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Craig MH, Scott JM, Slayton RL, Walker AL, Chi DL. Preventive dental care use for children with special health care needs in Washington's Access to Baby and Child Dentistry program. J Am Dent Assoc 2019; 150:42-48. [PMID: 30528747 PMCID: PMC6321780 DOI: 10.1016/j.adaj.2018.08.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preschool-aged children with special health care needs (CSHCN) from low-income households are at increased risk of developing poor oral health. The study goal was to assess preventive dental care use for CSHCN enrolled in Medicaid within Washington state's Access to Baby and Child Dentistry (ABCD) program. METHODS The authors analyzed 2012 Medicaid eligibility and claims files for children younger than 6 years in the ABCD program (N = 206,488). The authors used medical diagnosis and eligibility data to identify each child's special needs status (no or yes). The outcome was preventive dental care use (no or yes). The authors used modified Poisson regression models to estimate crude and covariate-adjusted prevalence rate ratios. RESULTS Of the 206,488 children in the study, 2.1% were CSHCN, and 114,570 used preventive dental care (55.5%). CSHCN used preventive care at rates similar to those of children without special health care needs (SHCN) (54.7% and 55.5%, respectively; P = .32). After adjustment for confounding variables, CSHCN were significantly less likely to use preventive dental care than were children without SHCN (prevalence rate ratio, 0.91; 95% confidence interval, 0.88 to 0.94; P < .001). Older preschool-aged children were significantly more likely to use preventive dental care than were younger preschool-aged children. A significantly higher proportion of preventive medical care users also used preventive dental care. CONCLUSIONS CSHCN who were enrolled in Medicaid in Washington's ABCD program were less likely to use preventive dental care than were children without SHCN who were enrolled in Medicaid. PRACTICAL IMPLICATIONS Future intervention research investigators should evaluate ways to improve access to preventive dental care for CSHCN. Additional strategies may be needed to improve oral health behaviors for preschool-aged CSHCN receiving Medicaid.
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Moore DL, Ding L, Yang G, Wilson S. Impact of Instituting General Anesthesia on Oral Sedation Care in a Tertiary Care Pediatric Dental Clinic. Anesth Prog 2019; 66:183-191. [PMID: 31891297 PMCID: PMC6938172 DOI: 10.2344/anpr-66-02-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/19/2018] [Indexed: 11/11/2022] Open
Abstract
Tertiary pediatric medical centers disproportionately care for low-income, underserved children with significant dental needs. Long wait times for hospital operating room treatment increase tooth loss rather than restoration. Oral sedation has commonly been provided to avoid the long waits for operating room treatment. However, this can be challenging with young, anxious patients. High failure rates and repeat visits for oral sedation have resulted in continued waiting for definitive dental services in the operating room. The Division of Dentistry requested the Department of Anesthesiology to create a general anesthesia program in the dental clinic to increase the use of anesthesia services but align the cost of the anesthetic with the revenue stream. Our aim was to objectively measure the performance of a dental clinic anesthesia service by comparing the percentage of case completions, percentage of complete radiographs, and number of serious adverse events to clinic-based oral sedations. We were also interested in total number of cases completed. We retrospectively studied data regarding an in-office general anesthesia (IOGA) program for dentistry and compared it to oral sedations before and after instituting the IOGA program. Patients received either a general endotracheal anesthetic or nonintubated total intravenous general anesthesia. Successful case completion increased from 88.6% (oral sedation) to 99.5% (IOGA). One hundred percent of IOGA cases had complete radiographs, as opposed to 63.4% for oral sedation. This was an increase from 53.5% from the previous 2 years with oral sedation. Serious adverse event rate was 0% (0/508) for oral sedation and 0.2% (1/418) for IOGA. Comparing 2 years before and after IOGA revealed a decrease in oral sedations from 930 to 508, whereas IOGA increased from 0 to 418 cases. Anesthesia services in dental clinic increased complete dental care and complete radiographs, reduced failed sedations, and were performed safely.
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Affiliation(s)
- David L. Moore
- Department of Anesthesiology and Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Gang Yang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephen Wilson
- Department of Dentistry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Abstract
Medical management of caries is a distinct treatment philosophy that employs topical minimally invasive therapies that treat the disease and is not merely prevention. This strategy is justified as an alternative or supplement to traditional care by significant disease recurrence rates following comprehensive operative treatment under general anesthesia. Silver diamine fluoride (SDF) is one agent to enable effective noninvasive treatment. The announcement of breakthrough therapy designation by the Food and Drug Administration (FDA) suggests that SDF may become the first FDA-approved drug for treating caries. Since our systematic review performed in April 2015, 4 clinical trials have been completed, which inform an update to the application protocol and frequency regimen. Suggestions from these studies are to skip the rinsing step due to demonstration of safety in young children, start patients with high disease severity on an intensive regimen of multiple applications over the first few weeks, and continue with semiannual maintenance doses as previously suggested. Breakthroughs in elucidating the impact of SDF on the dental plaque microbiome inform potential opportunities for understanding caries arrest. SDF can be added to the set of evidence-based noninvasive methods to treat caries lesions in primary teeth, such as the Hall crown technique and sealing lesions with accessible margins.
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Affiliation(s)
- J A Horst
- 1 Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
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Park JS, Anthonappa RP, King NM, McGrath CP. The family impact of dental general anaesthesia in children: A meta-analysis. Int J Paediatr Dent 2018; 29:149-161. [PMID: 30468690 DOI: 10.1111/ipd.12452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/10/2018] [Accepted: 11/05/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND The health and well-being of children are intimately linked to their parents' physical, emotional, and social health and social circumstances. AIM To conduct a meta-analysis of studies that have used the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the family impact scale (FIS) changes following their children's dental treatment under general anaesthesia (DGA). METHODOLOGY A systematic search was undertaken using the PRISMA guidelines. The inclusion criteria consisted of patients below 16 years of age, DGA, pre- and post-operative assessments, and the use of ECOHIS and COHRQoL. FIS changes were the primary outcome measure, where the mean difference (MD) was calculated. RESULTS After initial search of 105 studies in the database, twenty-one articles were included in the analysis. A positive outcome in the FIS changes was identified in all studies. The combined MD for FIS using ECOHIS and COHRQoL was 1.52 [95% CI: 1.15-1.89; P < 0.00001; I2 =87%] and 1.10 [95% CI: 0.68-1.52; P < 0.00001; I2 =79%], respectively. CONCLUSIONS Dental treatment with general anaesthesia for children had a significant positive impact on parental emotions, activity, and conflict. Following DGA, there was significant improvement in the FIS, with large MD.
