Lupine Publishers | Emergency Oral Health Care Provision for Late Squeal of Early Childhood Dental Caries in Covid-19 Lockdown Scenario

 Lupine Publishers | Journal of Pediatric Dentistry

Abstract

COVID-19 denotes a multifaceted global public health challenge that persists to impact health systems, economies, and societies across the globe almost over a period 12 months. Consequently, oral health care services have transformed to minimize the risk of COVID-19 infection transmission by adherence to patient triaging, risk stratification and meticulous infection control. Stringently imposed country-wise locks down scenarios were common in the first wave of COVID-19 that lasted early part of this year. Early childhood dental caries (ECC) as the most common chronic childhood disease affect toddlers and young children often resulting emergency paediatric dental visits due to its late sequel such as pain, swelling and infection. Against this backdrop, this short report investigates provision of emergency oral health care for children presented with late sequel of ECC to a premier tertiary public dental hospital in Sri Lanka during stringently imposed lock down.

Abbreviations: ECC: Early Childhood dental Caries; PPE: Personal Protective Equipment

Background

COVID-19 denotes an unprecedented persistent global public health challenge transforming health care delivery towards triaging and redefining of treatment priorities [1]. Providing emergency health care for patients while streamlining resources for managing COVID-19 epidemic has become the overarching goal of health administrators. Sri Lanka is a lower-middle-incomedeveloping country, possessing an efficiently pro-poor public health care delivery model [2]. Oral health care services are closely being integrated into the existing public health care delivery model from outpatient dental care to specialized care [3]. Oral health is fundamental to performing vital daily functions such as eating, speaking, and sleeping. A community’s opportunity to access to dental care, therefore, is considered to be a fundamental human right [4]. Early childhood dental caries (ECC) denotes one of the most common chronic childhood diseases [5] often goes untreated giving rise to late sequalae such as symptomatic pulp exposed teeth and frequent dento-alveolar infections. Consequently, such conditions give rise to emergency visits of children having dental pain and swelling [6]. Less optimal oral hygiene practices, cariogenic dietary patterns and lack of availability and accessibility to preventive oral health care services are the major determinants of dento-alveolar infections among children [7]. Untreated childhood dental caries, hence, constitutes one of the common unmet health needs in children especially from socially disadvantaged and culturally diverse backgrounds [8]. Preventive oral health package tailored to such children could make them “low risk” thereby preventing and controlling frequent emergency dental visits. This model has catered to high caries risk urban children in the Colombo Municipal Council area [9,10] identified as one of the high-risk zones for COVID-19 epidemic in the Colombo district. National Dental Hospital (Teaching) Sri Lanka is the premier multi-specialty tertiary care public dental hospital in the country. In this backdrop, present report explores some aspects of emergency management services offered by this hospital for children presented with pain, swelling and infection due to ECC in the peak of lockdown period and the challenges encountered.

Methodology

The data were extracted from performance statistics of Preventive Oral Health Unit (POHU), National Dental Hospital (Teaching) Sri Lanka, from 6th April 2020 to 5th May 2020 for a random sample of visits. Data were entered and analysed using SPSS-21 statistical software package.

Results

Figures 1 & 2 show presenting complaints and types of emergency management services provided respectively for 27 visits of children with ages ranging from 2 to 7-years. Accordingly, the majority, 66.7% of children’s visits were due to tooth ache with or without facial swelling. Consequently, 85.2% visits needed prescribing antibiotics and analgesics combined with other necessary treatment procedures. Dietary counseling and brushing advice were provided for 100% of visits.

Figure 1: Distribution of children’s emergency visits by presenting complaints.

Figure 2: Distribution of children’s emergency visits by type of treatment provided.

