Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 is challenging the dental community to an unprecedented degree. Knowledge of the increased risk of infection in dental settings has been disseminated to the public and guidelines have been formulated to assist dental attendance decision-making. However, dental attendance behaviors incompatible with treatment need is not uncommon in clinical settings. Important gaps remain in the knowledge about how psychological factors are affecting dental attendance behaviors during the COVID-19 epidemic. In this cross-sectional study, a questionnaire survey was performed during February and March 2020. A total of 342 and 294 dental patients who attended and avoided dental visits, respectively, were included. The participants were classified into four groups based on dental attendance behavior and emergent/urgent dental treatment need. Bivariate analysis was performed to investigate factors associated with dental attendance. Multivariable logistic regression based on principal component scores was performed to identify major psychological constructs associated with unnecessary dental avoidance and attendance. Among all the factors explored, inability to wear masks during dental treatment (P < 0.001; effect size: 0.32) was most closely associated with the overall pattern of dental attendance among participants. Multivariable regression suggested that unnecessary dental avoidance was associated with perceived risk of infection in general and in dental settings (odds ratio [95% CI]: 0.62 [0.53, 0.72]; p < 0.001), perceived impact of COVID-19 and dental problems on general health (0.79 [0.65, 0.97]; 0.021), and personal traits such as trust and anxiety (0.77 [0.61, 0.98]; 0.038). Unnecessary dental attendance was associated with optimism toward the epidemic (1.68 [1.42, 2.01]; <0.001) and trust (1.39 [1.13, 1.74]; 0.002). Multidisciplinary efforts involving dental and medical professionals as well as psychologists are warranted to promote more widespread adoption, among the general public, of dental attendance behaviors compatible with dental treatment need during the COVID-19 epidemic.
Highlights
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel strain of coronavirus of zoonotic origin, since its emergence in early December 2019 has resulted in a global pandemic of coronavirus disease 2019 (COVID-19) (World Health Organization, 2020)
Multivariable logistic regression based on group treatment needs who did not visit dentists (T-nV) and group C (Table 4, Supplementary Table 2) suggested that higher PC1 scores, which represented a lower perceived risk of SARSCoV-2 infection in dental hospitals, was associated with reduced likelihood of unnecessary dental avoidance
To the knowledge of the authors, this is the first study that has comprehensively investigated the impact of psychological factors on the patterns of dental attendance behavior during the COVID-19 epidemic
Summary
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel strain of coronavirus of zoonotic origin, since its emergence in early December 2019 has resulted in a global pandemic of coronavirus disease 2019 (COVID-19) (World Health Organization, 2020). Dentists and dental patients in clinical settings are at an increased risk of exposure and infection due to the physical proximity between dentists and patients, generation of large volumes of droplets and aerosol during treatment (Cristina et al, 2008), and the inability of the patients to wear masks during treatment. Patients suffering from dental problems are faced with the dilemma of two choices: either visiting dental care providers to alleviate symptoms at the cost of an increased risk of infection or living with symptoms of dental problems at home
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