Questions associated with the COVID‐19 pandemic that should be answered by traumatic dental injuries researchers

CONFLICT OF INTEREST

The authors declares that there are no conflicts of interest.

AUTHOR CONTRIBUTION

LAJ was responsible for the conception and writing; LCM was responsible for the conception, writing and revised the letter. All authors approved the final version.

Dear Editor,

In addition to the millions of lives lost around the globe due to the COVID‐19 pandemic, ¹ the dental community has also been severely affected by this catastrophic event. ²

Traumatic dental injuries (TDI) are the 5th most prevalent condition in the world, ³ , ⁴ and Brazil is the country that publishes most on the subject, with authorship of 18.27% of articles worldwide. ⁵ Brazil enacted a state of emergency due to COVID‐19 in March 2020. However, more than a year later, and unlike other countries, the daily average number of deaths exceeds the tragic number of 3000 people. ⁶ The prospect of flattening the epidemic curve is distant. Given the delay in initiating the process of mass vaccination, restrictive measures and social distancing remain extremely necessary.

The implications of the COVID‐19 pandemic in the context of multifactorial TDI management involve its etiology, treatment and the monitoring of sequelae. The scientific community reports ‘falling from own height’ as the most frequent cause of TDI. ⁷ However, the social isolation imposed by the pandemic has altered the lifestyle of people in all age groups, influencing their susceptibility to accidents of this type. Additionally, the increase in domestic violence rates in the country, mainly victimizing women, children and adolescents, ⁸ may increase the frequency of physical assaults in the etiologic panorama of TDI.

Due to the virus contingency measures in the country, the local activities of reference centres for research and care for TDI in Brazil, mainly located in higher education institutions, have been totally or partially paralysed, affecting the epidemiological monitoring of TDI nationwide. Thus, COVID‐19 has impacted not only the treatment and monitoring of patients who have suffered TDI but also the acquisition of new findings and further scientific contributions to the field, amplifying the challenges the pandemic poses for dentistry.

The monitoring and follow‐up of TDI are indispensable due to the negative impact on the quality of life of affected individuals and its high potential to cause sequelae for the traumatized tooth or its successor in the case of injuries to the primary dentition. ⁹ , ¹⁰ , ¹¹ In this sense, the COVID‐19 pandemic in Brazil is a limiting factor not only for the diagnosis and treatment of new injuries but also for the follow‐up of those who were already being monitored by reference centres.

In countries where teledentistry resources are available, basic monitoring of these cases can be done remotely. ¹² , ¹³ However, to date, the Brazilian Federal Council of Dentistry has not allowed the use of teledentistry by clinics linked to institutions of higher education, constituting yet another restrictive factor for the monitoring of TDI in the country during the pandemic.

Considering these limitations, it is of utmost importance that the reference centres maintain a presence in virtual environments. Through the creation of websites and profiles on social networks, reference centres can provide patients with educational materials on the prevention and treatment of TDI. This is a measure that, in addition to providing guidance and support for patients and family members, maintains the connection between patients and the centre, and reinforces the importance of resuming the follow‐up and monitoring of the TDI as soon as face‐to‐face activities resume.

In view of Brazil's robust contribution to the understanding of this important field of dentistry, we believe that the long period of paralysis of TDI reference centres in the country will be highly detrimental to the study of dental traumatology worldwide. In addition, due to the COVID‐19 pandemic, hundreds of patients with dental traumatic injuries are no longer receiving treatment or follow‐up and likely will suffer from the consequences associated with the injuries, whether dental or biopsychosocial.

The challenges the COVID‐19 pandemic has posed for the management of dental trauma are extensive worldwide, especially in countries such as Brazil that continue to face high incidence and death rates. Thus, on the resumption of the reference centres, researchers will need to investigate the impacts of the COVID‐19 pandemic on this important public health problem, which has historically affected the population at all stages of life.

Researchers on the subject must be prepared to answer questions that: (I) identify the influence of factors associated with the COVID‐19 pandemic on the prevalence of TDI in the general population and specific groups such as women, children and adolescents; (II) evaluate the possible changes in the etiological profile and risk factors related to the different types of dental trauma and their sequelae; and (III) determine the effects of the COVID‐19 pandemic on the physical, emotional and social health of patients affected by TDI and, finally, its impacts on the population's quality of life.

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no datasets were generated or analysed during the preparation of this Letter to the Editor.