Discussion

Children who made emergency visits for dento-alveolar infections were attended by dental surgeons who adhered to protocols of cross-infection control fully equipped with personal protective equipment (PPE). All parental care givers and children were triaged with history taking and temperature checks at the main entrance conducted by Nursing Officers supported by Health Assistants. This procedure was repeated at the waiting area of POHU. While prescribing antibiotics and analgesics, dietary and brushing advices highlighting the need for fluoride toothpaste use, night brushing and healthy dietary pattern were emphasized. Moreover, fluoride gel and varnish applications, simple fillings and fissure sealant applications were performed for selected children while addressing their painful teeth to augment further prevention of emergency dental visits due to acute exacerbations of dentoalveolar infections. This fostered stay-home-stay-safe strategy fundamental to containment of spread of COVID-19 [11,12]. Those complied with the international guidelines on paediatric dentistry that emphasized triaging and exclusive treatment for emergency cases by minimizing aerosol generation procedures underpinned by case-base selection of biological, non-invasive, or minimally invasive treatment methods [13]. Few children had repeated doses of antibiotic and analgesics as there were relapses of pain and residual infections which got aggravated at night resulted in making late night emergency visits to the emergency treatment unit. Other children developed toothache while eating food that needed special oral hygiene advice and management. Break down of routine preventive oral health care provision that comprised of regular follow-up visits could have substantially impacted on the oral health status of those children. This could have been mediated by cariogenic dietary patterns and less optimal brushing habits common among children who belong to families of low socioeconomic backgrounds [14]. A recent study conducted in Brazil reported those changes in dietary habits of children as perceived by parents and their fears in accessing dental care for the children except for urgent visits [15]. Therefore, such factors could have contributed for patterns of utilization of preventive oral health services observed in this study during COVID-19 waves. However, the absence of provision of routine services on comprehensive management of advanced childhood dental caries such as pulp therapy appeared problematic. Consequently, managing dental pain of some children became challenging. Furthermore, prevailed transport problems and allocation of health assistants for priority services at Infectious Disease Hospital and other hospitals with COVID-19 care provision resulted in unavailability of supportive staff at times.

Conclusion

Relieving dental pain and consequences of advanced early childhood dental caries by providing emergency management services during COVID-19 lock down scenario was a formidable challenge. However, the services provided for the children were helpful in controlling dento-alveolar infections whilst restoring their oral health status. With antibiotics and analgesics, the majority of children presented with dental pain and multiple dental caries received professional fluoride applications. The need for re-commencement of routine preventive and conservative dental treatment for high caries children with strict adherence to optimal safety measures seems an emerging need.

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Lupine Publishers | Dental Home Prevalence Among Children with Medicaid in the Bronx, New York

 Lupine Publishers | Journal of Pediatric Dentistry

Abstract

The successful management of patients with cleft lip and palate deformity requires a multidisciplinary approach. Historically, cleft lip and palate care starts with treatment modality of presurgical infant orthopaedics (PSIO). However, the necessity of presurgical orthopaedics in managing the resulting orofacial deformity is the discussion to ponder upon due to the variety of methodologies available and results produced by these devices. The objectives of this paper were to review the journey of PSIO appliances so far, basic principles of PSIO treatment, the various types of techniques and the protocol followed, and to critically appraise the advantages and disadvantages of these techniques. In conclusion, we believe that PSO treatment, with its objective to approximate the segments of the cleft maxilla may reduce the intersegment space in readiness for the surgical closure of cleft sites.

Keywords: Cleft lip and palate; presurgical infant orthopaedics; PSIO

Abbreviations: PSIO: Presurgical Infant Orthopaedics; CLP: Cleft Lip and Palate; NAM: Nasoalveolar Molding; DMA: Dentomaxillary Advancement Appliance; UCLP: Unilateral Cleft Lip and Cleft Palate