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Affiliation(s)
- Joon Soo Park
- Paediatric Oral Health Research Group, School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Robert P Anthonappa
- Paediatric Oral Health Research Group, School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Nigel M King
- Paediatric Oral Health Research Group, School of Dentistry, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Colman P McGrath
- Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
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Medical Malpractice Litigation Associated With Anesthesia in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2018; 76:1606-1610. [DOI: 10.1016/j.joms.2018.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 11/18/2022]
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Arrow P, McPhee R, Atkinson D, Mackean T, Kularatna S, Tonmukayakul U, Brennan D, Palmer D, Nanda S, Jamieson L. Minimally Invasive Dentistry Based on Atraumatic Restorative Treatment to Manage Early Childhood Caries in Rural and Remote Aboriginal Communities: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10322. [PMID: 30045834 PMCID: PMC6083045 DOI: 10.2196/10322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 12/03/2022] Open
Abstract
Background The caries experience of Aboriginal children in Western Australia (WA) and elsewhere in Australia is more than twice that of non-Aboriginal children. Early childhood caries (caries among children <6 years) has a significant impact on the quality of life of children and their caregivers, and its management is demanding and commonly undertaken under general anesthesia. A randomized controlled trial using a minimally invasive dentistry approach based on Atraumatic Restorative Treatment (ART) in metropolitan Perth, WA, has demonstrated a significant reduction in the rate of referral to a dental specialist for dental care among children with early childhood caries, potentially reducing the need for treatment under general anesthesia. The tested approach was clinically successful and was without adverse effects on child dental anxiety. The model of ART-based primary care requires further testing and development if similar outcomes for Aboriginal children in remote and rural settings are to be achieved. Objective The study aims to develop, implement, and evaluate a remote primary care model to deliver effective primary dental services, encompassing treatment and preventive services, to Aboriginal preschool children (based on minimally invasive approaches including ART). Methods This is a two-arm parallel cluster randomized controlled study in which a test group will be provided with the intervention treatment at the start of the study and a control group will be provided with the intervention treatment 12 months after study commencement (delayed intervention). Participating communities, stratified by size of community (ie, number of children in the sample frame) and baseline caries experience, will be randomly assigned using a computer-generated block randomized list into immediate (test group) or delayed intervention (control group; provided with standard care). Informed consent will be obtained from all participants. Aboriginal research assistants will explain the study to the parents and assist the parents in completing the questionnaires. Participants in the randomized study will be examined at baseline and at 12 months follow-up by a calibrated examiner. Test group participants will subsequently be contacted and appropriate appointments coordinated for treatment. Control group participants will be provided with standard preventive care by the Aboriginal Health Workers and managed for treatment as per standard procedures. Results Community consultations have been undertaken and 26 communities have agreed to participate. Fieldwork is in progress to recruit study participants. Conclusions The significance of the study lies in its holistic approach to testing the model of care. Clinical evaluations as well as oral health‒related quality of life evaluations will be undertaken. Cost-effectiveness and cost-utility evaluations will assist in the development of policy options for oral health services for rural and remote communities. The elicitation of caregiver perspectives through focus group interviews will supplement the clinical, psychosocial, and cost-utility evaluations and provide a richer evaluation of the intervention. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616001537448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371735 (Archived by WebCite at http://www.webcitation.org/70UMxndFZ) Registered Report Identifier RR1-10.2196/10322
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Affiliation(s)
- Peter Arrow
- Western Australia Dental Health Services, Research and Evaluation, Health Department of Western Australia, Perth, Australia
| | - Rob McPhee
- Kimberley Aboriginal Medical Services, Broome, Australia
| | - David Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, Perth, Australia
| | - Tamara Mackean
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | | | - David Brennan
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - David Palmer
- Community Development, Community Development, Murdoch University, Perth, Australia
| | - Soniya Nanda
- Health Department Western Australia, Office of Chief Dental Officer, Perth, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
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Mason KP, Burkle CM. Do patients require "escorts" or "carers" for discharge following day surgery and office-based anesthesia? Both sides of the debate explored. Minerva Anestesiol 2018; 84:980-986. [DOI: 10.23736/s0375-9393.17.12450-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Spera AL, Saxen MA, Yepes JF, Jones JE, Sanders BJ. Office-Based Anesthesia: Safety and Outcomes in Pediatric Dental Patients. Anesth Prog 2018; 64:144-152. [PMID: 28858554 DOI: 10.2344/anpr-64-04-05] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The number of children with caries requiring general anesthesia to achieve comprehensive dental care and the demand for dentist anesthesiologists to provide ambulatory anesthesia for these patients is increasing. No current published studies examine the safety and outcomes of ambulatory anesthesia performed by dentist anesthesiologists for dental procedures in pediatric patients, and there is no national requirement for reporting outcomes of these procedures. In 2010, the Society for Ambulatory Anesthesia Clinical Outcomes Registry was developed. This Web-based database allows providers of ambulatory anesthesia to track patient demographics and various outcomes of procedures. Our study is a secondary analysis of data collected in the registry over a 4-year period, 2010-2014. Of the 7041 cases reviewed, no cases resulted in serious complications, including death, anaphylaxis, aspiration, cardiovascular adverse events, or neurologic adverse events. Of the 7041 cases reviewed, 196 (3.0%) resulted in a predischarge or postdischarge adverse event. The predischarge adverse event occurring with the highest frequency was laryngospasm, occurring in 35 cases (0.50%). The postdischarge adverse event occurring with the highest frequency was nausea, reported by 99 patients (5.0%). This study provides strong clinical outcomes data to support the safety of office-based anesthesia as performed by dentist anesthesiologists in the treatment of pediatric dental patients.
