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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 5-9

Finding the calm amid chaos – Mental health of dentists during COVID-19 pandemic


1 Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
2 Department of Public Health Dentistry, Bhubaneswar, Odisha, India

Date of Submission27-Aug-2020
Date of Acceptance29-Oct-2020
Date of Web Publication25-Mar-2021

Correspondence Address:
Dr. Shilpa Rai
Department of Public Health Dentistry, Kalinga Institute of Dental Sciences, KIIT University, Campus – 5, Patia, Bhubaneswar - 751 024, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_114_20

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  Abstract 


COVID-19 has challenged health professionals all around the world. Dental practitioners are facing a challenge they were unprepared for. Two years ago, no dentist could have envisioned a situation where every step of every encounter requires personal protective equipment, frequent decontamination of the clinical environment, limiting the daily number of patients, and decreased financial security amid the constant fear of contracting the virus has affected the psychology of the dentists. Psychological distress may negatively affect the decision-making ability of the dentists which in turn might influence patient outcomes and well-being. Solutions need to be devised to attain stability and keep dentistry going. This article provides an overview of proposed mitigation measures.
The following core competencies are addressed in this article: Patient care, Interpersonal and communication skills, Medical Knowledge, Systems-based practice.

Keywords: COVID-19, dentistry, distress, mental health, psychology, stress


How to cite this article:
Kumar G, Rai S, Janeswar A, Suresan V, Jha K, Singh A. Finding the calm amid chaos – Mental health of dentists during COVID-19 pandemic. Int J Acad Med 2021;7:5-9

How to cite this URL:
Kumar G, Rai S, Janeswar A, Suresan V, Jha K, Singh A. Finding the calm amid chaos – Mental health of dentists during COVID-19 pandemic. Int J Acad Med [serial online] 2021 [cited 2021 Apr 16];7:5-9. Available from: https://www.ijam-web.org/text.asp?2021/7/1/5/311876




  Introduction Top


The novel coronavirus disease 2019 (COVID19) has entered our lives as an unwanted guest. This virus has not only affected China-the country of its origin but also affected every small or big nation globally. Globally, as of July 4, 2020, there have been 10,922,324 confirmed cases of COVID-19, including 523,011 deaths, reported to the WHO.[1] COVID-19 has challenged health professions and has evoked different speeds of reaction and types of response worldwide. Dental practice owners now face a challenge they have not been prepared for. With all the clinics, dental schools, and hospitals being shut during lockdown to only providing emergency services, no dentist could have envisioned a situation like this. There exists a lacuna that this pandemic has created in everyone's lives, source of income, and psychology.

This review was conducted to enumerate the potential impact of COVID-19 on the psychology of dentists in India. It additionally describes the problems encountered by dentists and sets out to suggest some strategies to enhance their mental health.


  The Link Between Covid-19 and Dentistry Top


The risk to health-care workers is evident and well-reported throughout the world. With increasing awareness and the uniform adoption of personal protective equipment (PPE), the risk has decreased progressively worldwide. Dental professionals work in proximity to the patient and are at constant risk of blood, saliva, and droplet exposure. The majority of the dental procedures involve the use of airotor and thus lead to the generation of aerosols that remain suspended in the operatory. Meng et al. found that, despite the use of protective measures such as masks and gloves, several dental staff members in Wuhan were found to have been infected with COVID-19 as part of their work, along with some of their close relatives.[2] Dental surgeons are losing lives to the virus across the world. Six dentists in Indonesia lost their lives as of April 6, 2020,[3] while seven dentists from Italy lost their lives to coronavirus by mid of May.[4]


  Hurdles for Dentists During the COVID-19 Pandemic Top


Currently, a fair number of dental offices have closed as only dental emergencies are being addressed. Even the number of patients visiting dental clinics has reduced drastically, and at the same time, it is advisable to limit the usual number of patients in the waiting area. The Ministry of Health and Family Welfare, Government of India, issued an advisory according to which oral cancer screening under the National Cancer Screening program should be deferred until new policy/guidelines are issued.[5] The majority of oral diseases are not receiving treatment, which is adding to the burden of oral diseases, especially oral cancer during the epidemic. Even the patients are willing to compromise their oral health over general health, which shall subsequently have an impact on their oral health-related quality of life. All these factors are either directly or indirectly contributing to the financial and psychological burden on dental practitioners.

With the closure of dental schools and colleges, many dental faculties and paramedical staff are facing the problem of salary deduction or loss of payment, which is ultimately adding to their psychological stress. The unavailability of an imperative number of PPE kits in every remote clinic is a serious concern. No treatment without PPE, frequent fumigation of the clinical setting, limiting the daily number of patients, and decreased financial security amid the constant fear of contracting the virus has affected the psychology of the dentists.