Introduction

The concept of a ‘dental home’ is analogous to the American Academy of Pediatrics’ (AAP) concept of a ‘medical home.’ The national guidelines of both the AAP and the American Academy of Pediatric Dentistry recommend that children have a dental visit by 12 months of age and receive preventive care at regular intervals thereafter [1]. Dental caries remains the most common chronic disease of childhood, and early childhood caries (decay among children less than six years) disproportionately affects children of low socioeconomic status [2]. The establishment of a dental home early in a child’s life is crucial to providing continuous and family-centered preventive dental care and mitigates the consequences of poor oral health such as pain, missed school days, and emergency department visits [3]. In this study we assessed the prevalence of a dental home among children with Medicaid benefits, ages 1-17 years, presenting for their well-child medical visit. To our knowledge, we are unaware of any studies that have presented prevalence estimates for age at dental home establishment among children with Medicaid benefits.

Methods

Our sample consisted of 2,360 children ages 12 months to 17 years who presented for their well-child visit at the Pediatric Primary Care Clinic at Jacobi Medical Center (JMC) in the Bronx, New York from January 2016 to June 2020. JMC is one of eleven safety net hospitals in New York City’s municipal hospital system serving a predominantly Hispanic/Latino and African American population. This observational study was approved by the Institutional Review Boards of Jacobi Medical Center and the Albert Einstein College of Medicine. As part of an interprofessional dental training program, pediatric dental residents provided dental screenings, risk assessment (AAP Oral Health Risk Assessment Tool), [4] and fluoride application in the pediatric medical clinic. The prevalence of a dental home at each age was calculated. Children making multiple visits were counted only once, resulting in a patient count rather than a visit count. All participants were Medicaid-eligible. Data analysis was conducted using Stata version 15.1 (Stata Corp) (Table 1).

Table 1:Age distribution of 2,360 children with Medicaid.

Results

Of the 2,360 children in this study, one-year-olds accounted for 20.1 percent of the sample and by this age 24.2 percent had a dental home. Children six years and younger accounted for 68 percent of the sample and by six years 49.7 percent had a dental home. Among teenagers 13-17 years old, 57 percent had an established dental home.

Discussion

The age distribution of our sample is consistent with national pediatric visit data and our analysis supports studies that have demonstrated that despite professional recommendations, significant gaps remain in the establishment of dental homes by age one for Medicaid-eligible children [5,6]. Although an upward trend is observed in the pre-school years among children with Medicaid, over 50 percent do not have a dental home by age six thereby missing a crucial opportunity for oral health education, anticipatory guidance, and preventive services during their growth and development. Among older children and adolescents, there is a plateau in establishment of a dental home at approximately 57 percent leaving many teenagers to rely on emergency departments for palliative care (Figure 1). Despite limited generalizability to a pediatric Medicaid population in the Bronx, the results of this study indicate that there is an urgent need for greater efforts and strategies to improve interprofessional education, care coordination, and dental referrals. Given that there are approximately ten well-child medical visits during the first two years of life, there is a unique opportunity for pediatric medical practitioners to provide oral health counseling and make timely referrals in order to establish a dental home by age one and end the epidemic of childhood decay among poor children.

Figure 1.

Funding/Support:

This research was supported by Health Resources and Service Administration grant D88HP28502.

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Lupine Publishers | Reconsidering Child and Adolescents Care Strategies in Dentistry School-Clinic: An Interdisciplinary Approach

 Lupine Publishers | Journal of Pediatric Dentistry

Abstract

During the coexistence of COVID-19 pandemic and with the oral health team furthest from the front line of care, mainly because of the increased risk of exposure and spread of this disease; care was more directed to emergency situations and emergencies. Most of the dentistry school clinics suspended elective care and there was a feeling of withdrawal, for the target public contemplated, especially when linked to public education, with free attention, in public universities in Brazil. The objective of this work was to describe a new look at the strategies for the reception of children and adolescents assisted in a clinic-school of a public university located in the northeast of Brazil. Strategy under construction, considering professors, students, patients, and those in charge. With the return to activities, in a hybrid way, it is expected to bring new approaches, with the necessary adjustments, to an inclusive, integral, and humanized attention.

