This year will be the first time in nearly two decades that children visiting Eastern Orthodontics and Pediatric Dentistry the first Friday in February will not be greeted with Purple the Clown, PeeDee the Pirate and the ECU cheerleaders.

Give Kids A Smile day, which provides free dental care to children, will not be held during National Children’s Dental Health Month due to the coronavirus pandemic. But members of the East Central Dental Society hope the effort will come up smiling later this year.

“We would like to be able to do it at some point this year. Right now we just say it is postponed,” said Dr. Lee Lewis, who co-chairs the local event with Dr. Billy Williams. “This program will continue. The only thing that we were worried about was making sure that we were doing what was in the best interest of everybody involved; we did not want to do anything that could endanger anybody coming.”

Since 2003, the East Central Dental Society-sponsored effort has provided hundreds of thousands of dollars’ worth of free dental care to area children in need. The annual event generally draws hundreds of people, including about 100 patients and their families and even greater numbers of volunteers and guests.

In addition to dental treatment, children also receive blood pressure, height, weight and body mass index measurements, a vaccination history review and educational information during the day, which is co-sponsored by the Pitt County Health Department, the James and Connie Maynard Children’s Hospital at Vidant Medical Center, ECU’s School of Dental Medicine, College of Nursing and Brody School of Medicine.

“The numbers of people that were in here (at previous events), at this particular time would not be considered safe,” Lewis said, adding that as many as 750 people generally come through the office during a typical Give Kids A Smile day. “It would be irresponsible for us as health care professionals to endanger anybody trying to put this on. Looking at the numbers specifically here in our state and in Pitt County, the general consensus among us was that it would be best to try to delay this until we were able to kind of see this getting under control.”

In February 2020, about 1,500 Give Kids A Smile days were held for nearly 350,000 children nationwide. Locally, about 80 children received $40,000 in free dental care, including 141 sealants, 82 x-rays, 39 fillings, five crowns and 31 extractions.

Lewis knows that having to delay this year’s event is likely to cause patients to require more restoration than preventive care.

“I think anytime you have a population that goes a long time without any kind of health care or dental care you’re going to experience issues,” he said. “That’s the basis for prevention.”

Lewis said that, in many cases, people spending more time at home during the pandemic have paid less attention to their oral health and have increased their snacking, which can be a major contributor to dental decay.

“Do I worry about people not receiving care? Yes,” he said. “Oral health plays a major role in overall health. When is that more important than in a global pandemic?”

Jennifer Pope, coordinator of East Central Dental Society’s Give Kids A Smile day, said that across the country, large-scale events have essentially disappeared this year due to COVID-19.

“The majority of what we’re seeing on the Give Kids A Smile website ranges from just doing some virtual education to doctors in the community taking on a set number of patients and doing some exams,” she said.

The disruption of Give Kids A Smile is the latest example of how COVID-19 has affected oral health care around the globe.

In its early stages, the pandemic prompted offices like Eastern Orthodontics and Pediatric Dentistry to close for weeks or even months. Dental practices in about 40 states, including North Carolina, were able to reopen in May after adapting procedures to conform to new Centers for Disease Control recommendations. In August, the World Health Organization issued a statement urging people to postpone dental cleanings and checkups during the pandemic.

While the American Dental Association challenged that recommendation, there is evidence that patients are continuing to heed it. Late last year, the ADA reported that dental visits had declined by about 20 percent.

A recent survey of 4,500 patients reported that 65% of North Carolinians have delayed routine check-ups due to fears about COVID-19. One in five said they would delay seeking medical treatment for a serious issue if it wasn’t causing them pain.

Dr. Ed Connelly, interim associate dean for clinical affairs at the ECU School of Dental Medicine, said that while dental students did not see patients from mid-March until late May, dental residents continued an emergency clinic throughout the pandemic.

“I don’t think they ever missed a day,” he said. “A lot of them (patients) didn’t even have access to their own dental offices.

“When you’re seeing people that are hurting, they’re in pain, they don’t really care too much about COVID. They’ve got a toothache. They’ve got a problem. They really need to be seen.”

As patients were invited back the school’s dental clinics for more routine care, some were quick to return but others were hesitant, despite enhanced safety measures including symptom and temperature screenings.

“We’ve had patients that were so glad to get out of the house and come up here and be treated. (But) we have had students who’ve reported that they have several patients that are still a little bit leery about getting out and getting into contact in the community and at a large school like this,” Connelly said, adding that he estimates the dental school lost about 100 clinic sessions due to COVID-19 concerns.

“Our clientele here probably tend to be a little older, so they’ve got additional worries about underlying health conditions,” he said.

Practices serving younger clientele are seeing fewer patients as well.

“By necessity with the new protocols we use, we see fewer patients,” Lewis said. “There’s just no way to get around it.”

He said that some parents are delaying their children’s treatment due to fears surrounding the virus. But others are canceling appointments due to having been exposed to the virus, testing positive or being advised to quarantine.

Having fewer appointments in the spring created complications for ECU’s senior dental students, who are required to perform a certain number of procedures to show competency that is required for graduation, Connelly said, adding that the school managed to schedule enough clinic hours to graduate all its students on time. But that is not expected to be the case this year.

“By our standards, they not only have so many things they have to accomplish in the clinics, they have to have so many contact hours for experience,” he said.

This year’s graduation is expected to be postponed by a month, he said, which will also cause a delay for the junior class.

“It’s going to have, as you call it, a trickle-down effect for this year and probably the next,” Connelly said. “I look forward to the day when we’re back on track and we’re doing things the way we’re accustomed to doing it, but it’s going to take us a while to work through that.”

“I think what you’re going to see is the ripple effects throughout everything we do, whether it’s health care, business, all of that,” he said. “There will be issues, ripples that will affect people down the road associated with this COVID-19 pandemic for years to come.”