Minimal Intervention Dentistry (MID) mainstream or unconventional option? Study exploring the impact of COVID-19 on paediatric dentists' views and practices of MID for managing carious primary teeth in children across the United Kingdom and European Union.

PURPOSE: To explore the techniques used to manage carious primary teeth during the COVID-19 pandemic by paediatric dentists and dentists with a special interest in paediatric dentistry (DwSI) who are members of the British Society of Paediatric Dentistry (BSPD) and the European Academy of Paediatric Dentistry (EAPD), and their views on the use of minimal intervention dentistry (MID) in children prior to, during and post the COVID era. METHODS: A total of 212 paediatric dentists and DwSI completed an online questionnaire. Six MID techniques were explored: fissure sealants, resin infiltration, Hall Technique (HT), 38% silver diamine fluoride (SDF), atraumatic restorative treatment (ART), stepwise removal and selective caries removal. RESULTS: The majority were specialists (26%) followed by clinical academics (23.1%) working mainly in university teaching hospitals (46.2%). Routine dental treatment for children with carious primary teeth was provided by the majority (92.5%) during the pandemic. HT (96%) and 38% SDF (65.7%) were the most commonly used techniques among the BSPD members whereas conventional restoration of non-selective caries removal and pulp therapy remained the most widely used technique among the EAPD members (66.2%). Most of the MID techniques were used as a treatment option (48.1%) rather than a choice (43.4%), with most of these choices having been affected by the patient's behaviour (82.5%). More than one thirds (39.2%) of the participants were reluctant to adopt MID after the pandemic. Several barriers such as lack of teaching and confidence as well as perceived lack of evidence were identified. CONCLUSION: A range of MID techniques is practiced broadly by a sample of paediatric dentists and DwSI across the United Kingdom (U.K) and European Union (E.U). The majority of clinicians are willing to continue using these techniques going forward after COVID restrictions are lifted. The pandemic served as an opportunity for many dentists to become familiar with various MID practices, such as SDF, which has been already established some time ago.

A systematic review of randomized controlled trials on survival rate of atraumatic restorative treatment compared with conventional treatment on primary dentition.

Background: In this COVID era, it's critical to promote nonaerosol procedures. Atraumatic restorative treatment (ART) is one of them, and it's particularly effective in children for lowering anxiety, enhancing dental health, and giving restorative care. Aim: The aim of this study was to assess the survival rate of ART compared with conventional treatment procedures in primary dentition. Materials and Methods: The review was done in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis statement and is been registered in PROSPERO (CRD42021213729). The studies included comprised clinical investigations with randomized controlled trials (RCTs) which compared the survival rate of ART and conventional restorative treatments using the same or different restorative materials to treat carious lesion. RCTs in which ART was compared with conventional treatment on patients in the age group of 6-10 years with minimum follow-up of 6 months. Studies available as open access and free full text in PubMed, DOAJ, and Google Scholar databases, and published in English Language only were included in the study. Cochrane's collaboration tool for RCTs was used for the assessment of risk of bias. Results: The survival rate of single surface and multiple surface in primary dentition treated according to the ART compared with conventional treatment was found to be similar. Conclusion: The ART approach is equally helpful in managing dental caries in children and this method may be considered a useful intervention in clinical practice to enhance the dental health of children.

COVID-19 and Paediatric Dentistry after the lockdown.

Coronaviruses are a large family of respiratory RNA viruses that can cause severe infections of the airways, as we have seen in the past, difficult months. We know that the route of transmission of the disease is through saliva droplets produced by speaking, coughing and sneezing. The virus is highly infectious, and each infected individual infects 2.5 people on average. The average incubation period is about 5 days, with an estimated range from 2 to 14 days; the incubation period in children is similar, however some have exhibited a longer incubation. The virus binds to the cellular receptor ACE2, which in children has a structural and functional immaturity thus offering lower affinity to the pathogen; this could explain the lower incidence of infection from SARS-CoV-2 in this segment of the population.The common clinical observation is that COVID-19 is less severe in children, and in this group the disease is often asymptomatic. Pending further clinical studies able to clarify the infection and transmission dynamics, it is therefore important to apply also in children all preventive and hygiene measures recommended by the health authorities during dental treatment. We should avoid procedures that generate aerosols as much as possible, minimising the use of the air syringe. When possible, it is recommended to employ minimally invasive procedures and ART (Atraumatic Restorative Treatment). The latter is a technique that can also be employed in very young and uncooperative patients with widespread carious lesions, in order to avoid more invasive and complex procedures. Ozone therapy could be of great help in the control of the progression of the asymptomatic carious lesions, especially during the Phase 2 of reopening, when we should to minimise the use of rotating instruments producing aerosols. The above introduces a new concept of "no aerosol" that will possibly guide our therapeutic choices not only in the immediate future but also in the long term, opening scenarios of prevention and cure that are more efficient, safe, and sustainable. During procedures that generate aerosols, the use of proper PPE is crucial to minimise the risk of transmission. It is also strongly recommended to work with an assistant, and to use double suction and a rubber dam. We will have to rethink and review the schedule of daily activities, in terms of timing and mode of delivery of care, on the basis of an agenda which can be divided into "no aerosol" and "aerosol" procedures, and "virtual visits" (including management of true emergencies), creating a virtuous optimisation of care for the safety of operators and office staff, as discussed in an article published on this very EJPD issue. In the coming months we will perhaps deliver more "patient-oriented" than "tooth-oriented" treatments, and this is true not only for young patients!