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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 13  |  Issue : 4  |  Page : 139-143

Retrospective evaluation of geriatric patients applying to a dentistry faculty during the COVID-19 pandemic


1 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Selcuk University, Turkey
2 Beyhekim Oral and Dental Health Center, Konya, Turkey

Date of Submission12-Oct-2022
Date of Decision17-Nov-2022
Date of Acceptance18-Nov-2022
Date of Web Publication15-Dec-2022

Correspondence Address:
Dr. Derya Icoz
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Selcuk University, Alaeddin Keykubat Campus, Yeni Istanbul Street, 309, Selcuklu, Konya
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/srmjrds.srmjrds_131_22

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  Abstract 

Background: COVID-19 has had a significant impact on dental procedures, as dentistry is one of the areas at the highest risk for the transmission of COVID-19. Aim: The aim of the present study was to determine the application density of geriatric patients during the pandemic and to investigate the most common reasons for referral to a dentistry faculty. Materials and Methods: For the study, the 1 year was divided into four equal periods of 3 months, and the number of patients examined in these periods; the age and gender information of the patients, their systemic conditions, and the primary reasons for admission were recorded from the patient files. Results: The total number of geriatric patients who were examined during this process was determined as 848. According to the periods, the number of patients who were examined was the lowest in the 1st period (53 [6.3%]) and the highest in the 4th period (349 [41.2%]). For all four periods, it was determined that the most common reason for the application was prosthetic reasons (39.4%), the most common comorbid disease was hypertension (37.7%), and cancer patients applied statistically significantly less in the 1st period (P = 0.040). Conclusion: According to the results of this study, the number of dental patients has gradually increased for the 1st year of COVID-19 cases. Although there was no statistical difference between the periods in terms of pain, alveolitis, need for restoration due to fracture, trauma, etc., COVID-19 had significant effects on dental applications, as in many areas.

Keywords: COVID-19, geriatric dentistry, retrospective study, severe acute respiratory syndrome-coronavirus-2


How to cite this article:
Icoz D, Karakurt R, Akgünlü F. Retrospective evaluation of geriatric patients applying to a dentistry faculty during the COVID-19 pandemic. SRM J Res Dent Sci 2022;13:139-43

How to cite this URL:
Icoz D, Karakurt R, Akgünlü F. Retrospective evaluation of geriatric patients applying to a dentistry faculty during the COVID-19 pandemic. SRM J Res Dent Sci [serial online] 2022 [cited 2023 Feb 7];13:139-43. Available from: https://www.srmjrds.in/text.asp?2022/13/4/139/363800


  Introduction Top


In December 2019, a pneumonia epidemic began to occur in the city of Wuhan, Hubei province of China, which was determined to have developed secondary to a new type of coronavirus infection. While the virus was initially called 2019-nCoV, on February 11, 2020, the World Health Organization (WHO) named the disease COVID-19, and the International Virus Classification Committee named the virus as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2).[1] Spreading in Europe and then all over the world, it was declared as a pandemic by the WHO on March 11, 2020. On the same day, the first case of COVID-19 was announced in Turkey.[2],[3],[4] This new coronavirus infection is similar to the symptoms of other coronavirus infections, with common symptoms such as fever, dry cough, and fatigue, but has a higher spread.[5],[6] SARS-CoV-2 may be transmitted direct (coughing, sneezing, and inhalation of droplets) and contact (mouth, nose, and eye mucosa) or by ingestion or inhalation of microorganisms in droplets/bioaerosols.[3],[7] Considering the working conditions of dentistry and the transmission routes of COVID-19, dentistry has been one of the most affected areas by COVID-19. The current data show that the transmission of this new type of coronavirus is easier and faster than other types of coronavirus, and people of all ages can be infected easily.[8],[9] The main source of infection is coronavirus patients, and the majority of them, especially asymptomatic patients are at risk of transmitting the disease without realizing that they are carriers.[8],[10]

Elderly individuals are more susceptible to infectious diseases due to their weaker immune systems.[11] Therefore, elderly individuals, especially those with multiple comorbidities, have been defined as the riskiest group in terms of fatal clinical outcomes of COVID-19. Many of these individuals use angiotensin receptor blockers (ARB) and angiotensin-converting enzyme (ACE) inhibitors for the treatment of their existing chronic diseases. Both ARB and ACE inhibitors upregulate ACE-2 receptors, which are receptors used by SARS-CoV-2 to enter host cells. Therefore, patients prescribed with these drugs are at an even higher risk for SARS-CoV-2 infection. However, some elderly patients with COVID-19 infection may have some organ damage caused by the disease, such as acute respiratory distress syndrome, acute kidney injury, and heart damage.[12]

A large proportion of elderly individuals are able to live independently in the community and have access to oral health services at rates similar to younger adults. Another group of elderly patients needs support to access health services or live completely dependent on someone else. With the COVID-19 outbreak, new challenges have emerged in this group of patients in accessing oral health services.[11] In the early stages of the COVID-19 pandemic, many countries suspended elective dental procedures, providing only emergency dental care and using teletriage.[13] Historically, oral health care in older adult patients has been associated with chronic oral health problems rather than acute exacerbations. Therefore, the probability of this patient group experiencing acute dental problems during the pandemic is considered to be less likely than younger age groups.[12],[14],[15] However, delaying oral care services to reduce the possibility of transmission of COVID-19 can exacerbate chronic problems and cause acute needs.[12]

The aim of the present study was to evaluate all geriatric patients (65 years old and over) retrospectively who attended a dentistry faculty for different oral and dental problems in the 1st year of the pandemic and to determine the systemic conditions, attendance density, and reasons for attendance.


