Comparison of the number of carious lesions in children before and after confinement linked to the COVID-19 crisis: a retrospective study.

Introduction: dental caries is an infectious pathology that is very often found during childhood. It has a multifactorial origin. This study aims to determine the incidence of carious lesions following the first confinement linked to the Covid-19 crisis. Material(s) and Method(s): retrospective study based on dental records of children from 0 to 18 years old from Cesar de Paepe site of the CHU Saint-Pierre, Belgium. First, data from patients who came for a consultation in pediatric dentistry between June and July 2019 and 2020 were collected. Then, these patients were classified into 3 distinct categories: patients who came for a check-up, during treatment or for a first visit to the pediatric dental consultation. Result(s): 1,631 patients were selected for the 2019 period compared to only 914 for 2020, i.e. a 44% drop in attendance. The very highly significant differences concerned the distribution in the categories and the presence of new caries between the two years. Discussion(s): The change in daily life caused by confinement might explain the appearance of new carious lesions. Conclusion(s): Our results confirm a highly significant increase in carious lesions following confinement.Copyright © 2022 Association des Medecins anciens etudiats de l'Universite libre de Bruxelles (A.M.U.B.). All rights reserved.

Evaluation of Internet users' interest in paediatric dental problems during the COVID-19 pandemic.

BACKGROUND: The coronavirus (COVID-19) pandemic had a significant impact on dental care providers; patients had trouble accessing routine dental care due to concerns about dentist and patient safety. People spent more time at home due to lockdown restrictions and a growth in individuals working from home. This increased the likelihood of looking for dental care information on the Internet. In the present study the aim was to compare the trends of Internet searches about paediatric dentistry before and after the pandemic. METHODS: The monthly variation in relative search volume (RSV) and the lists of paediatric dentistry-related queries were determined from December 2016 to December 2021 using Google Trends. Two separate datasets were obtained before and after the pandemic. One-way ANOVA was used to determine whether there was a significant difference in RSV scores between the first 2 years of COVID-19 and the first 3 years before COVID-19. T-tests were used for bivariate comparisons. RESULTS: There was a statistically significant increase in queries regarding dental emergencies, especially toothache (p < 0.01) and dental trauma (p < 0.05). The RSV of paediatric dentistry queries increased over time (p < 0.05). Other queries about recommended dental procedures during the pandemic, such as the Hall technique and stainless steel crowns, showed an increasing trend. However, these were not statistically significant (p > 0.05). CONCLUSIONS: More searches were carried out, related to dental emergencies, on the Internet during the pandemic. Moreover, non-aerosol generating procedures such as the Hall technique became increasingly popular according to the frequency of searches carried out.

Safety protocols at the American Board of Pediatric Dentistry Oral Clinical Examination during COVID-19.

BACKGROUND: There are continued concerns about holding large group gatherings with the ongoing COVID-19 pandemic. The American Board of Pediatric Dentistry (ABPD) made the decision to cancel the Oral Clinical Examination (OCE) in 2020 with a goal to host the exam in 2021. This cancellation postponed the board certification of over 400 pediatric dentists. There is limited published data on safety protocols for in-person examinations. AIM: To determine if safety protocols utilized in the administration of the 2021 ABPD Oral Clinical Examination (OCE) were reassuring to candidates and examiners, and effective at addressing prevention of COVID-19 infection. DESIGN: An electronic survey was emailed to candidates and examiners following completion of the board examination process. The candidate survey had 784 and the examiner survey had 108 eligible participants. Eight questions overlapped between the two surveys. Descriptive statistics were utilized. p-values < 0.05 were considered significant. RESULTS: Three hundred ninety-four candidates (response rate = 50.3%) and 97 examiners (response rate = 89.8%) completed their respective surveys. The majority of candidates (86.8%) and examiners (94.8%) felt safe participating the OCE, and found COVID-19 protocols reassuring, 69.3% and 89.7%. CONCLUSIONS: Participants agreed that safety protocols enacted by the ABPD kept everyone safe and led to a successful and safely conducted high-stakes oral clinical examination during the COVID-19 pandemic.

The Greater Manchester Child Friendly Dental Practice Scheme: Using a Transformational Commissioning Approach to Align Paediatric Dental Service Provision with Childhood Oral Health Needs in Greater Manchester.

