Impact of Covid-19 Induced Closure on Orthodontic Outcomes in the State of Illinois

The COVID-19 pandemic exacerbated the existing oral health care crisis in the United States. During the first wave of the pandemic, dental governing bodies across the world called for the shutdown of dental offices, as dental procedures were considered high-risk events for disease transmission. The purpose of this study was to assess the impact of the closure of dental offices on orthodontic outcomes. We hypothesize that the shutdown is associated with an increase in adverse orthodontic events. A browser-based questionnaire was distributed to all 455 active members of the Illinois Society of Orthodontists (ISO). The 31-item survey consisted of yes/no options, dropdown choices, multiple-choice, and open-ended answers. Most respondents (88%) agreed that there was a delay in provision of periodic care, and nearly all of them (92.7%) attributed the delay to regional or state regulations. The average treatment time increased significantly from 20 to 23 months (p=0.003). There was also a significant increase of adverse orthodontic events during the closure period, including displaced wires (p=0.007), overexpansion of the maxillary arch (p=0.034), development of posterior crossbites (p=0.018), proclined mandibular incisor teeth (p=0.007), fenestrations/dehiscences of the labial bone (p=0.043), white spot lesions (p<0.001), carious lesions (p<0.001), poor oral hygiene (p<0.001), broken appliances (p<0.001, and inadvertent tooth movement (p=0.008). The findings of this survey suggest that the closure of dental practices during the COVID-19 pandemic had a significant impact on orthodontic care. The results also highlight the importance of periodic orthodontic adjustments in maintaining oral hygiene and preventing adverse outcomes during orthodontic treatment.