Art-4_Karvelas
ORTHODONTICS www.stomaeduj.com
THE IMPACT OF COVID-19 ON ORTHODONTIC
Original Articles
POSTGRADUATE PROGRAMS IN BALKAN COUNTRIES:
RESULTS FROM AN INTERNATIONAL SURVEY
BY ORTHODONTIC RESIDENTS
1a* 2b 3c 1d**
Nikolaos Karvelas , Frantzeska Karkazi , Moschos A. Papadopoulos , Irina Nicoleta Zetu ,
2e**
Fulya Özdemir
¹Department of Orthodontics, Faculty of Dentistry, “Grigore T. Popa” University of Medicine and Pharmacy of Jassy, Jassy, Romania
²Department of Orthodontics, School of Health Sciences, Faculty of Dentistry, Marmara University, Istanbul, Turkey
³Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Greece
**
Equal last authors
a
DMD, Postgraduate student; e-mail: karvelas93@gmail.com; ORCHIDiD: https://orcid.org/0000-0002-5331-1019
b
DMD, Postgraduate student; e-mail: fkarkazi@aol.com; ORCHIDiD: https://orcid.org/0000-0001-7514-7427
c
DDS, Dr Med Dent, Professor, Chair & Program Director; e-mail: mikepap@dent.auth.gr; ORCHIDiD: https://orcid.org/0000-0002-7630-7258
d
DMD, PhD, Professor, Chair; e-mail: nicoleta.zetu@gmail.com; ORCHIDiD: https://orcid.org/0000-0001-7861-473X
eDMD, PhD, Professor, Head; e-mail: fulya.ozdemir@marmara.edu.tr; ORCHIDiD: https://orcid.org/0000-0003-2460-0724
ABSTRACT https://doi.org/10.25241/stomaeduj.2021.8(4).art.4
Design Multidisciplinary survey conducted via a web-based questionnaire for orthodontic postgraduate
students.
Settings Orthodontic residents from 9 countries were surveyed between April and May 2021. The majority
was from Romania 52.53% (n=83), Turkey 21.52% (n=34), Croatia 6.33 (n=10) and less than 5% of participants
from the other countries with Bulgaria 4.43% (n=7), Republic of Moldova 4.43% (n=7), Greece 3.80% (n=6),
Bosnia and Herzegovina 3.16%(n=5), North Macedonia 1.90% (n=3) and Serbia 1.90% (n=3).
Results The questionnaire was completed by 158 orthodontic postgraduate students from the Balkan
countries, of which 75.95% (n=120) were females and 24.05% (n=38) were males. The average age group of
the respondents was between 25-34 years (84.81% [n=134] of the participants), while there was a significant
difference (p<0.05) with students from Romania with 2.3 times more females from Turkey with 2.4 times more
males in comparison to other countries. A higher number of the participants 37.34% (n=59) were working
in both the private and public sectors. Most of the orthodontic residents were mostly in their 2nd year of
studies 72.78% (n=115). The majority of the postgraduate students (n=93, 58.86%) altered their plans and
service delivery following the instructions of their institutions. The impact of coronavirus was evident, since
a decrease in outpatient visits before and after the pandemic was evident, (from 15 patients to 12 patients
respectively per day), with an average of 6 working hours under current circumstances.
Conclusions In this first international survey for orthodontic residents, widespread changes in the orthodontic
education programs during the outbreak of COVID-19 are reported.
KEYWORDS
COVID-19; Pandemic; Orthodontic Residency; Service Delivery; Orthodontics.
