Research Summary: Mental distress in orthodontic patients during the COVID-19 pandemic

A summary of:

Xiong X, Wu Y, Fang X et al. Mental distress in orthodontic patients during the coronavirus disease 2019 pandemic. American Journal of Orthodontics and Dentofacial Orthopedics. 2020. doi:10.1016/j.ajodo.2020.07.005

COVID-19 was declared a global pandemic on 11th March 2020. Orthodontic treatment was halted due to the risk of virus transmission. 48 orthodontists were invited to distribute an anonymous online survey; with 558 patient responses collected. The aim was to evaluate patients’ mental health, producing results and suggestions to guide orthodontists from other countries in similar situations: 

(1)   Communicate with patients routinely and directly during a lockdown

  • 38% of orthodontic patients experienced mental distress during the pandemic.
  • The first step in preventing this distress is for the orthodontist to get in touch with the patient directly to explain the situation. Patients who were informed of appointment suspension personally by their orthodontist showed less anxiety compared with those informed by official accounts, websites, or other patients.
  • The frequency of contact from dentists was also associated with patients’ independence. (Independence refers to the ability to deal with orthodontic accidents and the initiative to communicate with the dentist).

(2)   Give priority of communication to more vulnerable groups 

  • Females and patients in the epicentre and rural areas were more likely to have mental distress about treatment outcomes.
  • This may be to do with income disparities, transport difficulties and their response to stressors and risk factors.
  • Therefore, additional attention could be given to these patients. 

(3)   Utilise “teledentistry” to give remote instructions to patients

  • Orthodontists should use “teledentistry” to give patients home care oral hygiene practices and emergency handling via telephones or the internet.

(4)   Consider aligners instead of labial fixed appliances and distribute enough sets of aligners during the early stage of a lockdown

  • Patients with invisible appliances felt less anxiety about the duration of treatment than those with fixed lingual appliances.
  • This may be because the aesthetics are better and clear aligners are less affected by orthodontic emergencies and missed appointments if patients have got enough sets.

Prolonged treatment delay, due to extensive lockdown periods, may have an impact on gingival health and white spot lesion development. Further research may be conducted to evaluate the longer-term impact of a lockdown on the mental and oral health of orthodontic patients and explore the exact reasons for lingual appliances’ positive impact on mental health.

Sumaya Al-Attar

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