: Gender-specific distribution of the pattern of dental disease

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During the COVID-19 pandemic, females were more likely to visit the dental center due to endo-perio origin or periodontal abscess, gingival abscess, dental abscess, and trigeminal neuralgia than males, while males were more likely to visit the dental center due to symptomatic apical periodontitis, and maxilla-facial or dentofacial trauma than females [Table 2].


  Discussion Top


In response to COVID-19, many countries including India are using a combination of containment and mitigation activities in alignment with WHO's strategic preparedness and response plan for COVID-19.[17] With the intention of delaying major surges of COVID-19 patients, elective dental health services across the world have been suspended.[1],[4],[6],[14],[15],[18] In India, dentists were advised to postpone elective procedures and limit operative interventions to emergencies only.[19] The present research attempted to study the pattern of patients visited for dental health care services during the lockdown period of the COVID-19 outbreak in India.

In this study, 1156 patients visited the hospital seeking dental treatment during the study period. However, during the same duration of 2019 more patients accessed dental care in the hospital (2726). This rapid decline (58%) in patients visiting dental hospitals might be due to awareness regarding the unavailability of routine dental services and the fear of the risk of COVID-19 during the epidemic. The drastic reduction of patient visits for dental services was in accordance with other published reports when compared to non-COVID-19 duration.[20],[21]

Elderly people especially with comorbidities are more vulnerable to fatal complications of COVID-19 and thus, care should be exercised to avoid cross-infection.[21],[22] In the present study, elderly patients (>60 years) were 15% who visited the hospital for dental services similar to Yu et al.(>65 years).[21]

The present study found that males are more likely to visit for symptomatic apical periodontitis, and maxilla-facial or dento-facial trauma than females, while females are more likely to visit for endo-perio origin or periodontal abscess, gingival abscess, dental abscess, and trigeminal neuralgia than males. Wu et al. in their study found that males are more likely to have trauma visits, while females are more likely to have acute gingivitis and acute periodontal disease visits.[23] Kudiyirickal and Hollinshead in their study found a significantly higher proportion of males compared to females who had apical periodontitis similar to the present study.[24]

In the present study, the most common dental problems were symptomatic apical periodontitis (48.33%) and endo-perio origin or periodontal abscess (16%). Kudiyirickal and Hollinshead in their study reported dental abscess to be the most common lesion (31.5%).[24] Bennardo et al. reported 98 cases of pericoronitis compared to 59 cases in the present study which may manifest as moderate to severe pain similar to pulpitis, difficult mastication, and trismus; if left untreated, the infection can spread to the fascial spaces converting into a true life-threatening emergency.[6]

The majority of patients (75%) visited for moderate-to-severe pain; this pattern of reporting to the dentist with significant pain remained similar to the non-COVID-19 duration.[25] The majority of the patient in this study required urgent dental service which is similar to other reports.[6],[18] The majority of urgent category patients require endodontic intervention. Dixit et al. in their study reported that the majority of patients visited the dental hospital for endodontic consultation and had dental emergencies resulting from dental pain and swelling (37.56%).[26] In contrast to Grossman et al., nonurgent visits were less comparatively in the present study (17.4% vs. 24.9%); however, emergency visits were higher (4.7% vs. 0.9%).[18]

The endodontic procedures which are aerosol-generating as well as essential for preserving patients' natural dentition were required as major treatment in this study. The endodontic diagnosis as the main reason for hospital visits was also reported by other authors.[20] The toothache that follows from endodontic diseases is persistent and often severe if not treated definitely. The oro-dental pain adversely affects the quality of life by restricting food choices, the pleasures of eating, proper sleep; inhibiting intimacy and social contact as well as psychological wellbeing. Thus, it is recommended to strengthen the teledentistry services as well as workforce to meet dental needs during current and future pandemics.

Limitation

This study is a record-based analysis from a single tertiary care center and hence findings may not be generalized beyond the study population.


  Conclusion Top


The study showed that the majority of patients visited the dental hospital during the COVID-19 pandemic period for urgent care and presented with moderate-to-severe pain of dental origin. The most common dental problem was symptomatic apical periodontitis and required endodontic consultation. The majority of patients presenting with dental or maxillofacial trauma were male.

Ethical clearance

Permission was obtained from the head of the hospital attached to the institute.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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