key: cord-0761433-mzsswzcr authors: Altan, Ahmet title: Emotional effect of the Covid-19 pandemic on oral surgery procedures: a social media analysis date: 2021-06-01 journal: J Dent Anesth Pain Med DOI: 10.17245/jdapm.2021.21.3.237 sha: 573344e50f686b31f7e14d7e89d04899de26082f doc_id: 761433 cord_uid: mzsswzcr BACKGROUND: This study aimed to analyze Twitter users' emotional tendencies regarding oral surgery procedures before and after the coronavirus disease 2019 (COVID-19) pandemic worldwide. METHODS: Tweets posted in English before and after the COVID-19 pandemic were included in the study. Popular tweets in 2019 were searched using the keywords “tooth removal”, “tooth extraction”, “dental pain”, “wisdom tooth”, “wisdom teeth”, “oral surgery”, “oral surgeon”, and “OMFS”. In 2020, another search was conducted by adding the words “COVID” and “corona” to the abovementioned keywords. Emotions underlying the tweets were analyzed using CrystalFeel - Multidimensional Emotion Analysis. In this analysis, we focused on four emotions: fear, anger, sadness, and joy. RESULTS: A total of 1240 tweets, which were posted before and after the COVID-19 pandemic, were analyzed. There was a statistically significant difference between the emotions' distribution before and after the pandemic (p < 0.001). While the sense of joy decreased after the pandemic, anger and fear increased. There was a statistically significant difference between the emotional valence distributions before and after the pandemic (p < 0.001). While a negative emotion intensity was noted in 52.9% of the messages before the pandemic, it was observed in 74.3% of the messages after the pandemic. A positive emotional intensity was observed in 29.8% of the messages before the pandemic, but was seen in 10.7% of the messages after the pandemic. CONCLUSION: Infectious diseases, such as COVID-19, may lead to mental, emotional, and behavioral changes in people. Unpredictability, uncertainty, disease severity, misinformation, and social isolation may further increase dental anxiety and fear among people. A pandemic is defined as an epidemic that occurs worldwide or over an extensive area, crosses international boundaries, and usually affects many people [1] . Pandemics in different periods throughout human history have led to social, political, and economic disruptions as well as sudden and wide-ranging morbidity and mortality. During epidemics, changes in mental, emotional, and behavioral responses have been noted in society [2] . The novel coronavirus disease 2019 (COVID- 19) , caused by the severe acute respiratory syndrome coronavirus 2, was first detected in Wuhan, China, in December 2019 [3] . This disease, which has now spread worldwide, was declared a pandemic by the World Health Organization (WHO) on March 11, 2020 [4] . After the WHO's outbreak declaration, governments began taking precautions against the disease. Preventive measures affecting the daily routines of the populations were implemented to limit the COVID-19 infection. Significant changes occurred in daily life routines because of school closures, changing working conditions, social activities restriction, and quarantine. As a result of the rapid increase in the number of confirmed cases and deaths, healthcare professionals, as well as the general population, experienced health-related problems and psychological pressure [5] . Oral and maxillofacial surgery was also one of the healthcare fields that had to change their working order. Maxillofacial surgery is an area of vulnerability, especially in an environment where a deadly virus is transmitted through the respiratory tract. Because of the nature of a physician's job, each examination and procedure carries the risk of viral transmission [6] . Therefore, all non-emergency healthcare appointments and procedures were postponed or canceled. Some patients who realized such a risk postponed their treatment themselves. Social media is a platform where people share their thoughts with others on the internet. Social networks include applications that enable individuals to share content and information and express their feelings comfortably. In the past decade, social media has been used to monitor people's emotions and communication patterns during the Ebola and Zika outbreaks [7] . In this study, we assumed that different emotions that have appeared on social media recently and the narratives underlying them are related to the current COVID-19 crisis. According to Plutchik's Wheel of Emotions [8] , fear-anger and sadness-joy are opposite experiences or basic emotion pairs. In this study, we aimed to analyze the results of Twitter users' emotional responses to oral surgery procedures before and after the COVID-19 pandemic. We focused on the following four emotions: fear, anger, sadness, and joy. The tweets posted in English around the world were included in the study. Popular tweets were reached using the keywords "tooth removal," "tooth extraction," "dental pain," "wisdom tooth," "wisdom teeth," "oral surgery," "oral surgeon," and "OMFS" in Twitter's search application between January 1, 2019, and December 31, 2019. These tweets represented the emotions related to oral surgery procedures before the COVID-19 pandemic. Between January 1, 2020, and December 31, 2020, a search was performed by adding the words "COVID" and "corona" to the abovementioned keywords. These popular tweets represented the emotions related to oral surgery procedures after the COVID-19 pandemic. The tweets sent from corporate accounts were not included in the study because they were sent for informative