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Affiliation(s)
- Allison L Spera
- Pediatric Dental Resident, Department of Pediatric Dentistry, Riley Hospital for Children/Indiana University School of Dentistry, Indianapolis, Indiana
| | - Mark A Saxen
- Adjunct Clinical Associate Professor, Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, Indiana
| | - Juan F Yepes
- Associate Professor of Pediatric Dentistry, Riley Hospital for Children/Indiana University School of Dentistry, Indianapolis, Indiana
| | - James E Jones
- Starkey Research Professor and Chair, Department of Pediatric Dentistry, Riley Hospital for Children/Indiana University School of Dentistry, Adjunct Clinical Professor of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian J Sanders
- Program Director and Professor, Department of Pediatric Dentistry, Riley Hospital for Children/Indiana University School of Dentistry, Indianapolis, Indiana
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Oral health-related quality of life changes in children following dental treatment under general anaesthesia: a meta-analysis. Clin Oral Investig 2018; 22:2809-2818. [DOI: 10.1007/s00784-018-2367-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 01/25/2018] [Indexed: 12/16/2022]
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Berglas NF, Battistelli MF, Nicholson WK, Sobota M, Urman RD, Roberts SCM. The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review. PLoS One 2018; 13:e0190975. [PMID: 29304180 PMCID: PMC5755935 DOI: 10.1371/journal.pone.0190975] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/23/2017] [Indexed: 11/27/2022] Open
Abstract
Background Over recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes—for any procedure—is unclear. Methods and findings We conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions. Conclusions More and higher quality research is needed to determine if there is a public health problem to be addressed through facility regulation and, if so, which facility characteristics may result in consistent improvements to patient safety while not adversely affecting patient experience or service availability.
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Affiliation(s)
- Nancy F. Berglas
- Advancing New Standards in Reproductive Health, University of California, San Francisco (UCSF), Oakland, California, United States of America
- * E-mail:
| | - Molly F. Battistelli
- Advancing New Standards in Reproductive Health, University of California, San Francisco (UCSF), Oakland, California, United States of America
| | - Wanda K. Nicholson
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Mindy Sobota
- Rhode Island Hospital, Alpert Medical School at Brown University, Providence, Rhode Island, United States of America
| | - Richard D. Urman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarah C. M. Roberts
- Advancing New Standards in Reproductive Health, University of California, San Francisco (UCSF), Oakland, California, United States of America
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Office Anesthesia in Dentistry:. Dela J Public Health 2018; 4:42-47. [PMID: 34466953 PMCID: PMC8396579 DOI: 10.32481/djph.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lee H, Milgrom P, Huebner CE, Weinstein P, Burke W, Blacksher E, Lantos JD. Ethics Rounds: Death After Pediatric Dental Anesthesia: An Avoidable Tragedy? Pediatrics 2017; 140:peds.2017-2370. [PMID: 29114060 DOI: 10.1542/peds.2017-2370] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/24/2022] Open
Abstract
Early childhood caries (ECC) is the single most common chronic childhood disease. In the treatment of ECC, children are often given moderate sedation or general anesthesia. An estimated 100 000 to 250 000 pediatric dental sedations are performed annually in the United States. The most common medications are benzodiazepines, opioids, local anesthetics, and nitrous oxide. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction, and death. There is no mandated reporting of adverse events or deaths, so we don't know how often these occur. In this article, we present a case of a death after dental anesthesia and ask experts to speculate on how to improve the quality and safety of both the prevention and treatment of ECC.
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Affiliation(s)
- Helen Lee
- Department of Anesthesiology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | | | | | - Wylie Burke
- Bioethics and Humanities, University of Washington, Seattle, Washington; and
| | - Erika Blacksher
- Bioethics and Humanities, University of Washington, Seattle, Washington; and
| | - John D Lantos
- Pediatric Bioethics Center, Children's Mercy Kansas City, Kansas City, Missouri
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King BJ, Levine A. Controversies in Anesthesia for Oral and Maxillofacial Surgery. Oral Maxillofac Surg Clin North Am 2017; 29:515-523. [PMID: 28987231 DOI: 10.1016/j.coms.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The future of office-based anesthesia for oral and maxillofacial surgery is at risk. Oral and maxillofacial surgeons have been on the forefront of providing safe and effective outpatient anesthesia for decades. Recent changes in Medicare policies have had, and will continue to have, a significant effect on the training of oral and maxillofacial surgery residents regarding anesthesia. The outcome of these changes can have a major effect on the specialty of oral and maxillofacial surgery and a cornerstone of the profession.
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Affiliation(s)
- Brett J King
- Department of Oral and Maxillofacial Surgery and General Surgery, LSU Health New Orleans, University Medical Center-New Orleans, Children's Hospital of New Orleans, Touro Infirmary, 1100 Florida Avenue, Box 220, New Orleans, LA 70119, USA.
| | - Adam Levine
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Pharmacological Sciences, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Otolaryngology, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Facco E, Zanette G. The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review. Front Psychol 2017; 8:1155. [PMID: 28744243 PMCID: PMC5504153 DOI: 10.3389/fpsyg.2017.01155] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/26/2017] [Indexed: 12/23/2022] Open
Abstract
Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for medical emergencies in the dental office, so their prevention is an essential part of patient safety and overall quality of care. Being DA and its consequences closely related to the fight-or-flight reaction, it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. Archeological findings suggest that humans have been surprisingly skillful and knowledgeable since prehistory. Neanderthals used medicinal plants; and relics of dental tools bear witness to a kind of Neolithic proto-dentistry. In the two millennia BC, Egyptian and Greek physicians used both plants (such as papaver somniferum) and incubation (a forerunner of modern hypnosis, e.g., in the sleep temples dedicated to Asclepius) in the attempt to provide some form of therapy and painless surgery, whereas modern scientific medicine strongly understated the role of subjectivity and mind-body approaches until recently. DA has a wide range of causes and its management is far from being a matter of identifying the ideal sedative drug. A patient's proper management must include assessing his/her dental anxiety, ensuring good communications, and providing information (iatrosedation), effective local anesthesia, hypnosis, and/or a wise use of sedative drugs where necessary. Any weak link in this chain can cause avoidable suffering, mistrust, and emergencies, as well as having lifelong psychological consequences. Iatrosedation and hypnosis are no less relevant than drugs and should be considered as primary tools for the management of DA. Unlike pharmacological sedation, they allow to help patients cope with the dental procedure and also overcome their anxiety: achieving the latter may enable them to face future dental care autonomously, whereas pharmacological sedation can only afford a transient respite.
