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Impact of the COVID-19 pandemic on dental practice business and treatment approaches. A literature review

There are many concerns globally as it relates to the impact on the business of the dental practice. This is also being driven by the patient’s ability to pay, be reimbursed or service provided by municipal /government contract. It may also drive treatment planning decisions by the patient in collaboration with the dental professional. 

With continued hotspots globally the dental practice business may continue to face or see higher infection risk for patients and staff(1). To help mitigate the risk the practice of dentistry may need to be modified(2). Results could lead to complications with long term impact(3). However there seems to be reason that Covid-19 can be tamed by vaccination or become less pathogenic and virulent in future(4). The impact on dental treatment approaches makes Teleorthodontics(5), Telemedicine(6) and Teledentistry(7) viable. This includes conducting triage by phone(8,9) or other communication apps(10). Sixty One percent of all treatment plans/protocols appear to be revised/amended(11). In Germany treatment utilization has been reduced by the following: 80% preventive, 76% periodontics, and 70% prothetics(12). Revisions to treatment not only involves aerosol reduction techniques but also infection control practices and procedures to mitigate aerosols(13,14,15,16,17). In addition, immunocompromised patients may not be allowed to receive what would be considered elective dental treatment18). Preventive oral health care is to be postponed for Covid 19 patients for 28 days from onset of symptoms(18). Children should be treated as if they were carriers(19). The short-term impact of a decline in dental care spending by 66% in 2020 and possibly 32% in 2021 is projected in the USA by the American Dental Association’s Health Policy Institute(20). Most dentists in the USA are reporting a decline in volume of their collections by 5%(20,21). The economic impact have been seen and most likely will increase(22). 

 [1] Zhang XH, Ling JQ. Guidelines on the Prevention and Control of Disease in Dental Practice during the Coronavirus Outbreak. Chin J Dent Res. 2020;23(2):89-94. 

[2] Lo Giudice R. The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) in Dentistry. Management of Biological Risk in Dental Practice. Int J Environ Res Public Health. 2020 Apr 28;17(9). pii: E3067. doi: 10.3390/ijerph17093067. 

[3] Barabari P, Moharamzadeh K. Novel Coronavirus (COVID-19) and Dentistry-A Comprehensive Review of Literature. Dent J (Basel). 2020 May 21;8(2). 

[4] Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care. J Endod. 2020 May;46(5):584-595. doi: 10.1016/j.joen.2020.03.008. 

[5] Maspero, C.; Abate, A.; Cavagnetto, D.; El Morsi, M.; Fama, A.; Farronato, M. Available Technologies, Applications and Benefits of Teleorthodontics. A Literature Review and Possible Applications during the COVID-19 Pandemic. J Clin Med 2020; 9: 1891. 

[6] Giudice A, Barone S, Muraca D, Averta F, Diodati F, Antonelli A, Fortunato L. Can Teledentistry Improve the Monitoring of Patients during the Covid-19 Dissemination? A Descriptive Pilot Study. Int J Environ Res Public Health. 2020 May 13;17(10). pii: E3399. doi: 10.3390/ijerph17103399. 

[7] Bhanushali P, Katge F, Deshpande S, Chimata VK, Shetty S, Pradhan D. COVID-19: Changing Trends and Its Impact on Future of Dentistry. Int J Dent. 2020 May 29;2020:8817424. 

[8] Passarelli PC, Rella E, Manicone PF, Garcia-Godoy F, D’Addona A. The impact of the COVID-19 infection in dentistry. Exp Biol Med (Maywood). 2020 May 21:1535370220928905. 

[9] Villani FA, Aiuto R, Paglia L, Re D. COVID-19 and Dentistry: Prevention in Dental Practice, a Literature Review. Int J Environ Res Public Health 2020; 17: 4609. 

[10] Gueiros LA, Melo TS, Carrard VC. A simple tool to a complex reality – WhatsApp use in a developing country during COVID-19 pandemic. Oral Dis. 2020 Jun 17. doi: 10.1111/odi.13495. 

[11] Ahmed MA, Jouhar R, Ahmed N, Adnan S, Aftab M, Zafar MS, Khurshid Z. Fear and Practice Modifications among Dentists to Combat Novel Coronavirus Disease (COVID-19) Outbreak. Int J Environ Res Public Health. 2020 Apr 19;17(8). pii: E2821. 

[12] Schwendicke F, Krois J, Gomez J. Impact of SARS-CoV2 (Covid-19) on dental practices: Economic analysis. J Dent. 2020 May 27:103387. doi: 10.1016/j.jdent.2020.103387. 

[13] Russell C. Development of a Device to Reduce Oropharyngeal Aerosol Transmission. J Endod. 2020 Jun 7. pii: S0099-2399(20)30346-0. doi: 10.1016/j.joen.2020.05.012. 2 

[14] Turkistani KA. Precautions and recommendations for orthodontic settings during the COVID-19 outbreak: A review. Am J Orthod Dentofacial Orthop. 2020 May 13. doi: 10.1016/j.ajodo.2020.04.016. 

[15] Ge ZY, Yang LM, Xia JJ, Fu XH, Zhang YZ. Possible aerosol transmission of COVID-19 and special precautions in dentistry. J Zhejiang Univ Sci B. 2020 May;21(5):361-368. doi: 10.1631/jzus.B2010010. 

PMID: 32425001; PubMed Central PMCID: PMC7089481. 

[16] Mupparapu M. Editorial: Aerosol reduction urgency in post-COVID-19 dental practice. Quintessence Int. 2020;51(7):525- 526. 

[17] Khanna R. Providing dental care in the current COVID-19 crisis. Marshall J Med 2020; 6: 3. 

[18] Tarakji B, Nassani MZ. Reactivation of COVID-19 – 14 days from the onset of symptoms may not be enough to allow dental treatment. Oral Dis. 2020 Jun 10. doi: 10.1111/odi.13487. 

[19] Jayaraman J, Dhar V, Moorani Z, Donly K, Tinanoff N, Mitchell S, Wright T. Impact of COVID-19 on Pediatric Dental Practice in the United States. Pediatr Dent. 2020 May 15;42(3):180-183. 

[20] Nasseh K, Vujicic M. Modeling the Impact of COVID-19 on U.S. Dental Spending. HPI Res Brief, 2020. 

[21] HPI. COVID-19: Economic Impact on Dental Practices Week of June 15 Results. Poll, 2020. 

[22] Milliman White Paper. COVID-19: Impact to dental utilization, 2020. 

A Dental Response to the COVID-19 Pandemic—Safer Aerosol-Free Emergent (SAFER) Dentistry

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