Issues and challenges in the Latvian dental care system during COVID-19 pandemic: qualitative study

To explore current issues, problems and challenges of dental caries during the COVID-19 pandemic in Latvia. Semi-structured online qualitative interviews were conducted and recorded between October and November 2020. Participants were eight dentists - head of large dental clinics, covering all regions of Latvia and two leaders of professional associations. After transcription of the interviews, thematic analysis was used for data processing. Three specialists combined all codes. Six themes with 13 subtopics emerged. The results were peer-reviewed by another team member. This study is a part of the project VPP-COVID-2020/1-0011. All clinic and association leaders acknowledged that the priority during the state of emergency was the health of personal and patients. Personal protective equipment (PPE), disinfection and other protective measures were introduced timely; currently, there are no problems with their delivery, and dental services continue to be provided in Latvia. The availability and provision of dental services significantly decreased because of existing restrictions during the state of emergency in Latvia. Clinics incurred financial losses, revenues decreased, but expenses for the purchase of PPE increased. The Latvian Dental Association was active and efficient, organized purchase and distribution of PPE, as well as provided recommendations and informed about restrictions that affected the dental service. Dentists and Dental Hygienists perceive that they are more at risk COVID19 infection because they work close to the patient, perform long procedures, and most are aerosol-generating manipulations. At present, all clinics have accumulated PPE, including specific to work with infected patients. Non-invasive manipulations are perceived as a solution by some respondents, but the main issue for their implementation are the costs and lack of preparation. To promote the use of remote consultations in dentistry, new skills and motivation should be created for dentists and patients.