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Affiliation(s)
- Enrico Facco
- Studium Patavinum, University of PaduaPadua, Italy.,Franco Granone Institute - Italian Center of Clinical & Experimental Hypnosis (CIICS)Turin, Italy
| | - Gastone Zanette
- Franco Granone Institute - Italian Center of Clinical & Experimental Hypnosis (CIICS)Turin, Italy.,Chair of Dental Anesthesia, Department of Neurosciences, University of PaduaPadua, Italy
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Mortazavi H, Baharvand M, Safi Y. Death Rate of Dental Anaesthesia. J Clin Diagn Res 2017; 11:ZE07-ZE09. [PMID: 28764309 DOI: 10.7860/jcdr/2017/24813.10009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/04/2016] [Indexed: 11/24/2022]
Abstract
Death was the most important side effect of anaesthesia in dentistry. In this article we reviewed more than 20 studies with adequate data focusing on death associated with dental procedures since 1955 and found 218 deaths out of 71,435,282 patients (3 deaths per 1,000,000 persons) with the mortality rate of 1:327,684. In addition, mortality rate per million has dropped to half (6.2 per 1,000,000 vs. 3 per 1,000,000) since 1955 till the last report in 2012 without any sex predilection. In children, most cases died in the age of two to five years. Hypoxia was the most common cause of death, and cardiovascular, respiratory, and endocrine disorders, hepatic cirrhosis, septicaemia, and bacterial endocarditis were the most frequent underlying systemic disease in deceased patients. Although rare death following general anaesthesia in dentistry, is a critical side effect mostly seen in patients with compromised health condition. Therefore, appropriate case selection in regard with patients' general health status as well as standard technical and equipment conditions are mandatory to diminish the risk of death during dental anaesthesia.
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Affiliation(s)
- Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Baharvand
- Department of Oral Medicine, School of Dentistry, Oral Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Molina GF, Faulks D, Mazzola I, Cabral RJ, Mulder J, Frencken JE. Three-year survival of ART high-viscosity glass-ionomer and resin composite restorations in people with disability. Clin Oral Investig 2017; 22:461-467. [PMID: 28547182 DOI: 10.1007/s00784-017-2134-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. MATERIALS AND METHODS Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36 months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3 years. RESULTS Sixty-six patients (13.6 ± 7.8 years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8 ± 2.1 and 82.8 ± 5.3%, respectively (p = 0.01). CONCLUSIONS The 3-year follow-up results confirm that ART is an effective treatment protocol. CLINICAL RELEVANCE Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach.
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Affiliation(s)
- Gustavo F Molina
- Universidad Nacional de Córdoba, Av. Maipú 177 4°, B - 5000, Córdoba, Argentina.
| | - Denise Faulks
- Service d'Odontologie, CHU Clermont-Ferrand, Université Clermont Auvergne, CROC EA4847, Clermont-Ferrand, France
| | - Ignacio Mazzola
- Universidad Nacional de Córdoba, Av. Maipú 177 4°, B - 5000, Córdoba, Argentina
| | - Ricardo J Cabral
- Universidad Nacional de Córdoba, Av. Maipú 177 4°, B - 5000, Córdoba, Argentina
| | - Jan Mulder
- Department of Functional Dentition and Prosthetic Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jo E Frencken
- Department of Functional Dentition and Prosthetic Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
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Jirativanont T, Manomayangkul K, Udomphorn Y, Yokubol B, Saguansab A, Kraiprasit K, Punchuklang W. Incidence and risk factors for adverse events during anesthesiologist-led sedation or anesthesia for diagnostic imaging in children: a prospective, observational cohort study. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0905.436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Pediatric sedation for diagnostic radiological procedures remains the mainstay for adequate imaging quality.
Objectives
To clarify the risk of adverse events during anesthesiologist-led sedation or anesthesia for diagnostic radiological procedures in children in order to improve quality of care.
Methods
We enrolled children aged <15 years given sedation or anesthesia by an anesthesiologist and scheduled for computed tomography, magnetic resonance imaging, or nuclear medicine imaging November 2010-September 2014. We recorded adverse events occurring in the first 24 h.
Results
Of 1,042 patients enrolled, adverse events were recorded in 254 (24.4%, 95% confidence interval [CI] 21.9 to 27.1). Adverse respiratory events occurred in 31 (3.0%), cardiovascular events in 7 (0.7%), sedation was prolonged in 165 (15.8%), there was one case of contrast allergy (0.01%), and there were 50 other minor complications (4.9%). Of the respiratory complications, there were 14 of airway obstruction (1.3%), 2 of apnea (0.2%), 14 of oxygen desaturation (1.3%), and one of laryngospasm (0.01%). There were no life threatening complications or consequences. Age <1 year (adjusted odds ratio [adjusted OR] 2.5, 95% CI 1.2 to 5.3) and American Society of Anesthesiologists (ASA) physical status classification 2 and 3 (adjusted OR 4.6, 95% CI 1.1 to 19.8, and adjusted OR 6.3, 95% CI 1.3 to 30.9, respectively) were risk factors for respiratory complications.
Conclusions
Adverse events were common during sedation or anesthesia, but no life threatening or sentinel events occurred under experienced supervision. Caution should be exercised in children <1 year or with an ASA classification >1.
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Affiliation(s)
- Tachawan Jirativanont
- Department of Anesthesiology , Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Kattiya Manomayangkul
- Department of Anesthesiology , Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Yuthana Udomphorn
- Department of Anesthesiology , Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Bencharatana Yokubol
- Department of Anesthesiology , Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Amorn Saguansab
- Department of Anesthesiology , Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Kanitha Kraiprasit
- Department of Anesthesiology , Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Wiruntri Punchuklang
- Department of Anesthesiology , Faculty of Medicine, Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
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69
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Tonmukayakul U, Arrow P. Cost-effectiveness analysis of the atraumatic restorative treatment-based approach to managing early childhood caries. Community Dent Oral Epidemiol 2016; 45:92-100. [PMID: 27859533 DOI: 10.1111/cdoe.12265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/02/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Paediatric dental care under general anaesthesia among preschool children in Western Australia is increasing and costly. This study assessed cost-effectiveness of the atraumatic restorative treatment-based (ART-based) approach against the standard care (SC) approach to managing early childhood caries in a primary care setting based on a 1-year pragmatic randomized controlled trial. METHODS Cost-effectiveness analysis, from the service provider perspective, was conducted. Outcomes include number of referral to specialists and dental treatments. One-way and probabilistic sensitivity analyses were undertaken to test the robustness of the cost-effectiveness estimates. RESULTS Six children in the ART-based group and 62 children in the SC group (n = 127 each group) were referred for paediatric dental specialist care. Children in the ART-based group received more dental services than those allocated to the SC group (mean = 3.8, SD 2.0 and mean = 1.8, SD 1.8, respectively, Wilcoxon rank-sum test, P < 0.01). Total costs of the ART-based approach and the SC group were $137 860 and $178 217, respectively. Based on probabilistic sensitivity analysis, $654 was saved per referral to specialist avoided and $36 was saved per additional dental treatment. The probability that the ART-based approach is cost-saving was 63%. Specialist dental treatment fees had a big impact on the cost-effectiveness estimates. CONCLUSION The ART-based approach appears to be a worthwhile intervention because it resulted in fewer referred cases and enabled more treatments to be provided with cost-savings.