purposes and had no emotional meaning. The tweets, including different keywords, were used once. Furthermore, the tweets containing only emojis, icons, and videos were excluded. In this study, no ethics committee approval was required since public data were used, and the study did not include human subjects. The emotions underlying the tweets were analyzed (Table 2 ). IBM SPSS V23 was used to analyze the data. A Chi-square test was used to compare the parameters before and after the pandemic. Analysis results were presented as frequency (percentage) for categorical data. The level of significance was set at P < 0.05. A total of 1240 tweets, 603 and 637 of which were posted before and after the COVID-19 pandemic, respectively, were analyzed (Table 3 ). There was a statistically significant difference between the distribution of emotions before and after the pandemic (P < 0.001) ( Table 4) . While there was a feeling of joy in 32.7% of the messages before the pandemic, this ratio was 11.1% after the pandemic. While there was a feeling of fear in 35.7% of the messages before the pandemic, this ratio was 51.8% after the pandemic. Furthermore, while 14.9% of the messages had a sense of anger before the pandemic, this ratio was 21.5% after the pandemic. There was a statistically significant difference between the distributions of emotional valence before and after the pandemic (P < 0.001) ( Table 5 ). While a negative emotion intensity was noted in 52.9% of the messages before the pandemic, this ratio was 74.3% after the pandemic. A positive emotional intensity was observed in 29.8% of the messages before the pandemic; however, this ratio was 10.7% after the pandemic. There was a statistically significant difference between the distributions of pre-and post-pandemic thresholds of the intensity (P < 0.001) ( Table 6 ). When the tweets' timing about oral surgery procedures was examined, a homogeneous distribution was observed before the COVID-19 pandemic; however, the tweets were concentrated around March and April 2020 (30.8%) after Social media enables people to convey their attitudes and emotions to a large population easily. Easy access to social networks, such as Twitter, allows researchers to use these tools as data sources on several issues, including attitudes towards health-related issues [9] [10] [11] . In this study, Twitter users' emotional responses to oral surgery procedures were analyzed. Many people have negative associations and emotions about dental treatment because of painful experiences in the past. Through this study, we determined that the COVID-19 pandemic made negative associations and emotions about oral surgery procedures even more negative. Fear and anxiety about visiting the dentist is an important problem for many people. In their study on Twitter, Johnsen et al. [12] reported that more negative words were used in the tweets about dentists than medical doctors and that the words related to pain were used at higher rates. Pain is an unpleasant sensory and emotional experience, and it has different personal effects on different people [13, 14] . Gao et al. [15] reported that aversive dental treatment, indirect learning through parents and peers, and exposure to negative information affected dental anxiety and fear. This study observed that negative emotions, such as fear and anger, were dominant in the tweets posted before the COVID-19 pandemic in 2019. Procedures related to oral surgery, such as "wisdom tooth removal," "tooth extraction," and "dental pain" have negative effects on people. However, it was observed that the pandemic led to increased negative emotions and decreased positive emotions in the tweets about oral surgery procedures. The COVID-19 pandemic is a highly devastating event that has significantly affected daily life in almost every country. COVID-19 can spread rapidly by asymptomatic and symptomatic individuals. The clinicians who interact with more than one patient may serve as vectors for viral transmission between the patients [16] . Because of close physical contact with patients, dentists are at a high risk of contracting infections and transmitting COVID-19 to their patients [17] . The best protection for dentists and their patients is to raise awareness, avoid unnecessary contact with people who may have COVID-19, use appropriate personal protective equipment, and draw attention to personal hygiene behavior, especially handwashing [18] . Because of the high risk of COVID-19 contraction among dentists and their patients, on March 16, 2020, the American Dental Association [19] recommended that dentists should delay elective procedures and only provide emergency dental care. Prevention [18] [20] reported anxiety, insomnia, and depressive symptoms in the participants. Du et al. [24] investigated the effects of COVID-19 on different occupational groups and reported that doctors, nurses, and students were prone to anxiety and other healthcare staff, students, and economics staff were vulnerable to stress. Physicians and healthcare professionals are constantly struggling and putting in all their efforts to control the pandemic and overcome this process while ensuring negligible impact and minimal loss of life. Unfortunately, worldwide, several healthcare professionals lost their lives in this struggle [25, 26] . In this study, when we searched for "oral surgeon" or "oral surgery" on Twitter after the COVID-19 pandemic, we can say that one of the reasons for our feelings of fear and sadness was, unfortunately, our colleagues who died due to COVID-19. 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