COVID has affected nearly every part of life, and we continually see not only the virus’s direct impact, but indirect effects as well – not least of all in children’s dental health.

Mask wearing, increased snacking, and longer waits for dental appointments, have all contributed to dentists seeing an uptick in decay and cavities among Valley children. That means it’s more important than ever to pay attention to daily dental hygiene.

Snacking at home

With many children now attending school virtually at home, they have more access to snacks throughout the day.

“Diets have definitely changed during the pandemic,” said Dr. Ralph Cianflone, a dentist in Northumberland. “Children are snacking more frequently, because snacks are readily available all day to them, versus when they are in school.”

Kim Maxwell, business manager at Valley Dental Group in Selinsgrove, said a lot of kids that come into their office are reporting that they are eating more sugar and soda, and aren’t eating healthy meals like they would have gotten in school. So far, she said they have seen some periodontal issues, but haven’t seen a growing number of cavities in their patients; however, “we are warning them against that,” she said, adding that it takes time for cavities to form, and daily habits will affect that outcome.

Dr. Natalie Stinton, a pediatric dentist for Geisinger, however, did say she is already seeing signs that frequent snacking possibly could be a culprit for an increasing number of dental issues.

“We definitely are seeing an uptick in cavities,” she said.

The problem, however, isn’t just the snacking itself.

“It’s really not the total amount of sugar and food you’re eating, but the amount of time your teeth are exposed to the acids in those foods,” Stinton explained. “Your mouth is acidic for 20 minutes after you’re done eating or drinking.”

So, when you’re eating throughout the day, that means hours of exposure to sugars that break down the teeth’s protective enamel.

With his pediatric patients, Cianflone offers a visual of “little pac-men coming out and eating away at the enamel” on their teeth while they’re sleeping. To avoid this, it’s necessary to brush their teeth before going to bed, and not eat anything at all after brushing. Stinton said this includes any medications.

Mask complications

Maxwell said their office is starting to see more children with periodontal, or gum disease. She said the uptick is due to the effects of continual mask-wearing which is “keeping germs and bacteria in the mouth.”

“When we breathe, (bacteria) leaves the system and dies,” she said, “but with a mask, it’s staying in.”

It’s especially a problem for kids who aren’t brushing well each day – “The bacteria is just kind of hanging around the mouth,” she said. They are also finding some patients are experiencing the growth of that bacteria on the outside of their mouth and lips, caused by masks that keep “moistness and germs next to the face.”

She advises wearing disposable masks. Cloth masks should be washed daily. And above all, stay committed to proper dental hygiene every day, which includes brushing twice daily. She also advises using a fluoride rinse or mouthwash to kill bacteria, and to also brush your tongue regularly.

Daily habits, proper hygiene

Stinton advises parents to give their children only water to drink throughout the day, and having milk or juice only at mealtimes. Also, choose snacks that don’t stick to their teeth – things such as bread, nuts, cheese, and fresh fruits and vegetables, rather than processed foods like crackers, gummies and cookies.

Cianflone also emphasizes counting to 55 while brushing. The ideal is two minutes, but he said “If I can get them from 6 to 55 seconds, and tell them to count slowly, 55 is an easy number to remember.”

Children should also be brushing in the morning; if possible, he said children should be brushing right after eating breakfast.

Stinton quips, “Brush at night to keep your teeth, brush in the morning to keep your friends.” Morning brushing, she said, can help remove some of the bacteria that causes bad breath overnight. While both are important, the nighttime brushing and flossing is primary to maintaining good dental health.

For the younger kids, it’s especially important for parents to watch them to make sure they are brushing accurately. Kids who don’t have the dexterity yet to write in cursive or tie their shoelaces, also don’t have the dexterity to properly brush their teeth, she said.

Stinton also recommends fluoride toothpaste, and keeping the size of paste on the brush to about the size of a grain of rice for children under 3; once a child is able to effectively spit out the toothpaste, the amount should be the size of a pea.

Parents can use apps that make toothbrushing for kids more fun and interactive. It may be helpful also to simply set a timer for two minutes. If parents want to check to make sure their child is brushing correctly, disclosing tablets with natural food dye can show any remaining plaque after brushing.

Maxwell said some parents have found success in placing a chart in the bathroom, for children to earn checkmarks or stars for proper brushing each day. She also suggests battery-operated spin brushes for children, which are more efficient than a regular toothbrush – especially for young children with tiny hands.

Importance of checkups

At his practice, Cianflone is seeing fewer patients per day because of COVID protocols that make each visit take longer, thus pushing back the wait time for appointments.

“I’m not able to see the patients every six months,” he said. “That’s been affecting what I see in my chair.”

The pandemic has only aggravated a pre-existing problem with dental care availability in the Valley, according to Stinton.

“We’ve always had a decreased access to care in this area,” she said. “I do think it’s even worse now than before. We’re able to see patients for emergencies, but I do think the preventative care is being pushed out more than it was.”

This delayed wait time is especially an issue for kids, since they grow and change quickly in six months.

“A lot of parents don’t quite get how quickly and how soon a decay situation can happen,” Maxwell said, adding that they have seen children as young as 3 and 4 with severe decay.

“Even though they’re technically baby teeth, it’s still going to cause ongoing issues,” she said.

Stinton recommends a child’s first dental checkup by age 1, or by the first tooth. If there are no teeth coming in by age 1, she said a checkup will help them to see what the delay might be. In addition, a dentist can start reviewing diet and hygiene recommendations with parents.

“It takes as little as three to six months for a cavity to start forming on a baby tooth,” she said, since it has only half the amount of protective enamel that an adult tooth has.

Infected baby teeth can cause pain and inability to focus on schoolwork – maybe even days in the hospital. Not to mention, “Some people don’t realize that it’s not until around age 12 that some of those baby teeth need to last until those new adult teeth come in,” Stinton said.

Baby teeth, she said, “act as a placeholder for the permanent tooth. The most common cause of dental crowding is actually due to cavities in baby teeth. Cavities form between the teeth, and everything kind of shifts forward.”

A goal of regular checkups and proper dental hygiene is to avoid braces whenever possible since brushing becomes much harder with braces, and the chance for cavities much greater.

During regular checkups, Cianflone said he seeks to do both a dental and growth evaluation on children, to see how their jaws are growing. This allows earlier detection and implementation of orthodontic intervention, and even minimizes that intervention later on.

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