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Affiliation(s)
- Utsana Tonmukayakul
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Peter Arrow
- Australian Research Centre for Population Oral Health, Adelaide Dental School, the University of Adelaide, Adelaide, South Australia, Australia.,Dental Health Services, Health Department Western Australia, Perth, Western Australia, Australia
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70
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Reuter NG, Westgate PM, Ingram M, Miller CS. Death related to dental treatment: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:194-204.e10. [PMID: 27989710 DOI: 10.1016/j.oooo.2016.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to identify factors associated with death in relation to dental care. STUDY DESIGN A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Dental and Oral Sciences Source, Web of Science, and the Cochrane database were searched, and the references of all retrieved articles were analyzed. Studies were included if death had occurred within 90 days of the dental appointment, and if the patient's age, procedure, and information regarding cause or time of death were provided. Factors associated with death were assessed by multivariate analyses and logistic regression. RESULTS Fifty-six publications, including retrospective studies and case reports/series that reported 148 fatalities, were analyzed. On average, 2.6 deaths were reported per year. The leading cause of deaths was anesthesia/sedation/medication-related complications (n = 70). Other causes were cardiovascular events (n = 31), infection (n = 19), airway-respiratory complications (n = 18), bleeding (n = 5), and others (n = 5). Age (P < .0001), disease severity (P < .02), disease stability (P < .006), dental provider characteristics (P < .05), level of consciousness/sedation (P < .02), and drug effects (P < .03) had significant associations with death. CONCLUSIONS Reports of death were rare; however, specific risk factors associated with dentistry were identified. A better understanding of these factors is important for the development of guidelines that help prevent fatalities in dentistry.
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Affiliation(s)
- Nathan G Reuter
- Department of Oral Health Practice, University of Kentucky, Lexington, KY, USA
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Mark Ingram
- Medical Library, University of Kentucky, Lexington, KY, USA
| | - Craig S Miller
- Department of Oral Health Practice, University of Kentucky, Lexington, KY, USA; Center for Oral Health Research, College of Dentistry, and University of Kentucky, Lexington, KY, USA.
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Coté CJ, Wilson S. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016. Pediatrics 2016; 138:peds.2016-1212. [PMID: 27354454 DOI: 10.1542/peds.2016-1212] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.
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72
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Arrow P, Klobas E. Child oral health-related quality of life and early childhood caries: a non-inferiority randomized control trial. Aust Dent J 2016; 61:227-35. [DOI: 10.1111/adj.12352] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- P Arrow
- Western Australian Department of Health and Dental Health Service; Western Australia Australia
- Australian Research Centre for Population Oral Health; The University of Adelaide; South Australia Australia
| | - E Klobas
- Western Australian Department of Health and Dental Health Service; Western Australia Australia
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73
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Southerland JH, Brown LR. Conscious Intravenous Sedation in Dentistry: A Review of Current Therapy. Dent Clin North Am 2016; 60:309-346. [PMID: 27040288 DOI: 10.1016/j.cden.2015.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Several sedation options are used to minimize pain, anxiety, and discomfort during oral surgery procedures. Minimizing or eliminating pain and anxiety for dental care is the primary goal for conscious sedation. Intravenous conscious sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate as well as cardiovascular function. Patients must retain their protective airway reflexes, and respond to and understand verbal communication. The drugs and techniques used must therefore carry a broad margin of safety.
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Affiliation(s)
- Janet H Southerland
- Department of Oral and Maxillofacial Surgery, Meharry Medical College School of Dentistry, 1005 Dr. DB Todd Jr. Boulevard, Nashville, TN 37208, USA.
| | - Lawrence R Brown
- Dadeland Oral Surgery Associates, 8950 S.W. 74th Court, Suite 1610, Miami Florida 33156; Baptist Hospital Of Miami, 8900 North Kendall Drive, Miami Florida 33176
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74
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Ramazani N. Different Aspects of General Anesthesia in Pediatric Dentistry: A Review. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e2613. [PMID: 27307962 PMCID: PMC4904485 DOI: 10.5812/ijp.2613] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/30/2015] [Accepted: 11/11/2015] [Indexed: 11/16/2022]
Abstract
Context Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. Evidence Acquisition A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings. Results Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical. Conclusions Besides criteria for case selection of dental GA, some degree of dental practitioner’s judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes.
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Affiliation(s)
- Nahid Ramazani
- Children and Adolescent Health Research Center, Oral and Dental Disease Research Center, Department of Pediatric Dentistry, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Nahid Ramazani, Department of Pediatric Dentistry, School of Dentistry, Azadegan St, Khorramshahr Ave, Zahedan, IR Iran. Tel: +98-5433414005, Fax: +98-5433420927, E-mail:
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75
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Threats to safety during sedation outside of the operating room and the death of Michael Jackson. Curr Opin Anaesthesiol 2016; 29 Suppl 1:S36-47. [DOI: 10.1097/aco.0000000000000318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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76
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Harbuz DK, O'Halloran M. Techniques to administer oral, inhalational, and IV sedation in dentistry. Australas Med J 2016; 9:25-32. [PMID: 26989448 DOI: 10.4066/amj.2015.2543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sedation in dentistry is a controversial topic given the variety of opinions regarding its safe practice. AIMS This article evaluates the various techniques used to administer sedation in dentistry and specific methods practiced to form a recommendation for clinicians. METHODS An extensive literature search was performed using PubMed, Medline, Google Scholar, Google, and local library resources. RESULTS Most of the literature revealed a consensus that light sedation on low-risk American Society of Anesthesiologists (ASA) groups, that is ASA I, and possibly II, is the safest method for sedation in a dental outpatient setting. CONCLUSION Formal training is essential to achieve the safe practice of sedation in dentistry or medicine. The appropriate setting for sedation should be determined as there is an increased risk outside the hospital setting. Patients should be adequately assessed and medication titrated appropriately, based on individual requirements.
