Factors affecting clinical outcome following treatment of early childhood caries under general anaesthesia: a two-year follow-up

Evaluation of Clinical Success, Caries Recurrence, and Oral Health-Related Quality of Life of Children Undergoing Full Mouth Rehabilitation for Early Childhood Caries: A Prospective Cohort Study

AIM

This prospective cohort study aimed to assess the clinical success, caries recurrence, and oral health-related quality of life of children undergoing full mouth rehabilitation for early childhood caries under general anesthesia. The study sought to understand the long-term impact of these interventions on early childhood caries (ECC) management.

METHODOLOGY

The study included 300 children aged three to six years diagnosed with ECC requiring full mouth rehabilitation under general anesthesia. The assessment included clinical success of various dental treatments, caries recurrence rates, and oral health-related quality of life using the Early Child Oral Health Impact Scale at baseline, 12 months, and 24 months post-treatment. Specialized caries preventive protocols were implemented, including education on oral hygiene, reminders, and nutritional guidance.

RESULTS

272 children attended the 12-month follow-up, out of which 11 children had new carious lesions. Two hundred fifty-two children were reported for the 24-month follow-up, in which 19 children reported new carious lesions. The clinical success rate of treatment was found to be high. The oral health-related quality of life showed a significant and sustained improvement from baseline to 12 months and further improvement at 24 months post-treatment.

CONCLUSION

Full mouth rehabilitation under general anesthesia is an effective approach for managing ECC in young children, with high clinical success rates and significant improvements in the oral health-related quality of life over two years. Preventive oral health strategies are necessary to maintain these positive outcomes and improve the overall well-being of affected children.

Evaluation of Factors Affecting Clinical Outcomes of Full Mouth Rehabilitation Under General Anaesthesia for Children With Early Childhood Caries: A Prospective Cohort Study

AIM

This study was designed to evaluate the factors affecting the clinical outcomes of full mouth rehabilitation under general anaesthesia for children with early childhood caries (ECCs).

MATERIALS AND METHODS

A prospective cohort of 200 children with early childhood caries and requiring dental rehabilitation under general anaesthesia was evaluated and treated. Children were recalled at six-month intervals for a period of two years and evaluated for the recurrence of caries and the need for repeat treatment of failed cases.

RESULTS

86.5% of the patients adhered to the six-month recall visits for 24 months. An overall caries recurrence rate of 14.5% was seen. Children who did not adhere to the follow-up plan and visited ad hoc had the highest caries recurrence rate (88%).

CONCLUSION

Good compliance with postoperative instructions after full mouth rehabilitation resulted in good oral hygiene and a limited recurrence of caries. Patients with poor compliance with recall visits and postoperative instructions had high rates of caries recurrence. Rehabilitation under general anaesthesia can be considered a viable treatment option for children diagnosed with early childhood caries.

Incidence and risk factors of unplanned retreatment following dental general anesthesia in children with severe early childhood caries

Objective

This study aimed to retrospectively describe the unplanned retreatment of dental general anesthesia (DGA) in children with severe early childhood caries (S-ECC) and explore potential factors that may influence the outcome of DGA treatment.

Methods

Medical records of children with S-ECC who received DGA treatment were screened, and necessary data were extracted. The Kaplan-Meier method and Cox proportional hazards model were used to estimate the DGA survival rate and explore the potential factors affecting the success rate of DGA treatment.

Results

Medical records of 852 children were included; 509 (59.7%) children with 1,212 (10.7%) teeth underwent unplanned retreatment. Restoration failure (30.12%) and new caries (29.46%) accounted for the most significant proportion of all failures. The median survival times were 510 and 1,911 days at the child and tooth levels, respectively. Unplanned retreatment risk was associated with the age of S-ECC children, frequency of follow-up, and fluoride application (hazard ratio = 0.97, 0.78, 0.69, P < 0.001).

Conclusion

The treatment outcome of DGA administered to children with S-ECC was satisfactory at the tooth level from the perspective of the incidence of unplanned retreatment. Restoration failure was the main reason for the high unplanned retreatment rate. Strategies for a better outcome of DGA include improving the professional knowledge and skills of pediatric dentists and enhancing compliance of parents/patients. Health education and regular topical fluoride application may improve the success rate of DGA treatment.

