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Cases of COVID-19 first emerged in December 2019. Since then, the virus has spread rapidly worldwide, with daily increases in the numbers of infections and deaths. COVID-19 spreads via airborne transmission, which renders dental treatment a potential source of virus transmission. Dental treatments require the use of handpieces, ultrasonic devices, or air–water syringes, which generate considerable amounts of aerosols. Jordan, being one of the affected countries, instituted preventive lockdown measures on March 17, 2020. Emergency dental treatments were only allowed in dental clinics of the Royal Medical Services of Jordan Armed Forces and Ministry of Health, and were prohibited in other sectors such as private clinics and universities.
The aim of this study is to investigate the dental treatments performed in three military hospitals during the 44-day lockdown period in Jordan. The investigation explores the impact of COVID-19 on the number of patients and types of performed dental treatments.
Data such as number of patients, patients’ age and gender, and performed dental treatments were collected retrospectively from the hospital records and were analyzed.
Our results showed a 90% (17,591 to 1689) decrease in patient visits during the lockdown period compared to regular days. The total number of treatments (n=1689) during the lockdown period varied between endodontic cases (n=877, 51.9%), extraction and other surgical cases (n=374, 22.1%), restorative cases (n=142, 8.4%), orthodontic treatments (n=4, 0.2%), and other procedures (n=292, 17.3%). The differences in gender and age group among all clinics were statistically significant (
The COVID-19 pandemic had a significant effect on the number of patients seeking dental treatments. It also affected the types of treatments performed. Endodontic treatment accounted for almost 50% of patient load during the lockdown compared to approximately 20% during regular days.
The World Health Organization declared the outbreak of COVID-19 a Public Health Emergency of International Concern on January 30, 2020. On March 11, 2020, the outbreak was declared a pandemic [
Dentists are among the highest occupational risk categories for the transmission and contraction of COVID-19. Routine dental treatments that produce significant amounts of aerosols, composed of saliva, blood, and tissue fluids, are considered to be at high risk for the spread of the virus, as it can spread via airborne transmission. Such treatments include the use of a turbine handpiece, air–water syringes, and ultrasonic scalers. During dental treatment, aerosols from a person who is infected or an asymptomatic carrier can transmit the virus directly to the dentist or dental assistant. Contact with contaminated instruments, surfaces, or airborne particles from such individuals is considered as the possible route of transmission [
Jordan responded to the pandemic by implementing early lockdown from March 17, 2020 [
There is a need for establishing clear guidelines and regulations for the management of dental emergency procedures during possible future epidemic or pandemic situations. Accordingly, the aim of this study is to assess the dental treatments performed in three military hospitals during the lockdown period in Jordan. This research explores the impact of COVID-19 on the number of patients and treatments performed.
This retrospective study was approved by the ethical committee of Royal Medical Services of Jordan Armed Forces. Data pertaining to patients requiring dental treatments during the lockdown due to the COVID-19 pandemic were obtained from the records of three major military hospitals in Jordan.
Data were collected from the lockdown and prelockdown periods. The lockdown period extended from March 17, 2020, to April 29, 2020 (44 days), during which the Government of Jordan had announced a total lockdown due to the COVID-19 pandemic; this period was referred to as T1. The prelockdown period extended from January 16, 2020, to February 29, 2020 (44 days), before Jordan recorded its first COVID-19 positive case on March 2, and this period was referred as T2. Data from T1 included the number of patients, their age and gender, and the performed dental treatments. Data from T2 included the number of patients and the performed dental treatments. The number of patients and performed treatments were compared between T1 and T2.
Data from T1 were entered and coded using the SPSS software version 17.0 (SPSS Inc). Values were reported as frequencies, means, and SDs. Cross-tabulation was used to test the correlations between variables.
During T1, 1689 patients, with an average age of 35.04 (SD 10.96, range 14-87) years, were treated in the three selected major military hospitals. A total of 39 (2.3%) patients were older than 60 years, 650 (38.5%) were aged between 14 and 30 years, and 1000 (59.2%) were aged between 30 and 60 years.
Statistical analysis of the distribution of the 1689 patients visiting the dental clinics in T1 showed that 877 (51.9%) patients were treated in endodontic clinics and only 4 (0.2%) were treated in orthodontic clinics, as depicted in
Distribution of patients visiting the dental clinics during T1 (the lockdown period extending from March 17 to April 29, 2020; 44 days).
Clinics | Patients (n=1689), n (%) | Valid percentage (%) |
Oral surgery | 374 (22.1) | 22.1 |
Endodontics | 877 (51.9) | 51.9 |
Restorative dentistry | 142 (8.4) | 8.4 |
Orthodontics | 4 (0.2) | 0.2 |
Others | 292 (17.3) | 17.3 |
Further analysis of the distribution of patients visiting dental clinics with respect to gender and age showed that, of all 1689 patients, almost two-thirds were male (n=1105, 65.4%) and one-third were female (n=584, 34.6%). The differences in gender and age groups among all clinics were statistically significant (
Distribution of patients in terms of gender and age in different clinics during T1 (the lockdown period extending from March 17 to April 29, 2020; 44 days).a
Clinics | Male age groups (years), n | Female age groups (years), n | ||||||
14-29 | 30-60 | >60 | Total | 14-29 | 30-60 | >60 | Total | |
Oral surgery | 86 | 113 | 5 | 204 | 62 | 106 | 2 | 170 |
Endodontics | 252 | 371 | 14 | 637 | 82 | 151 | 7 | 240 |
Restorative dentistry | 33 | 74 | 6 | 113 | 8 | 20 | 1 | 29 |
Orthodontics | 1 | 0 | 0 | 1 | 3 | 0 | 0 | 3 |
Others | 72 | 76 | 2 | 150 | 51 | 89 | 2 | 142 |
Total | 444 | 634 | 27 | 1105 | 206 | 366 | 12 | 584 |
aThe differences in gender (
The total number of patients had decreased by 90.4% (17,591 to 1689) when the number of patients visiting dental clinics was compared between T1 and T2. The highest reduction in the number of patients was recorded in orthodontic clinics, and the lowest reduction was observed in endodontic clinics (
Number of patients visiting dental clinics in T2 and T1.