1. INTRODUCTION COVID-19 epidemics. COVID-19 transmits via inhala-
tion by person-to-person and aerosol/droplet, as well
With the outbreak of coronavirus infection (COVID-19) as fomite and hand contamination [1]. Most people
in December of 2019, the pandemic spread though who get covid have mild symptoms like fever, dry
out the world, wreaking havoc on personal life, cough, shortness of breath, anosmia, and ageusia,
employment, and health care. Coronaviruses are while a small percentage of affected COVID-19 cases
a large family of viruses that usually cause mild to expressed severe complications such as acute respi-
moderate upper-respiratory tract illness [1,2,3]. ratory distress syndrome or even death [2,3]. Thus,
Seven different types have been found in humans, COVID-19 might trigger pneumonia (ranged from
including Severe Acute Respiratory Syndrome (SARS), mild to severe), cardiovascular diseases, gastrointes-
Middle East Respiratory Syndrome (MERS), and tinal manifestations, hematological complications,
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Karvelas N, Karkazi F, Papadopoulos MA, Zetu IN, Özdemir F. The impact of COVID-19 on orthodontic postgraduate programs in Balkan
countries: results from an international survey from orthodontic residents. Stoma Edu J. 2021;8(4):253-258
Received: November 26, 2021; Revised: December 11, 2021; Accepted: December 16, 2021; Published: December 20, 2021
*Corresponding author: Dr. Nikolaos Karvelas, DMD, Postgraduate student, Department of Orthodontics, Faculty of Dentistry, “Grigore T. Popa”
University of Medicine and Pharmacy of Jassy, 16, Universităţii Street, RO-700115 Jassy, România
Tel: +40.232.301.618; Fax: +40 232 211 820; e-mail: karvelas93@gmail.com
Copyright: © 2021 the Editorial Council for the Stomatology Edu Journal.
Stoma Edu J. 2021;8(4): 253-258 pISSN 2360-2406; eISSN 2502-0285 253
COVID-19 on Balkan orthodontic postgraduate programs
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as well as a broad spectrum for neurological features management plans, and the delivery service (whe-
Original Articles
[2,3]. ther they have been affected or not), as well as the
Considering the routes of transmission generally in Tele-health consultations and the pausing treatments.
dentistry, the dentists, their dental assistants and The third section was comprised of questions related
the patients are at a high risk of contamination [4]. to COVID-19 and the corresponding risk of contami-
Suspension of dental practice routine for a long-term nation, including contamination of patients, orth-
period was indicated in order to provide public health odontic residents, as well as the protective measures
and anticipate the development of transmission [5]. the orthodontic residents have taken during the
As a result, dental practitioners were required to get pandemic. In the fourth and last section, orthodon-
additional personal protective equipment (PPE) and tic residents were asked about chair time during
take extra precautions to reduce the risk of transmis- the pandemic, whether they worked part-time or full-
sion via aerosol and spatter [4,5,6]. time with patients, if the total chair time had been
In orthodontic treatment, the pandemic has resul- changed, if they avoided high-or low-speed hand-
ted in a suspension of scheduled appointments, piece, and if they bypass air-water spray.
negatively affecting the psychology of patients, In addition, three important questions were asked
orthodontic residents, and specialists, as well as to highlight the interest of orthodontic residents
in the overall treatment care. At the beginning of regarding the preference for indirect bonding,
the pandemic, only orthodontic emergencies were self-ligating brackets, and aligner cases in orthodon-
allowed, confusing what can and cannot be consi- tic treatment during the COVID-19 pandemic.
dered urgent in orthodontics [7,8]. Thus, adaptation The data received within 4 weeks after the survey
during orthodontic treatments is necessary to were sent to the orthodontic residents who were
improve the duration of linework [8]. Literature included in this study. Initially, a total of 173 par-
regarding the orthodontic emergencies, the preca- ticipants completed the survey. However, only 158
utions and the measures to be taken to resist with orthodontic residents were included in the current
success this COVID-19 pandemic is limited. However, evaluation, since 12 participants were orthodontists
there is no study regarding orthodontic resident’s
(non-residents) and 3 participants were residents of
experiences and perspectives during COVID-19.
other specialties, and thus they were excluded.
In the current study, aiming at a questionnaire survey,
we try to investigate the influence of the COVID-19
2.1. Statistical Analysis
pandemic on the orthodontic residents, concerning
Descriptive statistics were performed to summarize
their previously defined orthodontic programs, their
the characteristics of the included data, which were
relationship with patients, as well as the correspond-
analyzed by the statistical package Python Progra-
ing affections or modifications of the corresponding
ming Language version 3.9 software (CWI, Python,
treatment plans.