Evaluation of Change in Quality of Life, Dental Fear and Dental Anxiety in Young Children Following Full-mouth Dental Rehabilitation under General Anesthesia for Early Childhood Caries

AIM

To evaluate the change in quality of life, dental fear, and dental anxiety in young children following full-mouth dental rehabilitation under general anesthesia for early childhood caries.

MATERIALS AND METHODS

About 200 children who were diagnosed with early childhood caries requiring full-mouth rehabilitation under general anesthesia were recruited after obtaining parental consent. Oral health-related quality of life (OHRQoL) was measured using the Early Childhood Oral Health Impact Scale (ECOHIS). Dental fear was evaluated using Children's Fear Survey Schedule-Dental Subscale and dental anxiety was evaluated using the Facial Image Scale. Scores were taken on the day of intervention, and after 14 days when the child reported for posttreatment follow-up.

RESULTS

All 200 participants returned for a follow-up visit after 2 weeks. The child impact section was reduced from 15.7 ± 4.1 to 7.7 ± 1.9 after treatment. The family impact section was reduced from 9.6 ± 2.7 to 3.5 ± 2.6 after treatment. A statistically significant difference was seen in both sections when pre-and posttreatment values were compared (p < 0.001). The total ECOHIS showed statistically significant improvement as the pretreatment score of 21.6 ± 9.5 reduced to 11.2 ± 4.2 showing 51.9% improvement in OHRQoL after full-mouth rehabilitation under general anesthesia was done (p < 0.001). Dental fear and anxiety among the participants showed a statistically significant reduction after treatment was done and most participants were found to be less fearful of doctors, dentists, and injections after treatment.

CONCLUSION

Full-mouth rehabilitation was found to be a reliable treatment modality to improve the OHRQoL of children suffering from early childhood caries.

CLINICAL SIGNIFICANCE

Significant improvement was seen in the OHRQoL within 2 weeks after treatment and most participants were found to be less anxious and fearful toward dentists and dental treatment. Comprehensive dental rehabilitation under general anesthesia has been proven to be an effective treatment modality for early childhood caries and a productive treatment technique to reduce dental fear and anxiety.

Early childhood caries sequelae and relapse rates in an Australian public dental hospital

BACKGROUND

Early childhood caries (ECC) remains one of the most prevalent childhood diseases in Australia, disproportionately affecting disadvantaged populations.

AIM

To investigate the ECC experience including risk factors, incidence of caries, pain and infection as well as relapse rates of caries and secondary dental general anaesthesia (GA).

DESIGN

A retrospective cohort study included dental records of children with ECC, aged <72 months at an Australian public dental hospital paediatric dentistry department from 2013 to 2015 (n = 102). Dental caries, pain, infection, referral patterns, demographic and caries risk factor data were recorded for 24 months. Descriptive statistics were used for patient characteristics and clinical data, and Kaplan-Meier curves and parametric exponential survival models for time-to-event series.

RESULTS

The study population demonstrated higher-than-national average dmft and disease progression at baseline. Major risk factors for the development of caries, pain and infection were daily consumption of sweetened beverages, poor oral hygiene, residing in lower socio-economic areas, older age and being male. Rates of caries relapse and new referral for secondary treatment under general anaesthesia were relatively high.

CONCLUSION

A high degree of ECC progression and recurrence in this population indicates a need for a more comprehensive approach to ECC addressing multilevel root causes and systemic risk factors.

Clinical outcomes of dental treatment under general anesthesia and its effects on the caries activity and body growth of children: a 2-year retrospective study

OBJECTIVES

To analyze clinical outcomes of dental treatment under general anesthesia (DGA) and its effects on children's caries activity status and body growth within 2 years after the treatment.

MATERIALS AND METHODS

The case data and 2-year follow-up records of children who underwent DGA from February 2017 to February 2018 were collected and analyzed. The general characteristics of the sample, the success rates of treatment procedures, the caries recurrence rate, the caries activity test scores, and the BMI of all the children were described. The caries activity levels between children with and without caries recurrence at 24 months after DGA were compared before and after DGA to explore the relationship between caries activity level and caries recurrence. The correlation between BMI level and caries recurrence was explored using Cox regression analysis.

