Recommendations for pediatric dentistry during COVID-19 pandemic

COVID-19 recommendations

No routine dentistry should be provided for children during this pandemic. Routine dentistry should be deferred to minimise risk to patients, staff and the public. COVID-19 is seen to be transmitted via roplet, contact and airborne mechanisms. Aerosol Generating Procedures (AGP) present a higher risk of transmission of the virus and should therefore only be undertaken to provide urgent care (with all required safety protocols) where no other reasonable option is available.

COVID-19 has been identified to be in saliva of infected patients also. There is a minimum of three different pathways for COVID-19 to be present in saliva: from COVID-19 in the lower and upper respiratory tract, that enters the oral cavity together with the liquid droplets frequently exchanged by these organs; COVID-19 present in the blood, which can access the mouth via crevicular fluid; by major- and minor-salivary gland infection, with subsequent release of particles in saliva via salivary ducts.

For children who are able to split, pre-procedural mouth rinse with 0.5%–1% hydrogen peroxide should be used, as it has nonspecific virucidal activity against corona viruses. Pediatric Dentists should avoid or minimize surgical procedures that can produce droplets or aerosols (Basically avoiding the use of the dental drill). In extreme situations, an extraction may be the preferred treatment option for children with pulpal symptoms (in deciduous dentition) to reduce the need for aerosol generating procedures.

Additionally, according to the evolving situation, in the present circumstances, until COVID-19 will be completely eliminated, as advised by the American Academy Of Pediatric Dentistry (AAPD) Minimally Invasive Dentistry, such as Atraumatic Restorative Treatment (ART) which includes use of Silver Diamine Fluoride (SDF) (A solution that arrests dental caries progression any further), Selective Caries Removal ( using only manual dental hand instruments instead of the dental drill) and the Hall Technique wherever feasible (A method to put Stainless Steel Crowns on milk teeth without the usage of any drilling work over the tooth) , should be taken in to consideration.