Could COVID-19 change the way we manage caries in primary teeth? Current implications on Paediatric Dentistry

Silver Diamine Fluoride in Pediatric Dentistry: Effectiveness in Preventing and Arresting Dental Caries-A Systematic Review

BACKGROUND

Tooth decay is considered a global scourge by the World Health Organization (WHO) starting at an early age. In recent years, silver diamine fluoride (SDF) has regained interest, particularly in pediatric dentistry, used to prevent the development of carious lesions or arrest their progression.

OBJECTIVE

The aim of this study was to assess, through a systematic review of the literature, the effectiveness of SDF, used in pedodontics, in temporary teeth, in preventing or arresting dental caries.

MATERIAL AND METHODS

An electronic search was conducted on PubMed, Web of Science and Scopus. The effect of SDF on both temporary and permanent teeth has been considered.

RESULTS

The inclusion criteria identified 16 randomized controlled trials involving patients aged 18 months to 13 years and followed over a period of 12-30 months.

CONCLUSIONS

SDF is a practical, accessible and effective non-invasive way to prevent and arrest caries in temporary and permanent teeth. Its application requires regular monitoring. The resulting black spot is diminished by immediate application of potassium iodide but this may affect its effectiveness.

Brazilian dentist's knowledge of minimum intervention dentistry for caries management: application of a developed knowledge scale (MIDDeC-KS) and evaluation of its psychometric properties

AIM

To assess the knowledge of Brazilian dentists about Minimum Intervention (MI) using a Minimum Intervention Dentistry to Dental Caries-Knowledge Scale (MIDDeC-KS) and evaluate its psychometric properties.

MATERIALS AND METHODS

An online scale was developed to evaluate dentists' knowledge about MI. The higher the score, the greater the knowledge and vice versa. A preliminary study was carried out with 143 dentists to validate the MIDDeC-KS. For psychometric properties analysis, convergent and discriminant validity, test-retest reliability, and internal consistency of the instrument were assessed. After validation, MIDDeC-KS was applied to a representative sample of Brazilian dentists. T test for independent samples, Chi-square, and/or ANOVA one-way tests were applied.

RESULTS

The MIDDeC-KS convergent (Spearman's = 0.48) and discriminant (P = 0.001) validity and reliability (ICC = 0.85, α = 0.72 and ω = 0.74) were proved. The participants (n = 637) obtained an overall mean score of 7.4 ± 2.5. The sample was mainly composed of females (P < 0.01), who graduated over 10 years prior (P = 0.02), from public colleges (P < 0.01), and most were pediatric dentists (38.2%). The highest and lowest scores were reached by pediatric dentists (9.2 ± 1.6) and bucomaxillofacial professionals (3.1 ± 2.1), respectively. Brazilian dentists demonstrated more knowledge about diet, biofilm, and topical fluoride control (84.3%), while the Hall technique (31.9%), resin infiltrant (47.6%), and chemical mechanical caries removal (48.4%) were the least known MI techniques.

CONCLUSION

Brazilian dentists demonstrated more knowledge about preventive measures and less about more recent protocols, such as the Hall technique, resin infiltrant, and chemical mechanical caries tissue removal. Sufficient psychometric evidence of the MIDDeC-KS was found.

CLINICAL RELEVANCE

Identify dentist's knowledge about MI.

COVID-19 prevalence and infection control practices among dentists in Andhra Pradesh State, India

BACKGROUND

The coronavirus 2019 (COVID-19) pandemic posed a new challenge not only to public health but also to the health care systems and dentists are one of the highly vulnerable health care professionals for COVID-19 infection.

OBJECTIVE

To assess the COVID-19 prevalence, associated factors, and infection control practices among dentists in Andhra Pradesh State, IndiaMETHODS:A cross-sectional web-based questionnaire survey was conducted among dentists in Andhra Pradesh state, India. 21-item pretested questionnaire was used for data collection between January 30, 2021 and February 21, 2021. 3700 dentists from the Andhra Pradesh state were selected from the Dentists Register of India through systematic random sampling method.

RESULTS

Out of 3700 dentists invited to participate in this study, responses from 1876 dentists were received with response rate of 51%. Prevalence of 8 among the study population was 9%. Patients were the primary source of infection for 60.5% of the COVID-19 positive study participants. 65.8% of total respondents using full face shield and two-third of them using N-95 or equivalent mask while providing dental care.

CONCLUSION

This study found a high prevalence rate of COVID 19 among the dentists. Among the associated factors, being into active practice during the pandemic was found to be statistically significant. This study recommend for additional infection control protocols specific to the COVID-19 pandemic.