RESULTS

A total of 94 children consisting of 46 boys and 48 girls were included in this study. The average dmft score before DGA was 13.90. Within 2 years after the treatment, composite fillings and strip crowns of the anterior teeth achieved similar success rates, around 90%; SSCs showed a similar success rate to composite fillings of posterior teeth (P = 1.000); the clinical success rate of pulpectomy was 90.43%. All the children showed no caries relapse at 1 month after DGA. The number of children with caries relapse at 6-, 12-, and 24-month post-treatment was 24 (25.53%), 35 (37.23%), and 53 (56.38%), respectively. The caries activity scores at each follow-up were significantly lower than those before the treatment (P < 0.0001). Children with caries relapse within 2 years after DGA showed no significantly different caries activity scores than children without caries relapse before and after the treatment. The proportion of children with normal BMI at 12 months after DGA was significantly higher than that before DGA (P = 0.007), and the difference was still very significant at 24 months after DGA (P < 0.0001). Statistical results showed a correlation between BMI level before DGA and caries recurrence (P < 0.001).

CONCLUSIONS

Dental treatment under general anesthesia achieves acceptable clinical outcomes in this study. Children's caries activity scores decrease significantly. Low or high BMI levels before DGA drift towards normal after the treatment.

CLINICAL RELEVANCE

Acceptable outcomes are achieved within 2 years after dental treatment under general anesthesia. However, children with abnormal BMI before the treatment tend to have caries relapse.

Oral health-related quality of life after dental treatment in patients with intellectual disability

BACKGROUND

The influence of dental treatment on oral health-related quality of life (OHRQOL) has rarely been evaluated in patients with intellectual disability (ID) through validated questionnaires. The aim of this study was to estimate the changes on OHRQOL in patients with ID after the implementation of an institutional dental treatment program under general anesthesia using the Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHCOHRQOL-Q).

MATERIAL AND METHODS

A prospective longitudinal study was conducted on 85 patients (mean age=24.85 years) classified according to DSM-V whose parents/caregivers completed the FHC-OHRQOL-Q. We analyzed the changes in the questionnaire's overall score and its dimensions from pre-treatment to 12-months of follow-up, considering effect sizes and minimal important differences estimated by the standard measurement error. The impact of clinical and therapeutic factors was evaluated using univariate and multiple linear regression analysis (p<0.05).

RESULTS

Significant improvement of OHRQOL was found after dental treatment in oral symptoms (p0.001), daily life problems (p=0.018), parent's perceptions (p=0.013) and FHCOHRQOL-Q´s overall score (p=0.001). OHRQOL changes exhibited an intermediate magnitude (0.38-0.21) as estimated by effect sizes. Changes in oral symptoms showed positive correlation with DMFT index (r=0.375, p=0.002), decayed teeth (r=0.244, p=0.036), dental extractions (r=0.424, p<0.001) and number of treatments (r=0.255, p=0.019). The improvement was greater in patients with 4 decayed teeth (p=0.049) and undergoing 2 dental extractions (p=0.002). Multiple regression analysis demonstrated that dental extractions (p<0.001) and DMFT index (p=0.028) were significantly related to oral symptom improvement.

CONCLUSIONS

Dental treatment under general anesthesia showed a positive effect on the overall FHC-OHRQOL-Q score and most of its dimensions. At 12-months of follow-up, the improvement of oral symptoms was significantly associated with DMFT index, decayed teeth, dental extractions and number of treatments. In our clinical setting, the implementation of a dental treatment program enhanced the OHRQOL of patients with ID.

General anesthesia in the management of early childhood caries: an overview

Early childhood caries is a global healthcare concern in developing and industrialized countries. If left untreated, it leads to immediate and long-term complications that affect the well-being and quality of life of concerned families. Therefore, many preventive and treatment approaches are available to the healthcare provider to curb this virulent form of caries. After behavioral interventions, general anesthesia is used in specific settings when a young patient presents with extensive teeth damage and exhibits a lack of cooperation that is incompatible with conventional dental office care. However, without proper follow-up, any positive results might be lost over time.