Netherlands). Descriptive analyses were conducted
2. METHODS to describe the demographic characteristics related
to and the effects of COVID-19 pandemic on ortho-
This survey was designed by the Orthodontic dontic postgraduate programs. The Fisher exact
Departments of Iasi and Marmara Universities, test was used to compare categorical variables and
respectively, and was approved by the Ethical Shapiro-Wilk test to detect differences for pairwise
Committee of Clinical Research of Marmara comparison. The significance level was set at p<0.05
University (VE 09.2021.731). It was undertaken in and the odds ratio was expressed with 95% confi-
Balkan universities with orthodontic postgraduate dence intervals. The results were reported as per-
programs. A web-based online questionnaire was centages and ratio of performance which have been
created using Google Form (Google Inc., Moun- correlated with two categorical variables.
tain View, CA, USA) and sent via email to the Head
of the Orthodontic Department of each Balkan 3. RESULTS
country university for distribution to their residents.The
participation was entirely voluntary, and the 3.1. Study Population
participants were notified that the data would be The questionnaire was completed by 158 orthodon-
utilized solely for the purpose and scope of this study. tic postgraduate students from the Balkan countries
The questionnaire consisted of four sections. In the of which 75.95% (n=120) females and 24.05% (n=38)
first section, general questions were collected such males. The majority of the responders were from Ro-
as age, gender, working country, level of residency, mania 52.53% (n=83), Turkey 21.52% (n=34), Croa-
working in the public sector, private or both, and also tia 6.33 (n=10), and less than 5% of the participants
if the participants have undergone vaccination. The were from other countries with Bulgaria 4.43% (n=7),
second section comprised the effects of COVID-19 Republic of Moldova 4.43% (n=7), Greece 3.80%
on the orthodontic profession with questions about (n=6), Bosnia and Herzegovina 3.16% (n=5), North
the working hours per day, the outpatients before Macedonia 1.90% (n=3) and Serbia 1.90% (n=3) (
and during the COVID-19 pandemic per day, the Table 1).
254 Stoma Edu J. 2021;8(4): 253-258 pISSN 2360-2406; eISSN 2502-0285
Karvelas N, et al.
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Original Articles
Table 1. Description of female/male ratio according to each country.
Bosnia and Bulgaria Croatia Greece Moldova North Romania Serbia Turkey Total
Herzegovina Macedonia
Total 3.16% 4.43% 6.33% 3.80 4.43% 1.90% 52.53% 1.90% 21.52% 100%
(n=5) (n=7) (n=10) (n=6) (n=7) (n=3) (n=83) (n=3) (n=34)
Female 3.33% 4.17% 7.50% 1.67% 5.00% 0.83% 57.50% 2.50% 17.50% 100%
(n=4) (n=5) (n=9) (n=2) (n=6) (n=1) (n=69) (n=3) (n=21)
Male 32.6% 5.26% 63% 10.53% 2.63% 5.26% 36.84% 0.00% 34.21% 100%
(n=1) (n=2) (n=1) (n=4) (n=1) (n=2) (n=14) (n=13)
The average age group was between 25-34 years old the risks of COVID-19. As precaution measures, the
with 84.81% (n=134) of the participants, while there students had been provided with PPE, i.e., with a com-
is a significant difference (p<0.05) in Romania with plete set including a medical mask, N95 or equivalent
2.3 times more females and Turkey with 2.4 times mask, face shield or goggles, medical gloves, and
more males in comparison to other countries (Table gown (n=48, 30.38%). The most common precau-
2). In addition, Romania had 4 times more residents tion measures taken by the institutions included the
and Turkey 2 times more regarding the age group of vaccination of the staff (n=120, 64.4%), reduced
25-34 years (p<0.05). A higher number of the partici- working hours (n=91, 52.6%), increased precautions
pants 37.34% (n=59) were working in both the private measures (n=147, 85%), fever checking upon the
and public sectors. Most of the orthodontic residents entry into the hospital (n=130, 75.1%), decreased
were in their 2nd year of studies 72.78% (n=115). ratio of patients per day (n=102, 59%) and break
between the appointments (n=100, 57.8%). As a
3.2. Postgraduate students with patients diagnosed result, 60.76 % of the students have been vaccina-
with COVID-19 ted, while more than half 56.96% (n= 90) of the par-
In general, 70.89% of students reported having ticipants worked part-time. An interesting piece of
patients diagnosed with COVID-19 and only 1.27% information is that at the time of the questionnaire,
(n=2) declared patients died during the pande- in Romania and Turkey they were vaccinated 1.7 and
mic. Students who had a colleague diagnosed with 1.2 times more (p<0.05) than in the other Balkan
COVID-19 accounted for 71.52% (n=113) with 11.39% countries (Table 3).
