Pediatric Dentistry Faces the Ultimate Challenge in COVID-19

Dr. Steven Barefoot


The COVID-19 pandemic has almost certainly affected everyone. Lost lives, lost jobs, lost connections—nearly every facet of our society looks different roughly a year into this global fight. 

Imagine going through the experience as a child.

February is National Children’s Dental Health Month, making it a perfect time to discuss challenges born out of the pandemic from their perspective.

Kids and Oral Health

Kids have been isolated. Their schools have closed. Their play groups have been cancelled. Their access to community programs and support has been stripped away. And, in many cases, they have been forced to process unprecedented family stress around health and financial instability.

It’s no wonder kids are struggling.

It also tracks that children’s oral health, which is connected in so many ways to overall health and well-being, is bearing the consequences of this pandemic. One big reason for this? School closures cut a critical line of oral care for millions of underserved children nationwide, many of whom only ever saw a dentist through school-based and community-based oral health programs.

Even before the pandemic, tooth decay was the most common chronic disease among children nationwide. About 20% of children ages 5 to 11 have at least one untreated decayed tooth, and children ages 5 to 19 from low-income families are twice as likely to have cavities.

This, we know, impacts every aspect of a child’s overall health, from nutrition and eating habits to school attendance, academic performance and behavior, and mental health. As a dentist, the most challenging part of seeing a child suffer like this is knowing how easily it could have been prevented.

But the good news is we are on the right track toward making dental care more accessible to children and families as we move through this pandemic and beyond. For one, Medicaid enrollment has grown, meaning more children have access to public aid who may not have had insurance coverage prior.

Solutions on the Horizon

Here are several ways the industry, and DentaQuest in particular, is addressing the challenge and why I’m optimistic for the future.

Increasing access to oral care for Medicaid-enrolled children has to be a priority if we want to eliminate the deep disparities in our health system and reach the kids who most need our help. Many states are already doing this.

Texas’s First Dental Home, through a multi-pronged effort, succeeded in increasing access and utilization of preventive oral health services for children enrolled in Medicaid ages 6 to 35 months.

In Louisiana, DentaQuest, the state’s Medicaid benefits administrator, is specifically focused on ensuring more people see a dentist at least once per year. We’re doing this with programs that establish dental homes for both children and adults and working directly with rural communities that face unique challenges around getting to the dentist.

Community-based dental programs, like school-based care, provide essential access for kids. They are extremely effective at increasing preventive care utilization, as well as identifying more serious oral health issues that may have gone unnoticed for too long. School-based sealant programs, for example, have been shown to reduce decay by an average of 60% over five years.

Even as schools have closed, we’ve seen dentists turning to community centers and other locations to set up day clinics where families can bring kids to access the screenings and cleanings they missed through school.

New Models and Tools

Value-based care (VBC) models that reward providers for quality health outcomes rather than the quantity of care delivered continue to become more popular among states and employers. And interest has grown among providers since the pandemic. DentaQuest has been actively rolling out VBC programs focused on access and preventive care for children in multiple states.

These models support the move toward population health management, in which caries risk assessments inform treatment plans and eventually, if successful, reduce overall population risk. We’ve seen time and again how this approach can reduce costs and increase access, while allowing dentists to offer care that is focused on prevention, personalization, and best practices.

Innovative tools and technologies, including minimally invasive techniques like silver diamine fluoride (SDF), have been game changing in recent years, making dental care more accessible and easier to provide in various locations and settings, especially for children.

For example, SDF can be used to arrest caries as a far less invasive (and costly) alternative to surgical restorations. What’s more, early lesions may be candidates for remineralization that avoids the need for SDF or restorations. The pace of innovation in this space continues to accelerate in exciting new ways.

Teledentistry has become a critical pathway for dentists and patients alike. The pandemic has accelerated the interest in telehealth as a patient interaction modality, so much so that it is the first element of a new recommended care model from the DentaQuest Partnership for Oral Health Advancement called the Three Domain Framework.

Going forward, as part of this framework or not, teledentistry provides a myriad of opportunities to better engage patients around oral health, allowing us to reach them at home and in their communities to provide care and resources.

We’ve already seen some dentists offer families virtual classes and education on how to practice preventive oral health care at home. This not only helps families improve their oral health habits, but also helps children feel more comfortable and familiar with their dentist when they do eventually come to the office for care.

The challenge now, as we face an unprecedented public health crisis, is to act strategically but with urgency. The problems surrounding access to pediatric dentistry are not new. But like many other systemic problems, they have only deepened as our awareness of them has grown.

We must do the work every day to address them. We must commit now to building back a better system that improves oral, and overall, health outcomes for our children.

Dr. Barefoot is a clinical leader at DentaQuest, one of the nation’s largest oral health organizations working to improve the oral health of all. His 30-year career in dentistry includes clinical experience delivering patient care in private practice, as part of an HMO dental clinic, via mobile dentistry serving mostly Medicaid schoolchildren, and with other volunteers caring for rural communities in Honduras.

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