In response to the impact of the COVID-19 pandemic on access to already oversubscribed specialist paediatric dental services, a pilot of an enhanced primary care paediatric dental pathway, known as the Child Friendly Dental Practice (CFDP) scheme, was commissioned by the Greater Manchester Health and Social Care Partnership. Supported by a transformational commissioning approach, the ambition of the CFDP pilot was to manage or stabilise the oral health of high-need paediatric patients who had been referred to specialist dental services within Community or Hospital Dental Service settings, through timely access to primary care clinicians who were confident and experienced in treating children. The theory of change of the CFDP pilot proposed that rapid access to enhanced primary dental care would reduce the need for onward referral to specialist paediatric dental services, whilst also stabilising the oral health of children who require more complex management in specialist services. A formative evaluation of the phase one pilot implementation of the CFDP Scheme has demonstrated the potential of the CFDP Scheme to improve access to dental services for paediatric patients referred from their General Dental Practitioner. Comparison of waiting times between the CFDP pathway and the standard paediatric dental referral pathway have revealed substantially reduced waiting times to access care along the CFDP pathway, while less than 30% of those who attended CFDPs required onward referral to specialist paediatric dental services. Encouragingly, similar attendance and treatment completion rates were noted among patients from all levels of socio-economic deprivation, reducing concerns regarding the potential for service-based interventions to increase oral health inequalities. Following successful completion of the phase one pilot implementation and evaluation, the CFDP Scheme has now been rolled out across all localities in Greater Manchester as part of a second phase pilot implementation. Public Health Competencies; Equitable healthcare provision, Partnership working, Evidence-based public health, Systems thinking, Transformational commissioning, Healthcare evaluation.

Hybrid versus distance learning environment for a paediatric dentistry course and its influence on students' satisfaction: a cross-sectional study.

BACKGROUND: During the novel COVID-19 pandemic, many universities adopted distance and hybrid learning as a modification to their teaching methods to ensure continuity of education, abiding by the worldwide recommendations of social distancing. AIM: To compare learning environments created through hybrid learning versus distance learning, to deliver paediatric dentistry course, and to assess the correlation between the created learning environment and students' satisfaction. METHOD: In this cross-sectional study, students enrolled in a hybrid paediatric dentistry course were asked to participate in an electronic survey. The learning environment was assessed using Distance Educational Learning Environment Survey (DELES), students' satisfaction was assessed using Satisfaction Scale (SS). Retrospective data for distance learning course was used for comparison. Ordinal data were compared using Mann-Whitney U test. Spearman's rank order correlation coefficient was used to correlate students' satisfaction with DELES. Multiple regression analysis was used to predict satisfaction. RESULTS: A total of 376 students' data were considered in the study. Hybrid learning had significantly higher scores than distance learning in 3 DELES scales. There was a statistically significant weak positive correlation between satisfaction and DELES. Multiple regression analysis model was statistically significant and accounted for (22.8%) of the variance in students' satisfaction. Only "Instructor support" (p = 0.001) and "Student autonomy" (p < 0.001) had a significant effect on satisfaction. CONCLUSION: This study supports the superiority of a hybrid learning environment over a complete distance learning environment, it also shows that satisfaction is correlated and can be predicted by the created learning environment. TRIAL REGISTRATION: This study has been registered on clinicaltrials.gov on 21 May 2020 with an identifier: NCT04401371 .

Teledentistry and its applications in paediatric dentistry: A literature review.

BACKGROUND: During the unfortunate event of the COVID-19 pandemic, restrictions were placed on face-to-face interactions in dentistry to promote social distancing and reduce spread of virus. In order to provide dental services teledentistry was employed. OBJECTIVE: This article aims to review the literature and information available on the provision and utilization of teledentistry as a method to address oral health needs of paediatric patients. RESULTS: Teledentistry has been utilised in paediatric population for the purpose of oral health education and promotion, remote diagnosis and monitoring, and behaviour guidance. Studies involving paediatric population for aforementioned applications have shown that this practice strategy is beneficial to provide dental treatment in remote locations with little access to paediatric dental specialists, monitor patients between appointments, conduct remote diagnosis and screening programmes, promote oral health of children through dental education, and in pre-appointment behaviour guidance. This method was particularly useful during the current COVID-19 pandemic where dentists use their mobile phones, computer webcams for patient appointments while maintaining safe distance and avoid exposing themselves as well as patient to the virus. CONCLUSION: Teledentistry can be a supplement to face-to-face methods of paediatric dental care, ultimately leading to better patient management. This technology can make a significant contribution in reducing the supply-demand gap of paediatric dental specialists in places where healthcare facilities are limited and ensure safety during the pandemic whilst providing dental care to paediatric patients. Further research is required for safe, effective and evidence-based use of teledentistry in the field of paediatric dentistry.

Education Technology in Orthodontics and Paediatric Dentistry during the COVID-19 Pandemic: A Systematic Review.