On March 26, 2020, the finance minister of India under the Pradhan Mantri Garib Kalyan package announced a Rs 50 lakh insurance cover per person for frontline health workers involved in managing the Coronavirus (COVID-19) outbreak. This scheme was further extended on June 26, 2020, for 90 days beyond the original period of 3 months.[6] The coverage includes sanitation staff, doctors, ASHA workers, paramedics, and nurses. However, dentists find no mention in this scheme.


  Effect of the Pandemic on Dentists' Psychology Top


In the face of the COVID-19 pandemic, medical staff worldwide are facing constant and high-magnitude stress during their daily work, which entails elevated risk of infection, frustration, exhaustion, social isolation, and being apart from their families.[7] Such stressful events during the COVID-19 pandemic may lead to an increased risk of developing anxiety and stress disorders among medical staff, such as posttraumatic stress disorder (PTSD).[8] Consequently, these mental health issues may negatively affect the decision-making ability of the medical staff, leading to less than optimal treatment for their patients as well as deteriorating their psychological well-being.[7]

Psychological distress during the COVID-19 pandemic is not solely limited to SARS-CoV-2 infection. It may be also related to social, cultural, and environmental factors, which may act as additional stressors. Fear and anxiety about a new disease and what could happen can be overwhelming and cause strong emotions in adults and children.[9] Providing care to others during the COVID-19 pandemic can lead to stress, anxiety, fear, and other strong emotions.

Experiencing or witnessing life-threatening or traumatic events impacts everyone differently. In some circumstances, the distress can be managed successfully to reduce associated negative health and behavioral outcomes. In other cases, some people may experience clinically significant distress or impairment, such as acute stress disorder, PTSD external icon, or secondary traumatic stress (also known as vicarious traumatization). Compassion fatigue and burnout may also result from chronic workplace stress and exposure to traumatic events during the COVID-19 pandemic.[10]

Huang et al. reported that the incidence of anxiety in medical staff was 23.04% and it was higher in the female staff than that in males. The incidence of anxiety in nurses was higher than that in doctors.[11] The incidence of stress disorder in medical staff was 27.39%, with higher scores among female medical staff.[11]

Mijiritsky et al. conducted a cross-sectional study to explore the relationship between psychological distress and subjective overload among dental staff from various countries where they found that the positive association between subjective overload and psychological distress was different among countries, suggesting a higher association in Italy in comparison to China, India, and Israel.[12] Subjective overload, a psychological term which in the case of dentists, may relate to their perceptions and understanding of their given circumstances, is not limited to their dental practice but rather involves other aspects of their everyday lives. It also relates to their coping mechanisms, and it may determine their level of job stress. The association between subjective overload and psychological distress is highly correlated with certain COVID-19-related factors like fear of contracting COVID-19 from patients, fear of one's family contracting COVID-19 and receiving enough professional knowledge regarding COVID-19.[12] The results of the study have been depicted in [Figure 1].
Figure 1: The association between subjective overload and psychological distress for each country[12]

Click here to view


Several studies (e.g., from China and Italy) have offered different recommended infection-control protocols for dental practices.[2] These recommendations demand a change in traditional dental infection-control measures and require different adjustments to be made by all involved sections, including dental health policy-makers and the dental staff. Thus, subjective overload might be increased, which in turn may cause additional psychological distress. The psychological distress ultimately affects the decision-making ability of a dentist, which in turn negatively affects the patient's welfare.


  Coping Up and Enhancing Resilience Top


Efforts need to be made both on a personal as well as the professional level to combat the effect of this pandemic on our psychology and mental health. Some of the strategies have been depicted in [Table 1].[13] Innovation and invention is the demand of the hour. The use of telephonic consultations can not only reduce the risk of disease transmission but also ensure that dentists do not lose their bread and butter. Countries, namely Italy, Northern Ireland, UK, are making efficient use of telephonic triage.[14] Online lectures, case studies, and problem-based learning tutorials should be adopted to avoid unnecessary aggregation of people and associated risk of infection at the same time ensuring the continuation of work for the teaching dental staffs.[2] Deployment to new roles and volunteering has become the method of choice for dentists and dental nurses in hospital practice, dental foundation trainees, and core trainees during the crisis.
Table 1: Strategies for enhancing mental health at both workplace and home

Click here to view


The Dental Council of India announced a list of duties that a dentist could accomplish during this period of deployment towards making the country COVID-free.[15] These activities included[16] [Figure 2]:
Figure 2: Timeline showing major decisions taken by the DCI to combat COVID-19

Click here to view


  1. Prescreening, routine medical examination, and first aid
  2. Recording detailed case history and identification of vulnerable age groups
  3. Community engagement, contact tracing, and patient tracking
  4. Health facility infection control management
  5. Administrative work related to COVID-19 from purchases, record management, etc.,
  6. Health Dashboard maintenance and information, education and communication related activities
  7. Laboratory investigations such as nasal swabs and throat swabs after necessary training
  8. Postdischarge counseling and management of patients
  9. Review supply Chains and stocks of essential medicines
  10. Organizing capacity building and training for health-care professionals.


