Children's dentistry in secondary care during COVID-19

With COVID-19, the past few months have brought about challenges that are unique to the management of paediatric dental patients. This has led to the adaptation of paediatric dental services across the country and inspired innovations to facilitate the continuity of emergency and elective procedures. At the Royal London Dental Hospital, Barts Health NHS Trust, some of these innovations will have a lasting impact and can be utilized going forward into the recovery phases and beyond.

We receive approximately 5,000 referrals and undertake 15,000 outpatient appointments in the Paediatric Dental department annually. The COVID-19 pandemic has temporarily halted elective face-to-face dental assessments and procedures. This resulted in a precarious situation of having a large backlog of patients requiring dental assessment and treatment.

Dental anxiety is prevalent for many children accessing dental care. Changes in our environment, such as having to wear personal protective equipment (PPE), can enhance children's anxiety further.

The reduced provision of general anaesthetic (GA) services following the cancellation of all elective procedures has had a profound effect on our service. Dental caries accounts for a large proportion of general anaesthetic admissions for children in the UK. In 2015-16, tooth decay was the most common reason for hospital admission for children aged 5 to 9 years-old and the sixth most common procedure in hospital for children aged 4 years and under.¹ London alone has a combined waiting list of over 3000 children awaiting dental procedures under GA. The children presenting to our service are largely pre-cooperative, have special care needs or are medically compromised. Our current waiting list of over 700 patients has been exacerbated by new emergency cases requiring dental treatment under GA. General anaesthetic services across the United Kingdom are still limited for many paediatric dental units, who are competing for theatre access with other surgical specialties and are operating with a significantly reduced patient flow.