Over the last decade, medical education changed from traditional teaching methods to telematic and networking scholar and e-learning approach. The objective of the present systematic review was to evaluate the effectiveness and teachers/student's acceptability of e-learning applied to the field of orthodontics and paediatric dentistry. A database search of the literature was conducted on PubMed and Embase databases from January 2005 to May 2021. A total of 172 articles were identified by the electronic search, while a total of 32 papers were selected for qualitative analysis. Overall, 19 articles investigated the effectiveness of e-learning, and no difference of acceptability was reported between e-learning and traditional methods for a wide part of the articles selected. A total of 25 papers provided a satisfaction questionnaire for learners and all were positive in their attitude towards e-learning. The results showed that e-learning is an effective method of instruction, complementing the traditional teaching methods, and learners had a positive attitude and perception. The evidence of the present study reported a high level of acceptability and knowledge level of e-learning techniques, compared to frontal lecture methods, in the fields of orthodontics and paediatric dentistry.

Stainless-steel crowns in children: Norwegian and Finnish dentists' knowledge, practice and challenges.

BACKGROUND: Stainless-steel crowns (SSCs) are recommended for restorative treatment of young teeth severely affected by caries, fractures or dental developmental disorders (DDDs). However, despite recommendations and clinical evidence, SSCs are not widely used by general dentists, who favour extraction and more conventional restorations. The present study aimed to investigate the views of and use of SSCs among Norwegian and Finnish dentists. METHODS: The present study was a cross-sectional survey among Norwegian and Finnish dentists. An electronic questionnaire was sent to Norwegian and Finnish dentists asking whether they used SSCs and on which indications. In addition, the questionnaire assessed reasons for non-use and dentists' perceptions regarding advantages and challenges in the use of SSCs, as well as the need for additional training. Distributions of background characteristics, use of and views on SSCs were calculated, and statistical significance of the associations between respondents' background and their answers were evaluated. RESULTS: Of the 574 Norwegian and 765 Finnish respondents, only 12.0% and 12.9% reported to use SSCs, respectively. The most frequently reported barrier reported by those who did not use SSCs was lack of practical training. The most frequent challenge reported by those using SSCs was difficulties in crown adjustment followed by aesthetic issues, and the most frequently reported advantage was that SSCs maintain the function and occlusion. The majority of respondents reported a need for more information and practical training in the use of SSCs, with hands-on course as their most frequently preferred education type. CONCLUSION: Although the value of SSCs for restoring young molars is recognized by Norwegian and Finnish dentists, SSCs are rarely used by general dentists. The majority of the respondents reported lack of training and materials and was interested in receiving more information and education.

Influence of COVID-19 pandemic on paediatric dental attendance.

OBJECTIVES: This retrospective study aimed to evaluate the effect of COVID-19 pandemic on dental attendance and emergency/non-emergency visits of children during the outbreak, compared to the same period of 2019. MATERIALS AND METHODS: Patients who visited the paediatric department clinic during the observed period were included in this study. The patient's demographic data, purpose of visit, and treatment type were evaluated retrospectively from patient examination records. The Pearson chi-square and t-tests were used for comprehensive statistical analysis. RESULTS: A total of 1454 patient files (1184/270 cases from non-pandemic/pandemic period) were assessed. A significant reduction was found in aggregated emergency/non-emergency visits during the pandemic period (p < 0.01). During the pandemic, average daily visits for emergency dental care were observed to have a decrease to half of the non-pandemic period. Non-emergency routine dental visits have also exhibited a drastic decline. Severe dental pain due to pulpal inflammation and abscess/swelling were the most frequently reported urgent dental complaints that patients applied to the paediatric dental clinic during the pandemic period. CONCLUSION: COVID-19 pandemic has a significant influence on patients' attendance to paediatric dental clinic. Therefore, concerning a potential post-pandemic increase in treatment demand, meticulous future planning and proper regulation of dental care should be provided for better oral health and children's quality of life. CLINICAL RELEVANCE: This study's importance is the observation of dramatically reduced number of patient visits during the pandemic period which may yield increased number of oral health-related complications in the long run.

Paediatric dental pain and infection during the COVID period.

BACKGROUND: During the coronavirus pandemic, paediatric patients will still likely present with dental pain and infection. In order to streamline care at King's College Hospital (KCH), Paediatric Dentistry and Oral and Maxillofacial Surgery (OMFS) have developed a collaborative working approach allowing patients to be treated effectively and to streamline patient care in the absence of easy access to general anaesthetic facilities. METHOD: Presenting complaints, treatment need and the treatment received were recorded for all paediatric patients presenting with dental pain and infection in the "lockdown" period (23rd March- 14th June) during "normal" working hours and "out of hours" to either paediatric dentistry or OMFS. RESULTS: 420 calls were triaged which converted to 67 patients seen face-to-face for oro-facial pain and infection. 41% of children were treated successfully under Local anaesthetic alone, only 13% required a general anaesthetic (GA) in the "lockdown" period. The vast majority of patients had antibiotics prescribed prior to attendance (80%). CONCLUSION: We have demonstrated the demographic, presenting complaints and treatment need of patients who presented to KCH during the lockdown period with dental pain and infection. The majority were able to be treated without needing for GA facilities. This paper highlights how a collaborative approach between paediatric dentistry and OMFS can help streamline patient care and is a model which can be adopted by other units in the event of further "lockdowns".

