May 16, 2022

Did COVID-19 affect the outcome of orthodontic treatment?

During the early stages of the COVID-19 pandemic, all dental treatment was disrupted or stopped because of the lockdowns. At the time, there were concerns that this would result in a reduction in the outcome of orthodontic treatment. In this post, I will discuss two recent papers that provide some reassurance to us.

At the time of the various pandemic lockdowns, there was concern that unsupervised orthodontic treatment may lead to problems. One of these was the overall quality of treatment because treatment was stopped for some time. This was looked at in these two papers. One was from a team in the UK, and the other was from a team based in Sweden. I will briefly look at each one separately.

What did they ask?

This team based in Norway asked:

“What was the treatment outcome for patients whose treatment was completed before or during the COVID-19 pandemic”?

What did they do?

They did a retrospective study of case records. This involved several steps.

  • They selected a random sample of 100 patients treated with fixed appliances.
  • This group was divided into two groups. The Pre-pandemic group finished before the pandemic. The post-pandemic group completed their treatment during the pandemic.
  • They scored the 3D scans of the pre and post-treatment study models with the Peer Assessment Rating and the Objective Grading System.
  • Then they compared the groups with the relevant univariate statistics.

The clinic lockdown was from March-July 2020.

What did they find?

They reported their findings in a series of simple tables. Firstly, there were no differences between the groups at the start of treatment.

There was no difference in treatment duration between the two groups.

The mean pre-treatment PAR scores for pre and post-pandemic groups were 32 and 30, respectively. At the end of treatment, the pre-pandemic group had a mean PAR score of 1, and for the post-pandemic group, this was 2. These were not statistically or clinically significant. This represents a high standard of treatment.

When they looked at the OGS scores. These were 32 for the pre- and 33 for the post-pandemic groups. Again, these were not clinically or statistically significant.

Patients in the pandemic group had more canceled and a reduction of 9 appointments in the number of appointments.

Their conclusions were:

“There were no differences in the occlusal index scores between the patients whose appliances were removed before or after the pandemic”.

This team did a similar study.

What did they ask?

They asked these simple questions:

“What was the effect of the temporary cessation of orthodontic treatment for patients having treatment during the COVID-19 pandemic”?

What did they do?

They did this study in two main parts.

In the first part, the investigators developed a patient-reported experience measure questionnaire. This was directed at gathering the patients’ perceptions of their treatment and concerns about the lockdown.

The second part collected a sample of patients who had their treatment completed after the lockdowns. These were analysed with the Peer Assessment Rating and compared with the results of care for another group whose treatment was completed before the cessation of care. The patients were being treated in 7 hospital-based orthodontic departments.

They scored the study casts of the patients with the PAR index.

The first UK lockdown for clinical treatment ran from 25 March-4 July 2020.

What did they find?

They collected data on patient experience from 711 participants. Their principal findings were that the patients felt relaxed about visiting the hospital clinics during COVID. However, 40% were concerned there would be delays to their treatment because of the lockdown. Unfortunately, this was the case as the treatment duration for the pandemic patients was 126 days longer than the group who finished before the lockdown.

When they looked at the PAR scores. They collected data on 280 patients divided into those who had been treated before and during the pandemic.

Pre-pandemic patients had a mean percentage reduction in PAR score of 83%. For the pandemic patients, the mean reduction was 80%. This represents a high quality of treatment. However, this was not a clinically significant difference.

Their overall conclusions were:

“The cessation of orthodontic treatment during the first UK lockdown impacted on the duration of treatment. Despite this a high standard of treatment was provided”.

What did I think?

These two studies were very interesting and reassuring. It was good to see that the overall standard of treatment reported in both settings was high. However, when I looked at the effect of lockdowns on the overall duration of treatment, I could not really think of a reason for the differences between the two studies. Nevertheless, the Swedish team did point out that we needed to be cautious in interpreting their findings because of a potential reduction in generality.

Both studies were retrospective. This means that there must be some selection bias. Nevertheless, we do not know the direction of this bias. Another potential bias in the UK study was that they did not do any examiner reliability for PAR. However, the examiners had been previously calibrated in this measure.

I also thought that it was interesting that the treatment standard was high, even though treatment was disrupted. Can we conclude that we do not need to see our patients as frequently as we do? But this opens a real Pandora’s box. So, we shall not go there now!

Final thoughts

These papers were very interesting and simply presented. This was great. We need to appreciate that they suffer from some flaws and consider these when we interpret the results. Nevertheless, they are probably the best studies that could have been done during this time.


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Have your say!

  1. Not really sure what this hospital based study tells us about the effect(s) of COVID
    Sure, the outcomes were identical, what about the effects of increase treatment times?
    Remember, that in UK when the chief dental officer closed down a whole profession for months ; a total disgrace IMHO and none of the profession bodies challenged the total lack of evidence for the decision
    – I was personally told by our ‘great’ NHS that I was NOT to see a patient in pain!

    Due to COVID in UK primary care in the we are seeing much longer treatment times; patients opting to abandon treatment due the length of time appliances have been on; a massive increase in assessment and treatment waiting lists and many patients opting for private treatment over government funding NHS care

  2. It might be better to ask about the affect of the Covid pandemic.

  3. When the pandemic shut down blocked our children’s(ages 9 and 13) plans for orthodontics which were based on their dentist’s recommendations, they ended up never going for any orthodontics. 2 and half years later: our 9 year old daughter’s overbite self-corrected, and our 13 year old son’s crowding went away, and all his teeth are almost fully descended in ideal position. Our dentist says there is no need for ortho and admits that sometimes ortho is over-recommended. So, the pandemic shut down was a blessing for our children, sparing them unneeded intervention and saving us money for their education.

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