Keywords: Oral Health; user embracement; coronavirus infection

Introduction

The concepts of welcome and well-being are essential and inseparable from the promotion of oral health, as they involve humanization and quality of care. By welcoming the patient, we allow the relationship and the creation of bond between the patient and the dental team. Welcoming generates humanized relationships between those who care and those who are cared for, assuring the concept of caring the sense of reflecting, thinking, being interested in, worrying, considering the other. Welcoming actions in dentistry can be considered crucial to improve the quality of the care provided and should be taught and developed during the training of the professional [1]. In this context, the moment of reception in dental care for children and adolescents, particularly in Brazilian university clinics, enables actions of orientation, desensitization, listening, clarification of doubts and a greater commitment of all those involved in the dynamics of this care, in order to achieve goals of changes to healthy habits and to favor better development and quality of life of this target population. And empathy, affection and contact with the eyes, touch with the hands, hug, are very common demonstrations in this practice. Here is the record of the hospitality actions proposed at a public university in the city of Recife, northeast Brazil. These covered the listening and workshops directed by psychology professionals, reinforcing resilience and understanding or interpreting the reactions and behaviors presented and the needs of interventions found in children, adolescents and their caregivers, referred for dental treatment.
The reception also took place in conjunction with the phono audiology, occupational therapy and medicine team, in order to analyze these users in an integrated manner, in order to establish a “logistics” of integral approaches, guided by the priorities presented and specificities identified. How to work better the environment, even if not ideal, a positioning as appropriate as possible, in the dental chair, at the time of waiting. Oral health in the context of the general health of the individual, being the playful very guiding of these strategies. When it seemed that reception was in the right direction, there was the OVID-19 pandemic. The COVID-19 pandemic posed a great challenge to dentistry, which confronted with the restriction of service and resource shortage. Transmission occurs primarily through droplet spread or contact routes. Due to the characteristics of dental settings, the risk of cross infection between Dental Health Care Personnel (DHCP) and patients can be very high, particularly in paediatric patients [2,3]. While the outbreak is active it is strongly recommended to stop the face-to-face exercise of dentistry. However, in cases of urgency and emergency, the care should be performed following protocols different from the usual ones. Social distancing, unique care with a decrease in the work team and reinforcement in the professional’s personal protection equipment, is essential to avoid the spread of the virus. Another reality is the virtual screening, seen as essential for the performance of face-to-face care, since at least the patient must be classified as at risk or not and, in case of suspicion, enable a future diagnosis of COVID-19 by conducting a questionnaire on the last symptoms of the individual [4,5].

The paediatric emergency and non-emergency problems should be clearly distinguished and sufficient instructions provided in the special period of COVID-19. As emergency dental consultations were considered swelling, pain, and trauma with or without systemic symptoms [6]. These situations are more related to discomfort, to the need for invasive interventions. Children and adolescents who use dental treatment in Brazilian university clinics have gone through a long period of disaffection. Orientation and referrals to emergency situations, with a targeted screening process that, associated with distance and protection measures, leads to a feeling of impersonality. In view of the technologies and telehealth, the proposal is for channels of guidance, clarification, suggestion, and that make possible a new type of reception for children, adolescents, and their relatives or carers. Suggestions and creativity are being worked on in groups with teachers, students, and technicians, concerned with a holistic vision and integrality in health. This group also includes the assisted users and their caregivers, so that they feel they are participants in the process of building a differentiated assistance, but with the recognition of the particularities, socio-cultural characteristics, experiences/ experiences, exchanges, priorities, and expectations. Simpler and more direct messages and exchanges. This is a proposal that is being built. The first results comprise the orientation videos, the second moment is under construction, a channel for direct exchanges and continuous information. They are welcomed in this new concept!

Conclusion

Thinking about dental care for children and adolescents in the times of the OVID-19 pandemic is quite challenging. However, using technological resources, creativity and listening to all those involved, from an integrative perspective, new paths may be being implemented.

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