Impact of COVID-19 on Pakistani dentists: a nationwide cross sectional study.

BACKGROUND: The COVID-19 outbreak which developed into a public health crisis has raised concerns regarding infection control among health care workers particularly dentists all over the world. The aim of this survey was to assess awareness, fear and compliance with practice modification according to CDC guidelines during COVID-19 pandemic among Pakistani dentists. METHODS: A cross-sectional study was conducted using an online survey questionnaire. The questionnaire was designed on Google Forms and was distributed among all seven regions of Pakistan through social media and WhatsApp after carrying out the reliability analysis. Statistical analysis was performed using SPSS 20.0. Question wise analysis using frequencies and percentages was done. Pearson correlation and Kruskal Wallis test was applied to check association of awareness level with qualification and workplace setting. RESULTS: A total of 313 dentists participated and submitted the form online from all regions of Pakistan. The response rate was quite satisfactory as Pakistan was under an official lockdown and most of the hospitals/clinics were either closed or operating with minimum staff. Most of the dentists were well aware of the CDC guidelines. However, 75% of the dentists were afraid of getting infected and 88% of them were anxious while providing treatment. Sixty-eight percent of them were avoiding aerosol generating procedures and only 28% were using rubber dam isolation. Regional analysis was also done and areas of poor compliance were identified. Only 38.5% dentists in Balochistan were using N95 masks and none of the dentists (0%) were using rubber dam isolation. A large number of dentists (80.9%) were afraid and wanted to close their dental practice in Khyber Pakhtunkhwa. Furthermore, a positive correlation was seen between the designation and awareness level (p = 0.01). Similarly, significant correlation (p = 0.03) was seen between qualification and workplace setting. CONCLUSION: The results of the study can help devise strategies to ensure adherence with infection control guidelines in regions with poor compliance. Initiation of awareness programs to help overcome fear and train the faculty and staff in the targeted areas would greatly contribute towards reducing the spread of infection and thus lowering the healthcare burden in a third world country like Pakistan.

Clinical consequences of untreated dental caries assessed using PUFA index and its covariates in children residing in orphanages of Pakistan.

BACKGROUND: The purpose of this study was to determine the prevalence and clinical effects of untreated dental caries in Pakistani children residing in orphanages using the DMFT and PUFA index; association of decay and untreated dental caries with demographics including type of orphanage; behavioural and dental visiting pattern; and association of dental pain experience and type of orphanage with dental visiting. METHODS: A cross-sectional survey was conducted on a total of 753 orphan children belonging to 4-17 years of age group residing in twin cities of Rawalpindi and Islamabad, Pakistan. Clinical examination of children was performed using the DMFT and PUFA index for the assessment of dental caries and untreated decay, followed by questionnaire enquiring about eating and oral hygiene habits, dental visiting pattern and dental pain and swelling experience. Association between dental decay, child's dental visiting and pain as a consequence of untreated decay was carried out using chi square test and logistic regression analysis. RESULTS: The overall caries prevalence was 34.8% and overall prevalence of PUFA/pufa was 15.9%. The mean score of DMFT and dmft was 1.18 (SD 0.39) and 1.04 (SD 0.23), and mean PUFA was 1.18 (SD 0.57) and mean pufa score 1.14 (SD 0.35). Untreated caries ratio was found to be 49.1% indicating half the decay had progressed to involve the pulp. No significant association of gender was found with DMFT, dmft, PUFA and pufa (p > 0.05), however, when analysed individually, the 'D' component of DMFT was significantly associated with male gender (p = 0.05). Furthermore, no significant association of DMFT/dmft or PUFA/pufa in either dentition was found with behavioural characteristics such as dietary and oral hygiene habits. Also, 66.2% children who experienced pain had not been to the dentist in the past year (p = 0.013) and 52.6% children who mentioned experiencing pain at night had not been to the dentist in the past year (p = 0.009). Children with decay were more likely to have visited the dentist (OR 3.3, 95% CI 1.42-7.6, p = 0.006). However, children who reported to have experienced pain were less likely to have visited the dentist in the past year (OR 0.53, 95% CI 0.32-0.88, p = 0.014). CONCLUSIONS: Moderate levels of decay were found in the sample with 'd' component majorly responsible for the cumulative DMFT index. However, alarmingly almost half of the decay component (49.1%) had progressed to involve the pulp. Experiencing pain in teeth prompted dental visits. Initiation of preventive services for children residing in orphanages in Pakistan would help greatly towards reducing the burden of untreated decay.