Being safe without being scary: Unique approaches to infection control at pediatric dental practices

A trip to the dentist can induce anxiety in anyone. The thought of being stuck in a chair while someone pokes and prods in your mouth is disconcerting enough, and that’s been ratcheted up during 2020. In a COVID-19 era, the people holding those dental instruments are wearing face masks, face shields, goggles, surgical hats, gloves, shoe coverings, and disposable gowns.

Now, imagine what all that looks like to a child.

Pediatric dental practices have always faced unique challenges. In addition to serving a specialized community—children who may be anxious—they must also manage infection control concerns in a pandemic environment. That's especially difficult when your clientele wants to touch everything, and possibly even put it in their mouths.

Specialized practice

In a way, pediatric dental practices are like orthodontists, endodontists, and prosthodontists—they serve a specific group of patients, many referred from their family dentist.

“It's tough with kids,” Timothy Voss, DDS, a pediatric dentist in Maumee, Ohio, observes. “Kids don't really understand what’s going on right now. They have grown acclimated to it, but when we reopened, we were trying to anticipate how to convey to them what's going on. Just working on children when you’re masked up and wearing PPE is a really tough thing.”

COVID changed everything, and now it’s even tougher, he acknowledged.

“When we work with children, we normally invite them into our office to play with games, to be around other kids, and to be exposed to kid-friendly things. Pretty much all of that was wiped out by COVID,” Dr. Voss says. “They’re not allowed to come into the office. They have to fill out the paperwork electronically. They have to wait in the car. We can’t welcome them to our reception area where they can see our smiling faces. They can’t play with games and get acclimated in the reception area and see other kids that are there. Those are all hard things for us to work through.”

Pediatric offices encounter an extra layer of complexity on top of an already challenging system. In addition to the mandates and recommendations from organizations, associations, and governmental entities, pediatric dentists have to put themselves in the minds of children and anticipate the many things that they may touch, and the types of things that might make them anxious.

“We miss all the things we had for kids to interact with. That's the whole nuts and bolts of pediatric dentistry. Even in our reception area and treatment areas there were papers and boxes of crayons for kids to color, boogie boards and Etch-a-Sketches, because we created a kid-friendly zone and absolutely everything that they could touch or interact with is gone.

“Even their ability to roam around is gone,” he continued. “Take our open concept room. We have to be more restrictive about where people can go and how many people are allowed in a particular area at a time. All of this hurts because we want the kids to have a great time and trust and like their pediatric dentist.” Some of the tools that help Dr. Voss deliver care are games that both distract and put patients at ease.

“We now have a no-touch video game that broadcasts 100 video games onto the floor,” Dr. Voss says. “The kids can stomp around on it. They get points, but it’s not like they’re playing a video game at home in front of the TV. It's entertainment that doesn't require us to wipe down or have an aseptic technique for the kids to enjoy.

“It tells them, ‘We are kid-friendly, this is a place for the children. This is a thing that you can do while we talk to your parents and make sure that all your information is accurate,’” he says. “There were always things to do. There were books, magazines, a chalkboard, a giant Connect Four, a giant checker game. All that stuff has been taken away because anything they can touch is a possible source of transmission.”

Personal protective equipment

One of the things that has been challenging for all dental practices this year is the mandate for new and more extensive PPE. While the goal is to protect staff and patients, the new look can be off-putting, especially for children.

“It’s definitely harder for our under age five children because they don't necessarily have interaction with many adults,” Dr. Voss says. “They don't really understand why the world is doing this and that we're wearing face shields and N95s and a disposable gown for each patient interaction. We have to wear our N95 no matter where we are in the office, but we've tried to layer on the other PPE as we interact with each patient. I try to layer on the PPE in their presence so they can see that I am a person underneath. I go in there wearing scrubs and a jacket and N95, and then I interact with a patient before I add my face shield and single-use gown.”

Dental practices have had to take their infection control cues from many different sources, and that information, or sometimes the lack thereof, can be a challenge to incorporate.

“Luckily, the collaborative organizations of pediatric dentistry and other pediatric dental forums are very open and sharing, and everybody has great ideas and shares terrific concepts,” Dr. Voss says. “We ask questions such as: Where can you get this type of curtain? Where can you get this kind of face shield that has stickers on it so children will like it? Many of the items we discuss are very small batch, niche things that are hard for the average person to know about.”

Lessons learned

If nothing else, practices like Dr. Voss’s are learning from the times and taking advantage of the opportunity for growth.

“We've definitely started to maximize our use of the electronic-based health systems,” he says. “Electronic reminders, check-ins, and screening tools have all been very easy to integrate, and they've been very well-received by our patients. We used paper charts until the first of the year, so it’s a blessing that we were set up before the pandemic. Being electronic has been very helpful with how we accomplish our goals on the administrative end. Being in tune with patients and the risk factors associated with COVID has helped us to better gauge how to care for our patients. We're doing our best to reach out, and they challenge us to draw those personal connections. We're just here to take care of them.”

Infection control was challenging enough before COVID-19. It became even more taxing with all of the new precautions required today. It’s yet even more demanding for those dental practices that serve specialized communities, such as pediatric dentists. The dental community is expert at leaning in, navigating, and resolving challenges with tried-and-true, as well as out-of-the-box, solutions, just like Dr. Voss.

Karen Daw, MBA, CECM, “The OSHA Lady,” is an award-winning speaker, consultant, and author of articles and CE courses on safety in dentistry. She holds an MBA with concentrations in Healthcare Administration and Business Management. After graduation, Daw was recruited from the emergency department to her roles as assistant director of sterilization monitoring and health and safety director for the Ohio State University College of Dentistry. She draws on her rich background to educate audiences on how to avoid penalties, negative reviews, and the 6 o’clock news! Learn more about Daw at karendaw.com.