  Materials and Methods Top


Study design

The present study was carried out based on retrospective archive records and approved by the Noninterventional Clinical Research Ethics Committee of the Dentistry Faculty of Selçuk University (Date: July 14, 2021 Number: 2021/33). All the participants provided informed consent for their participation in the study. All procedures performed in the study were conducted in accordance with the ethical standards given in the 1964 Declaration of Helsinki, as revised in 2013.

Study size

All geriatric patients (n = 848) who attended Selçuk University, Faculty of Dentistry, Oral and Maxillofacial Radiology Department for examination with different oral and dental problems between March 11, 2020, and March 10, 2021, were included in this study by filtering from the hospital information management system (Turcasoft Software).

Study setting

This 1 year was divided into four equal periods as March 11, 2020–June 10, 2020 (1st period), June 11, 2020–September 10, 2020 (2nd period), September 11, 2020–December 10, 2020 (3rd period), and December 11, 2020–March 10, 2021 (4th period). For 848 geriatric patients in total, age, gender, periods of examination, systemic conditions (cardiovascular system [CVS] diseases, hypertension, diabetes, chronic obstructive pulmonary disease [COPD], asthma, cancer, and other), COVID-19 histories and primary reasons for admission (pain, alveolitis, and abscess), presence of bruxism, jaw fracture, caries, fallen/broken filling, epulis, broken tooth/root, cyst, obturator requirement, periimplantitis, periodontal, prosthetic causes, temporomandibular joint (TMJ) discomfort, trauma, and soft tissue lesions were recorded.

Participants

Patients who were over 65 years as of the date of examination, attended to the faculty for any oral or dental problems such as pain, prosthetic reasons, and trauma, and whose primary reason for attendance could be determined were included in the study.

Statistical analysis

SPSS (Statistical Package for the Social Sciences) version 22 (IBM, New York, USA) statistical analysis program was used to analyze the data. The data were analyzed with descriptive statistics (mean and frequency distribution) and the Chi-square test, and a comparison between the columns (z-test) was made for the difference between periods according to the primary attendance reason. The level of significance was set at P < 0.05.


  Results Top


The study included 848 geriatric patients (365 women [43%] and 483 men [57%]). The ages of the patients ranged from 65 to 96 years, and the mean age was 70.58 ± 5.07 years. Considering the number of geriatric patients who applied to our faculty for examination according to the periods and met the inclusion criteria, it was determined as 53 (6.3%) for the 1st period, 132 (15.5%) for the 2nd period, 314 (37%) for the 3rd period, and 349 (41.2%) for the 4th period. The distribution by gender of the individuals who were examined and included in the study in each period is shown in [Table 1]. When the periods were compared according to the gender of the patients who were examined, it was seen that the number of women who applied in the 1st period and the number of men who applied in the 3rd period were statistically significantly higher (P = 0.000), and there was no statistically significant difference according to the gender in the other periods. For all four periods, the most common reason for admission was prosthetic reasons. Prosthetic causes include missing teeth and denture replacement (297 (88.92%), fallen crown/bridge cementation (14 [4.19%]), denture repair (19 [5.69%]), and denture knock (4 [1.2%]). Of the 297 patients who applied for missing teeth and prosthesis replacement, 76 (25.59%) were completely edentulous patients. The distribution of the primary reasons for admission according to the periods is shown in [Table 2]. When the primary reasons for admission were compared according to the periods, there was no statistically significant difference at the P = 0.05 level between the periods in terms of pain, alveolitis, bruxism, fallen/broken filling, broken tooth/root, cyst, obturator requirement, periimplantitis, trauma, and presence of a soft-tissue lesion. A statistically significant difference was found between the periods in terms of examination applications made for abscesses, jaw fractures, caries, epulis, periodontal and prosthetic reasons, and TMJ disorders.
Table 1: Distribution of patients examined in each period according to periods

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Table 2: Distribution of application reasons according to periods

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According to the periods, the number of systemic diseases in the patients was between 0 and 3 in the 1st period, whereas it was between 0 and 4 in all other periods, and it was determined that 63.1% of the individuals had at least one systemic disease. There was no statistically significant difference between the periods in terms of the number of systemic diseases (P = 0.062). When the systemic conditions of the patients were evaluated, it was found that the most common systemic disease was hypertension (37.7%), and COPD (2.1%) the least. It was determined that 0.9% of the individuals included in the study had a history of COVID and there was no statistically significant difference between the periods (P = 0.083) [Table 3].
Table 3: Systemic disease distribution of patients examined in each period

