Age-specific vulnerabilities in paediatric dental emergencies before, during, and after COVID-19 lockdown: a retrospective comparative analysis with emphasis on early childhood (0–3 years)

Purpose: To examine the unique vulnerability patterns of very young children (0–3 years) in dental emergencies before, during, and after the COVID-19 lockdown period, compared to older paediatric patients. The study aimed to identify age-specific risk factors and treatment needs that demonstrate increased susceptibility to severe dental emergencies during healthcare crises. Methods: A retrospective analysis of 6,024 emergency dental visits of children under 12 years was conducted, comparing three periods: pre-COVID (March–May 2019), during the first lockdown (March–May 2020), and post-lockdown (March–May 2021). Data from a major Israeli healthcare provider's dental clinics were analysed for age-specific patterns in emergency presentations, treatment requirements, and clinical outcomes. Results: Children aged 0–3 years showed distinct emergency patterns during lockdown, with significantly higher rates of pulpal pain (51.2% vs. 42.1% pre-COVID) and dental abscess (24.8% vs. 19.5% pre-COVID). This age group experienced the highest proportion of invasive treatments (24.8% requiring extraction) compared to other age groups. The mean age of emergency presentations decreased significantly during lockdown (6.2 years vs. 7.1 years pre-COVID, p < 0.001), with the 0–3 age group showing the most marked increase in severity of presentations. Conclusion: Very young children (0–3 years) demonstrated specific vulnerabilities during the healthcare crisis, characterized by increased susceptibility to severe dental emergencies, higher rates of invasive interventions (44.5% vs. 30.6% pre-COVID), and disproportionate representation in emergency presentations. These findings demonstrate age-specific vulnerabilities that require targeted emergency protocols and preventive strategies during future healthcare crises.