German Dentists Research Articles

Performance of restorations in primary molars over a seven-year period

ObjectiveThe aim of this study was to evaluate the use and reintervention rate of fillings compared to preformed metal crowns in the everyday clinical practice of German dentists. MethodsIn this retrospective, longitudinal analysis, fee codes from the Kassenzahnärztliche Vereinigung Westfalen-Lippe for restorations placed in primary molars between 2012 and 2015 in children until 7 years of age followed for a 7-year period (latest until December 2022) were filtered and analyzed with the Fine and Gray competing risk regression and Cox proportional hazards regression to calculate the risk of reintervention divided into the main outcomes “Successful”, “Minor Failure/Repair” and “Major Failure/Endodontic Treatment/Extraction”. 367,139 primary molars (one-surface fillings: n = 117,721; two-surface fillings n = 198,815; three-surface fillings n = 36,695; more than three-surface fillings n = 8,267 and preformed metal crowns n = 5,641 were included in this study. ResultsTeeth treated with preformed crowns needed significantly less re-interventions. Subdistribution hazard ratio for minor events was 0.117 (95 %-CI: 0.097 to 0.141) and hazard ratio of major events (HR=0.786; 95 %-CI: 0.695 to 0.890) when compared to one-surface fillings in multivariable adjusted analysis. Within 7-year follow-up preformed crowns required less repairs (80.6 % success rate, minor failure 4.4 %, major failure 16.3 %) than the teeth treated with composite fillings (46.2 %–52.6 % success rate, minor failure 27.0 %–39.5 %, major failure 15.5 %–28.4 %, p < 0.001). ConclusionWithin the German healthcare system fillings are the first choice for treating primary molars despite considerably higher reintervention rates. This encourages a discussion on the indication of fillings and the more durable preformed metal crowns to reduce unnecessary reintervention in young children. Clinical significanceThis study gives an unprecedented insight into the German healthcare system regarding the reintervention rates of the most relevant treatment techniques for caries in primary molars.

Musculoskeletal disorders and risk indicators for pain chronification among German dentists: A cross-sectional questionnaire-based study

ObjectivesThe aim of this study was to determine the prevalence of musculoskeletal (MS) disorders in practicing German dentists and identify risk factors for pain chronification. MethodsThis was a cross-sectional, quantitative, questionnaire-based study in which the validated German version of the Örebro Musculoskeletal Pain Questionnaire was sent out to practicing German dentists. ResultsOf the 8,072 questionnaires sent out, 576 dentists responded (60.2% men, 39.8% women; mean [SD] age, 50 [10.1] years; response rate, 7.1%). Overall, 344 dentists had current pain at 719 pain sites (point prevalence, 59.7%). The risk of chronic pain in dentists with current MS pain was high in 28.5% (n = 98), moderate in 30.5% (n = 105), and low in 41% (n = 141). The multivariate logistic regression analysis showed that specialization in restorative dentistry was associated with a significantly higher risk of experiencing pain chronification (odds ratio [OR], 3.94; P = .008), followed by specialization in pediatric dentistry (OR, 0.35; P = .048). A history of current pain, particularly current leg pain, was predictive of higher chronification risk (OR, 22.0; P < .001) and neck pain (OR, 4.51; P = .001). ConclusionsAlmost two-thirds of practicing German dentists have MS pain, and one-third of these have a moderate through high risk of developing pain chronification. These health problems have an adverse impact on their ability to successfully perform dental services, with the potential for prolonged sick leave, disability, and early retirement. Accordingly, these problems deserve greater attention from the scientific community (identification of risk factors), universities (sensitization and education), and policy makers (development and implementation of appropriate countermeasures for MS disorders in the dental profession). Practical ImplicationsKnowing the risk factors associated with acute and chronic MS pain may help dentists take preventive measures and thereby improve their physical well-being and work-related quality of life.