COVID-19 Related Information on Pediatric Dental Care including the Use of Teledentistry: A Narrative Review

In addition to the direct impact of the SARS-CoV-2 infection, the COVID-19 pandemic reports multiple effects on people's health and psycho-physical well-being. In the dental field, oral hygiene sessions, regular dental check-ups, and aerosol-generating procedures were commonly postponed, thus resulting in repercussions on oral health also favored by the changing eating and oral hygiene habits during the multiple lockdowns. Furthermore, dental settings and practices were generally perceived as at high risk for SARS-CoV-2 transmission, thus unsafe, and by general and pediatric dentists themselves. Last, the consequences of stress related to deprivation of social life and playful activities should not be underestimated in children, exposing them to the deleterious effects of bad oral habits, with repercussions on the balanced growth and development of the stomatognathic system. The present work intends to analyze the medium-term and long-term impact of COVID-19 on pediatric oral and dental care provision, reviewing pediatric dentistry practice and oral and dental needs of pedodontics patients during the first peak and the various waves of the COVID-19 pandemic, and lessons learned.

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.

Possible Relationship Between the Oral and Gut Microbiome, Caries Development, and Obesity in Children During the COVID-19 Pandemic

The COVID-19 pandemic has brought health damage and socioeconomic disruptions, together with lifestyle disorders around the world. Children are one of the most commonly affected, mainly due to social isolation and changes in eating habits and physical activities. This way, the risk of weight gain and obesity is possibly enhanced, as well as poor oral hygiene conditions and early childhood caries (ECC) development during the lockdown. In children under 6 years of age, ECC is defined as carious lesions in one or more primary teeth, with or without cavitation. Importantly, alterations in the oral microbiome caused by changes in children lifestyles have much more than a local impact on oral tissues, interplaying with the gut microbiome and influencing systemic environments. Recent studies have been exploring the oral health conditions, eating habits, and weight gain in the childhood population during the COVID-19 pandemic; however, there is a lack of information concerning the association among oral and gut microbiome, dental caries, and obesity in the COVID-19 era. In this context, this review aimed at analyzing a possible relationship between the oral and gut microbiome, caries, and obesity in children during the COVID-19 pandemic.

The impact of COVID-19 on paediatric dental services and tips for patient management

Managing paediatric patients in primary dental care while awaiting treatment by the specialist paediatric dental services can be tricky. COVID-19 has had a significant impact on dental services meaning wait times to be seen by a paediatric dental service may have been delayed. This article will discuss the management of paediatric patients in primary dental care and provide an update on some of the latest techniques in paediatric dentistry. It also covers tips that can be employed in the primary dental care setting such as the use of tooth mousse and silver diamine fluoride.

Changes in paediatric dental clinic after reopening during COVID-19 pandemic in Wuhan: a retrospective study

OBJECTIVES

Affected by COVID-19 pandemic, The Department of Paediatric Dentistry of School and Hospital of Stomatology, Wuhan University was closed in late January 2020, and resumed on 20 April. Our study aimed to explore the effects of COVID-19 pandemic on paediatric dental services which might assist global paediatric dentists to build confidence and make appropriate policies under the pandemic.

DESIGN

A retrospective study was performed. Medical records of patients were retrieved but without any private information, including patient name, ID number and address.

PARTICIPANTS

All data of the patients from 20 April to 31 July in 2020 and 2019 were extracted and analysed including demographics, dental diagnosis and treatment methods. A total of 18 198 patients were included in the study.

RESULTS

During this period, no medical staff or patient was infected with COVID-19 due to dental services. A total of 6485 in 2020 but 11 713 during the same period in 2019 visited the department. Compared with 2019, gender distribution did not change, but age distribution changed with an increase under 6-year-old. The diagnoses including caries, retained primary teeth, malocclusion, deep pits and fissures changed significantly, while pulpitis, apical periodontitis, tooth trauma, early loss of primary teeth, supernumerary teeth showed little change. Aerosol generating procedures were adopted less frequently overall in this period.

CONCLUSIONS

The reopening of paediatric dental services is proceeding steadily with significant changes in the characteristics of the patients and treatment procedures.

Impact on Utilization and Shift in Treatment Needs Post-COVID Lockdown of Pediatric Dentistry in a Tertiary Care Hospital

Background: The COVID-19 pandemic has brought all treatments other than emergencies to a halt. Dental disease, being a multifactorial microbial disease, is capable of progressing to pulpits and its sequelae. The purpose of this study is to predict the impact of utilization of dental services and the progression of treatment needs in children during the lockdown and partial lockdown.

Methods: Outpatient department data from the year 2017–2019 from the Department of Pediatric and Preventive Dentistry, JSS Dental College was collected. A table of treatments provided was prepared. Utilization of services as care-seeking rates at 10, 25, and 50% were assumed and modeled corresponding to each stage of the lockdown using linear regression analysis. Dental caries progression was calculated as shifts in treatment needs from permanent restorations to temporary restorations, pulpectomies, or extraction, assuming a 10% progress to each sequela.

Results: The p-values for 10, 25, and 50% care-seeking rates were 0.021, &lt;0.001, and &lt;0.001, respectively.

