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South African Journal of Agricultural Extension

On-line version ISSN 2413-3221
Print version ISSN 0301-603X

S Afr. Jnl. Agric. Ext. vol.41 n.1 Pretoria Jan. 2013


The number of patients who consulted due to impacted third molar (3Ms) problems was higher than all other types of consults during all levels lockdown. Compared to global pre-covid period (October to December 2019), the number of consultations showed a substantial decline. (Figure 2). Consultations for infection, trauma and pathology were more frequent during pre-lockdown and level 3 lockdown. However, these differences were not significant (Table 1). The number of patients reviewed for trauma, pathology or infections were higher than cases of consultations for all levels of the lockdown. Reviewed cases were significantly lower during lockdown levels 5 and 4, for infection and pathology (p=0.001 and 0.002). Figure 3 shows the marked decline in the number of review cases from October 2019 until the end of May 2021.





Overall, the period of hard lockdown (levels 5 and 4) resulted in a drastic drop in the number of patients reporting at the facility for maxillofacial treatment.



This retrospective study sought to evaluate the impact of the COVID-19 pandemic lockdown restrictions on the utilization of maxillofacial services in a tertiary referral hospital. The study focussed on comparing the volume (quantity) of consultations and the type of clinical findings (quality) reported at the department during the studied periods. This study provides evidence that the pandemic has affected all dental services including urgent and emergency care. The reduction in the number of patients attending maxillofacial services in our setting is immense compared to similar institutions. Our findings show a decline of 88% and 86% during level 5 and 4 lockdown periods. In comparison Bartella12, Donohoe13 and Vishwakarma14 reported a 45%, 46% and 73.90% drop in maxillofacial patients due to COVID-19. We reported similar differences for trauma 9.3% versus 35%.13 ; and consultations for infection 4.08% compared to 28%.13 More reviews were recorded than consultations for cases of trauma, infections, and pathology for all periods of the lockdown. Globally, comparatively more cases of maxillofacial trauma, infection and pathology were treated than in our clinic.15,16

Most hospitals in the developing world adopted COVID-19 prevention protocols more readily and were thus able to resume maxillofacial operation on a regular basis. The few consultations at this tertiary hospital are indicative of the low number of patients referred from feeder clinics and hospitals. The majority of these institutions reduced their operating times or suspended services altogether during the lockdowns. The change in services times might account for the reduction in referrals for oral pathologies. Patients in the resource constrained environment often face financial, logistical and transport challenges that often derail their access to maxillofacial treatment. The situation worsened during the lockdown as resources were redirected towards the pandemic control. The majority of patients seen in our facility are indigent and rely on state-funded transportation for their hospital access.

Treatment of impacted third molars were performed more frequently during all phases of the lockdown than other services. Impacted third molars are associated with severe pain, pericoronitis, swelling, trismus and other signs of spreading infection.17 Therefore, patients suffering from these dental complications are likely to seek help than patients with innocuous soft tissue pathology. Several studies confirm that during the pandemic dental extractions were performed most frequently.18

We attribute the decline in the utilization of maxillofacial services in our facility to several reasons: Firstly, the hard lockdown severely restricted the movement of people including visits to healthcare facilities. Secondly, during this period of total shutdown, the world was overwhelmed by anxiety and fear of the virus. Consequently, the majority of people requiring treatment postponed healthcare services, including maxillofacial treatment.15,19 Patients were genuinely afraid of being exposed to the virus in hospitals. In their study, Wong and colleagues reported that patients viewed hospitals as infectious reservoirs, "crawling with COVID-19".8 The cumulative fear of dentists, of COVID-19 and implementation of travel restrictions provide powerful and justifiable excuses to postpone healthcare services.20

Thirdly, the initial shortages in covid tests and the long waiting periods for laboratory results caused unnecessary delays and postponement of urgent maxillofacial treatment. Fourthly, shortages of personal protective equipment (PPEs), critical equipment and consumables had a negative effect on patient treatment and outcomes. During the early phases of the pandemic, the global shortages in PPEs, ventilators and other related equipment had reached catastrophic levels. Despite, instituted rationing, the level of scarcity had an impact on the medical and surgical services.21 Lastly, delays in the adoption of COVID-19 protocols in our facility contributed to deferrals and postponement of patient treatment. It is only after these constraints were addressed that some form of normalcy was attained and the patient number started to rise. Still, the maxillofacial services have not returned to pre-covid figures.



The significant decline in the number of patients treated at our facility highlighted the negative impact of the COVID-19 pandemic on maxillofacial service. Healthcare services are vulnerable to pandemics. Therefore, referral systems and infrastructure must be strengthened to support and maintain patient care beyond tertiary centres.



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3. Chinazzi M, Davis JT, Ajelli M, et al. The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science. 2020;368(6489):395-400.         [ Links ]

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11. Pabst A, Zeller AN, Sader R, et al. The influence of the SARS-CoV-2 pandemic on oral and maxillofacial surgery: a nationwide survey among 54 hospitals and 240 private practices in Germany Clin. Oral Investig... 2021;25(6):3853-3860.         [ Links ]

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Batlhalefi R Legalamitloa
Department of Oral and Maxillofacial Surgery
School of Oral Health Sciences, Sefako Makgatho Health Sciences University
Pretoria, South Africa



 Author contributions:
1 . BR Legalamitloa: 40% - Conceptualization, writing, edition and final review
2 . IT Munzhelele: 15% - Conceptualization, edition and final review
3 . K. Syebele: 15%- Conceptualization, edition and final review
4 . PD Motloba: 30% - Data analysis, writing, edition and final review

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Association of parental factors and delayed dental care for children



NA Mukhari-BaloyiI; KJ RamphomaII; MG PhalwaneIII; PD MotlobaIV

IDepartment of Community Dentistry, University of Pretoria. ORCID Number: 0000-0002-4374-0186
IIDepartment of Community Dentistry, Sefako Makgatho Health Sciences University, ORCID Number: 0000-00019975-2912
IIIDepartment of Community Dentistry, Sefako Makgatho Health Sciences University, ORCID Number: 0000-00022977-9092
IVDepartment of Community Dentistry, Sefako Makgatho Health Sciences University. ORCID Number: 0000-00031379-7576





INTRODUCTION: There is a general perception that majority of parents delay seeking oral health care services for their children. However, the reasons for this health seeking behaviour and the related contributing factors are poorly understood
AIMS: To investigate the parental factors that influence delayed dental care for their children

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