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Affiliation(s)
| | - Michael O'Halloran
- School of Dentistry, University of Western Australia, Perth, WA, Australia
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Whitley DR. Integrative Literature Review: Ascertaining Discharge Readiness for Pediatrics After Anesthesia. J Perianesth Nurs 2016; 31:23-35. [PMID: 26847777 DOI: 10.1016/j.jopan.2014.08.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 08/03/2014] [Accepted: 08/09/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Unplanned hospital readmissions after the administration of general anesthesia for ambulatory procedures may contribute to loss of reimbursement and assessment of financial penalties. Pediatric patients represent a unique anesthetic risk. The purpose of this integrative literature review was to ascertain specific criteria used to evaluate discharge readiness for pediatric patients after anesthesia. DESIGN This study is an integrative review of literature. METHODS An integrative literature search was conducted and included literature sources dated January 2008 to November 2013. Key words included pediatric, anesthesia, discharge, criteria, standards, assessment, recovery, postoperative, postanesthesia, scale, score, outpatient, and ambulatory. FINDING Eleven literature sources that contributed significantly to the research question were identified. Levels of evidence included three systematic reviews, one randomized controlled trial, three cohort studies, two case series, and two expert opinions. CONCLUSIONS AND IMPLICATIONS This integrative literature review revealed evidence-based discharge criteria endorsing home readiness for postanesthesia pediatric patients should incorporate consideration for physiological baselines, professional judgment with regard to infant consciousness, and professional practice standards/guidelines. Additionally, identifying and ensuring discharge to a competent adult was considered imperative. Nurses should be aware that frequently used anesthesia scoring systems originated in the 1970s, and this review was unable to locate current literature examining the reliability and validity of their use in conjunction with modern anesthesia-related health care practices.
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78
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Merigo E, Fornaini C, Clini F, Fontana M, Cella L, Oppici A. Er:YAG laser dentistry in special needs patients. Laser Ther 2015; 24:189-93. [PMID: 26557733 DOI: 10.5978/islsm.15-cr-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Between a quarter and a third of adults with intellectual disability is estimated to have dental anxiety. Unpleasant stimuli, such as the injection of local anaesthesia or the noise and vibration of rotary instruments, may provoke anxiety and subsequent low compliance until the opposition to the treatment. The use of Er:YAG laser in conservative dentistry had a great development in these last years thank to new devices and also to their advantages when compared to the conventional instruments. The aim of this clinical study was to show the advantages of the Er:YAG laser in the conservative treatment of Special Care patients. METHODS Four cases are here described to show the Er:YAG laser use in our Unit on special needs patients. RESULTS AND CONCLUSIONS Based on the experience gained on conservative laser-assisted treatments performed in a time of 5 years at our Dentistry, Special Needs and Maxillo-Facial Surgery Unit we may affirm that Er:YAG laser may be considered as a good way to improve the cooperation, to reduce anxiety related to rotating instruments and to reach better results with equal or shorter operating times.
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Affiliation(s)
- Elisabetta Merigo
- Dentistry, Special Needs and Maxillo-Facial Surgery Unit - Hospital "Guglielmo da Saliceto" - Piacenza
| | - Carlo Fornaini
- Dentistry, Special Needs and Maxillo-Facial Surgery Unit - Hospital "Guglielmo da Saliceto" - Piacenza
| | - Fabio Clini
- Dentistry, Special Needs and Maxillo-Facial Surgery Unit - Hospital "Guglielmo da Saliceto" - Piacenza
| | - Matteo Fontana
- Dentistry, Special Needs and Maxillo-Facial Surgery Unit - Hospital "Guglielmo da Saliceto" - Piacenza
| | - Luigi Cella
- Dentistry, Special Needs and Maxillo-Facial Surgery Unit - Hospital "Guglielmo da Saliceto" - Piacenza
| | - Aldo Oppici
- Dentistry, Special Needs and Maxillo-Facial Surgery Unit - Hospital "Guglielmo da Saliceto" - Piacenza
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Abstract
High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques.
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Affiliation(s)
- Travis M Nelson
- Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA
| | - Zheng Xu
- Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA
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80
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Molina GF, Faulks D, Frencken J. Acceptability, feasibility and perceived satisfaction of the use of the Atraumatic Restorative Treatment approach for people with disability. Braz Oral Res 2015; 29:S1806-83242015000100292. [PMID: 26247515 DOI: 10.1590/1807-3107bor-2015.vol29.0097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/04/2015] [Indexed: 11/22/2022] Open
Abstract
Unmet caries treatment need is prevalent among people with disability, partly due to difficulties cooperating with conventional dental treatment. This study compared Atraumatic Restorative Treatment (ART) with conventional restorative treatment (CRT) in the clinic and under general anaesthesia (GA), in terms of feasibility, acceptability and respondent satisfaction in patients referred for special care dentistry. Patients referred for dental restorative care were treated using either ART or CRT approach. Acceptance, feasibility and level of satisfaction with the treatment provided were assessed. ANOVA with Bonferroni correction and Chi-square tests investigated differences in age, gender and Visual Analogue Scale satisfaction scores. A total of 66 patients (mean 13.6 ± 7.8 years) were included and 43 respondents chose ART. ART was feasible for 47 patients, with optimal placement of restorations for 79% of all patients receiving ART. CRT in the clinic was chosen by 15 respondents and was feasible for 5 (33%). Local anaesthesia was required for 4 of the 47 patients receiving ART and for 3 of the 5 patients receiving CRT in the clinic. Neither ART nor CRT could be performed in the clinic for 14 patients who were treated under GA (21%). Respondent satisfaction was higher for those receiving ART than CRT (in the clinic and under GA). It was concluded that ART is a satisfactory, feasible, acceptable and effective approach to restorative dental treatment in patients with disability who have difficulty coping with conventional treatment. More research is now required to confirm these results in a larger study population.
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Affiliation(s)
- Gustavo Fabián Molina
- Department of Dental Materials, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Denise Faulks
- CHU Clermont-Ferrand, Université d'Auvergne, Clermont Ferrand, France
| | - Joannes Frencken
- Department of Global Oral Health, College of Dental Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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81
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Kranz AM, Preisser JS, Rozier RG. Effects of Physician-Based Preventive Oral Health Services on Dental Caries. Pediatrics 2015; 136:107-14. [PMID: 26122805 PMCID: PMC4485004 DOI: 10.1542/peds.2014-2775] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most Medicaid programs reimburse nondental providers for preventive dental services. We estimate the impact of comprehensive preventive oral health services (POHS) on dental caries among kindergarten students, hypothesizing improved oral health among students with medical visits with POHS. METHODS We conducted a retrospective study in 29,173 kindergarten students by linking Medicaid claims (1999-2006) with public health surveillance data (2005-2006). Zero-inflated regression models estimated the association between number of visits with POHS and (1) decayed, missing, and filled primary teeth (dmft) and (2) untreated decayed teeth while adjusting for confounding. RESULTS Kindergarten students with ≥4 POHS visits averaged an adjusted 1.82 dmft (95% confidence interval: 1.55 to 2.09), which was significantly less than students with 0 visits (2.21 dmft; 95% confidence interval: 2.16 to 2.25). The mean number of untreated decayed teeth was not reduced for students with ≥4 POHS visits compared with those with 0 visits. CONCLUSIONS POHS provided by nondental providers in medical settings were associated with a reduction in caries experience in young children but were not associated with improvement in subsequent use of treatment services in dental settings. Efforts to promote oral health in medical settings should continue. Strategies to promote physician-dentist collaborations are needed to improve continuity of care for children receiving dental services in medical settings.
