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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 35-38

Impact of the COVID-19 pandemic on the management of dental pain and odontogenic infections in pediatric patients


1 Dental School, José do Rosario Vellano University, UNIFENAS; Center for Rehabilitation of Craniofacial Anomalies, UNIFENAS, Alfenas, São Paulo, Brazil
2 Department of Oral diagnoses, State University of Campinas, FOP-UNICAMP, Piracicaba, Sao Paulo, Brazil
3 Dental School, José do Rosario Vellano University, UNIFENAS, São Paulo, Brazil
4 Department of Nephrology, University of California, San Diego, UC SanDiego, California, United States of America; Department of Pediatrics, Federal University of Minas Gerais, UFMG, Belo Horizonte, São Paulo, Brazil
5 Center for Rehabilitation of Craniofacial Anomalies, UNIFENAS, Alfenas;a Primary Care/Health Science Postgraduate Program, State University of Montes Claros, UNIMONTES, Montes Claros, Minas Gerai, São Paulo, Brazil

Date of Submission29-Oct-2021
Date of Acceptance12-Jul-2021
Date of Web Publication06-Apr-2022

Correspondence Address:
Nelson Pereira Marques
State University of Campinas (UNICAMP), 901 Limeira Avenue, Piracicaba-SP
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_172_21

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  Abstract 


Objective: This study aimed to compare the number of procedures for dental pain relief and odontogenic infection control performed annually in pediatric patients before and during the pandemic to date. Methods: The longitudinal association between the number of procedures to treat pediatric urgent dental emergencies from the previous (2017–2019) to the pandemic (2020) period was evaluated by a negative binomial regression in the form of incidence rate ratio with 95% confidence interval. Results: This study showed a significant decrease in the number of pulp capping, pulpotomy, access to dental pulp and medication, endodontic medication with/without biomechanical root canal preparation, abscess drainage, and extraction of primary or permanent teeth, performed in patients up to 12 years old from the previous to the pandemic period. Conclusions: Therefore, the COVID-19 pandemic has adversely impacted on the number of procedures for dental pain relief and odontogenic infection control performed in pediatric patients.

Keywords: COVID-19, dental care for children, public health dentistry


How to cite this article:
Teixeira Marques NC, Marques NP, Teixeira Rodrigues SV, Freitas Miranda-Filho AE, Esteves Orsi VM, de Oliveira EA, Martelli-Júnior H. Impact of the COVID-19 pandemic on the management of dental pain and odontogenic infections in pediatric patients. J Dent Res Rev 2022;9:35-8

How to cite this URL:
Teixeira Marques NC, Marques NP, Teixeira Rodrigues SV, Freitas Miranda-Filho AE, Esteves Orsi VM, de Oliveira EA, Martelli-Júnior H. Impact of the COVID-19 pandemic on the management of dental pain and odontogenic infections in pediatric patients. J Dent Res Rev [serial online] 2022 [cited 2022 May 26];9:35-8. Available from: https://www.jdrr.org/text.asp?2022/9/1/35/342705




  Introduction Top


The COVID-19 pandemic period started with the global spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in March 2020. Since then, the COVID-19 has reached 21 million Brazilians, leading to the death of more than 607 thousand people in the country until October 29, 2021 (https://COVID-19.saude.gov.br/). Due to its rapid dissemination by droplets from coughing and sneezing or contact with contaminated surfaces and objects, the World Health Organization asked governments for action plans to guide professionals on reinforcement of biosafety measures in health care.[1]

Promptly, many protocols were updated to reduce the risk of spreading SARS-CoV-2 by the Brazilian Unified Healthcare System (Sistema Único de Saúde [SUS]) that provides health services to millions of Brazilians funded by public resources. The General Coordination of Oral Health (Coordenação Geral de Saúde Bucal) of the Ministry of Health (Ministério da Saúde [MS]), in accordance with the Federal Council of Dentistry (Conselho Federal de Odontologia [CFO]), determined the suspension of elective dental care in public services at the beginning of the pandemic period, maintaining only emergency and urgent dental care.[2] Hence, Chisini et al. (2021)[3] showed a drastic reduction in the number of general pediatric dental procedures performed on SUS, mainly in the initial period of COVID-19 pandemic exponential growth. Likewise, Bergo et al.[4] showed the impact of the pandemic period on dental surgery procedures performed by maxillofacial surgeons in Brazil. Primary and specialized preventive health care actions, the oral care including endodontics, periodontics and oral surgery treatments significantly decreased for the entire population in the first half of 2020.[5]

