Dental caries is a common childhood disease of multifactorial origin and factors like dietary habits and carriage of oral cariogenic organisms play a major role in etiology [1]. Several other risk factors like oral hygine, malocclusion, socio-economic status, literacy, cultural factors and fluoride intake are also associated [1]. The recent COVID-19 pandemic has negatively modified many of these risk factors, and may increase the risk of dental caries.

The year-long curbs imposed due to COVID-19 pandemic has predisposed children to unhealthy lifestyle and altered behavioral profile [2]. The prolonged indoor stay due to lockdown restrictions has led to a sedentary lifestyle, reduced outdoor physical activity, altered eating patterns, especially increased snacking and junk food craving, and increased screen time [3]. Increased screen time also exposes children to commercials of caries-inducing foods and beverages. Several studies have linked these factors to increased incidence of obesity and dental caries among children [4]. However, unlike obesity, caries is often slowly progressive and sub-clinical, making early diagnosis challenging. The exact incidence of dental caries during COVID-19 pandemic may be underreported due to its sub-clinical progression and challenges in performing oral examination due to risk of aerosol transmission.

Children with dental caries often present to healthcare setups during acute exacerbations [3,4]. Since it is mostly asymptomatic, it can lead to delayed diagnosis, wherein a critical window time period for preventive interventions or slowing disease progression is missed. Disregarding routine dental care for long periods can predispose children to present with advanced disease. Moreover, during the first wave of COVID-19 pandemic, dental associations were the first to recommend postponement of elective dental procedures because of high risk of aerosol generation and were also the last services to resume [5].

Untreated tooth decay in children can lead to discomfort or toothache, increased chances of sepsis, malnourishment due to reduced food intake or obesity due to non-consumption of regular food and dependency on easily chewable carbohydrate-rich food, impaired cognitive development, disturbed sleep, reduced self-esteem and social acceptance among peers [1].

Health workers and parents need to be sensitized regarding the risk of dental caries during the lockdown period. ‘Dental selfies’, which can allow indirect oral examination via tele-dentistry, should be encouraged. Parents and children should be counselled on healthy lifestyle behaviors, measures to improve oral hygiene and need for scheduled hospital visits for dental caries screening.

1. American Academy of Pediatric Dentistry (AAPD). Caries-risk Assessment and Management for Infants, Children, and Adolescents [Internet]. Accessed May 8, 2021. Available from: https://www.aapd.org/research/oral-health-policies–recommendations/caries-risk-assessment-and-management- for-infants-children-and-adolescents/

2. Babu TA, Selvapandiyan J. The psychological effects of COVID-19 pandemic related lockdown in children. Indian Pediatr. 2020;57:1087.

3. Pietrobelli A, Pecoraro L, Ferruzzi A, et al. Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: A longitudinal study. Obesity. 2020;28:1382-85.

4. Kim K, Han K, Yang SE. Association between overweight, obesity and incidence of advanced dental caries in South Korean adults: A 10-year nationwide population-based observational study. PLoS One. 2020;15:e0229572.

5. Centers for Disease Control and Prevention (CDC). Guidance for Dental Settings. Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic. Accessed August 2, 2021. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html