(n=18) of them needing to be admitted in a medical However, residents in Romania declared part-time
care unit. work 2 times more (66.67%, p<0.05), and in Turkey
(32.35%, p<0.05) full-time work 3 times more com-
3.3. Precautions due to COVID-19 pared to the other countries (Table 4).
The majority of the postgraduate students (n=93, However, it seems that almost one-fifth of the
58.86%) altered their plans and service delivery students believe that not all their colleagues have
following the instructions of their institutions, while re-assessed their precautionary measures following
almost 20% believed that patients should have the recommendations of international expert com-
access to a standard of care treatments despite mittees.
Table 2. Description of the age of the participants compared to each country.
Bosnia and Bulgaria Croatia Greece Moldova North Romania Serbia Turkey P-value
Herzegovina Macedonia
18-24 0.00% 0.00% 0.00% 0.00% 40.00% 0.00% 0.00% 0.00% 60.00% p<0.05
(n=0) (n=0) (n=0) (n=0) (n=2) (n=0) (n=0) (n=0) (n=3)
25-34 1.49% 4.48% 2.24% 2.99% 3.73% 2.24% 58.21% 1.49% 23.13% p<0.05
(n=2) (n=6) (n=3) (n=4) (n=5) (n=3) (n=78) (n=2) (n=31)
35-44 16.67% 5.56% 38.89% 11.11% 0.00% 0.00% 22.22% 5.56% 0.00% p<0.05
(n=3) (n=1) (n=7) (n=2) (n=0) (n=0) (n=4) (n=1) (n=0)
45+ 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 100.00% 0.00% 0.00% p<0.05
(n=0) (n=0) (n=0) (n=0) (n=0) (n=0) (n=0) (n=0) (n=0)
Total 18% 10% 41% 14% 44% 2% 180% 7% 83% p<0.05
(n=5) (n=7) (n=10) (n=6) (n=7) (n=3) (n=83) (n=3) (n=34)
Table 3. Description of the vaccination rate compared to each country.
Bosnia and Bulgaria Croatia Greece Moldova North Romania Serbia Turkey Total P-value
Herzegovina Macedonia
Yes 2.08% 2.08% 3.13% 6.25% 4.17% 0% 58.33% 1.04% 22.92% 100% p<0.05
(n=2) (n=2) (n=3) (n=6) (n=4) (n=0) (n=56) (n=1) (n=22) (n=96)
No 4.84% 8.06% 11.29% 0% 4.84% 4.84% 43.55% 3.23% 9.35% 100% p<0.05
(n=3) (n=5 (n=7) (n=0) (n=3) (n=3 (n=27) (n=2) (n=12)) (n=62)
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Original Articles Table 4. Description of part/full-time working compared to each country.
Bosnia and Bulgaria Croatia Greece M o l d o - North Romania Serbia Turkey Total P-value
Herzegovina va Macedonia
Full- 4.41% 5.88% 13.24% 1.47% 1.47% 2.94% 33.82% 4.41% 632.35% 100% p<0.05
time (n=3) (n=4) (n=9) (n=1) (n=1) (n=2) (n=23) (n=3) (n=22) (n=68)
Part- 2.22% 3.33% 1.11% 5.56% 6.67% 1.11% 66.67% 0.00% 213.33% 100% p<0.05
time (n=2) (n=3) (n=1) (n=5) (n=6) (n=1) (n=60) (n=0) (n=12) (n=90)
Total 7% 9% 14% 7% 8% 4% 100% 4% 46% 200% p<0.05
(n=5) (n=7) (n=10 (n=6) (n=7) (n=3) (n=83) (n=3) (n=34) (n=158)
Table 5. Description of outpatients before/during COVID-19 compared to age.
P-value was measured with Fisher exact test.
Age Before During Sd P-value
Average Sum Average Sum Before During
18-24 10.4 52 5.4 27 2.58 1.36 0.025
25-34 13.47 1913 10.39 1465 22.01 21.14 p<0.05
35-44 31.81 668 28.95 637 29.74 28.03 0.15
45+ 9 18 6 12 1.00 2.00 0.3
3.4. Patient management due to COVID-19 pandemic self-ligating brackets (n=40, 25.32%) due to the
The impact of coronavirus is clearly evident, since COVID-19 pandemic. Most of the participants pre-
there was a decrease in outpatient visits before and ferred direct bonding placement during this period
after the pandemic, from 15 patients to 12 patients (n=130; 82.28%), rather than the indirect technique
respectively per day, in an average of 6 working hours (n=28, 17.72%).
