For Kids, Toothaches Become Another Kind of Pandemic Pain

Pediatric dentists seeing more cavities and infections after COVID interrupts routine checkups

Very little has been normal for children these past two years, and some youngsters are feeling the pandemic’s effects in their mouths. Pediatric dentists report seeing more decay and cavities, along with serious infections—some even requiring treatment in the operating room.

“We know there have been a lot of parents who were hesitant about coming to a dental visit,” says Cheen Loo, professor and chair of pediatric dentistry at Tufts University School of Dental Medicine. “They have delayed dental treatment for their children until more recently,” with some waiting until their children could be vaccinated.

This hesitancy, coupled with the fact that dental offices were first closed, and then at reduced capacity, after COVID initially appeared, has meant fewer routine cleanings, checkups, and preventive care like fluoride applications and sealants. The likelihood of a child in the U.S. having a dental visit in 2020 was 27% lower than in 2019, according to a study in the Journal of the American Dental Association. The numbers held, regardless of children’s demographic or socioeconomic status.

Add in higher consumption of sugary foods and beverages and less toothbrushing—the byproduct of online school and disruption of routines—and it’s a recipe for dental woe. At Tufts’ pediatric dentistry clinic, “we’re seeing a lot more dental caries and infection,” says Loo, using dentists’ preferred term for cavities.

Cavities and decay, if left untreated, can be painful and make it difficult for kids to chew, sleep, or pay attention in school. They can also lead to a bacterial infection and an emergency trip to the dentist. Before COVID, 44% of the emergency pediatric cases seen at Tufts were for dental infections; after the appearance of COVID, that number rose to 56%. (Emergency care for children remained available at Tufts without pause throughout the pandemic.)

“It’s all linked together. Postponing treatment because of the fear of going to the dentist because of COVID just made the infections worse,” says Alhanouf Alhussaini, DG22, a postgraduate resident in the pediatrics department. Alhussaini, Loo, and colleagues analyzed pediatric emergency cases at Tufts from 2018 to 2021, and Alhussaini will present the study’s findings in May at the annual meeting of the American Academy of Pediatric Dentistry in San Diego.

“Dental infection happens when the cavity is left untreated and it gets deeper toward the nerve of the tooth,” Alhussaini says. This could lead to an abscess; symptoms such as fever or difficulty breathing; and possibly life-threatening complications. “It really is something that the parent needs to address as soon as possible ,” she says.

During the pandemic, pediatric emergencies also included a lower percentage of cases related to trauma from accidents and sports injuries. “Usually, the most common dental injuries in children 7 to 11 years old are trauma from sports,” Alhussaini says. “I think the way COVID has restricted everything, children spent more time indoors.

Another significant finding, Alhussaini says, is that during COVID, young emergency patients, regardless of what they were treated for, were less likely to return for follow-up visits than patients in previous years. “Parents would say that they’re not comfortable coming because of the pandemic,” she says.

­­Since the study ended in August 2021, Alhussaini says she’s noticed an uptick in patient flow, and that parents appear more comfortable bringing their children in for routine appointments. Loo agrees. “We’re pretty much close to our pre-COVID capacity now, which is good for our patients.”

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