COVID-19 challenges to dentistry in the new pandemic epicenter: Brazil

  1. Rafael R. Moraes
  2. Marcos B. Correa
  3. Ana B. Queiroz
  4. Ândrea Daneris
  5. João P. Lopes
  6. Tatiana Pereira-Cenci
  7. Otávio P. D’Avila
  8. Maximiliano S. Cenci
  9. Giana S. Lima
  10. Flávio F. Demarco

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Abstract

A nationwide survey of dentists was carried out in Brazil, a new pandemic epicenter, to analyze how dental care coverage has been affected in public versus private networks, changes in routine and burdens, and how local prevalence of COVID-19 affects dental professionals. Dentists were recruited via email and Instagram®. Responses to a pre-tested questionnaire were collected May 15–24, 2020. COVID-19 case/death counts in the state where respondents work was used to test associations between contextual status and decreases in weekly appointments, fear of contracting COVID-19 at work, and current work status (α = 0.05). Over 10 days, 3,122 responses were received (response rate ~2.1%) from all Brazilian states. Work status was affected for 94%, with less developed regions being more impacted. The pandemic impact on clinical routine was high/very high for 84%, leading to varied changes to clinic infrastructure, personal protective equipment use, and patient screening, as well as increased costs. COVID-19 patients had been seen by 5.3% of respondents; 90% reported fearing contracting COVID-19 at work. Multilevel models showed that greater case and death rates (counted as 1000 cases and 100 deaths per million inhabitants) in one’s state increased the odds of being fearful of contracting the disease (18% and 25%). For each additional 1000 cases/100 deaths, the odds of currently not working or treating only emergencies increased by 36% and 58%. The reduction in patients seen weekly was significantly greater in public (38.7±18.6) than in private clinics (22.5±17.8). This study provides early evidence of three major impacts of the pandemic on dentistry: increasing inequalities due to coverage differences between public and private networks; the adoption of new clinical routines, which are associated with an economic burden for dentists; and associations of regional COVID-19 incidence/mortality with fear of contracting the disease at work.

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  1. Version published to 10.1371/journal.pone.0242251
  2. ScreenIT

    SciScore for 10.1101/2020.06.11.20128744: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Study design: The study protocol was approved by our institutional research ethics board (#4.015.536).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed in Stata 14.2 (StataCorp, College Station, TX).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Although the representativeness of the sample may have limitations, online surveying methods are particularly important during this time when sanitary measures prevent traditional research approaches. The distributions of responses by region, gender, and age were similar to the overall distributions of dentists in Brazil (Morita et al. 2010), except for a slightly higher response rate from females and from Southern Brazil, where the study was originated. It is worth mentioning that the South and Southeast regions, which have similar human development index and per capita income values (IPEA 2016; IBGE 2019), represent the highest-income regions of Brazil. Notwithstanding, our sample variability was supported by the large numbers of responses received. The present results provide early evidence of three major aspects being at stake in dentistry in the new pandemic epicenter. First, differences in coverage between public and private clinics suggest an intensification of regional and socioeconomic inequalities. Second, although dentists have a similar fear of contracting COVID-19 as other healthcare providers, they report feeling less prepared to assist patients (Zhang et al. 2020). Third, dentists have adopted new routines and incurred increased costs, which eventually will be transferred to patients or paid by the government in public clinics. The scenario is aggravated by disjointed responses from public agencies and the associated lack of an effective coordinated national re...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.06.11.20128744v1 on medRxiv