Clinics | T2a, n | T1b, n | Change (%) |
Oral surgery | 2715 | 374 | –86.2 |
Endodontics | 3683 | 877 | –76.2 |
Restorative dentistry | 3018 | 142 | –95.3 |
Orthodontics | 6146 | 4 | –99.9 |
Others | 2029 | 292 | –85.6 |
Total | 17,591 | 1689 | –90.4 |
aT2: prelockdown period extending from January 16, 2020, to February 29, 2020 (44 days).
bT1: lockdown period extending from March 17, 2020, to April 29, 2020 (44 days).
Although the total number of patients visiting dental clinics decreased in T1, there was a noticeable increase in the proportion of patients visiting endodontic and oral surgery clinics. Out of 1689 patients, 877 (51.9%) required endodontic treatment in T1, while out of 17,591 patients, only 3683 (20.9%) required treatment in T2. Out of 1689 patients, 374 (22.1%) were treated in oral surgery clinics in T1, while out of 17,591 patients, only 2715 (15.4%) were treated in T2 (
Distribution of treated patients in the dental clinics at T1 and T2. T1: lockdown period extending from March 17, 2020, to April 29, 2020 (44 days); T2: prelockdown period extending from January 16, 2020, to February 29, 2020 (44 days).
To the best of our knowledge, this is the first study to analyze the effect of the pandemic on dental treatments during the lockdown period in Jordan. In accordance with the results of other similar studies [
Several reasons could be attributed to the decrease in the number of dental patients and treatments. The primary reason could be the knowledge pertaining to the nature of COVID-19 spreading easily through aerosols, splashes, and droplets, inevitable with almost all types of dental treatments [
There was also a decrease in the number of treatments performed in different specialty clinics, with the highest decrease being observed in the number of patients visiting orthodontic clinics. In total, only 0.2% (4/1689) of orthodontic patients visited the orthodontic clinics during T1 compared to 34% (6146/17,591) in T2. This represents a decrease of 99.9%, which can be explained by the fact that orthodontic emergencies are well tolerated. The number of performed restorations (amalgam, composite, glass-ionomer, and temporary fillings) also showed a 95.3% (3018 to 142) decrease during the COVID-19 lockdown.
This study showed that more male patients sought dental treatments than female. Of the 1689 patients, 1105 (65.4%) male patients sought dental treatments, in comparison to only 584 (34.6%) female patients. This result is in concordance with that of a similar study [
This total reduction in the number of patients treated in dentistry is alarming, as it increases the risk of dental health deterioration. The reluctance to seek treatment resulting from fear of the virus should not be underestimated. Understanding the current situation can help in the accurate prediction of future dental needs. In addition, requirements for dental services might increase dramatically post COVID-19.
The results of this study show that COVID-19 affected the distribution of patients in different dental specialties. A high percentage of treatments (877/1689, 51.9%) were performed for pulp-related pathosis such as acute pulpitis, acute apical periodontitis, and acute apical abscess. Endodontic emergencies account for the majority of dental emergencies in normal conditions [
A higher percentage of patients visited oral surgery clinics during the lockdown (374/1689, 22.1%) compared to the prelockdown period (2715/17,591, 15.4%). The performance of other procedures (examination, diagnosis, consultation, and referrals) increased in the COVID-19 lockdown (292/1689, 17.2%) compared to the prelockdown period (2092/17,591, 11.3%). This increase could be attributed to the fact that dentists chose to perform procedures with minimal aerosol generation to relieve the pain of patients, since health authorities worldwide had classified general dentists and dental hygienists as high-risk professions [
This study shows the effect of the COVID-19 pandemic on dental treatments performed during the lockdown period in Jordan; data from the prelockdown period served as a control. Additional studies are needed to analyze the effects of the COVID-19 pandemic on dental treatments performed in the postlockdown period. Jordan has not attained the peak of infection yet; therefore, the impact on dentistry should be analyzed while the COVID-19 cases are rising.
The COVID-19 pandemic has had a substantial influence not only on the number of patients seeking dental treatments but also on the type of treatment performed. The overall decrease in the number of treated patients was 90.4% (17,591 to 1689). This decrease affected all dental specialties, especially orthodontics. However, endodontic treatments dominated the number of performed treatments during the COVID-19 lockdown, as 51.9% (877/1689) of performed treatments were related to endodontics.
As the pandemic is still not under control, only focusing on the direct causes and control measures of COVID-19 alone could be shortsighted. The possible deterioration in the dental health of the population should be considered. Requirements for dental services might increase dramatically post COVID-19, especially in the field of orthodontics.
In case of a possible second lockdown, augmenting the endodontic specialty with adequate staff and more clinics to help in catering to the increased demands seems essential. Sufficient planning to organize and direct the available dental resources during and after the COVID-19 pandemic is the needed. There is also a need for regulations and preventive approaches in dental treatments to control the spread of COVID-19 in both governmental and private sectors.
American Dental Association
None declared.