COVID-19 and Its Aftermath on Pediatric Oral Health: A Study of Dental Caries and Hygiene in Romanian Children

<b>Background/Objectives</b>: Official data on the oral health of young children in Romania are limited, especially concerning the societal shifts following the COVID-19 pandemic. This study aimed to compare the oral health status, hygiene habits, diet, and dental care patterns of 6-year-old children in a rural Romanian region before and after the pandemic. <b>Methods</b>: A cross-sectional survey studied two groups of 6-year-olds from rural Transylvania: Group 1 (<i>n</i> = 77), assessed 2018-2020 pre-pandemic, and Group 2 (<i>n</i> = 136), assessed in 2024 post-pandemic. Clinical data used the Decayed, Missing, and Filled Teeth (DMFT) index. Parents completed questionnaires on oral hygiene, diet, dental visits, and pandemic-related topics for Group 2. Chi-square, Student's <i>t</i>-tests, and a multiple linear regression were used to analyze the data. <b>Results</b>: Post-pandemic, 70% of children brushed twice daily, up from 26%. Despite this, negative outcomes increased: the number of affected teeth rose from 6.8% to 29.6% (<i>p</i> < 0.001), sugar intake increased, and dental visits became more reactive, with pain being the main reason for 61% of post-pandemic visits, compared to 17% pre-pandemic. <b>Conclusions</b>: This study reveals a significant oral health paradox: despite a three-fold increase in recommended toothbrushing, caries experience in permanent teeth increased four-fold. This outcome was driven by a high-risk environment of more cariogenic diets and reduced preventive care, with lower maternal education also identified as a key independent risk factor. These findings show that promoting hygiene alone is insufficient, underscoring the urgent need for public health programs that integrate nutritional counseling, improve access to preventive care, and address underlying socioeconomic disparities.