Pediatric Safety: Protecting Both Oral and Overall Health

Safety and hygiene protocols have always been integral to a dental practice, but until March 2020, your patients probably took them for granted. Now, almost a year since the COVID-19 pandemic forced public awareness of personal protective equipment (PPE), disinfection practices and social distancing, even those who were previously compliant with biannual dental visits may think that unless something is noticeably wrong, in-office dental care can be postponed indefinitely.

Reassuring adults – who may have been reluctant patients even before the coronavirus emerged – is one challenge, but with National Children’s Dental Health Month (NCDHM) kicking off soon, another highly important task is conveying to parents what efforts your practice is making to maintain a child-safe environment.

Infectious disease

By this time, COVID-19 screening protocols have become familiar for appointments almost everywhere, from the hair salon to the doctor’s office. Still, every business has its own checklist, and both parents and children need to know what to expect at your door when they arrive. Although your practice has likely already sent out letters or emails to patients describing the changes in your office (no toys or books in the waiting room, requests for patients to wait in the car until called, limits on the number of people who can enter the building), a follow-up communication aimed at parents for NCDHM may be beneficial. Information to include can range from tips for good home care to an overview of what to expect at the next dental visit so parents can help prepare their child in advance.

In addition, you might take the opportunity to outline some of the standard precautions your office takes against transmission of infectious disease, such as PPE for staff, sterilization of equipment, and other elements of the latest Centers for Disease Control and Prevention guidance on infection prevention in dental settings.

Radiation

Although current recommendations from the international organizations supporting the Image Gently Alliance are to minimize radiation exposure in children by using radiography based on individual clinical need, not for routine screening, such needs inevitably arise. Because radiation risks are higher for children, keeping the radiation dose to the minimum required for diagnostic purposes by following the basic rules of justification, limitation, and optimization is particularly important in these cases. Depending on the view needed and the specific speed of film vs. detector sensitivity, digital radiography can reduce the radiation dose of a dental exposure by up to 90% versus film, making it preferable for use in all patients, but particularly children.

In addition to “child-sizing” the exposure time and dose, other more familiar safety precautions that parents can easily understand include using protective aprons to shield against scatter radiation, and disposable and single-patient intraoral sensor sheaths and holders. For example, Patterson Dental’s BiteWing-Ease Tabs quickly and easily wrap around digital radiography sensors to provide a tab to go between the patient’s teeth; at the same time, the padded wrap cushions the hard sensor edge, and an extended flap protects the wire to keep it out of the way. The wraparound design is also compatible with Patterson’s Digital Sensor Shields – vinyl sheaths that protect sensor technology and patient health. Both products come in sizes to fit smaller sensors. Patterson also offers child-sized protective X-ray aprons with thyroid collars, both lead-containing and lead-free. The lead-free aprons are lighter weight, more flexible, and made from environmentally friendly barium composite.

Oral health

The most fundamental part of patient safety in dentistry may be preserving dental health itself, including caries prevention through regular home and office care. Remind parents that “nonemergency” does not mean “nonessential,” especially in children who are at higher risk of developing caries, and that good oral health and hygiene are important to overall health. Both the American Academy of Pediatric Dentistry and the American Academy of Pediatrics recognize the importance of a professional “dental home” in pediatric care – a concept that parents may or may not be aware of.

No matter how diligent parents may be in encouraging children to brush their teeth in their “real” home, professional examinations to detect lesions, diagnose caries, and if necessary, perform restorations are fundamental to overall health. While the detection method of visual assessment with the assistance of an explorer remains tried and true, detection dyes like Patterson’s Caries Detector Kit can help not only locate lesions, but, by staining only carious dentin, also guide cavity preparation to avoid over-excavation, thereby promoting conservative dentistry and allowing for the use of less anesthesia. And the timely application of pit and fissure sealants (also available from Patterson Dental) can help fend off the need for further, more invasive treatment.

Anesthesia safety

For many patients, “getting a cavity filled” is one of the least enjoyable experiences in the dental office. Following proper anesthesia and analgesia protocols for children who need caries treatment can help avoid creating an unpleasant experience that will set up a lasting negative perception of dental care, as well as protect them from adverse effects of anesthesia.

In 2019, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry collaborated on guidelines for sedation of pediatric patients. These guidelines describe five goals of sedation:

  1. Guard the patient’s safety and welfare
  2. Minimize physical discomfort and pain
  3. Control anxiety, minimize psychological trauma, and maximize the potential for amnesia
  4. Modify behavior and/or movement to allow the safe completion of the procedure
  5. Return the patient to a state in which discharge from medical/dental supervision is safe

To achieve these goals, the guidelines recommend using the drug with the highest therapeutic index at the smallest effective dose and ensuring that at least two people who are trained to provide advanced life support measures are always in the room. Regardless of the level of sedation being provided, parents can be assured during the informed consent process that all precautions are being taken to keep their child safe.

A friendly face

Knowing that something is safe is one thing, but feeling it is just as important. For parents – and children – who are particularly concerned about a personal visit, a telehealth session may be helpful in determining the source and seriousness of any problems, or indeed simply to allow an initial “face-to-face” conversation without a potentially intimidating mask in the way. With visible smiles a rare treat, some creativity in the meet-and-greet process may be needed to put young patients at ease, and positive verbal praise, body language, and tone of voice are at a higher premium than ever.

Selected references

American Academy of Pediatric Dentistry. Periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. 2018.

American Academy of Pediatric Dentistry. Talking to parents about the COVID-19 pandemic.

American Academy of Pediatrics. Preventive oral health intervention for pediatricians. Pediatrics. 2008;122(6):1387-1394.

Aps J. Considerations for pediatric dental radiography. Decisions in Dentistry. April 1, 2016.

Coté CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics. 2019;143(6):e20191000.

The Image Gently Alliance. Image gently during dental procedures.

Kracher CM. Digital imaging in dentistry: Intraoral, extraoral, and 3D technology. February 2018.

Mungo R. I’m a pediatric dentist. Here’s what I want parents to know about dental care during COVID-19. May 14, 2020.

Patient Safety Network. COVID-19 and dentistry: Challenges and opportunities for providing safe care. August 31, 2020.

Poiset M. Pediatric dental care and the art of soothing a child’s anxiety. Dentistry IQ. October 26, 2016.

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This article originally appeared in the January 2021 issue of OnTarget. Read the latest issue and view current promotions at pattersondental.com/dental/ontarget.