per day in the current situation. Interestingly, female
residents presented a different average of about 3 4. DISCUSSION
patients less during the COVID-19 pandemic along
with the male patients having 4 patients less (p<0.05). This study is the first that assessed orthodontic
The average age group of 25-34 years presented the postgraduate students’ experiences and perspectives
most significant reduction for safe results, i.e., about related to COVID-19, the perceived changes, and the
3 fewer patients on average during the pandemic behavioral and protective measures following the
(p<0.05) (Table 5). outbreak. The COVID-19 pandemic places additional
The patients visit per student in a day was decreased strain on the global healthcare systems, while health-
in Romania (4%), Greece (2%,) and Bosnia and care workers must provide patient care while ma-
Herzegovina (1%), was increased in Croatia (4%), naging the hazard. However, reports on the long-term
Serbia (2%), and Bulgaria (1%), while it remained impact of such a crisis on healthcare systems are
stable in Turkey. scarce. Orthodontists and residents are exposed
All countries showed a percentage of patients who on a regular basis due to the nature of their work.
would like to pause their orthodontic treatment due Fortunately, as compared to other dental special-
to COVID-19, with a mean percentage of 16%. These ties, orthodontics produces less air droplet pollu-
percentages were higher in Bosnia and Herzegovina tion and aerosol [4,9]. However, in such an environ-
(30%) and North Macedonia (20%), respectively. ment, a controversial and disputed debate over the
In the curative environment, the majority of the categories of orthodontic emergencies may ensue.
students indicated no change in the chair time (n=72, Orthodontists commonly define emergency injuries
caused by band/bracket failure, soft/hard tissue dam-
45.86%). However, almost one-third of the partici-
age, and issues with retention appliances [6]. Many
pants decreased their chair time (n=48, 30.57%). Resi-
studies are evaluating the effects of COVID-19 on the
dents seem to prefer low speed handpiece (n=120,
mental health, anxiety, behavior change, and psycho-
75.95%) and air-water spray (n=113, 71.52%) than
logical perceptions among the medical staff [10-14].
high speed handpiece (n=87, 55.06%). Almost a
Yilmaz and Ozbilen reported that 16.7% of the Turkish
quarter of the participants (n=27, 17.09%) avoided
orthodontists had been diagnosed with Generalized
debonding of brackets during the COVID-19 pan-
Anxiety Disorder (GAD) during the COVID-19 pan-
demic. Fifty three percent of the patients in North
demic [7]. According to Lim et al., the level of anxiety
Macedonia have been treated by tele-dentistry, while
and behavior of a population can be influenced by
in Bosnia and Herzegovina the percentage reached
the updates it receives [11]. Huang and Zhao report
18%. a severe anxiety level (37.4%) in the healthcare work-
Students were more likely to choose fixed orthodon- ers, with people younger than 35 years showed more
tic treatment (n=127, 80.38%) for their patients than anxiety symptoms [12]. A study of a Chinese popula-
an aligner treatment (n=31, 19.62%). One-fourth tion recorded a significantly increased change in the
of the students showed a specific interest in behavior of hand-washing and wearing a mask when
256 Stoma Edu J. 2021;8(4): 253-258 pISSN 2360-2406; eISSN 2502-0285
Karvelas N, et al.
www.stomaeduj.com
Original Articles
hanging out in the outbreak [13]. Moreover, the Management of orthodontic treatment, when follow-
suspension of closure of dental offices despite the ing the guidelines and protocols for the protective
negative impact on the mental health and anxiety measures provided by the WHO and local authorities
is clear and effective. Although, the COVID-19 pan-
levels of professionals had also economic conse-
demic constitutes a critical factor between orthodon-
quences [5,7,14]. tic practice and public health, there is no reported
In our study, we found that approximately 20% of case of cross-contamination of the coronavirus at the
orthodontic postgraduate students believe that their dental society [23].
