Challenges to Orthodontic Practice in COVID-19

The COVID-19 pandemic is unlikely to end soon as early breakthrough in development of vaccine is uncertain. Hence, it is pertinent to chalk out a plan where orthodontic patients whose ongoing treatment was abruptly suspended are rendered treatment, as indefinite postponement of appointments will hamper and compromise the treatment outcome.

In the current scenario, we proposed to divide orthodontic appointments into the following: short duration (10–15 min), intermediate duration (15–20 min), and long duration (>20 min) according to time required for procedure. Short duration appointments may include change of elastomeric modules or chains, adjustments of removable appliances, or managing orthodontic emergencies. Intermediate duration procedures are rebonding or cementation of any attachment, change of wires, and placement of fixed retainers. Long duration procedure includes full mouth bonding of orthodontic brackets and placement of mini implants.

Guidelines^{1, 2} in the COVID-19 pandemic will vary depending on the type of orthodontic practice, such as exclusive, visiting, and institutional orthodontic practice. The most common difficulty that will be seen in all kinds of dental practice is to regulate the number of appointments per day as extra time will be consumed in preparing dental operatory and implementing new guidelines. This can be managed easily in private practice; however, it is challenging at institution level, especially in a government setup where number of outpatients are generally high. A simple way to handle this is to divide patients into 30- and 45-day recall visits on the basis of treatment need. Similarly, advise patients to come alone or with one bystander and to wait in their vehicle till they are informed to enter in premises, maintaining social distancing. As cold sterilization has been considered relatively safe and acceptable, owning 3–4 sets of pliers is a norm for most orthodontists. Although, having more sets of pliers is the best practice, it has added financial burden and pain of carrying extra heavy burden.

Keeping all these factors in mind, we proposed to schedule the appointments in such a way that short duration appointments are in sequence followed by intermediate or long duration appointment, which provides enough time to autoclave1 used instruments for further use. Follow the rule of 321 where have three sets of instruments and scheduling two short followed by one long/intermediate appointment. Segregating instruments into different sets of pliers according to the type of procedure can help in preventing unnecessary soiling of unused instruments which can be used for other patients.

Thus, an orthodontist like any other professional has to live and thrive with COVID-19 and has to find ways like contact-less appointments, with the introduction of digital payments and digital record maintenance, to remain relevant in this new normal situation.