February is National Children’s Dental Health Month, and when it comes to pediatric dental health, you can’t but help think of the mantra:

'Brush after every meal, floss daily, see the dentist twice a year for checkups, and avoid sugary foods and drinks.’

Beginning these habits as infants and toddlers can lead to a lifetime of dental health, reducing the incidence of cavities (dental caries), gingivitis (gum disease), and lost teeth as adults.

But during the pandemic, what advice do parents need to help keep their children’s teeth healthy when pediatric dental clinics may be closed on bases?

In a non-COVID-19 world, “My primary advice for parents can be broken into three main areas: examinations, home care, and diet,” said Air Force Col. John Kersey Jr., a pediatric dentist at the 86th Dental Squadron, Ramstein Air Base, Germany.

“Examinations should start with children when their teeth erupt, usually around 6 months of age. They should be seen subsequently at least every year,” Kersey advised.

“If their risk of dental disease is high, they may need to be examined much more frequently. It is better for the child and the parents if disease or problems with dental development are treated early,” he said.

“Home care should include brushing the teeth from the first baby tooth to the last adult teeth,” Kersey explained. While parents need to control tooth brushing at first, “as their child’s dexterity increases, parents can begin to transition to more supervised brushing with a pea-sized amount of fluoridated toothpaste after age 2,” Kersey said. “When teeth start to touch one another, flossing once a day should be added.”

As for diet, sugar is the bane of healthy teeth.

“Tooth decay, or dental caries, is caused by the Streptococcus mutans bacteria that takes sugar in the diet and converts it to acid, which demineralizes teeth,” Kersey said. “This acid dissolves the hard, calcified tooth tissue. If de-mineralization predominates in the mouth due to frequent sugar intake, dental cavities will be the result. These cavities will continue to enlarge until they reach the center of the tooth causing pain.”

He also noted the importance of mouth guards to protect teeth as children play sports or take part in fast-moving activities, such as biking or skiing.

The pandemic had affected what procedures were being conducted at Ramstein, with those producing aerosols, such as drilling for fillings and dental cleanings, not being scheduled during the first year of the pandemic. Full-spectrum dental care returned there Jan. 18 after a “cautious ramp-up,” Kersey said.

Army Lt. Col Leslie Oakes, a dentist formerly stationed at Walter Reed National Military Medical Center in Bethesda, Maryland; and currently stationed at Fort Irwin, California, said: “In general, dentistry was handicapped early on in the pandemic because funding and the supply of Personal Protective Equipment were going toward critical needs.”

However, by July 1, Walter Reed Bethesda “reopened to conducting about 80% of services we did before.” That contrasts with the rural Fort Irwin, about halfway between Los Angeles and Las Vegas, which is expected to begin providing routine care again around the beginning of March, according to Oakes.

“I’m curious to see what the past year has done to the community’s dental health,” Oakes commented, especially if children did not see a dentist during that time. She noted that emergent cavities in children can quickly turn into major cavities and other dental issues that should be addressed during checkups.