Does information about MIH on dental homepages in Germany offer high quality? A systematic search and analysis

PurposeThe internet is increasingly used to seek health information. A dental condition of increasing concern and public interest is molar incisor hypomineralisation (MIH), why we evaluated the information quality of German dentists ‘websites on the topic of MIH.MethodsA systematic search was performed by two independent investigators using three search engines. The information content of websites on MIH and technical, functional aspects, overall quality, and risk of bias were assessed using validated instruments (LIDA, DISCERN). Practice-related characteristics (practice type, specialization, setting, number and mean age of dentists) were recorded, and associations of these characteristics with websites’ overall quality were explored using multivariable linear regression modelling.Results70 sites were included. 52% were multipractices in urban areas (49%). The most common age group was middle-aged individuals (41–50 years). The average number of dentists/practice was 2.5. The majority met more than 50% of the DISCERN and LIDA criteria (90%, 91%). The MIH definition was frequently used (67%), MIH symptoms were described (64%), and 58% mentioned therapies. The prevalence of MIH was mentioned less frequently (48%). MIH example photographs were rarely shown (14%). In multivariable analysis, most practice-related factors were not significant for overall site quality. Only chain practices had slightly higher quality in this regard (2.2; 95% CI of 0.3–4.1).ConclusionsMIH is mentioned on a large proportion of dentists’ websites. Overall technical, functional, and generic quality was high. Risk of bias is limited. While most websites provided a basic definition of MIH and its symptoms, important information for patients was missing.

Facts and trends in dental antibiotic and analgesic prescriptions in Germany, 2012–2021

ObjectivesThe study aims to overview German dentists’ development of antibiotic and analgesic prescriptions from 2012 to 2021.Materials and methodsA longitudinal database analysis was performed based on the annual reports of the “Research Institute for Local Health Care Systems” (WIdO, Berlin).ResultsFrom 2012 until 2021, dental antibiotic prescriptions fell by 17.9%. In contrast, the dental proportion of antibiotic prescriptions compared to all antibiotic prescriptions in Germany increased from 9.1 to 13.6%. Aminopenicillins enhanced their share from 35.6 to 49.4%, while clindamycin prescriptions declined from 37.8 to 23.4%. The proportion of ibuprofen prescriptions significantly increased from 60.4% in 2012 to 79.0% in 2021.ConclusionsSince 2013, the most frequently prescribed antibiotic by German dentists has been amoxicillin reaching nearly half of all dental antibiotic prescriptions in 2021. Simultaneously, the proportion of clindamycin has steadily decreased, but the level is still high compared to international data. During the past decade, ibuprofen as a first-line analgesic in German dentistry was continuously gaining in importance.Clinical relevanceAminopenicillins have the best risk–benefit balance in dentistry, but the use of antibiotics generally must be limited only to cases of severe infections or compromised patients. Pre-existing diseases or permanent medications should always be considered when choosing an analgesic.

Infection Concerns and Economic Burden: Dentists' Cancellations During COVID-19

ObjectivesDuring the COVID-19 pandemic, dental appointments were cancelled or postponed by both patients and dentists. This study investigated the associations between German dentists’ concerns on cross infection and their emotional burden due to personal economic impact on dentist-initiated appointment cancellations. MethodsData were collected using an anonymous cross-sectional online survey of outpatient physicians in Germany from March through April 2020. Dental treatments were divided into 3 treatment categories (plannable treatments, acute treatments without COVID-19–like symptoms, and acute treatments with COVID-19–like symptoms). Descriptive analyses and multivariate logistic regression models were performed. ResultsA sample of 269 self-employed dentists was considered. Cancellations of prophylaxis appointments were reported by 82% of dentists, whilst 49% reported cancellations of appointments for acute complaints with simultaneous patient-side COVID-19–like symptoms. Further, 58% of respondents stated high or very high concerns about COVID-19 self-infection; 81% stated to be emotionally burdened by the personal economic impact. Dentists’ concern of infecting themselves significantly decreased the likelihood of maintaining appointments, with odds ratios of 0.635 (95% confidence interval [CI], 0.426 to 0.932) for plannable treatments and 0.587 (95% CI, 0.367 to 0.916) for treatments of patients with acute complaints and simultaneous COVID-19–like symptoms. In addition, there was a significant negative association between dentists who reported emotional distress due to personal economic impact and the likelihood to maintain appointments, with odds ratios of 0.291 (95% CI, 0.123 to 0.695) for plannable treatments and 0.231 (95% CI, 0.053; 0.706) for treatments of patients without acute complaints and simultaneous COVID-19–like symptoms. ConclusionDentists’ fear of infecting themselves with COVID-19 played a role in terms of practice-related appointment cancellations. Dentists differentiated their appointment cancellations according to different treatment categories and patient needs. If dental care is to be maintained in pandemic times, physicians’ personal factors such as concerns about infection and perceived pandemic-related personal economic impact need to be considered.

