In the present study, around 70% of the female dentists felt emotionally affected by COVID-19. The type of emotional impact reported was significant and related to depression symptoms, anxiety and psychological instability. A systematic review of the literature reveled that dentist experience a high prevalence of fear and anxiety because of COVID-19.¹⁶ In addition, a large meta-analysis using data from more than 200 countries identified that the pandemic has increased the prevalence of depression and anxiety. Major depressive disorder caused 49.4 million disability-adjusted life years (DALYs) and anxiety disorders caused 44.5 million DALYs globally in 2020. Moreover, major depressive disorder was more frequent in women than in men.¹⁷

Dentists, like other healthcare workers, are at an increased risk of contracting SARS-CoV-2 due to their close contact with patients. For instance, in Italy, dentists were afraid to work in the dental office because they considered their job to be a high risk to their health, and transmitting the infection to their families was also a concern.¹⁸ According to a study of Turkish dentists, 84.1% of female dentists and 70.7% of male dentists answered affirmatively to the question Do you think that current COVID-19 events affect you spiritually?¹⁹

Among the Mexican women dentists surveyed, emotional distress was associated with age. Young women dentists were more affected than older practitioners; this could be because are more likely to be in their first years of practice and may be overwhelmed by the demands of the profession. They may also be less experienced and have fewer coping mechanisms than their older counterparts. A multi-country study in Spanish speaking Latin American countries, identified that dentists who had relatively few years of experience found it difficult to balance their practice with household responsabilities.¹⁰ The pandemic affected every aspect of life. The Mexican women dentists studied were affected psychologically. It is essential that the need for gender-sensitive mental health services is addressed, to ensure that both men and women have access to the care they need.

In this survey, 90.12% of the respondents indicated using PPE following Mexican regulations.²⁰ Also, they had to adjust their practice protocols to comply with the new regulations. Accordingly, a survey of Mexican dentists, conducted in June 2020, showed that most dentists (70 to 96%) wore the different components of PPE.²¹ Due to the way in which respiratory viral infections are transmitted, dentists can play an active role in fighting epidemics caused by infectious diseases. Additionally, they have extensive training in infection control procedures.^22,23

Most of the participants have taken additional infection control measures at home. In several countries, dentists have expressed concern about the health of their families. In Turkey, more than 90% of dentists who participated in a large COVID-19 survey were concerned about themselves and their families.¹⁹ In addition, a sample of Spanish-speaking dentists, most of whom practiced in Mexico, reported that their families were concerned about them becoming infected at work.⁹

In the present study, approximately three quarters of the women dentists surveyed felt that COVID-19 would increase treatment costs. A study of German health providers showed that income from insurance and out-of-pocket expenses decreased by approximately 20% during the pandemic.²⁴ Also, Iranian dentists considered that their income decreased during the pandemic;²⁵ similarly, 90% of Brazilian dentists surveyed identified a decreased in income associated with the COVID-19. They reported a high level of concern regarding the negative economic impact of the quarantine.²⁶ This suggests that COVID-19 had drastically reduced the financial stability of dental practices, with possibly serious consequences for both providers and patients. It is not surprising that Mexican dentist also experience economic difficulties and no significant financial help was available to mitigate the problem.

There may be several reasons causing dentists to experience financial difficulties, for example, increases in supplies costs, increases in operating costs, continuous payment of fixed expenses; in addition, the reduced demand for dental services may contribute to financial difficulties as well. The pandemic has also resulted in an economic recession and high unemployment rates in many countries, which limit access to dental care.²⁷ Bastani et al,⁷ based on a systematic review, found four main areas of concern for dentists: ethical, social, professional and economic.

Several strategies have been adopted to address dentist concerns during COVID-19, including improving information regarding patient management and infection control practices, as well as utilizing the latest technologies to increase the knowledge of COVID-19 and virtual clinics addressing dental problems of patients.⁷ Some of these strategies may have been used by the women dentists in this study who were not severely affected by the pandemic. By providing adequate information, dentists could better understand the risks associated with treating patients and take appropriate steps to protect themselves. Additionally, virtual clinics have allowed dentists to provide advice to patients without having to be in close contact with them.

An association was observed between the perception of higher costs and experiencing more emotional impact of the pandemic. Consistently, concerns about the negative impact of the pandemic on income were present among dentists in Italy, more Italian female dentists than men dentists responded affirmatively to the question How worried are you about the consequence of income loss for you and/or your family because of lockdown?²⁸

Women carried a double burden, Biroli et al,²⁹ analyzed data from UK, Italy and US, households and it was found that men’s collaboration inside the household was low, and it was associated with increased stress in the couple relationships. This discrepancy in workload caused tension in relationships and put a strain on women’s mental health. Moreover, a study performed in Spain identified that women were more likely to lose their jobs than men during the pandemic, most of the burden in the household felt on the women; however, men have increased their participation at home and in taking care of children during the pandemic. Therefore, policies that favor men working at home may have a positive impact on reducing the gender gap.^30,31

Among the limitations of the study is that the sample was taken from dentists attending a dental conference in the year before the pandemic, so its representability is limited. However, we obtained a good response rate, suggesting adequate internal validity. Also, we collected information from dentists with different specialists and a variety of ages. The survey had a small number of questions and did not allow an in-depth exploration of the psychological response to COVID-19; nevertheless, longer surveys may result in a lower number of participants answering the questionnaire. Further studies are required regarding the long-term emotional effects of the COVID-19 among women in healthcare services. This could give insight into the most effective ways to improve the government and community’s response to pandemics.