Restrictive measures, such as lockdown and restriction or rescheduling of elective dental care, have impaired the oral health care even in highly developed nations.[6] The remote care, through telephone or social media resources, has been a worldwide trend toward confirming the cases that need face-to-face consultation and to the management of elective cases,[7],[8],[9],[10] but this practice still needs to be effectively evaluated in Brazil.[11] While elective procedures can be postponed, urgent dental emergencies, involving dental pain and infectious complications, must be promptly and safely treated.[7],[8] Since the emergency and urgent care should not be avoided in the pandemic period, this study aimed to compare the number of procedures for dental pain relief and odontogenic infection control performed annually in pediatric patients from SUS before and during the pandemic to date.


  Methods Top


To measure procedures performed to treat pediatric urgent dental emergencies, this quantitative, retrospective, descriptive study used dental records collected out of the public data from the Health Information System for Primary Care (Sistema de Informação em Saúde para Atenção Básica) and the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatistica). The difference between the mean number of pediatric dental consultations performed in the five geographic regions of Brazil (North, Northeast, Southeast, South, and Midwest) by SUS from 2017 to 2019 compared to 2020 was analyzed descriptively (%). A negative binomial regression was used to evaluate the longitudinal association between the number of pediatric urgent dental procedures in the form of incidence rate ratio (IRR) and confidence intervals at 95%, using the BioEstat 5.0 statistical software (Biostatistical Institute of Science and Technology).


  Results Top


Considering all Brazilian regions, a total of 78,187 pediatric dental consultations were performed by SUS in 2020 versus annual mean of 182,476 during 2017–2019. The drop in the number of pediatric dental consultations in the overall Brazilian average reached −104,289 (−57.1%), corresponding to a reduction of almost 8691 consultations per month during the COVID-19 pandemic [Figure 1].
Figure 1: Difference between the mean number of pediatric dentistry consultations (n) performed in Brazil by the Brazilian Public Health System from 2017 to 2019 compared to 2020 (%)

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[Table 1] shows the difference between the mean number of pulp capping, pulpotomy, access to dental pulp and medication, endodontic medication with/without biomechanical root canal preparation, abscess drainage, and extraction of primary or permanent teeth, performed in patients up to 12 years old from the previous to the pandemic period (%). The reduction was consistent in all evaluated procedures, ranging from −67.1% pulp capping to −49.5% abscess drainage. The decrease in general procedures reached −993,026, corresponding to an average reduction of 82,752 procedures per month during the COVID-19 pandemic. The rates of all these procedures significantly decreased in the pandemic period (−55.9%, IRR = 0.43, 95% CI: 0.42–0.45, P < 0.0001) [Table 2].
Table 1: Difference between the mean number of pediatric urgency dental procedures (n) performed in Brazil by the Brazilian Public Health System from 2017-2019 compared to 2020 (%)

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Table 2: Incident rate ratio and 95% confidence interval for pediatric urgency dental procedures per million population in Brazil according to the periods 2017-2019 versus 2020

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  Discussion Top


This study showed a great reduction in the number of conservative (pulp capping and pulpotomy) and invasive pulp therapies (access to dental pulp and medication and endodontic medication with/without biomechanical root canal preparation), or radical procedures (extraction of primary or permanent teeth, and abscess drainage), performed in pediatric patients during the COVID-19 pandemic. Bergo et al.[4] revealed a similar reduction in number of permanent tooth extractions and abscess drainage in the general population. As highlighted by Chisini et al. (2021),[3] the restrictive measures to prevent the disease spreading are among the reasons for the lower rates of elective dental procedures performed in SUS. However, its impact on procedures for dental pain relief and odontogenic infection control should be clarified.