All these efforts shall indirectly add to the psychological well-being of dental professionals.

The Government of India on June 25, 2020, granted MSME status to dental practice activities.[17] This shall not only create employment but also lead to the opening of double the number of dental clinics. It shall help India grow as an independent body in research and technology related to dentistry. This effort of the government shall help in covering the financial lacunae and thereby shall have a positive impact on the psychology of dentists in India.


  Conclusion Top


COVID-19 has had many immediate complications for dentistry, of which some may have further long-term impacts on clinical practice, dental education, dental research, and ultimately the psychology of the dental professionals. Mental health is an important part of overall health and well-being. This unprecedented period is about supporting each other in our professional family and looking out for our and others' mental health and well-being.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

The authors of this manuscript declare that this scientific work complies with reporting quality, formatting, and reproducibility guidelines set forth by the EQUATOR Network (http://www.equator-network.org). The authors also attest that because there was no clinical investigation carried out, the Institutional Review Board/Ethics Committee approval was not required.



 
  References Top

1.
World Health Organization. Coronavirus Disease (COVID-19) Dashboard. Available from: https://covid19.who.int. [Last accessed on 2020 Aug 02].  Back to cited text no. 1
    
2.
Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020;99:481-7.  Back to cited text no. 2
    
3.
COVID-19 Fast Response Team Calls on Dentists, ENTs to Stop Operating Amid Pandemic. Available from: https://www.thejakartapost.com/news/2020/04/06/covid-19-fast-response-team-calls-on-dentists-ents-to-stop-operating-amid-pandemic.html. [Last accessed on 2020 Aug 02].  Back to cited text no. 3
    
4.
Dentistry and Corona: The Ignored Limb of the Public Health System. Available from: https://science.thewire.in/health/dentists-coronavirus/. [Last accessed on 2020 Aug 02].  Back to cited text no. 4
    
5.
Guidelines for Dental Professionals in COVID-19 Pandemic Situation. Available from: https://www.mohfw.gov.in/pdf/DentalAdvisoryF.pdf. [Last accessed on 2020 Oct 27].  Back to cited text no. 5
    
6.
Ministry of Health and Family Welfare. Government of India. Available from: https://www.mohfw.gov.in/pdf/PMGKPInsuranceextensionletter.pdf. [Last accessed on 2020 Aug 03].  Back to cited text no. 6
    
7.
Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7:e14.  Back to cited text no. 7
    
8.
Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19. Chin J Ind Hyg Occup Dis 2020;38:E001.  Back to cited text no. 8
    
9.
Coping with Stress. Available from: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html. [Last accessed on 2020 Aug 03].  Back to cited text no. 9
    
10.
Health care Personnel and First Responders: How to Cope with Stress and Build Resilience during the COVID-19 Pandemic. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/mental-health-healthcare.html. [Last accessed on 2020 Aug 03].  Back to cited text no. 10
    
11.
Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. Mental health survey of medical staff in a tertiary infectious disease hospital for COVID-19. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2020;38:192-5.  Back to cited text no. 11
    
12.
Mijiritsky E, Hamama-Raz Y, Liu F, Datarkar AN, Mangani L, Caplan J, et al. subjective overload and psychological distress among dentists during COVID-19. Int J Environ Res Public Health 2020;17:5074.  Back to cited text no. 12
    
13.
Employees: How to Cope with Job Stress and Build Resilience during the COVID-19 Pandemic. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/mental-health-non-healthcare.html. [Last accessed on 2020 Aug 03].  Back to cited text no. 13
    
14.
COVID-19: Routine Dental Care Ends throughout the UK. Available from: https://www.fgdp.org.uk/news/covid-19-routine-dental-care-ends-throughout-uk. [Last accessed on 2020 Aug 03].  Back to cited text no. 14
    
15.
Appointment as State Nodal Officers for Workforce to fight against COVID-19. Dental Council of India. Available from: https://dciindia.gov.in/Admin/NewsArchives/Letter%20to%20SDC%20-%20Appointment%20as%20SNO.pdf. [Last accessed on 2020 Oct 27].  Back to cited text no. 15
    
16.
Bawankar PV. Combating COVID-19: A dentist perspective. Acta Scientific Dental Sciences 2020;4:59-62.  Back to cited text no. 16
    
17.
Path-Breaking News-Government Grants MSME Status to Dental Practice Activities. Available from: https://blog.ida.org.in/#/News? [Last accessed on 2020 Aug 03].  Back to cited text no. 17
    


    Figures

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    Tables

  [Table 1]



 

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