Level of Knowledge,Understanding,and Impact of the COVID-19 Pandemic on Continuing Fixed Orthodontic Treatment in Adults: A Questionnaire Study

Question 2: Are you willing to undergo treatment from an orthodontic team who were previously affected with COVID-19?

Of the patients, 5.6% are probably not willing to undergo treatment from an orthodontic team previously affected by COVID-19. Most patients believe that they could get infected via dentists with viral infections. ⁹ Moreover, recurrence of COVID-19, with a previously infected person capable of transmitting the virus to other people even after a second negative test, has been reported in the literature. ¹⁰ This could be a probable reason why patients tend to avoid treatment from a previously infected orthodontist.

Question 3: Are you willing to disclose your COVID-19 status and undergo pretreatment screening before every appointment?

Of the patients, 64.8% are definitely willing, and the rest are still in a dilemma over disclosing their COVID-19 status and undergoing pretreatment screening before every appointment. This is a dangerous sign and might put many at risk of contracting the virus. Thus, we need to make patients understand the importance of their status disclosure and participation in a pretreatment triage. ³

Question 4: What is your view on visiting the orthodontic office after the COVID-19 pandemic?

Of the patients, 63.0% are willing to visit the orthodontic office after the COVID-19 pandemic if proper infection control precautions are followed. However, the rest of the patients fear cross infection in a dental office and do not want to risk it. ⁹

Question 5: Do you adhere to strict appointment timings for the clinical area’s adequate sanitization to counteract COVID-19?

Of the patients, 71.3% are definitely ready to adhere to strict appointment timings to sanitize the clinical area to counteract COVID-19. More emphasis should be placed on this aspect among orthodontic patients. Additional time is required for proper sanitization of the clinical area, as the virus has been detected on stainless steel, on plastic, and in aerosols for up to 5.6, 6.8, and 3 hours, respectively.^{1, 11}

Question 6: Would you like to adhere to “Strictly no accompanying person” (until and unless specified by the orthodontist) for future appointments?

Of the patients, 53.7% would like to adhere to “Strictly no accompanying person” (until and unless specified by the orthodontist) for future appointments. The current unprecedented circumstances put the accompanying person also at risk of COVID-19 infection. Performing pretreatment triages as a routine procedure for accompanying persons adds a physical burden on the dental team. ¹

Question 7: Do you have any pain or discomfort due to missed appointments during the COVID-19 pandemic?

Of the patients, 34.3% have no pain or discomfort due to missed appointments during the COVID-19 pandemic. There is a nonlinear relationship between age, gender, psychological state, and cultural background in pain perception following placement of an orthodontic appliance, according to the literature. However, with fixed orthodontic treatment, mild to moderate pain or discomfort is often experienced by patients. ⁶

Question 8: For unexpected orthodontic problems, which of the following options do you choose?

Of the patients, 46.3% preferred telecommunication in case of unexpected orthodontic problems. Gender distinction was observed in the participants’ responses (P = .06). While most females expressed interest in teleconsultation with the dental office, males demonstrated readiness in visiting the dental office and seeking care. Teledentistry facilities should be encouraged during this pandemic to prevent unnecessary visits to the dental office. This would aid patients in resolving a new orthodontic problem that can be managed at home and help determine which patients need in-person attendance.

Question 9: Do you think missed appointments will have an effect on your orthodontic treatment during the COVID-19 pandemic?

Of the patients, 60.2% think missed appointments due to the COVID-19 pandemic would prolong their overall treatment time. Association of the pandemic with orthodontic treatment time and outcome has not been previously investigated.

Question 10: Would you like to undergo additional treatment procedures, if indicated by your orthodontist, to compensate for the lost time?

Of the patients, 46.3% are definitely willing to undergo additional treatment procedures to make up for the lost time. From a patient’s perspective, shorter treatment times impact psychosocial well-being, which contributes to the overall quality of life.^{12, 13} Comprehensive orthodontic treatment requires, on average, less than 2 years to be complete. ¹⁴ The lost time during the pandemic prolongs the overall treatment duration. Males (P = .022) and more qualified participants (P = .028) expressed willingness to undergo additional procedures in this regard. However, the type of intervention and financial aspect may affect patients’ decision to undergo additive procedures when indicated.

Question 11: Does your current financial situation have any effect on future orthodontic appointments?

The virus has spread throughout the inhabited world and led to unprecedented financial crises. Of the patients, 51.9% opined that their financial situation is affected but they can afford future treatment. However, economic crises depend upon several factors, such as the lockdown period, type of occupation, and socioeconomic status.

Question 12: Protective gear and equipment to counteract COVID-19 may increase future treatment costs. What is your opinion?

Of the patients, 38.0% revealed that while protective gear and equipment might increase future treatment costs, they cannot bear that extra amount, and 27.8% expect the dental institution/clinician/government/insurance companies to bear the additional amount.