Activities of the Young Forum at the 73rd Congress and Practice Management Seminar of the DGMKG and the German Dentists Day

Activities of the Young Forum at the 73rd Congress and Practice Management Seminar of the DGMKG and the German Dentists Day

Implementation of repairs in dental practice: Randomized behavior simulation trial

BackgroundDespite increasing evidence, dentists have not widely adopted repairs. The authors aimed to develop and test potential interventions targeting dentists’ behavior. MethodsProblem-centered interviews were performed. Emerging themes were linked to the Behavior Change Wheel to develop potential interventions. The efficacy of 2 interventions was then tested in a postally delivered behavioral change simulation trial among German dentists (n = 1,472 per intervention). Dentists’ stated repair behavior regarding 2 case vignettes was assessed. Statistical analysis was performed using McNemar test, Fisher exact test, and a generalized estimating equation model (P < .05). ResultsTwo interventions (guideline, treatment fee item) were developed on the basis of identified barriers. A total of 504 dentists participated in the trial (17.1% response rate). Both interventions significantly changed dentists’ behavior toward repairs of composite and amalgam restorations, respectively (guideline: difference [Δ] = +7.8% and Δ = +17.6%, treatment fee item: Δ = +6.4% and Δ = +31.5%; adjusted P < .001). Dentists were more likely to consider repairs if they already performed repairs frequently (odds ratio [OR], 1.23; 95% CI, 1.14 to 1.34) or sometimes (OR, 1.08; 95% CI, 1.01 to 1.16), if they regarded repairs as highly successful (OR, 1.24; 95% CI, 1.04 to 1.48), if their patients preferred repairs over total replacements (OR, 1.12; 95% CI, 1.03 to 1.23), for partially defective composite restorations (OR, 1.46; 95% CI, 1.39 to 1.53), and after receiving 1 of the 2 behavioral interventions (OR, 1.15; 95% CI, 1.13 to 1.19). ConclusionsSystematically developed interventions targeting dentists’ repair behaviors are likely efficacious to promote repairs. Practical ImplicationsMost partially defective restorations are replaced completely. Effective implementation strategies are required to change dentists’ behavior.This trial was registered at https://www.clinicaltrials.gov. The registration number is NCT03279874 for the qualitative phase and NCT05335616 for the quantitative phase.

Awareness and Knowledge of Rare Diseases in German Dentists, Dental Specialists and Oral and Maxillofacial Surgeons: A Country-Wide Survey