Emergency situations in pediatric patients are commonly related to dental trauma, caries, and infectious disorders, with great occurrence of dental pulp involvement.[12] Therefore, endodontic and surgical procedures are the most commonly recommended treatments, being the focus of this investigation. Removing the cause of discomfort, through the local treatment as endodontic and surgical approaches, aims to improve the quality of life for children and reduce health risks.[13],[14],[15],[16],[17]

Due to the fear of contracting the SARS-CoV-2 virus in dental clinics, even in urgent dental emergencies caused by caries or trauma, many parents do not seek dental care for their children during the COVID-19 pandemic.[9],[10],[11],[12],[18] According to Campagnaro et al.,[11] this worrying behavior is more common in Brazilian families from areas with higher rates of COVID-19. Although children appear to be less affected by SARS-CoV-2 infection than adults, they can silently transmit and contribute to the virus spreading into the broader community[7],[8] that could justify the reduced number of procedures for dental pain relief and odontogenic infection control observed in this research.

Misinformation on COVID-19 received by social media has led to confusion, increasing the panic in the face of the current situation. The decline in daily COVID-19 cases, advancement of vaccination, and dissemination of information about infection control measures during dental practice, may increase parental confidence in seeking dental care for their children during the pandemic period.[9],[18]

Dentists are classified as workers with very high exposure risk to SARS-CoV-2 due to the proximity to the patient, contact with oral fluids, and aerosol-generating procedures during dental treatment.[19] However, at the beginning of the pandemic period, CFO issued a report stating that only 0.17% of people affected by the COVID-19 were dentists,[20] even though most of the professionals had not suspended dental practice in Brazil,[21] showing knowledge about biosafety measures. Subsequently, the MS published a guideline for dental care in the COVID-19 pandemic, directing the gradual resumption of elective dental care, planned according to local epidemiological data, the availability of personal protective equipment, as well as the qualification of health workers.[22]

Besides the necessary care during the pandemic, the restrictive measures have overwhelmed parents for helping in homeschooling added to daily activities that include supervising oral hygiene and feeding of children with a noncariogenic diet.[9] Parental supervision during toothbrushing of preschool children favors a satisfactory oral health, due to the lack of manual dexterity in this age group. Among the reasons for inadequate parental-supervised toothbrushing are the lack of time and insufficient attention to children.[23] This scenario suggests that the reduced number of dental procedures was mainly due to a lower demand and not by lack of need for dental care.

Overall, it is very important to advise parents that damage to primary teeth, involving inflammatory reactions, may affect the development of permanent successors due to their close anatomical proximity. Depending on the different stages of odontogenesis, sequelae in permanent dentition vary from enamel opacity, hypoplasia, crown or root dilaceration, partial or complete arrest of root formation, to eruption disturbances.[16],[24] In the knowledge that neglecting preventive and curative dental care negatively affects pediatric patients' oral health, increasing the risk of severe health problems in the near future, actions of public health to avoid possible consequences of the restrictive measures, and uncertainties regarding the pandemic period must be implemented.


  Conclusions Top


Therefore, the COVID-19 pandemic has adversely impacted and drastically dropped the number of procedures for dental pain relief and odontogenic infection control performed in pediatric patients from the Brazilian Public Health System, probably due to fear and lack of knowledge of the population about the reinforcement of biosafety measures in this period and the consequences of not seeking dental care for their children during the pandemic on the development of permanent dentition. Thus, quick and safe actions are needed to regularize or at least minimize both the critical immediate risks as well as the possible long-term COVID-19 pandemic negative impacts over pediatric patients.

Ethical clearance

This manuscript does not require ethics committee approval since it analyzed public data from the System for Primary Care of the Brazilian Unified Healthcare System.

Acknowledgments

This study was supported by the National Council for Scientific and Technological Development (CNPq).

Financial support and sponsorship

This study was financially supported by the National Council for Scientific and Technological Development (CNPq) (PIBIC #120667/2020-7).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Campagnaro R, Collet GO, Andrade MP, Salles JP, Fracasso ML, Scheffel DL, et al. COVID-19 pandemic and pediatric dentistry: Fear, eating habits and parent's oral health perceptions. Child Youth Serv Rev 2020;118:105469.  Back to cited text no. 11
    
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Coll JA, Dhar V, Vargas K, Chen CY, Crystal YO, AlShamali S, et al. Use of non-vital pulp therapies in primary teeth. Pediatr Dent 2020;42:337-49.  Back to cited text no. 16
    
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