WHAT HAS HAPPENED IN THE DENTAL WORLD DURING THE PANDEMIC – AND WHAT'S HAPPENING INSIDE OF OUR KIDS' WORLD?

BY DAVID A. TESINI, DM, MS AND LYRIC JORDAN, CLASS OF '22

THE PANDEMIC & DENTISTRY

As many of us have learned through our years, the only constant in life is change. The year 2020 has certainly epitomized life's lesson. The aspirations of a promising new year were quickly dispelled by a virus which has altered our lives and the world we once knew. Parents, children, and health care workers have been attempting to adapt to a "new normal" yet, uncertainty and anxiety still linger amongst families of children with special needs (CSHCN). The challenge of parenting has grown, it feels like the world is upside down and, in the world of children with special needs, their world has gone "wild".

A recent study that surveyed families of children with ASD found 93.9% of families reported experiencing challenges regarding managing daily activities of their children, especially more frequent and intense behavioral problems. This has also been apparent in the testimonials from families in a series called "Our COVID19 Stories" through the American Academy of Developmental Medicine & Dentistry (AADMD). For children who rely heavily on predictability and familiarity, times of uncertainty like these can be unimaginably difficult for these children. Through this turmoil, many are asking a very simple question. "What truly matters at the end of the day?"

With the focus of family safety at the forefront of our minds, it's only natural to limit our interactions with those deemed necessary. One of the effects we have seen is apprehension towards visiting the dentist mistakenly understood to mean the risk of transmission. Dentistry has risen to the challenge – access to care, appointments available in a timely fashion, utilization of non-aerosol generating procedures such as caries arresting, visible safety precautions to in-office protocols, greater use of teledentistry, and new behavior guidance techniques. In addition, children may experience higher incidences of cavities if there is an interruption in routine dental care. It's important to continue to encourage adaptability and innovation through these times of great change. The "new normal" in the dental office will be driven by the experiences that parents share with the dental team.

PREPARING FOR A "NEW NORMAL"

Eventually, this pandemic will pass and, with it, the lifestyle modifications we have become accustomed to. However, many of the new protocols in healthcare will remain. Familiarity and routine are paramount to a child's ability to feel secure in any situation,

OPEN WIDE: Dentistry has risen to the Covid-19 challenge — access to care, appointments available in a timely fashion, visible safety precautions to in-office protocols, greater use of teledentistry, and new behavior guidance techniques.

something dental offices are making a focal point when considering their special health care needs patients. 

For instance, an emphasis to accommodate your child in the same dental room, with the same staff, wearing similar clothes, performing the same procedural steps, and so on. Due to the pandemic, many offices have been forced to adapt and are currently experiencing a "new normal". Check-in process may require questionnaires and temperature recordings, masks worn up until treatment is initiated, oral rinses administered when possible prior to treatments, changes in operatory designs, and extensive PPE, including gowns and face shields.

So, what does this mean for apprehensive children visiting their dentist? Liken this scenario to visiting your local grocery store only to find everything has been rearranged. For most, it would be seen as a minor inconvenience. Yet, for those children who rely on familiarity and routine, this can become overwhelming and stressful. These are some of the experiences we anticipate for children coming back to the office with new protocols adopted. Anticipating this, our mission is to facilitate a smooth experience through innovative, yet readily-available means. In the American Association of Pediatric Dentistry/AAPD's "Re-entry to Practice" survey, it was reported that one of the most effective methods being used is staff wearing 6" buttons with their image so the child knows who is behind all the PPE. Tools like these help the child connect something unfamiliar to the familiar. It may also be helpful to take your child on a "virtual office tour" to explore the new changes or create updated story boards that fit the new dental office narrative. Collaborate with your child's dentist to create an experience that will assist them in transitioning to a new office environment.

TELEDENTISTRY & THE IMPORTANCE FOR CSHCN

This pandemic has forced many alterations onto healthcare offices, perhaps one of the more positive has been the utilization of teledentistry. The American Dental Association (ADA) defines teledentistry as the use of "a broad variety of technologies and tactics to deliver virtual medical, health, and education services." While considered a great resource for dentists to triage patients in pain and assess dental emergencies, teledentistry has also found a home for dentists working with children who have special health care needs. Techniques like the D-Termined Program of Familiarization and Repetitive Tasking (EP Magazine, November 2020) have innovated to the video conference era.

Virtual visits offer a unique glimpse into the dental experience. Children can be comfortably introduced to the staff and doctors wearing new personal protective equipment like face shields. Televisits also offer dental staff the opportunity to work with children on practicing safe dental procedures such as "open mouth," "close mouth," "legs out straight" and, "hands on tummy, please." Working with the child remotely will not only save parents time by not having to drive to the office for these introductory appointments, but they will allow the child to progress in a setting they are most secure in. When the time comes to actually visit the office, it can be an exciting and rewarding experience for the child… and for you.•

ABOUT THE AUTHORS:

David Tesini DMD MS ia Associate Clinical Professor Tufts University School of Dental Medicine. Lyric Jordan is with Dentistry class'22 University of New England College of Dental Medicine.

DON'T FORGET THE BASICS : FOUR CRUCIAL STEPS

Plain and simple, good oral hygiene begins at home and it begins early -- soon after the primary tooth erupts. Good oral health requires discipline and parents and caregivers need only follow these four simple steps to assure a healthy smile:

STEP 1 EARLY INFANT ORAL CARE IS IMPORTANT FOR ALL CHILDREN

When that first tooth erupts, it doesn't know into whose mouth it has arrived. "Will I be kept clean?" "Will I be crowded?" it asks itself. It does not know that it has now made a home in the mouth of a child with special needs. Brushing at least twice daily, good diet (no fruit-roll-ups), no nighttime bottles or before-bed snacks, and first dental visit prior to the first birthday, are simply the first steps to a lifetime of good dental health.

STEP 2 IF YOU DON'T HAVE A DENTIST YET… START LOOKING FOR A DENTIST NOW! 

Ask your neighbors, friends, coworkers, pediatrician, relatives, and school contacts if they know a dentist who is able to treat your child with special needs. Remember, the capabilities of the ancillary staff--dental assistants and hygienists--are just as important as the training and experience of the dentist. Open a dialogue with the dental staff. Ask the dentist about his recommendations and experience in treating people with disabilities and how you as the parent or direct support professional (DSP) can aid in the process. Find out what you can do between visits to prepare your child to become familiar and accepting of the dental experience.

STEP 3 DO YOUR PART: KEEP YOUR APPOINTMENTS! 

Many times, a breakdown occurs in the patient/doctor relationship because patients (parents/DSPs) do not take seriously the need to keep appointments and be timely. The dentist has organized her daily schedule to accommodate all her patients. You may even want to call first thing on the morning of the appointment and offer to come in a little earlier or later if the doctor would like.

STEP 4 ADVOCATE AS PART OF THE TEAM

Remember, the dentist and his staff are part of your service and support team. Accept the possibility that your own past experiences may have created some negative attitudes that will only hamper the dentist's efforts. Be open to suggestions and opinions that may vary a bit from your own. Imagine a child with a cavity whose parent says, "I don't want the fillings done because it will be too traumatic," instead of "How can we work together to get the fillings done?" Which scenario do you think is most likely to achieve a lifetime of good dental health?

— Originally published in EP Magazine, October 2001