Caries Management in Children
Lessons learned from the pandemic should result in directional change
Joel H. Berg, DDS, MS
As we analyze trends that emerged during the COVID-19 pandemic, we need to keep the pediatric context at the forefront of our minds. The pandemic brought heightened focus to shortcomings regarding efficiently, purposely, and effectively managing dental caries in children. At the outset of the shutdown, existing treatment plans for restorative dentistry were often not completed, and existing caries lesions intended to be halted in their progression grew larger and more problematic. In addition, homecare patterns in place to avert the onset of caries lesions were often disrupted by many pandemic-related events. Children were home from school, and parents were teachers, babysitters, and full-time employees; at least two new roles added manifold responsibility to parents conducting their own work from home. This created the perfect storm of neglecting basic homecare to prevent oral disease in children.
As the pandemic moves into the rear-view mirror, its lessons ought to carry forward. It behooves us generally to step back and consider the oral hygiene of the population at large as a different matter than that of the pediatric population. When including adults, many oral hygiene recommendations and treatments are related to the prevention and management of periodontal disease. In children, periodontal disease does exist, yet its prevalence at this stage of life is minor in comparison to its prevalence and devastating outcomes in adults when unmanaged. This example drives a broader intersectional point home: Although most children manifest the precursor to periodontal diseases in the form of gingivitis, the much larger issue is with failure to manage dental caries as a disease.
Given the recent experience of much of the pediatric population that now has a less-than-stellar dental hygiene history and the pre-existing, population-specific disease risks, I would offer a suggestion of a freshly invigorated common-sense approach to caries management. The three elements of caries management in children are diet management, oral hygiene management, and fluoride management. Each of these elements of homecare for children was somewhat disrupted during the pandemic. Of particular concern is the change in dietary habits. The snacking behavior of children deteriorated as frequent snacking (on fermentable carbs), which is the largest contributor to caries lesion initiation and progression, served as a "pacifier" to caregivers overwhelmed with their children at home.
Yet, some positive directional change will emerge because of what the pandemic catalyzed. It has reminded us of the prioritized need to focus on these three elements of caries management and in the stated order of importance. To change the focus of managing dental caries in children to a "medical model," we must realign the focus of our disease management. This means changing our perspective from mostly surgical and restorative treatment to a much stronger focus on executing individualized homecare plans, tailored to the needs of each individual child, given their risk profile.
About the Author
Joel H. Berg, DDS, MS, is an emeritus professor at the University of Washington School of Dentistry and the Pediatrics section editor for Inside Dentistry.