Background and objectives: Rare diseases affect an estimated four million patients in Germany. Approximately 15% of the approximately 6000 to 8000 rare diseases known globally show manifestations in the dental, oral and maxillofacial regions. The present survey evaluated the knowledge and management of rare diseases and their orofacial alterations by dentists, dental specialists and oral and maxillofacial surgeons and dentists working at university hospitals for dentistry and/or oral and maxillofacial surgery. Materials and Methods: The study was designed as an anonymous cross-sectional study. Two anonymous online surveys were performed in all dentists in Germany using the open-source survey software limesurvey. The study cohorts were divided into dentists, dental specialists and oral and maxillofacial surgeons in practice, and dentists who worked in university dental and oral and maxillofacial surgery centers. The survey was performed between 1 October 2020 and 31 March 2021. Results: A total of 309 dentists and oral and maxillofacial surgeons in private practice and 18 dentists or oral and maxillofacial surgeons working at universities participated. A total of 209 (86.7%) study participants working in private practice indicated that the topic of rare diseases should be considered clinically relevant. University participants indicated that there was a lecture on rare diseases in only 7 (63.6%) cases. Only 2 (13.3%) participants reported active research on the topic in their department. Conclusions: The current knowledge on rare diseases is inadequate in suitable screening and therapy. Most of the participants believed that knowledge of rare diseases was very important for daily dental practice. The self-estimations showed that all of the participants estimated their knowledge as very good or inadequate, with a tendency in the direction of inadequate knowledge.

Is examining children and adolescents with autism spectrum disorders a challenge?-Measurement of Stress Appraisal (SAM) in German dentists with key expertise in paediatric dentistry.

This questionnaire-based validation study investigated if the dental examination of children and adolescents with autism spectrum disorder is viewed by dentists with key expertise in paediatric dentistry as a challenge or a threat in terms of transactional stress theory. The Stress Appraisal Measure (SAM) was used for this purpose and it's feasibility and validity was examined as a first part of a multi-stage process for validation in dentistry with a sample of German dentists. It has hardly been investigated how the treatment of children and adolescents with a disorder from the autism spectrum is perceived by dentists. An online-based survey (39 questions) plus the SAM as an add-on as well as a preceding short story of imagination on the topic (appointment for a dental check-up in a special school) were developed. Via e-mail members of the German Society of Paediatric Dentistry (DGKiZ) received a link which enabled interested members to participate. The majority of the members of the DGKiZ have additional qualifications in the treatment of children and adolescents and further training in the area of special needs care in dentistry. The data analysis was based on the SAM and its subscales. Out of the 1.725 members of DGKiZ 92 participants (11 male, 81 female) fully completed the questionnaire and the SAM. All in all the dentists rated their own psychological and physical stress in course of treating children and adolescents with a disorder from the autism spectrum between less and partly stressful. Although the structure of the SAM could not be fully mapped by means of a factor analysis, the different ratings "challenge" or "threat" could be comprehensibly evaluated after reading the story. The participants rated the situation from the story in general as challenging but not as threatening. Intercorrelations between the subscales of the SAM (e.g threat and centrality) of r = .56 showed that the scales are not clearly independent of one another. According to the transactional stress model, the SAM bases on, stress (perceived stressfulness) arises from appraisal processes (e.g. threat, controllable-by-self) that bring about a comparison between the requirements for the described situation and one's own possibilities in terms of a person-environment-fit. In the hierarchical regression a variance of R2 = .48 could be explained with all six subscales (appraisal processes) to predict perceived stressfulness of the SAM within a sample of dentists. Due to the response rate the results of the SAM are not representative for all German dentists, but it offers an insight into topics of special needs dentistry in Germany that have not yet been examined. Overall, the feasibility and validity of the SAM in the context of mapping cognitive appraisal processes and stress could be confirmed. Taking into account the result that the treatment of children and adolescents with autism spectrum disorder is seen as a challenge, it is concluded that there is a need to improve the education of dental students and graduated dentists in Germany in the field of special needs dentistry.

Self-Assessment of Knowledge on the Treatment of Children and Adolescents with Special Care Needs: Results of a Survey amongst German Dentists with Key Expertise in Paediatric Dentistry.

