Paediatric Dental Care in COVID-19 Pandemic - Time to Rethink - A Review

Abstract

Corona virus infection has affected many people and resulted in numerous deaths. SARS-CoV-2 is a novel strain of coronavirus that has not been recognized in humans earlier. The disease originated in China and has now become a pandemic affecting countries worldwide. The clinical characteristics in children seem to be milder as compared to adults, but the exact clinical features related COVID-19 are still unknown and unclear. This is the reason why a child can be considered as a “silent carrier” for COVID-19. The pandemic has affected the children as well. Children usually suffer from the most common oral disease of dental caries. Dental caries in children has been attributed to having its pathophysiology related in a cytokine response. In the recent COVID-19 pandemic, the adverse outcomes in children, though reported less, has been related to the establishment of a cytokine storm, the components of which are common with the cytokine expression profile of Dental caries and early childhood caries in children. Early carious lesions results in early involvement of dental pulp thereby resulting in periapical pathology. The open carious lesions can result in the direct entry of virus from saliva in the dental pulp of infected patients. The resulting periapical pathology contains viral load and hence virus enters the blood circulation. A dental setting is at a high risk of cross infection amid patients and dental practitioner’s owing to the spread of infection via droplets suspended in the air by infected symptomatic or asymptomatic subjects. This article informs about measures which reduce facility risk, manage symptomatic patients and protect personal health care and management with reference to pediatric dentistry. The antimicrobial therapy to be given to pediatric patients has been also highlighted in the present review. The clinical characteristics of COVID-19 in children, though they are milder are given equal importance. Also this article reviews the precautions and guidelines to be followed by the dentists. The present article reviews the impact of Coronavirus infection on pediatric dental practice and gives the future recommendations. The present article also gives the future directions to the government which can considered if possible. KEY WORDS Children, COVID-19, Pediatric Dentistry

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

“…Although evidence is weak, irrigation before surgery with 0.2% povidone-iodine or hydrogen peroxide (1.5%) has been recommended [ 6 , 27 , 28 ].…”

“…Specifically, symptomatic caries of the deciduous and permanent dentitions were recommended to be medically approached, in the first instance [ 6 ]. In cases of coronal pulp involvement, agents inducing reparative dentin formation could be employed.…”

“…In cases of coronal pulp involvement, agents inducing reparative dentin formation could be employed. Pulpectomy was indicated, instead, in case of root pulp involvement and preferably performed in a single rather than multiple operative session, thus efficiently reducing pediatric patients’ symptoms and exposure [ 6 ].…”

“…During the first peak of the COVID-19 pandemic, routine dental practice was suspended or postponed, and dental interventions were limited mainly to dental emergencies [ 1 , 2 ] to prevent further spread of SARS-CoV-2 infection and to minimize the risk of developing cross-infections in the dental setting [ 3 , 4 , 5 , 6 ].…”

“…According to the American Dental Association (ADA) guidelines [ 5 ], emergency dental procedures could only be performed in dental facilities in patients without clinical signs or symptoms of SARS-CoV-2 infection and using appropriate protocols; conversely, patients with obvious symptoms had to be referred to appropriate facilities [ 4 ]. Patients who have recovered from COVID-19 could access dental settings after 72 h [ 6 ].…”