285 - Effect of COVID-19 in Pediatric Dental Emergency Care in PR

Purpose: This retrospective study aims to analyze data from the Emergency Room Register and progress notes at the Pediatric University of Puerto Rico Hospital Dr. Antonio Ortiz (HOPU), focusing on dental emergencies across three timeframes: pre-pandemic, during the pandemic, and post-pandemic. The objective is to identify the main reasons for pediatric emergency dental visits, such as traumatic injuries, caries, infections, pain, abscesses, and cellulitis, and to assess trends in patient volume in these periods.

Methods: This study will employ a retrospective analysis. Data will be gathered from Hospital Patient Records, focusing on progress notes from pediatric emergency room cases related to dental services across three distinct COVID-19 periods. Records encapsulate ER admissions, detailing the date of emergency, patient's residential area, birth date and age at the time of emergency, gender, visitation reason, final diagnosis, treatment provided, and the number of visits per patient. The population includes all pediatric patients from age 0 to 21 with dental caries who sought dental services at the HOPU ER from March 2018 to March 2024. The study will calculate the total and oral complaint-specific ER visits for each pandemic period.

Results: Following meticulous compilation and analysis of electronic records collected over three designated periods meeting predefined inclusion criteria, a total of 1,690 pediatric patients presenting with dental emergencies were identified within the emergency room dataset. Notably, the year 2023 witnessed a significant escalation in emergency room visits, accounting for 381 cases. Traumatic incidents comprised a mere 27.34% of the total cases, while dental pain, facial cellulitis, dental abscess, floor consultations, dental clearances, orthodontic appliance removal, and dental referrals constituted 56.21%, 11.60%, 26.86%, 19.53%, 4.67%, 1.6%, and 29.88% of cases, respectively. The predominant treatment modality involved extraction, administered to 51.95% of patients, with 40.47% receiving sedation during the procedure, and 18.17% receiving antibiotic therapy as the final course, either intravenously or orally.

The outcomes from periods preceding, during, or following the COVID-19 pandemic were assessed utilizing Pearson Chi-square and Fisher exact tests. This analysis revealed no notable disparity concerning the occurrence of dental traumas across the three periods, with a probability value of 0.123. Conversely, a noteworthy elevation in the proportion of patients seeking emergency dental care due to dental pain was observed in the post-COVID-19 period, accounting for 71.8%, which demonstrated statistical significance with a probability value of 0.000.

Additionally, there was a notable rise in the incidence of dental abscesses among patients in the post-COVID-19 period, constituting 32.50% of cases, a finding that exhibited statistical significance with a probability value of 0.000. Dental consultations were also more frequently reported after the COVID-19 period, representing 33.90% of cases, a statistically significant observation with a probability value of 0.000. Concerning dental referrals, whether from generalists or pediatric dentists, a heightened presence of such cases was evident post-COVID-19, comprising 30.79% of cases, a finding that demonstrated statistical significance with a probability value of 0.000. Despite a higher incidence of facial cellulitis in the post-COVID-19 period, at 13.86%, no significant difference was observed, with a probability value of 0.070.

Conclusion: Our study, which rigorously compiled and scrutinized electronic records across distinct time frames, elucidated a considerable cohort of pediatric patients encountering diverse dental emergencies, predominantly comprised of males. Notably, a significant surge in emergency room visits transpired in 2023. Traumatic incidents constituted a minor fraction of cases, whereas dental pain, dental abscesses, and dental consultations exhibited greater prevalence.

Moreover, our analysis disclosed a substantial uptick in patients seeking emergency dental care attributable to dental pain, alongside an escalation in dental abscess incidence during the post-COVID-19 period. This observation intimates a plausible impact of the COVID-19 pandemic on pediatric oral health. Additionally, the augmented rates of dental consultations and referrals after the COVID-19 era further substantiate this conjecture.

Fundamentally, our hypothesized correlation between the COVID-19 pandemic and pediatric oral health was substantiated by statistically significant findings. The heightened occurrence of dental emergencies, particularly concerning pain and abscesses, underscores the imperative for ongoing vigilance and intervention to mitigate potential oral health ramifications during and beyond global health crises like COVID-19. Further investigations are warranted to elucidate the underlying determinants of these trends, including the demand for pediatric dentists in Puerto Rico, and to devise targeted strategies aimed at ameliorating adverse oral health outcomes among pediatric populations.