How will COVID-19 impact paediatric dentistry?

Claire Stevens and Roksolana Mykhalus, of Happy Kids Dental, have spoken out about children's dentistry in the face of COVID-19As the UK looks to ease itself out of lockdown, the dentistry industry prepares to adjust its practices to the ‘new normal’ following COVID-19.

And paediatric dentistry is no exception, with the pandemic bringing new challenges and pressures when it comes to getting children into the chair.

Dentistry Online has spoken to Claire Stevens CBE who discuss where she sees paediatric dentistry heading and what she is doing in the face of COVID-19.

Claire is spokesperson for the British Society of Paediatric Dentistry (BSPD) and a clinical advisor to Sara Hurley, chief dental officer (CDO) for England.

How to you think COVID-19 will affect paediatric dentistry?

COVID-19 has already had a significant impact on paediatric dentistry. We have seen cancellation of routine operations as hospitals use manpower, equipment, and theatre space to support the nationwide NHS response.

Many of our amazing nurses have been redeployed, working away from the comfort of what is known. Our clinicians too are working in A&E, intensive care, on COVID-19 wards and in the Nightingale Hospitals.

General dental practitioners have felt frustrated at being unable to care for their patients, whilst worrying about their businesses and their teams. It will take time to recover, both physically and mentally, and this must be factored into our recovery planning.

Once we hit the criteria defined by Public Health England to move to our ‘recovery’ phase, we will see a gradual expansion of our dental practice. This has to be managed very carefully.

Too much, too soon would see us putting our patients and the profession at risk. We will undoubtedly reintroduce the lower aerosol generating exposures (AGE) first, such as examinations and extractions, leaving the UDCs to perform the higher risk AGEs with enhanced PPE.

New ways of working will be explored to minimise footfall into our practices and hospitals. Some of our care can be provided remotely – for our vulnerable patients ‘checking in’ is as important as doing a ‘check-up’.

We will also need to think about how we deliver our services – staggering our working hours will allow us to spread patient care throughout the day, minimising numbers of patients in clinic at any time and avoiding rush hour commutes.

AGEs will be minimised for the foreseeable future, favouring evidence-based techniques which are successful and acceptable to patients such as hall crowns, silver diamine fluoride but, where necessary, extractions.

For some children, a stabilisation phase accompanied by enhanced prevention in line with Delivering Better Oral Health may keep a child pain and infection free until the time that higher risk AGEs can be more widely provided.

What challenges will social distancing pose for nervous patients?

There is no doubt that we are going to have to change many things in the way we deliver dental services. Social distancing will need to be maintained in waiting rooms for the foreseeable future. Only one responsible adult will be able to accompany a child or young person, in line with NHS recommendations.

For our anxious patients, we will need to invest in additional time to prepare them for their appointment.  This may take the form of a preparatory video consultation, allowing the dental team to take a history and talk through the proposed procedure and providing an opportunity for the patient to ask questions.

Establishing a rapport prior to attendance will reduce anxiety and minimise time spent in the dental setting.

Wonderful members of the British Society of Paediatric Dentistry have created a range of resources to support children requiring urgent dental care. These include an editable social story and leaflets and are free to access here.

What can practices do to encourage frequent attendance?

Parents may be reluctant to bring their children to practices, especially in the early days of practices reopening.  This is understandable.

We have spent weeks telling them to ‘stay safe, stay home’ so any change to this message requires explanation. In the first few weeks it is likely that practices will provide urgent dental care to their own patients. Many of these parents will be incredibly grateful to see their child relieved of pain.

Once more routine appointments are made available, parents will require reassurance that it is safe to attend. Dental teams should explain the measures that they are taking to provide safe oral healthcare – sharing this information via social media and on their practice websites.

The needs of shielded patients must not be overlooked.  For the time being these children should not be near a hospital or practice setting unless urgent dental care is indicated.

Dentists say the pandemic could have a detrimental effect on children's oral health
How have you started to plan for the return to routine dentistry?

I have been tasked with leading the recovery plan for paediatric dentistry with my consultant colleague, Oosh Devalia, who leads the Mini Mouth Care Matters (MiniMCM) campaign.

This is both a huge responsibility but also a great opportunity. What we do know is that this is not ‘getting back to normal’. Things might not look ‘normal’ for some time – maybe as long as two to three years, depending on the speed of developing a safe vaccine. We have tasked expert groups with supporting this work. For example, there is a rapid review looking at the guidelines followed internationally.

It is important that we do not reinvent the wheel, but also recognise that some countries have had a significantly different level of disease experience. This is reflected in their national recommendations.  We have also asked SDCEP, a recognised authority in this field, to review their guideline on the management of dental caries in children.

What impact could COVID-19 have on children’s oral health as a whole?

If we get this wrong, the impact on children’s oral health could be catastrophic. Already long waiting times for operations could spiral out of control and a stretched workforce would face inevitable burnout.

But what if opportunity should emerge from this disaster? An opportunity to create an oral healthcare system that works and is accessible to all. A system that supports the most vulnerable, a system that is prevention focused and a system which works not just for children but for practitioners too?

I genuinely believe we have this opportunity. The existing dental contract does not work for children.  A move to a capitation system for children would allow our hardworking GDPs to provide preventively focused, evidence-based oral healthcare. They would once again become the care co-ordinators for our children, ensuring that every child fulfilled their right to have a smile for life.

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