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COVID-19 pandemic had both positive and negative consequences for orthodontists

All adaptations made by orthodontists during COVID-19 might not remain in place. However, some clinicians report that they will continue certain practices in response to ongoing trends. (Image: DC Studio/Shutterstock)

RICHMOND, Va., US: No orthodontic clinician in the world was left unaffected by the extreme adaptation to practice and procedure required during the COVID-19 pandemic. A new report by researchers at Virginia Commonwealth University highlights enhancements in safety protocols, changes in aerosol procedures, the rise of clear aligners and the surge of virtual appointments as consequences of the pandemic. The study gives insights into the perceived effectiveness of these adaptations, the anticipated continuation of these changes post-pandemic and how these measures have reshaped the landscape of orthodontic practice in the face of unprecedented challenges.

The COVID-19 pandemic necessitated the adaptation of orthodontic practices in order to enhance safety and infection control. The authors of the study noted that the four specific categories of changes made by clinicians within their practices were those of infection control, social distancing, appliance type and tele-orthodontics. Though initially required at the start of the pandemic to close their practices temporarily, upon reopening, orthodontists had to implement strict safety protocols in line with recommendations from various health organisations. Adapting to new norms, clinics started screening patients for symptoms, minimising aerosol-generating procedures, enhancing personal protective equipment (PPE) usage and incorporating social distancing measures in their practices.

Utilising 160 surveys from practising orthodontists in 38 US states, the researchers found that the demographics of the respondents mirrored the demographics of orthodontists in the US. Most were male and private solo practitioners with over a decade of experience. Notably, during the COVID-19 pandemic, most of them had adopted stringent health protocols, such as temperature screenings, use of HEPA filters and wearing of PPE. However, significantly fewer planned to continue these after the pandemic, with the exception of the use of surgical masks. During the pandemic, there had been adaptations to procedures that produced aerosols; for example, high-volume suction had been added and distances maintained between patients. Though the use of PPE is expected to decrease, the clinicians who responded did expect to keep using high-volume suction.

The use of clear aligner therapy became an emergent trend during the pandemic, as it was preferred over fixed appliances owing to fewer emergencies, shorter chair time, ease of remote monitoring and fewer in-office visits. The survey responses indicated that the popularity of clear aligner therapy will continue to increase even after the pandemic.

Telehealth was key for the initial triage of orthodontic emergencies, reducing the need for physical contact with a median of five virtual visits per week. These changes were significantly associated with provider region and practice size. Although studies have shown varied patient perceptions regarding virtual care, its value increased during the pandemic, and about 45% of respondents plan to continue after the pandemic, mainly for new patient screenings and the monitoring of clear aligners.

The results also indicated that orthodontic practices had experienced lower infection rates compared with other segments of the healthcare industry. However, these adaptations were not without challenges. They increased operational costs, disrupted workflows and forced orthodontists to strike a balance between safety and continuity of care and economic viability. The variance in the implementation and success of these adaptations remains largely unexplored, as does their future in post-pandemic orthodontic practice. This leads to crucial questions on the efficacy of these changes, their permanence and their impact on the practice of orthodontics. Future studies could focus on the perspectives of orthodontists and the demographic differences in the application of these adaptations and could help shape post-pandemic orthodontic best practices.

The study, titled “Adaptations in orthodontics for current and future coronavirus disease 2019 best practices”, was published in the July 2023 issue of the American Journal of Orthodontics and Dentofacial Orthopedics.

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