Background: The treatment of children and adolescents with disabilities (CA-Dis) and psycho-emotional disorders (CA-Psy) places special demands on dentists. Aim: To explore German dentists’ (with key expertise in paediatric dentistry) perception of their competence and comfort levels in dealing with these patients, and implications for access to care. Methods: Online questionnaire surveying demographic information and self-assessment of training, knowledge, and comfort in dealing with CA-Dis and CA-Psy among 1725 members of the German Society of Paediatric Dentistry (DGKiZ). Results: Ninety-two participants (11 male, 81 female) completed the questionnaire: 17.4% (n = 16) treated CA-Dis once or more a day; CA-Psy were rarely treated on a daily basis (7.6%; n = 7). In regard to CA-Dis, 62% (n = 57) rated their level of expertise as “good” or “very good”; for CA-Psy this was 40.2% (n = 37). Overall, 76.1% (n = 70), respectively, 88.0% (n = 81) of the respondents felt they had been inadequately prepared to treat CA-Dis or CA-Psy. Although the physical burden of treating CA-Psy was rated as “not at all stressful” or only “slightly stressful” by 45.7% of the participants, 31.5% rated the psychological distress as “very stressful” or “extremely stressful”. The better their self-assessed expertise in treating CA-Dis was, the lower their own psychological distress was rated (r = −0.34). Training on this topic seems to have an impact on the perceived burden of treating such patients. Conclusions: A core curriculum in special care dentistry needs to be embedded in the German dental curriculum. The results permit the development of health programs for workplace health management in dentistry.

“How obsessive are dentists?”––A personality styles & disorder inventory based prospective, controlled study

ObjectivesThe aim of this study was to examine the typical personality traits of dentists and to discuss critically their influence on the necessary characteristics for a good dentist-patient relationship. MethodsTwo groups were invited via e-mail to participate the study in 2015–2020. One group consisted of German dentists (DENT N = 580). The other group was formed by German speaking psychotherapists from Germany, Austria and Switzerland (DACH N = 1.027). The Personality Styles and Disorder Inventory was used in its short form (PSDI-S) via online survey. The normalization sample (NORM N = 3.392) of the PSDI-S was used to compare the results with a normative sample. ResultsDentists differed in 10 out of 14 personality styles from the normalization sample (NORM), and in 13 out of 14 personality styles compared with the psychotherapists (DACH). Female dentists differed in 7 out of 14 personality styles to their male colleagues. ConclusionsThe most significant differences in personality styles were willful (PN), spontaneous (BL), reserved (SZ), ambitious (NA), optimistic (RH) and conscientious (ZW), which seem to be necessary for a good dentist-patient relationship and dental procedures. The expression of personality styles is most likely to influence the choice, delivery and cost as well as patient perception of treatment. Clinical significanceDentist's personality has an important impact on the interpersonal, which influences the dentist-patient relationship and its therapeutic outcome.

German Dentists Knowledge About How to Proceed in Cases of Suspected Child Abuse and Neglect

Studies from several countries have shown that there is a lack of knowledge related to child protection among dentists and their teams. So far, there are no data available about the situation in Germany. Aim of this study is to describe the perception of the role of German dentists in terms of child abuse and neglect.

Soviet-German communications in the field of dentistry in the 1920s

This article is devoted to the history of SovietGerman relations in the field of dentistry in the 1920s. Despite ideological differences, Soviet and German dentists joined forces to overcome the negative consequences of prolonged hostilities and international isolation. The historically formed traditions of the exchange of scientific knowledge and practical experience resulted in the mutually beneficial interaction between the two countries. In this process, both sides were guided by purely pragmatic considerations and used the possibilities of cooperation to achieve their own, significantly different goals. The organizers of Soviet dentistry used the experiences learned, personal observations, and information received from German colleagues to build a state dental service, while providing an opportunity to promote communist ideology and achievements of the Soviet state.

Dental Neglect and Its Perception in the Dental Practice

In 2020, the number of reported cases of child maltreatment in Germany has never been higher and most of them showed signs of neglect. Most of the time, dental neglect (DN) appears together with a general form of neglect, and includes, apart from caries, many other negative short- and long-term effects for the affected child. In this study, the prevalence of DN in Germany and the way dental practices are currently addressing the topic are examined. Moreover, this study explored whether the experiences of German dentists with DN are related to their work experience, their gender or further education about DN. The data was collected using an anonymous questionnaire. The hypotheses were tested using unpaired t-tests based on differences in mean values. The three most common reasons for a suspected case of child maltreatment were the interaction of children with parents, or a legal guardian, insufficient oral or general hygiene, and grave caries. Even though most of the participating dentists agree that it is the task of the dentist to report suspected cases of child maltreatment, only few of them have done so in the past themselves. Not only insecurity about recognition and whom to contact in the suspected case, but also concern about unfounded suspicion were the most common reasons not to report a suspected case of DN. The detection and communication of suspected cases should be encouraged in order to protect affected children.