Conclusion: The number and severity of cases were predicted to have increased. However, after removal of lockdown, it was noted that the number of patients seeking care was significantly less. The advancement in progression of dental disease further adds to the burden of society and caregivers.

Delivery of Health Care by Spanish Dental Hygienists in Private and Public Dental Services during the COVID-19 De-Escalation Phase (June 2020): A Cross-Sectional Study

Background: The first wave of the COVID-19 pandemic in Spain posed a major challenge for Spanish dental professionals. The objective of this work is to describe the dental hygienists’ work status and employment patterns during the de-escalation phase in order to analyse the standards of knowledge, compliance with official recommendations, and dental activities both in the public health service and in the private sector. Material and Methods: A cross-sectional questionnaire was answered by Spanish dental hygienists via WhatsApp, Facebook, and Instagram. The questionnaire was piloted before it was distributed and carried out during June 2020. Results: Here, 517 dental hygienists were surveyed, of which 86.2% followed the official recommendations to avoid contagion and 63.8% agreed with the gradual return to work by limiting the use of aerosols. Private dental hygienists identified more with returning to work without restrictions (14.5%) versus those working for the public service (1.2%) (p < 0.005). Conclusions: Dental hygienists’ return to work has involved different strategies, aimed at controlling infection and guaranteeing the safety of patients and the rest of the dental team. The availability of personal protective equipment, the adaptation of clinical infrastructure, and patient care management have differed between professionals working in the private and public sectors.

COVID-19 Pandemic impact on Brazil's Public Dental System

The present study aimed to estimate the impact of the COVID-19 pandemic on dental care procedures in the Public Health System in Brazil. A retrospective, ecological study was carried out, comprising 5,564 Brazilian municipalities. The number of dental procedures (per 100,000 inhabitants) performed in the Brazilian Public Health System (SUS) was the outcome. The impact of the pandemic was estimated by comparing the rate of procedures for each month of 2020 with the rates observed in the equivalent months in 2019, considering the period from March to August. Regulatory legislation regarding restrictions on dental care, issued by the state governments of 27 Brazilian federative units, was used for mediation analysis. A 55% reduction was observed in March for all procedures (IRR = 0.45, 95%CI 0.39-0.51), while in the other months, the rate of reduction remained ≥ 88%. The biggest decrease was observed in collective preventive procedures (reduction ≥99%) between April and August. Procedures that were less likely to generate aerosols (tooth extraction and prosthetic) and emergencies showed the smallest reduction. The reduction was not mediated by the restrictions imposed by state governments (p>0.05). The impact of the COVID-19 pandemic was noteworthy in terms of the decrease in the number of dental procedures carried out in the Brazilian Public Dental Service. The lack of access, the delay of elective procedures and the lack of preventive collective procedures could result in an overburdened system, post-Pandemic.

Children and parents perspectives on children's dental treatment under general anesthesia: a narratology from Saskatoon, Canada

Aim

This study aimed to explore the emotional and psychological effects of dental treatment under general anesthesia (DTGA) on children and parents in Saskatoon city, Saskatchewan, Canada.

Design

Semi-structured interviews, video diaries, drawings, and a questionnaire were used to collect data. The study used a narrative perspective and thematic analysis to analyze data.

Results

The findings from children and their parents (N = 25) indicated DTGA is disconcerting from both views. Parental guilt and the desire of both parents and children to not have to go through the experience again fueled at least short-term compliance with brushing, flossing, and changes in dietary habits.

Conclusion

The children participants provided valuable information to augment that gathered from parents. As the study revealed that the DTGA is psychologically and emotionally troubling for both children and their caregivers, it is imperative to explore ways to ease the GA experience. Specific recommendations were provided for optimizing dental and health services for those children and their families.

The clinical practice of Pediatric Dentistry post-COVID-19: The current evidences

The Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV-2 virus has quickly spread all over the world, directly affecting the dentistry practice. This study aimed to perform a literature review about the current evidences on biosafety practices and clinical recommendations regarding the return to the elective dental care in the practice of Pediatric dentistry. An electronic search was performed in PubMed, Scopus, Web of Science and Grey literature databases using the terms "Pediatric dentistry" and "COVID-19". Initially, 38 studies were retrieved. After title and abstract were read, it was identified that 22 studies referred specifically to children's dental practice. A total of 19 studies were included in this study. The COVID-19 pandemic will imply significant changes in the reorientation of dental practices, from biosafety issues to technical procedures. Greater rigor in the use of Personal Protective Equipment (PPE) may cause strangeness for children. Consequently, an improvement in the management of patient's behavior before and during the treatment and new approaches to perform the procedures will be demanded. Non-aerosol techniques and minimally invasive procedures will be preferable whenever possible. Professionals will need to be constantly updated based on what the scientific literature recommends. The moment is suitable for the use of preventive practice and minimally invasive techniques.