Effect of the COVID-19 Mitigation Measure on Dental Care Needs in 17 Countries: A Regression Discontinuity Analysis.

ABSTRACT

Objectives: The effect of COVID-19 mitigation measures on different oral health care needs is unclear. This study aimed to estimate the effect of COVID-19 mitigation measures on different types of oral health care utilization needs and explore the heterogeneity of such effects in different countries by using real-time Internet search data. Methods: Data were obtained from Google Trends and other public databases. The monthly relative search volume (RSV) of the search topics "toothache," "gingivitis," "dentures," "orthodontics," and "mouth ulcer" from January 2004 to June 2021 was collected for analysis. The RSV value of each topics before and after COVID-19 was the primary outcome, which was estimated by regression discontinuity analysis (RD). The effect bandwidth time after the COVID-19 outbreak was estimated by the data-driven optimal mean square error bandwidth method. Effect heterogeneity of COVID-19 on dental care was also evaluated in different dental care categories and in countries with different human development index (HDI) rankings, dentist densities, and population age structures. Results: A total of 17,850 monthly RSV from 17 countries were used for analysis. The RD results indicated that advanced dental care was significantly decreased (OR 0.63, 95% CI 0.47-0.85) after the COVID-19 outbreak, while emergency dental care toothache was significantly increased (OR 1.54, 95% CI 0.99-2.37) 4 months after the COVID-19 outbreak. Compared to the countries with low HDI and low dentist density, the effect was much more evident in countries with high HDI and high dentist density. Conclusions: COVID-19 mitigation measures have different effects on people with various dental care needs worldwide. Dental care services should be defined into essential care and advanced care according to specific socioeconomic status in different countries. Targeted health strategies should be conducted to satisfy different dental care needs in countries.