Determinants affecting the decision of German dentists to set-up an office

Regarding a peril to full-coverage dental care, it is reasonable to find a method to identify the crucial determinants affecting dentists’ decision to set-up a practice (office). METHODS: A systematic literature review was conducted for the years 2010-2020 using the databases Elsevier-Scopus, Springer-SpringerLink and MedLine-PubMed. The factors found in the literature were compared in a pairwise comparison within the framework of a pilot study and could be weighted using the Analytical Hierarchy Process (AHP) and verified for their consistency. RESULTS: Nine factors could be identified. They got weighted: quality of life in private environment (24.12%), environment for the family (20.26%), infrastructure (14.80%), location of the practice (9.72%), real income (7.51%), support programs (6.86%), professional cooperation’s (6.39%), dentist density (5.51%), funding conditions (4.82%). The consistency check resulted in CR=0.06 and is considered consistent. CONCLUSION: The AHP method is a way to analyse relevant factors for the setting-up of dental practices. The AHP can be used as an approximation method for further analysis of business types and socio-demographic differences within the dental profession.

Nazi dentists before British courts: aspects on the role of the German dental profession in the Third Reich.

This study is the first to identify and investigate German dentists tried for war crimes by British courts after 1945. Drawing on wide-ranging archival court documents and sources from various international archives, we found and studied 11 dentists from the Third Reich who were put on trial, the majority of whom were accused of manslaughter, homicide or being accessories to murder. Of the accused, two were sentenced to death while the rest (n = 9) were forced to serve prison sentences. After their release, all nine of these dentists were able to resume and advance their professional careers in Germany, most as owners of a private dental practice (n = 8) and one as a clinic director. Many settled in small towns, where they became esteemed members of their local communities.

Implementation of COVID-19 Infection Control Measures by German Dentists: A Qualitative Study to Identify Enablers and Barriers

Objectives: COVID-19 infection control measures have been recommended for dental practices worldwide. This qualitative study explored barriers and enablers for the implementation of these measures in German dental practices. Methods: Semi-structured phone interviews were conducted in November/December 2020 (purposive/snowball sampling). The Theoretical Domains Framework (TDF) and the Capabilities, Opportunities and Motivations influencing Behaviors model (COM-B) were used to guide interviews. Mayring’s content analysis was employed to analyze interviews. Results: All dentists (28–71 years, 4/8 female/male) had implemented infection control measures. Measures most frequently not adopted were FFP2 masks, face shields (impractical), the rotation of teams (insufficient staffing) and the avoidance of aerosol-generating treatments. Dentists with personal COVID-19 experience or those seeing themselves as a role model were more eager to adopt measures. We identified 34 enablers and 20 barriers. Major barriers were the lack of knowledge, guidelines and recommendations as well as limited availability and high costs of equipment. Pressure by staff and patients to ensure infection control was an enabler. Conclusions: Dentists are motivated to implement infection control measures, but lacking opportunities limited the adoption of certain measures. Policy makers and equipment manufacturers should address these points to increase the implementation of infection control measures against COVID-19 and potential future pandemics.

