COVID-19: implications for paediatric dental care in the hospital setting.

Abstract

Optimal oral health is essential to ensure health and well-being, especially for children with underlying medical conditions. However, among the many impacts of the COVID-19 pandemic, there are concerns that restrictions on dental services may lead to a major oral health crisis in children.1 Our study of COVID-19-related impacts on service provision in a tertiary Australian children's hospital highlights the importance of integrated dental services to ensure ongoing essential dental care in children with complex medical conditions. From January to May, 2408 patients were reported in the department of dentistry in 2020, which was 40.2% less than in 2019. The reduction in attendance for routine dental care was substantial, with 35.1%, 90.9% and 90.6% fewer patients in March, April and May, respectively. Among specific services, preventive treatments, such as periodic dental examinations and fluoride applications, reduced by 90% (Fig. 1). Similarly, routine dental services provided under cleft and craniofacial schemes, including orthodontic care and paediatric dental reviews, were reduced by at least 90% in April and May (Fig. 1). Although the number of non-emergency treatments were reduced, the availability of an onsite, internal, specialist service enabled ongoing access to comprehensive care for priority patients including prior to oncology treatment, transplant surgery and cardiac surgery; urgent care for those children in pain with complex cardiac, endocrine, haematological, metabolic conditions; or urgent care for existing patients experiencing uncontrolled pain. This critical care was unavailable through community dental services and therefore highlights the integral role of paediatric dental care in tertiary settings. However, our study also demonstrates the major effect of COVID-19 on dental care for children. Lack of timely dental care, including preventative measures, is likely to lead to more severe oral disease; complex treatment options, such as extractions and hospitalisation; and poor health outcomes, including pain and infection. Even prior to COVID-19, dental problems were the leading cause of preventable childhood hospitalisation of children under 10 years in Victoria, with over 3000 hospitalisations per year.2 In tertiary settings, paediatric dentists work within multidisciplinary teams and often take on a coordinating role for patients with craniofacial conditions, and the lack of such support may exacerbate distress and anxiety in families. Despite the major disruptions, COVID-19 has provided health-care systems the opportunity to review procedures and develop innovative approaches, such as tele-dentistry, to deliver high-quality, efficient care.3 Paediatric dentistry remains an essential service in tertiary level care, especially in the COVID-19 era. The authors would like to thank Ms Catherine Quartermain for her assistance with collating data used in this publication.