Post-COVID oral health care for children

Jatinder Ubhi shares eight strategies for the whole team to implement to help deliver care to younger patients safely and effectively.

Pre-COVID-19, the statistics on children’s oral health were alarmingly poor.

Public Health England (PHE) reveals inequalities in the prevalence of tooth decay in five-year-old children in England spiked from 2008 to 2019. Meanwhile, NHS figures show that dentists saw only 29.8% of children under 16 in England last year. This is down more than 60% in 2019.

The Wrigley Oral Healthcare Programme conducted a more recent survey (2021). It showed that 65% of dentists said they expected normal service to resume within six months to a year.

The British Dental Association warns it may take years to repair the damage the pandemic has caused. Also, while the profession locks horns with the government over an NHS contract some argue is no longer fit for purpose, those responsible for the nation’s oral health need to consider how to deliver care to younger patients safely and effectively.

As well we know, children come with unique challenges – in terms of clinical time, decision-making, concentration and communication. As such, this can be stressful for all involved.

Litigation

Sadly, with a backlog of treatments to attend to, there comes a higher risk of litigation. Teams struggle to play catch-up and meet expectations.

This means clinicians need to monitor, communicate, educate, ensure informed consent and record efficiently and effectively in order to prevent complaints.

Any oral health instruction needs to be communicated to both parent/carer and child, and clinicians need to be confident that all parties have understood the rationale behind each clinical decision, as well as the health risks if advice is not followed. If this is not documented comprehensively and contemporaneously, teams run the risk of compromised complaint handling and escalation to the regulator.

One of the measures suggested to overcome barriers to NHS care listed in the PHE report, Inequalities in oral health in England, was the use of appropriate skill mix to deliver services.

With talks regarding changes in the NHS commissioning of dental services, a flexible approach may work well. It is often the teams who promote prevention and behaviour change (rather than focus primarily on units of activity) that are the most successful.

See them early

Incorporate the British Society of Paediatric Dentistry’s Dental Check by One into your practice.

Even if clinicians do not get an opportunity to look inside the mouth, offer advice to parents. Discuss appropriate toothpastes, sugar frequency and diet. Talk about caries, and check the child’s toothbrush.

Tell, show, do

This approach is a basic principle of good instruction. Apply a disclosing agent to patients’ teeth to visually show them plaque. Then, use the Oral-B Test Drive to teach how to use an electric brush effectively.

Direct parents (and older children) to online resources, such as the Oral Health Foundation and Oral-B websites.

Tailor advice

Children are interesting from a dentolegal perspective, as complaints and subsequent cases do arise from parents. It is therefore important to ensure successful communication and deliver clear age-related instructions.

Not all parents understand the need to look after deciduous teeth properly. So offer education and support – from conversations to social media to the displays you have in practice.

From the point of view of caries prevention – and to ensure lifelong good habits – we need to be mindful of what we are saying. These are not ‘just baby teeth’, so consider the language used by everyone in the practice – from reception staff to those in clinic.

For older children, engage by getting to know the patient. For those interested in technology, talk about this in terms of the ‘gadgets’ you are recommending, such as Oral-B electric toothbrushes and the related apps. Talk to them in terms of key events that may be coming up – the relaxing of restrictions will mark a key change in social mixing – and suggest that improving their oral health will help achieve that ‘perfect picture’ smile.

Spend time getting to know them. One way to collect this information can be via a simple questionnaire filled in before they come in to see you or completed with a dental nurse. For many young patients, it gives them a sense of responsibility and ownership of their care.

Record taking

We must always write down the reasons for what we are doing – or not doing. Standard practices, such as record keeping, can prove challenging when the pressure is on to hit UDA targets. Let’s not forget the fact that we need to record everything, including fallow time and the steps we are taking to mitigate risks.

Have you used an FFP3 mask/used rubber dam? Based on your practice SOP, are you meeting the requirements and documenting everything? Note down any provisional diagnosis or impression. What are the options for care based upon? Ensure there is clarity.

Social and medical history

Parents can be defensive when it comes to discussing their children’s teeth. Don’t skip over that extra few minutes to find more about the social history – and where the sugar is coming from. Do we need to dig a little bit more to ascertain habits and sugar frequency? Sometimes it may take further questioning if parents are in denial.

It may be the grandparent who looks after the child who is responsible for those sweet treats, or that ‘no added sugar’ fruit drink that the child is having daily.

Behaviour change

To achieve better habits, our messaging needs to be consistent. Consider the ‘seven touches’ – a basic marketing principle that suggests it takes seven times for a message to be relayed before a person buys into it.

So, use:

Social media and website
Signage in the practice
The reception desk team
Reminder letters, texts and emails
Dental nurses
Dental hygienist/therapists
Dentists.

Ensure you are all giving the same consistent message.

Make it fun

PPE has had a huge impact on how we communicate with patients. For children, this can be a barrier. Overcome this by talking about what the team is wearing in a fun way. Pre-empt the fear factor by sharing photos on social media – have a ‘meet the team Monday’ post and introduce yourselves.

Display photos of staff in the reception area, or in reminder letters or use social media platforms such as Instagram or Tiktok and post a ‘before and after’ PPE video.

Make time for children

Consider holding an open day for an oral health education session or an afternoon clinic of fluoride application. Set aside the time to address common issues in an online FAQ session.

Conclusion

As generations move on, we need to adapt the way we treat patients, and part of this process involves a more holistic approach to managing expectations, avoiding complaints and mitigating litigation.

Every patient is the concern of every member of the team. As a profession, we need to look at the competencies of the whole team, upskilling each member and utilising skill mix to help the team deliver great dental care and achieve future job satisfaction.

A collective approach can have an incredibly powerful impact on the long-term health of our patients and staff morale. This pandemic has certainly provided food for thought for the future delivery of dentistry.

Children’s oral health post-COVID