Impact of Second Wave of Corona Virus Disease-2019 on Utilisation Pattern of Dental Services in a Dental Teaching Hospital

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METHODS
Oral health care delivery and utilisation are particularly affected because of the high risk situation due to its route of transmission. 13This study was conducted during the lockdown period due to the second wave of COVID-19 to assess the impact in utilisation of oral health services and was compared with the utilisation pattern during the pre-lockdown period.The present study shows that significantly higher number of the males (126, 53.6%) went to the dental OPD for consultation during the lockdown period (P=0.002)whereas most of the females visited the same hospital before lockdown (652, 57.2%).In general, females show higher levels of compliance in comparison to males and they report to have more positive behaviour regarding regular dental visits 16 as seen in the pre-lockdown period in this study.However, the low attendance of females during lockdown can be related to their higher tendency of fear perception and their negative expectations about health related consequences of COVID-19 than men that might have made them reluctant towards dental visit unless any emergency oral health condition prevail. 17 There is a strong parental concern regarding physical health of their loved ones and they fear of rapid transmission to their children. 20ong 235 individuals who presented to the dental OPD during lockdown in the current study, majority (67, 28.5%) were referred to the Department of Oral and Maxillofacial

CONCLUSION
The results of this study concluded that there was impact of second wave of COVID-19 lockdown on utilisation of dental services.Since the effect of COVID-19 is not over yet, safety protocols including proper infection control measures need to be implemented to reduce the risk of transmission and provide quality oral health services.
An analytical cross-sectional study was conducted to assess the impact of second wave of COVID-19 pandemic on utilisation of dental services in Tribhuvan .Ethical clearance was obtained from Institutional Review Committee of the same institute.In this study, census method was used for selecting the eligible participants where all 235 individuals visiting dental outpatient department as new cases from 29th April 2021 up to one and half months of lockdown period were included.Informed consent was received from the study participants before data collection.Since all the departments were functioning normally during the lockdown period, patients were considered for referral to respective specialty departments based on their chief complaint and oral examination.Individuals who came in follow-up visits for their ongoing dental treatment, those having symptoms of COVID-19 like fever, cough and cold or diarrhoea; those who have been tested positive to COVID-19 or those in contact with COVID-19 patient within the past three days were excluded.

Total of 1 ,
374 individuals visited the Dental Teaching Hospital, Maharajgunj, during three months of pre-lockdown and lockdown period.When the number of individuals visiting dental OPD were compared in two different time frames of same duration (one and half months each), it was found that individuals visiting the Dental Teaching Hospital during pre-lockdown period were 4.85 times more than during the lockdown period.The decrease in flow of patients seems obvious because there was restriction in public transportation facilities announced by the Nepal Government during the lockdown period effective from 6 am, April 29, 2021 as per the Cabinet's decision made in April 26, 2021 in order to prevent transmission of COVID-19 by reducing unnecessary mobilisation of general public.4This restriction may have led only the individuals who had emergency oral health conditions to visit the Dental Teaching Hospital, Maharajgunj.However, during the pre-lockdown period, there was free movement and all the individuals who felt the oral health need could visit the dental hospital.Fear of transmission of Corona virus is the other major reason behind the individuals' hesitation in visit to the dental hospital during the lockdown period.14,15 Similar findings are shown by a study done in China by Guo et al.where female attendees were more during the pre-covid phase than in the time of lockdown. 10n the current study, out of 235 individuals who physically attended the hospital for dental check-up during one and half month duration of lockdown, only 23 (9.8%) belonged to the age group 0-14 years.However, during the prelockdown phase, 161 (14.1%) of those who visited the dental OPD were children.Likewise, comparatively less number of patients reported to a pediatric clinic in a study done by Noy et al. at Israel during lockdown than the pre and post lockdown period.18In this study, although, overall flow of patients in the dental hospital was low, the restrictions in child patients attending the dental clinic was higher in comparison to other age group.The possible reasons behind the unwillingness of parents to take the children for dental visit can be the unavailability of vaccines to children against COVID-19 till date.Parents became reluctant to expose their children to crowded spaces due to spiking COVID-19 cases.19 Dahal et al: Impact of Second Wave of Corona Virus Disease-2019 on Utilisation Pattern of Dental Services in a Dental Teaching Hospital

Table 1 :
Demographic characteristics of individuals visiting dental outpatient department.
The referral of the patients during lockdown was then compared with the referral of 1,139 patients done during one and half months just before lockdown.Data were entered in Microsoft Excel Sheet and analysed in SPSS Statistics for Windows, Version 16.0 (IBM Corp, Armonk, N.Y., USA).For descriptive statistics, frequency and percentage were calculated for categorical variables and mean±standard deviation were calculated for continuous variables.In order to determine the association between age, sex, and the departments referred with COVID-19 lockdown and pre-lockdown period in Dental Teaching Hospital, Maharajgunj, Chi-square test was done.group of 15-29 years (P=0.002,Table1).Most of the individuals (67, 28.5%) who visited dental OPD during lockdown, complaint of oral surgical concern and were referred to the department of Oral and Maxillofacial Surgery followed by dental problems of endodontic concern (50, 21.3%) and were referred to the Department of Conservative Dentistry and Endodontics.However, during the pre-lockdown period, majority (377, 33.1%) were referred to the Department of Conservative Dentistry and Endodontics followed by referral to the department of Oral and Maxillofacial Surgery (275, 24.1%).The proportional difference in referral between these two periods were statistically significant (P<0.001).

Table 2 :
21sociation of departments referred with Corona virus disease-2019 lockdown and pre-lockdown period.Dixit et al. also reported prosthodontic concern of patients as the least reported condition for their visit to the dental hospital.21Thisstudy has some limitations.Only new patients presented in the dental OPD of the teaching hospital have been reported in this study which may have led to underestimation of cases.However, there were many followup patients who where not considered in this study like those reporting to different specialty dental departments due to emergency conditions led by their problems like broken orthodontic brackets, fractured crown or other dental appliances, dental pain or swelling in the tooth undergoing treatment and so on.