COVID-19 Prevalence and Related Practices Among Dental Hygienists in the United States

 

TAKE-HOME MESSAGE

  • This web-based survey of 4776 registered dental hygienists from across the US, including Puerto Rico, was designed using 30 questions to estimate the prevalence of COVID-19, describe infection control and prevention procedures, and identify associated mental health trends among dental hygienists in clinical practice. Elevated symptoms of depression and anxiety were reported by respondents, while 3.1% (n = 1) had ever been diagnosed or tested positive for COVID-19, and a majority (99.1%; n = 3328) in practice reported enhanced infection control/prevention efforts in their primary practice. PPE use was not significantly associated with the type of dental practice (P = .1) but was significantly associated with level of PPE supply availability (P < .01), level of concern about COVID-19, and hygienists’ years of experience.

  • The authors concluded that, while the estimated prevalence rate of COVID-19 infection among practicing hygienists is low, there remains a need for support for the mental health of dental hygienists and use of PPE as well.

 Clinical Dentistry

The American Dental Hygienists Association (ADHA) and the American Dental Association (ADA) collaborated in the fall of 2020 to conduct a web-based survey of dental hygienists. The purpose of the study was to estimate COVID-19 infection prevalence, infection prevention and control practices, and associated trends in mental health among dental hygienists in the United States during the COVID-19 pandemic.

The 30-question survey was constructed for this research and is similar to the survey of US dentists.1 The web-based survey was administered from September 29 to October 8, 2020. All 133,00 registered dental hygienists in the ADHA database received an invitation to participate. Eligibility criteria included that participants were licensed dental hygienists in the United States, were at least 18 years of age and employed as a dental hygienist on March 1, 2020. A total of 4776 dental hygienists originating from all 50 states and Puerto Rico participated in the web-based survey with a 99.4% completion rate.

In the 2 weeks before taking the survey, 25.7% of the respondents experienced elevated symptoms of anxiety and 16.05% experienced elevated symptoms of depression. Symptoms of anxiety and depression were significantly associated with age, with the highest levels of symptoms among those aged 18 to 29 years and the lowest levels among those aged 64 years or older.

The prevalence of having had COVID-19 was estimated to be 3.1% among the participants. In the general US population on the same date, an estimated 2.3% or 7.6 million people have had COVID-19.2 Both of these cumulative prevalence rates are lower than has been found in non-dental, healthcare workers in the United States.3

Enhanced infection prevention and control measures were reported in 99.1% of the dental practices. However, not all dental hygienists reported using personal protective equipment (PPE) according to the CDC interim infection prevention and control guidance for dental settings during the COVID-19 response.4 The authors suggest that this finding may improve with increased access to PPE. Years of experience as a dental hygienist was significantly associated with always following CDC PPE guidelines. Respondents expressing the highest levels of concern regarding COVID-19 transmission to themselves or patients were more likely to always use PPE as recommended by the CDC.

The authors acknowledge limitations to their findings. The study is based on self-reported data, which can be subject to recall or social desirability bias. COVID-19 testing availability was limited at the time of the study to primarily individuals with symptoms or contact with someone who tested positive for COVID-19. Consequently, some less severe or asymptomatic cases of COVID-19 may have been missed. There was insufficient statistical power to test for differences in recent COVID-19 infection by dental practice–related factors, such as PPE use and other infection control practices.

This study is the first of an ongoing longitudinal study. Future research will continue to examine prevalence of COVID-19 among dental hygienists in the United States, risk factors for COVID-19, use of PPE in dental practice settings, employment factors, and mental health status. The authors suggest that further study is needed to identify other factors that may be associated with COVID-19 infection, including awareness of and strict adherence to guidance, philosophy of dental practice, availability of other PPE, and financial issues.

Even though the authors cite several limitations to the findings, this study is significant, as the first large-scale report of data surveilling rates of COVID-19 infection and infection prevention and control practices among US dental hygienists.

References

  1. Estrich CG, Mikkelsen M, Morrissey R, et al. Estimating COVID-19 prevalence and infection control practices among US dentists. J Am Dent Assoc. 2020;151(11):815-824. https://linkinghub.elsevier.com/retrieve/pii/S0002-8177(20)30658-9
  2. John Hopkins University & Medicine. Coronavirus Resource Center. COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. JHU.edu; 2020. Accessed November 30, 2020. https://coronavirus.jhu.edu/map.html
  3. Kambhampati AK, O'Halloran AC, Whitaker M, et al. COVID-19-Associated Hospitalizations Among Health Care Personnel - COVID-NET, 13 States, March 1-May 31, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(43):1576-1583. https://www.cdc.gov/mmwr/volumes/69/wr/mm6943e3.htm?s_cid=mm6943e3_w
  4. Interim infection prevention and control guidance for dental settings during the COVID-19 response. US Department of Health and Human Services; 2020. Last updated June 29, 2020. Accessed November 30, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html

PURPOSE

Throughout the COVID-19 pandemic, health care professionals have been challenged to provide appropriate preventive and therapeutic measures while using precautions to minimize disease transmission. The purpose of this study was to estimate the prevalence of COVID-19 among United States (US) dental hygienists, describe infection prevention and control procedures and any associated trends in mental health.

METHODS

Registered dental hygienists (RDHs) licensed in the US were invited to participate in a 30-question web-based survey. COVID-19 infection items included probable and confirmed results, COVID-19 related symptoms experienced in the last month, and level of concern about COVID-19 transmission to patients and themselves. The validated Patient Health Questionnaire 4 screened respondents for depression or anxiety. Personal protective equipment (PPE) use when treating patients was assessed. The research protocol and survey were approved by the American Dental Association IRB and registered at clinicaltrials.gov (NCT04542915). Kruskal-Wallis and X2 tests were used to test for associations between PPE use, PPE supply, mental health symptoms, and concern about COVID-19 transmission.

RESULTS

As of October 8, 2020, a total of 4,776 dental hygienists from all 50 states and Puerto Rico participated in the study. Respondents reported elevated symptoms of anxiety and depression. Of the respondents, 3.1% (n=149) had ever tested positive or been diagnosed with COVID-19. The majority of respondents (99.1%; n=3,328) who practiced dental hygiene reported their primary dental practice had enhanced infection prevention or control efforts in response to the pandemic. PPE use was significantly associated with years of experience as a dental hygienist, level of concern about COVID-19, and level of PPE supplies available (p-values<0.01), but not type of dental practice (p-value 0.1).

CONCLUSION

As of October 2020, the estimated prevalence rate of dental hygienists in the US having had COVID-19 was low. There is a need for further support for dental hygienists' use of PPE and mental health.

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