Unsurprisingly, the closure of routine dental services, both public and private, during the lockdown in March last year had an effect on dental services throughout the country.
Many services did not resume until the summer, months with delays evident from the redeployment of public dentists, dental nurses and hygienists. When it comes to our children’s dental health, parents are urged to be more vigilant with how children care for their teeth due to the impact lockdowns and restrictions can have on their behaviours.
"This cessation of dental services, albeit necessary, has inevitably had a knock-on effect on the provision of emergency and routine dental care with children having dental treatment deferred," says Dr Aifric Ní Chaollaí, paediatric dentist with Dental Care Ireland.
“Although it is anecdotal, many parents have reported that the complete lack of routine in their children’s lives during the school closures led to a breakdown in dental health routines at home and a change, for the worse, in dietary habits. The full extent of the impact of the pandemic on children’s dental health may never be fully known. Just as other aspects of health have been adversely affected by the pandemic, dental health is no different.”
Dental care at home
With routine dental treatment thankfully continuing, under necessary precautionary measures, during Level 5 of the Living with Covid-19 framework, the dental profession also encourages us to adhere to appropriate dental care at home. Lack of access to services, negative attitudes to dental health and a poor ability to routinely care for our oral health can act as barriers to sufficient care.
“Dental decay is the most common chronic disease of childhood,” says Dr Ní Chaollaí, “and it often causes small children to experience pain, infection and to need invasive dental treatment such as crowns or extractions. It is depressingly common in preschool children in Ireland even though, with simple measures, it is almost always preventable. Caught early, it can be managed fairly inexpensively”.
According to a recent survey conducted by BabyDoc Club, 75 per cent of parents surveyed with children aged between two and five had not yet paid a visit to the dentist.
Parenting expert with BabyDoc Club, Laura Erskine says: "This may be in part due to the fact that over half of these parents report a fear of the dentist themselves, with one in five avoiding the dentist completely. The Covid-19 pandemic has certainly had some impact when it comes to our children's dental health with 34 per cent in the survey saying that the routine of both brushing and attending the dentist has been disrupted – while 13 per cent of parents say their children have been eating more sweets than usual."
Of the parents surveyed with children up to age five, just four in 10 brush their children’s teeth twice a day, with 13 per cent admitting to doing it just a few times a week and 46 per cent just once a day. Only a small percentage (4 per cent) encourage their children to brush their teeth for longer than the recommended two minutes.
Erskine says: “[A total of] 73 per cent of BabyDoc Club parents believe the Government are not doing enough to support children’s dental health. According to these parents, the two free screenings in primary school and free emergency treatment up to age 16 simply isn’t enough.”
Oral health programme
The new government oral health programme for children from birth to 16 years was due to be rolled out in 2020. The Health Service Executive (HSE) advise that an early priority of the new policy was the rollout of packages of care for children under six. Due to Covid-19 restrictions and measures, this proposal was delayed, however the HSE suggest it remains a priority for 2021.
“While the policy is on hold and there are already delays with school screenings due to a shortage of dentists in the HSE public dental service,” says Dr Gillian Smith, family dentist with The Dental Suite, “I believe the opportunity should now be taken to revisit the changes recommended in the new national oral health policy as regards dental care for children.
“It is important that any new discussions involve those dentists who are intended to provide care to children in the future under the proposed scheme; both in the public service and in private practice. The failure to properly engage those expected to deliver any reforms was the biggest weakness in the process the last time. This resulted in many recommendations which were problematic or simply not realistic.”
In the interim, as we work our way through more delays, restrictions and school closures, it’s necessary for parents to continue to establish and support good oral health habits in children with routine dental visits a necessity.
Dr Ní Chaollaí says: “Children usually enjoy their dental visits where there is no need for intervention other than simple preventive measures.”
“And when a child is already in the habit of attending regularly, should the need for treatment arise, he or she already has a rapport with their dentist and trusts him or her and is therefore much less likely to be fearful.”
Advice
While dental visits can be an anxious appointment for some children, Dr Smith offers the following advice in supporting children with any fears.
- If the child is nervous of attending the dentist due to a bad experience in the past, it is worth ensuring the dentist is accustomed to treating nervous children.
- Children will often mirror the emotions and feelings of a caregiver. It helps if the adult who accompanies the child is not an anxious patient.
- Avoid negative discussions about the dentist and the upcoming appointment. Avoid involving other friends and families who are often too willing to share their horror stories.
- There are many resources available for parents to help a fearful child successfully attend the dentist. Many characters have stories such as Peppa Pig and there are online resources available for all ages about going to the dentist and having a positive experience.
- Older children may find sending the practice an email with their questions or fears in advance of the appointment helpful.
- Some practices may offer an introductory appointment where the child can meet the team and see the premises with no pressure to have any examination or treatment.
Dr Smith says: “The important message for patients, where possible, is to continue to visit your dentist despite the pandemic. It is a safe environment and we have seen internationally that dental practices are highly effective in preventing the spread of infection. Dental practices are still open as an essential service and prevention is always better than cure. Preventative treatments and early intervention procedures are less invasive, less expensive and more predictable, which is good news for your oral health or that of your child in the long term.”