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Affiliation(s)
| | | | - R. Gary Rozier
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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82
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Arrow P, Klobas E. Minimum intervention dentistry approach to managing early childhood caries: a randomized control trial. Community Dent Oral Epidemiol 2015; 43:511-20. [DOI: 10.1111/cdoe.12176] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Arrow
- Dental Health Services; Bentley Delivery Centre; Perth WA Australia
| | - Elizabeth Klobas
- Dental Health Services; Bentley Delivery Centre; Perth WA Australia
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83
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Heard C, Wanamaker C. Dental Sedation in Children. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-015-0110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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84
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Sitkin SI, Gasparian AL, Ivanova TI, Nesterova EI, Drozdova NI. [Long-term dental interventions in mentally retarded children under general anesthesia with sevoflurane]. STOMATOLOGII︠A︡ 2015; 94:59-60. [PMID: 25909619 DOI: 10.17116/stomat201594159-60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dental procedures in mentally retarded children is challenging for both dentist and for anesthesiologist. The aim of the study was to evaluate the efficacy and safety of dental care procedures under general anesthesia with sevoflurane by means of laryngeal mask in mentally retarded children. The randomized controlled study included 65 mentally retarded children with ASA 2-3 who underwent dental treatment. All patients had multiple caries. The children were divided into two groups. The first group included 35 children with normal body weigh while the second one - 30 obese children. All patients received a rapid induction with sevoflurane with the subsequent installation of the laryngeal mask. In the second group the signs of hypoventilation recorded an average of 10 ± 4 minutes after induction of anesthesia, which was manifested in increasing Pсо₂greater than 50 mm Hg. In the first group, the signs of hypoventilation marked an average of 18 ± 3.5 minutes from the start of induction of anesthesia. All patients were transferred to the artificial lung ventilation through the LMA. By dental treatment under general anesthesia with sevoflurane and laryngeal mask all mentally retarded children had respiratory depression with increased levels of carbon dioxide greater than 50 mmHg, but obese children developed these signs of hypoventilation twice as fast. Conducting long dental treatment in mentally retarded children require artificial lung ventilation.
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Affiliation(s)
- S I Sitkin
- Tverskaia gosudarstvennaia meditsinskaia akademiia Minzdrava Rossii, 170000, Tver', Rossiia
| | - A L Gasparian
- Tverskaia gosudarstvennaia meditsinskaia akademiia Minzdrava Rossii, 170000, Tver', Rossiia
| | - T Iu Ivanova
- Tverskaia gosudarstvennaia meditsinskaia akademiia Minzdrava Rossii, 170000, Tver', Rossiia
| | - E Iu Nesterova
- Tverskaia gosudarstvennaia meditsinskaia akademiia Minzdrava Rossii, 170000, Tver', Rossiia
| | - N I Drozdova
- Tverskaia gosudarstvennaia meditsinskaia akademiia Minzdrava Rossii, 170000, Tver', Rossiia
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85
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Mason K. Challenges in paediatric procedural sedation: political, economic, and clinical aspects. Br J Anaesth 2014; 113 Suppl 2:ii48-62. [DOI: 10.1093/bja/aeu387] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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86
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Molina GF, Faulks D, Mazzola I, Mulder J, Frencken JE. One year survival of ART and conventional restorations in patients with disability. BMC Oral Health 2014; 14:49. [PMID: 24885938 PMCID: PMC4017030 DOI: 10.1186/1472-6831-14-49] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 04/24/2014] [Indexed: 11/23/2022] Open
Abstract
Background Providing restorative treatment for persons with disability may be challenging and has been related to the patient’s ability to cope with the anxiety engendered by treatment and to cooperate fully with the demands of the clinical situation. The aim of the present study was to assess the survival rate of ART restorations compared to conventional restorations in people with disability referred for special care dentistry. Methods Three treatment protocols were distinguished: ART (hand instruments/high-viscosity glass-ionomer); conventional restorative treatment (rotary instrumentation/resin composite) in the clinic (CRT/clinic) and under general anaesthesia (CRT/GA). Patients were referred for restorative care to a special care centre and treated by one of two specialists. Patients and/or their caregivers were provided with written and verbal information regarding the proposed techniques, and selected the type of treatment they were to receive. Treatment was provided as selected but if this option proved clinically unfeasible one of the alternative techniques was subsequently proposed. Evaluation of restoration survival was performed by two independent trained and calibrated examiners using established ART restoration assessment codes at 6 months and 12 months. The Proportional Hazard model with frailty corrections was applied to calculate survival estimates over a one year period. Results 66 patients (13.6 ± 7.8 years) with 16 different medical disorders participated. CRT/clinic proved feasible for 5 patients (7.5%), the ART approach for 47 patients (71.2%), and 14 patients received CRT/GA (21.2%). In all, 298 dentine carious lesions were restored in primary and permanent teeth, 182 (ART), 21 (CRT/clinic) and 95 (CRT/GA). The 1-year survival rates and jackknife standard error of ART and CRT restorations were 97.8 ± 1.0% and 90.5 ± 3.2%, respectively (p = 0.01). Conclusions These short-term results indicate that ART appears to be an effective treatment protocol for treating patients with disability restoratively, many of whom have difficulty coping with the conventional restorative treatment. Trial registration number Netherlands Trial Registration:
NTR 4400
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Affiliation(s)
- Gustavo F Molina
- Cátedra de Materiales Dentales, Facultad de Odontología, Universidad Nacional de Córdoba, Av, Maipú 177 4, B - 5000 Córdoba, Argentina.