Material preferences for tooth-supported 3-unit fixed dental prostheses: A survey of German dentists

Statement of problemDifferent material options are available for fixed dental prostheses (FDPs), but valid data on the favored materials of German dentists for 3-unit FDPs are lacking. It is unclear whether preferences depend on the individual characteristics of the dentists or their dental practices. PurposeThe purpose of this survey was to identify the preferred material selection of German dentists for the fabrication of tooth-supported 3-unit FDPs depending on the location of the abutment teeth and the individual characteristics of the dentist or the dental practice. Material and methodsA survey was developed that included questions on the demographic characteristics (sex, area of expertise, age group, time since graduation, number of inhabitants, and the postal code of the dental practice or dental school) of the participating dentist and their preferred materials for the fabrication of tooth-supported 3-unit FDPs. Three clinical scenarios (anterior maxillary FDP, posterior maxillary FDP, posterior mandibular FDP) were presented. The dentists were allowed to select from predefined options or to give a free answer. For comparisons of characteristic associations, the number of inhabitants was chosen to represent the characteristics of the dental practice, and sex and time since graduation were selected to represent the characteristics of the dentist. Group comparisons were conducted with Chi-square tests (α=.05). ResultsA response of 721 dentists from all parts of Germany was received, and data from 688 dentists were included in the analyses. Ceramic was the most preferred material for the fabrication of 3-unit FDPs independent of the location of the abutment teeth with veneered zirconia as the favored option. Metal-ceramic was ranked second. The time since graduation ≤15 years was associated with a preference of ceramic over metal-ceramic for the anterior restoration (P<.001). ConclusionsMost participating dentists selected appropriate restorative materials depending on the individual clinical setting presented in the survey. For the anterior 3-unit FDP, time since graduation was associated with the preference for a restorative material. Some dentists selected lithium-X-silicate ceramics for situations beyond their recommended indication range.

Dental Workload Reduction during First SARS-CoV-2/COVID-19 Lockdown in Germany: A Cross-Sectional Survey.

An observational cross-sectional survey was planned to analyze the weekly workload reduction of German dentists during lockdown due to the global COVID-19 pandemic. Participants were predominantly members of the Free Association of German Dentists and filled in an online questionnaire. The questionnaire was sent to a total of 9416 dentists, with a response rate of 27.98% (n = 2635). Respondents were divided into seven macro areas by gross domestic product. Nearly two-thirds of dentists (65.16%) reported a reduction in their practice workload of more than 50% compared to the pre-pandemic period with statistically significant differences between German macro areas (p < 0.01). Weekly workload was reduced during the lockdown in 93.00% of study participants, while 55.33% dental care centers with multiple employed dentists under the direction of a non-dentist general manager had only a 40% reduction in weekly workload compared to a solo practice or a practice of a dentist with an employed dentist (30.24% and 28.39%, respectively). Dentists in Germany drastically reduced their practice activity during the first wave of the COVID-19 lockdown, both in rural and urban areas. Short, medium, and long-term effects of the pandemic on dental practices, dental staff as well as patient care need to be further investigated.

The Psychological Impact of the COVID-19 Pandemic on Dentists in Germany.

Since the announcement of the coronavirus 2019 (COVID-19) outbreak as a pandemic, several studies reported increased psychological distress among healthcare workers. In this investigation, we examined the association between psychological outcomes and various factors among German dentists. Dentists from all German federal states were invited to participate in this study through a self-administered online questionnaire between July and November 2020. This questionnaire collected information on demographics, Depression Anxiety Stress Scales (DASS-21), and the Impact of Events Scale-Revised (IES-R) instrument. The associations displayed between demographic and psychological outcomes of depression, anxiety, stress, intrusion, avoidance, and hyperarousal were evaluated. Seven-hundred-and-thirty-two dentists participated in the survey and reported overall scores of (4.88 ± 4.85), (2.88 ± 3.57), (7.08 ± 5.04), (9.12 ± 8.44), (10.68 ± 8.88) and (10.35 ± 8.68) for depression, anxiety, stress, intrusion, avoidance, and hyperarousal, respectively. For females, being between 50–59 years of age, being immune deficient or chronically ill, working at a dental practice, and considering the COVID-19 pandemic a financial hazard were reported as significant associated factors (p < 0.05) with higher DASS-21 and IES-R scores. These findings underline the aspects which need to be taken into attention to protect the mental wellbeing of dentists in Germany during the crisis.