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  Discussion Top


This study aimed to analyze geriatric patients who applied for dental treatments in 1 year after the declaration of the first case in our country, with the declaration of COVID-19 as a pandemic by the WHO, in terms of reasons for admission and systemic status, according to periods. Considering that the most risky group for COVID-19 is older adults with comorbid diseases and dentistry is one of the professions most exposed to SARS-CoV-2 transmission, the approach of older adults to dental treatments during the pandemic period is important. In this study, unlike the articles in which the effects of COVID-19 on geriatric dentistry were evaluated, all geriatric patients who applied to a dentistry faculty for dental treatments in the 1st year of the pandemic process in our country and met the inclusion criteria in the study were retrospectively analyzed in terms of systemic disease and reason for admission.[11],[12],[16],[17],[18],[19],[20],[21]

The number of patients who applied for examination gradually increased in every 3 months of the 1st year. After COVID-19 was declared as a pandemic in the world, elective dental procedures were postponed in our country, as in many countries, and only emergency dental interventions were performed. For this reason, the minimum number of geriatric patients who applied for dental treatments in the 1st period (6.3%) for 1 year and the increase in the number of patients who applied after June 01, 2020, when the first partial normalization process started, is an expected result.

When the primary reasons for admission were compared according to the periods, it was seen that there was no statistically significant difference at the level of 0.05 between the periods in terms of pain, alveolitis, bruxism, fallen/broken filling, broken tooth/root, cyst, obturator requirement, periimplantitis, trauma, and presence of a soft-tissue lesion. This result may be related to the fact that the complaints of pain, alveolitis, fallen/broken filling, broken tooth/root, cyst, obturator requirement, periimplantitis, trauma, and presence of soft-tissue lesions are not postponed by the patients due to the concern that the pandemic conditions may worsen gradually and the symptoms will increase, and for this reason, no difference is considered between the periods. It is thought that the number of patients who applied for bruxism may not have differed between periods due to the very small number of patients in each period and the lack of sufficient data. Similarly, the number of admissions due to alveolitis, cyst, obturator requirement, periimplantitis, and soft-tissue lesion does not differ between periods but is low for each period. However, prosthetic reasons constitute the highest rate among the reasons for applying to our faculty for each period. In a study evaluating the demographic factors and oral health behaviors associated with tooth deficiencies in elderly adults in Turkey, the rate of edentulism was found to be 48% in individuals aged 65–74 years, and it was concluded that total tooth loss and periodontal diseases increased significantly with age.[22] For this reason, it is not surprising that the most common primary reason for admission in every period is prosthetic reasons.

In a study conducted by Üstün et al. which examined the dental applications of pediatric patients during the COVID-19 pandemic process, it was found that there was a significant decrease in applications for both emergency and elective procedures when the pre- and postpandemic period was evaluated. In a study comparing the distribution of dental patients before the pandemic, it was determined that the number of patients decreased by 83%, and the distribution of dental problems varied significantly. It is expected that the number of admissions will decrease before and after the pandemic period, and a statistically significant decrease has been reported in studies.[3],[23] In this study, unlike the aforementioned studies, only geriatric patients and dental applications during the 1-year pandemic period were evaluated. In another study, in which a retrospective analysis of patients aged between 2 and 96 years who applied for emergency dental services were compared; the number of treated patients was determined as 160 and 724, respectively, when April 2019 and April 2020 were compared.[24] Similar to the results of our study, the number of applications for dental treatments increased in the later months of the pandemic.

When the comorbid diseases of the patients who applied for dental treatments in 1 year in our country were analyzed retrospectively, it was determined that 63.1% of the individuals had at least one systemic disease and the number of comorbid diseases ranged from 0 to 4. When the periods were compared, it was seen that there was no statistically significant difference between the periods in terms of comorbid diseases, except for cancer disease. It is known that comorbid diseases such as diabetes, CVS diseases, chronic kidney diseases, and obesity are strongly associated with advanced age, the severity of COVID-19 disease symptoms, and hospitalization rate.[25] As a natural consequence of the increase in the incidence of the disease, it was observed that the majority of patients who applied for dental treatments in this process had comorbid diseases. It is thought that the fact that geriatric cancer patients apply for dental treatments statistically less in the 1st period and the increase in the number of applications in cancer patients in the following periods may be related to the concern that the conditions may worsen and the guidance of the patients by the physicians who follow the disease to manage the cancer treatment process in a healthier way. In the present study, only 0.9% of the patients had a history of COVID, and this is thought to be related to the fact that the curfew continued in our country for individuals over the age of 65 during the period of this study, and therefore the transmission was low.

The most obvious limitation of this study was that systemic histories of the patients and COVID-19 history were self-reported and it was a single-center study. We think that evaluations to be made with data from more centers and therefore more patients will be more effective in the process analysis.


  Conclusion Top


Prosthetic reasons were the most common admission reason for all periods in the 1st year when the pandemic conditions were most severe. COVID-19 has had significant effects on oral and dental health services, as in many other areas.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3]



 

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