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87
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Achembong LN, Kranz AM, Rozier RG. Office-based preventive dental program and statewide trends in dental caries. Pediatrics 2014; 133:e827-34. [PMID: 24685954 PMCID: PMC5002973 DOI: 10.1542/peds.2013-2561] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To evaluate the impact of a North Carolina Medicaid preventive dentistry program in primary care medical offices (Into the Mouths of Babes Program [IMBP]) on decayed, missing, and filled teeth (dmft) of kindergarten students statewide and in schools with a large proportion of students from low-income families. METHODS An ecologic study using panel data of 920,505 kindergarten students with 11,694 school-year observations examined the effect of the IMBP on dmft scores from 1998 to 2009. Ordinary least squares regression with fixed effects determined the association between IMBP visits per child 0 to 4 years of age per county and mean dmft scores per kindergarten student per school, controlling for school-level poverty and ethnicity, county-level Medicaid enrollment, and supply of dentists and physicians. RESULTS Mean dmft per kindergarten student per school increased from 1.53 in 1998 to 1.84 in 2004, then decreased to 1.59 in 2009. The mean number of IMBP visits per child 0 to 4 years of age per county increased from 0.01 in 2000 to 0.22 in 2009. A 1-unit increase in IMBP visits per county was associated with a 0.248 (95% confidence interval, -0.40 to -0.10) decrease in dmft per kindergarten student per school. For schools with more students at high risk for dental disease, a 1-unit increase in IMBP visits was associated with a 0.320 (95% confidence interval, -0.55 to -0.09) decrease in dmft. CONCLUSIONS IMBP reduced dental caries among targeted vulnerable children, which helped reduce oral health disparities among preschool-aged children in North Carolina.
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Affiliation(s)
- Leo N. Achembong
- Oral Health Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina; and
| | | | - R. Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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88
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Benzon HA, De Oliveira GS, Hardy CA, Suresh S. Status of pediatric anesthesiology fellowship research education in the United States: a survey of fellowship program directors. Paediatr Anaesth 2014; 24:327-31. [PMID: 24308729 DOI: 10.1111/pan.12321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently, very little information is known regarding the research education of pediatric anesthesia fellows. OBJECTIVE The main objective of the current investigation was to evaluate the status of research training in pediatric anesthesia fellowship programs in the United States. METHODS Survey responses were solicited from forty-six pediatric anesthesia fellowship directors. Questions evaluated department demographic information, the extent of faculty research activity, research resources and research funding in the department, the characteristics of fellow research education and fellow research productivity, departmental support for fellow research, and perceived barriers to fellow research education. RESULTS Thirty-six of forty-six fellowship directors responded to the survey, for a response rate of 78%. Eight of fourteen (57%) programs with a structured curriculum had more than 20% of graduating fellows publish a peer-reviewed manuscript compared with only five of twenty-two (23%) programs, which did not have a structured research curriculum (P = 0.03). While the majority of program directors (thirty of thirty-six (83%)) did not think that fellows are adequately trained to pursue research activities, only a minority of program directors (7 of 36 (19%)) thought that an extra year of fellowship dedicated to research should become a requirement. CONCLUSION Structured research curriculum is associated with increased research productivity during pediatric anesthesia fellowship. Important barriers to fellows' research education include high clinical demands and lack of research time for faculty. Despite acknowledging the poor research education, a small minority of fellowship directors supports the addition of an extra year exclusively dedicated to research.
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Affiliation(s)
- Hubert A Benzon
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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89
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O'Halloran M. The use of anaesthetic agents to provide anxiolysis and sedation in dentistry and oral surgery. Australas Med J 2013; 6:713-8. [PMID: 24391684 DOI: 10.4066/amj.2013.1836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Throughout the world there is considerable variation in the techniques used to manage anxious dental patients requiring treatment. Traditionally anxious or phobic dental patients may have been sent for general anaesthesia to allow dental treatment be undertaken. While this is still the case for the more invasive oral surgical procedures, such as wisdom teeth extraction, sedation in general dentistry is becoming more popular. Various sedation techniques using many different anaesthetic agents have gained considerable popularity over the past 30 years. While the practice of sedating patients for dental procedures is invaluable in the management of suitably assessed patients, patient safety must always be the primary concern. Medical, dental and psychosocial considerations must be taken into account when evaluating the patient need and the patient suitability for sedation or general anaesthesia. The regulations that govern the practice of dental sedation vary throughout the world, in particular regarding the techniques used and the training necessary for dental practitioners to sedate patients. It is necessary for medical and dental practitioners to be up to date on current practice to ensure standards of practice, competence and safety throughout our profession. This article, the first in a two-part series, will provide information to practitioners on the practice of sedation in dentistry, the circumstances where it may be appropriate instead of general anaesthesia and the risks involved with sedation. It will also discuss the specific training and qualifications required for dental practitioners to provide sedation. The second article in this series will outline the different techniques used to administer inhalation, oral and intravenous sedation in dentistry and will focus on specific methods that are practiced.
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90
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Sterzik V, Tatschner T, Roewer N, Barrera D, Bohnert M. Fatal visit to the dentist. Int J Legal Med 2013; 129:219-22. [PMID: 24202697 DOI: 10.1007/s00414-013-0930-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/10/2013] [Indexed: 11/30/2022]
Abstract
A 23-year-old woman was mortally afraid of dental interventions and decided to have her four wisdom teeth removed by outpatient surgery under endotracheal anaesthesia. According to the files, the patient was categorized as ASA I and Mallampati II, and surgery was considered an elective routine intervention. Soon after initiation of anaesthesia, O2 saturation and blood pressure dropped, and the young woman died shortly afterwards in spite of immediate resuscitation measures. At first, an allergic reaction to succinylcholine, which had been administered as a muscle relaxant, was suspected. Autopsy and histological examination showed haemorrhagic pulmonary oedema and a defined lesion in the midportion of the oesophageal mucosa in spite of correct placement of the endotracheal breathing tube. Ultimately, misintubation into the oesophagus, which had not been noticed at first, was determined as cause of death.
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Affiliation(s)
- Vera Sterzik
- Institut für Rechtsmedizin, Julius-Maximilians-Universität, Versbacher Str. 3, 97078, Würzburg, Germany,
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91
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Beck G. Not a disease entity. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:751. [PMID: 24280431 PMCID: PMC3831241 DOI: 10.3238/arztebl.2013.0751a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Grietje Beck
- *Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Dr. Horst Schmidt Kliniken GmbH, Klinikum der Landeshauptstadt Wiesbaden,
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