Paediatric Oral Health during and after the COVID-19 Pandemic.

BACKGROUND: During the period of health emergency linked to the current COVID-19 pandemic, the paediatric dentists' management of oral health problems in children must have as primary objective the control of the spread of the disease according to specific protocols aimed at minimizing the risk of viral transmission. AIM: This paper examines the possible clinical conditions that may require intervention by the paediatric dentist, distinguishing clinical situations that fall into the category of paediatric dental emergencies from conditions of oral pathologies that normally do not represent an emergency. The definition of rigorous and highly effective infection control protocols in the dental settings must therefore be complemented by the development and strengthening of remote communication techniques with the parents, who must be adequately educated on preventive and palliative measures for the management of their children's oral health, with the aim of postponing clinical attendance to when the circumstances become favourable. CONCLUSIONS: The experience gained with these approaches and models of treatment, where remote interaction techniques play a central role, will hone the communication skills of the paediatric dentist and will retain its usefulness even at the end of the current emergency period.

Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: A retrospective study.

BACKGROUND: The COVID-19 pandemic posed a great challenge to paediatric dentistry, which confronted with the restriction of service and resource shortage. AIM: To retrospectively analyse the information of children's dental online health consultation during the COVID-19 pandemic in China, and to provide methods to distinguish between dental emergencies and non-emergencies as well as their management. DESIGN: We collected all the online consultation information in Dept. of Paediatric dentistry, School & Hospital of Stomatology, Wuhan University, from 2 February to 31 March 2020, and extracted the information of age, gender, reason for consultation, description of symptom, and preliminary diagnosis of the children. RESULTS: A total of 474 online consultations of paediatric dentistry were included within 59 days during lockdown, and 190 (40.1%) were dental emergencies and 284 (59.9%) non-emergencies. Of 190 emergency consultations, 186 (97.9%) showed swelling, pain, and trauma with or without systemic symptoms. Among 284 non-emergency consultations, retained primary teeth (n = 126) and orthodontic consultation (n = 53) were the most common reasons for consultation. CONCLUSION: The paediatric emergency and non-emergency problems should be clearly distinguished and sufficient instructions provided in the special period of COVID-19. Priorities also should be set to deal with urgent conditions after the release of lockdown.

Assessment of paediatric dental guidelines and caries management alternatives in the post COVID-19 period. A critical review and clinical recommendations.

PURPOSE: The first aim of this paper is to provide dental professionals caring for children and adolescents during and after the COVID-19 pandemic with a reference to international dental guidelines. The second aim is to suggest minimally invasive treatment alternatives for caries management, minimising the risk of viral cross-infection and offering a safer clinical environment. METHODS: An evidence-based pertinent literature search of different electronic databases was performed in addition to leading global dental authorities, royal colleges, and programmes. RESULTS: All guidelines released in response to COVID-19 centred around minimising Aerosol Generating Procedures (AGP) impacting the provision of regular dental treatment of paediatric patients. There was an emphasis on triaging and only treating emergency and urgent cases. Special attention was given to medically compromised children in the guidelines. Detailed guidelines for the dental environment and equipment were given. This paper also summarised the relevant evidence-based guidelines for the use of non-invasive and minimally invasive caries management techniques. CONCLUSION:  Specific recommendations for dental management of paediatric patients during and in the post-COVID-19 era are suggested. Minimisation of AGP procedures, and case-based selection of biological, non-invasive or minimally invasive methods are recommended.

Coronavirus disease (COVID-19): Characteristics in children and considerations for dentists providing their care.

The emergence of the novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease (COVID-19) has led to a global pandemic and one of the most significant challenges to the healthcare profession. Dental practices are focal points for cross-infection, and care must be taken to minimise the risk of infection to, from, or between dental care professionals and patients. The COVID-19 epidemiological and clinical characteristics are still being collated but children's symptoms seem to be milder than those that adults experience. It is unknown whether certain groups, for example children with comorbidities, might be at a higher risk of more severe illness. Emerging data on disease spread in children, affected by COVID-19, have not been presented in detail. The purpose of this article was to report current data on the paediatric population affected with COVID-19 and highlight considerations for dentists providing care for children during this pandemic. All members of the dental team have a professional responsibility to keep themselves informed of current guidance and be vigilant in updating themselves as recommendations are changing so quickly.