CHILDREN’S ORAL HEALTH IS IN CRISIS, TOO

HE WAS giggling when I saw it — a large tooth poking out over the top of a milk tooth. I stopped my son Alex, 11, mid-laugh and asked him to open his mouth wider. ‘Ah yes,’ I said. ‘An adult tooth is growing over your baby tooth. We’ll call the dentist.’

Only, of course, in that split second I’d forgotten: we couldn’t call the dentist. Since the lockdown, practices have been shut.

Alex still has to lose all his milk molars and some other teeth. He is late for his age group — usually, milk molars have fallen out by the age of ten-and-a-half — and we have been warned he may need them removed if they don’t make way for the adult teeth soon.

Now an adult tooth is bearing down on a milk tooth that is stubbornly refusing to budge, forcing the adult tooth out at an angle and pressing on the baby tooth.

‘It hurts badly in the gum,’ Alex told me. I called our dentist to be told that they are only doing emergency sessions over the phone. Children’s checkups would have to wait.

As well as the pain and overcrowding, my son also regularly has fluoride painted on his teeth to protect them from cavities. With the most recent appointment cancelled, he will miss out on this, too.

Meanwhile, a friend’s teenage daughter, who has braces, has been unable to see her orthodontist for her check-up and tightening because of Covid-19.

‘It will probably set her back by months,’ her mother said.

Another friend has a child with several fillings who now has toothache. But their dentist remains closed.

Fortunately, our problems are not as bad as many others.

Every year nearly 60,000 children have to be admitted to hospital to have teeth extracted under general anaesthetic, mainly due to tooth decay, according to NHS Digital.

Regular dental visits to check for cavities and give children fluoride treatments to strengthen enamel are vital for many — so, if dentists can’t see children at a higher risk of dental cavities, will we see an increased need for extraction and other NHS treatment?

The reason dentists had to close is because dentistry is considered to be one of the high-risk professions in terms of spreading the virus, which could happen through aerosols and droplets during invasive procedures, says Dr Claire Stevens, a consultant in paediatric dentistry at Manchester University NHS Trust and spokesperson for the British Society of Paediatric Dentistry.

‘Dentists can’t do a check-up without getting very close to patients,’ she says. There is a risk of transmission to dentist, dental nurse and patient.

When it comes to decay, she says, most children will be fine. ‘Lockdown is unlikely to have a huge impact in terms of children’s oral health because decay happens over months, not weeks,’ she explains.

As for children with braces, Dr Stevens says: ‘Lockdown will mean many can’t be seen in person by their orthodontist and may need to wear braces for longer. But wearing a brace for an extra six weeks is still preferable to spreading coronavirus. There is a low risk to children in delaying adjustments for braces.’ However, she concedes that lockdown may cause families to lapse into unhealthy dental habits.

‘In nearly all cases, dental decay is preventable,’ says Dr Stevens. ‘We are urging parents to maintain a strict oral health routine, especially during lockdown, which includes avoiding or limiting sugary drinks and snacks, and having tap water or milk in between meals. Encouraging your child to brush twice a day, for two minutes, and not to rinse out fluoride toothpaste after use are also good things you can do.’

My own dentist has said they will not be reopening until June at the earliest. But Dr Stevens stresses that for emergencies and severe pain, children can still get dental care. ‘We have not stopped treating emergency cases,’ she says.

‘We are still here if a child has severe pain or for dental trauma. We continue to see a lot of trauma possibly because children in lockdown are enjoying playing outside.

‘I have treated injuries where children have fallen off trampolines or gone over their bike handlebars.

‘The first point of call is your own dentist, who can do an assessment via video call and refer you to an emergency clinic if your child has severe pain or dental trauma.’