Hereditary Gingival Fibromatosis: a Case Report with Seven-Year Follow-up

Introduction

Hereditary gingival fibromatosis (HGF) is a rare disease characterized by gingival enlargement, normal color with benign and firm consistency. This growth may be exacerbated by use of drugs and plaque build-up. The treatment for this clinical condition is surgical excision of the enlarged gingival tissue or the extraction of all teeth.

Case Report

A 20-year-old Brazilian female handicapped patient with a chief complaint of exaggerated gingival enlargement who had been prescribed Carbamazepine and Gardenal was referred to our center. According to the clinical presentation and family history, the final diagnosis of gingival enlargement was HGF. Full dental treatment was performed, including basic periodontal treatment, restorations, sealants, and gingivoplasty with internal bevel. Special care was taken to ensure that there was no change in patient’s anticonvulsant medication. The patient has been monitored for seven years without signs of recurrence of gingival hyperplasia due to constant professional and home control of plaque.

Perceived outcomes and satisfaction of Saudi parents and their children following dental rehabilitation under general anesthesia: A 2-year follow-up

PURPOSE

To investigate the perceived clinical outcome and parents' satisfaction after dental rehabilitation under general anesthesia over a follow-up period of 2 years.

MATERIALS AND METHODS

A prospective study of questionnaire data obtained from 352 pediatric patients before and after treatment of early childhood caries with full dental rehabilitation under general anesthesia. Questionnaires focused on oral symptoms, functional limitations, and emotional and social well-being before and after dental treatment. Cases were followed up for 2 years postoperatively.

RESULTS

A dramatic disappearance of symptoms was reported from parents' perspective. There was a high satisfaction rate (99.14%) also among parents of the children included in the study.

CONCLUSION

Children with early childhood caries do not necessarily express it verbally as pain. The disease has a lot of other expressions affecting children's behavior and habits, including the ability to sleep, thrive, and socialize. This study contributes to the existing literature that full dental rehabilitation under general anesthesia [dental general anesthesia (DGA)] has an immediate positive impact on the physical and social quality of life of children suffering from early childhood caries as well as on their families. Postoperative preventive care, early diagnosis, and treatment of recurrent caries are key factors to maintain postoperative outcome of DGA.

Five-year follow-up of children receiving comprehensive dental care under general anesthesia

Background

Dental general anesthesia (DGA) is part of public dental care in Finland, but the intention is to return the patient to routine dental care. The aims of this study were to describe the details of treatments under DGA given to generally healthy children and to explore the outcome of their dental care during a 5-year follow-up, with special focus on preventive care. In particular, we examined the return of the patients to routine dental care, of which, to our knowledge, little is known.

Methods

Our prospective 5-year follow-up of generally healthy children (aged 0–13 years) treated under DGA by the Helsinki Public Dental Service in 2004 was based on official dental and general anesthesia documents. The statistical analyses employed chi-square tests, t-tests, Pearson’s correlation coefficient (r), Fisher’s transformation to test r ≠ 0, and logistic regression modeling.

Results

The most common reason for DGA was uncooperation (82%), followed by dental fear (56%). Filling therapy predominated in the treatments given under anesthesia, and the mean number of treatments per patients was 9.5 (SD = 4.2). Throughout the follow-up, 54% of the patients continued to have co-operation problems and 53% expressed dental fear; 11% of the patients received repeat DGA. The mean follow-up time was 48 (median 52) months. The postoperative review visit was actualized within 1.5 (SD = 0.8) months and the first visit to the home dental clinic of the patients in 12.0 (SD = 11.8) months for the 0–5-year-olds and in 7.2 (SD = 5.9) months for the 6–13-year-olds (p < 0.001). The mean time elapsed to the first need for treatment was 18.5 (SD = 14.1) months. During the follow-up, the mean number of treatments per patient was 5.3 (SD = 4.9); almost all patients (97%) received preventive treatment at one of two visits, but the control of dental fear remained rare.

Conclusions

To return to routine dental care after DGA, most of the generally healthy children in our study still needed special attention due to their uncooperation and dental fear, thus calling for a renewal of practices to treat these patients.