Abstract
BACKGROUND: While COVID-19’s impact on dental services has been widely studied, limited research exists on how the pandemic altered clinical decision-making and treatment selection in pediatric dental emergencies. This study examined changes in treatment patterns and clinical interventions for pediatric dental emergencies during the COVID-19 lockdown, aiming to understand how crisis conditions influence clinical approaches and treatment outcomes. METHODS: This retrospective study analyzed 6,024 emergency dental visits of children under 12 years across three distinct periods: pre-COVID (March-May 2019), during first lockdown (March-May 2020), and post-lockdown (March-May 2021). Data were collected from electronic dental records of a major Israeli healthcare provider operating 50 dental clinics. Treatment categories were classified as conservative (medication only, temporary restorations) or invasive (extractions, pulp therapy). Statistical analysis included chi-square tests for treatment distribution comparisons and multivariate logistic regression to evaluate factors influencing treatment selection, adjusting for age, sex, and presenting conditions. RESULTS: During lockdown, invasive treatments increased significantly, with extraction rates rising from 18.4 to 24.8% and pulp therapy from 12.2 to 15.6% (p < 0.001). Pharmaceutical-only interventions decreased from 44.6 to 22.4%. Multivariate analysis revealed higher odds of receiving invasive treatment during lockdown (OR = 1.82, 95% CI: 1.54–2.15) compared to pre-COVID period, even after adjusting for presenting conditions. The trend toward invasive treatments persisted but moderated in the post-lockdown period, with rates returning closer to pre-pandemic levels (19.2% for extractions, 11.8% for pulp therapy). Treatment planning showed a significant shift from conservative to invasive interventions during lockdown, with conservative treatments (pharmaceutical management, temporary and permanent restorations) decreasing from 89.6 to 56.1%, while invasive treatments (pulp therapy, extractions, drainage) increased correspondingly. CONCLUSIONS: The pandemic crisis was associated with shifts in treatment patterns, favoring definitive interventions over temporary solutions. This change in clinical decision-making patterns suggests a crisis-induced adaptation in treatment planning, potentially influenced by uncertainty about future care accessibility. These findings provide important insights for developing clinical guidelines for pediatric dental emergency care during future healthcare crises. CLINICAL TRIAL NUMBER: Not applicable.