colleagues do not follow the recommended precau- Due to the restrictions during the COVID-19 pande-
tions. The majority of the students use a medical mic, this web-based questionnaire evaluation was
the only exclusive alternative but also voluntary
mask, N95 or equivalent mask, face shield, medical to perform such an investigation. A possibility of
gloves, and gown as PPE. According to the Centers for selection bias could be considered, regarding the
Disease Control and Prevention (CDC), N-95 or FFP2 difficulty to promote this survey in 9 different
masks are superior and recommended as compared countries and particular to orthodontic postgradu-
to standard medical masks due to their resistance to ate students. Moreover, considering the quite small
number of participants, studies with larger sample
a sufficient amount of aerosol load [6].
sizes and long-term protocols may produce more
In the literature it is accepted that reducing aero- induced results.
sol use is necessary to disrupt the transmission of
the coronavirus, thus limiting the use of droplet 5. CONCLUSION
generating procedures [4,16]. Because even the
asymptomatic patients can spread the virus, every The first international survey for orthodontic resi-
dents reported widespread changes in the ortho-
patient in the dental clinic should be considered dontic education programs during the outbreak of
as a potential COVID-19 carrier, and thus the stu- the COVID-19 pandemic. The orthodontic residents
dents should avoid aerosol-generating procedures. of the Balkan countries have been affected following
However, in the current evaluation it is shown that this pandemic since, among others they worked on
even though most of the residents prefer to use a part-time basis with a reduced number of patients
per day.
low-speed handpiece (75%) and air-spray syringe
(71%) than high-speed handpiece (55%), there is an ACKNOWLEDGMENTS
increased number of residents (82%), who did not We would like to thank all the orthodontic residents that
avoid debonding during the outbreak. participated and completed this survey, as well as all the professors
In the orthodontic profession aligners treatment, who promoted our study to their orthodontic departments.
indirect bonding or self-ligating brackets show
decreased number of appointments, as the num- AUTHOR CONTRIBUTIONS
ber of emergency visits, and overall treatment time, NK: Conceptualization. NK, FK: Data curation and formal analysis.
which can be sufficiently valuable to defend our FK: Investigation. IZ, FO: Project administration. MAP, IZ, FO:
Supervision, review and editing. MAP: Validation. NK, FK, MAP, IZ,
patients’ health care [16-22]. Yet, orthodontic post-
FO: Visualization. NK, FK: writing.
graduate students promote direct bonding (82%),
straight-wire technique (74%), and fixed brackets CONFLICT OF INTEREST
(80%), but this can be interpreted that they are still The authors declare that they have no conflict of interest.
not specialists but simply students in educational
programs who require basics first and then further FUNDINS
complex treatments. None.
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Nikolaos KARVELAS
DMD, Postgraduate student
Department of Orthodontics
Faculty of Dentistry “Grigore T. Popa” University of Medicine and Pharmacy of Jassy
Jassy, Romania
CV
Nikolaos Karvelas received his DMD (2017) from the Medical University of Sofia, Bulgaria. Since 2019, he has been a postgraduate
student (3d year) and doctoral candidate (2021) at the Department of Orthodontics within the Faculty of Dental Medicine of
“Grigore T. Popa” University of Medicine and Pharmacy of Jassy, Jassy, Romania.
Questions
1. The effectiveness of piezocision is observed when:
qa. 173 postgraduate students;
qb. 200 postgraduate students;
qc. 158 postgraduate students;
qd. 12 postgraduate students.
2. Which of the following statement is True on the findings of this article?
qa. Romania had 4 times more orthodontic residents and Turkey 2 times more regarding the age group of
25-34 years (p<0.05);
qb. Romania had 2 times more orthodontic residents and Turkey 4 times more regarding the age group of
25-34 years (p<0.05);
qc. Romania had 8 times more orthodontic residents and Turkey 2 times more regarding the age group of
25-34 years (p<0.05);
qd. Romania had 4 times more orthodontic residents and Turkey 4 times more regarding the age group of
25-34 years (p<0.05).
3. Which statement is NOT True based on the findings of this article?
qa. The most common precaution measure taken by the institutions is the vaccination of staff;
qb. The most common precaution measure taken by the institutions is the reduced working hours;
qc. The most common precaution measure taken by the institution is the fever checking upon the entry
into the hospital;
qd. The most common precaution measure taken by the institutions is a written statement.
4. Which is the percentage of students who chose fixed appliances over the aligner
treatment based on the findings of this article?
qa. 19.62%;
qb. 22.45%;
qc. 62.19%;
qd. 45.22%.
258 Stoma Edu J. 2021;8(4):253-258 pISSN 2360-2406; eISSN 2502-0285