Use of general anaesthesia in paediatric dentistry: barriers to discriminate between true and false cases

Management of Post-Traumatic Dental Care Anxiety in Pediatric Dental Practice-A Clinical Study

BACKGROUND

It is important to avoid giving children traumatic dental experiences that induce post-traumatic dental care anxiety (PTDA) in clinical dental practices. The aim of this study was to evaluate whether non-pharmacological behavior management procedures can effectively reduce the use of pharmacological behavior management in children who have PTDA and are referred for regular dental treatments under general anesthesia (GA) and sedation.

METHODS

This clinical study consisted of two groups. The treatment group involved 20 healthy children aged 4-14 with PTDA and also those referred by other institutions for dental treatment with/without GA. The control group was sampled retrospectively from the patient records and involved 20 healthy uncooperative children aged 4-14 with PTDA who had been treated under GA.

RESULTS

The number of multiple appointments was significantly higher in the treatment group than in the control group. Only 25% of children in the treatment group underwent GA and the rest (75%) were managed with non-pharmacological management techniques. Nine (60%) children who were treated with minimally invasive techniques did not require GA.

CONCLUSIONS

It is important to treat children as much as possible without causing PTDA by using appropriate behavior management techniques. This study emphasizes the usefulness of thoroughly employing non-pharmacological behavior management methods before directing a child with PTDA for dental treatment under pharmacological behavior management, which can prevent the over-utilization of sedation and GA.

Changes in oral health-related quality of life among Austrian preschool children following dental treatment under general anaesthesia

Objectives

To analyse possible changes in oral health-related quality of life (OHRQoL) before and after dental treatment under dental general anaesthesia (DGA) among Austrian preschool children.

Methods

A consecutive sample of 89 parents of children aged 2 to 5 years, suffering from early childhood caries (ECC) and scheduled for DGA, were recruited from two locations in Austria (Vienna and Salzburg). Parents self-completed the German version of the ECOHIS before (baseline) and 4 weeks (T4) after their child’s dental treatment. The ECOHIS consists of 13 questions and is divided into two main parts, namely, the child impact section (9 items) and the family impact section (4 items).

Results

A total of 80 children (89%) completed a sufficient number ECOHIS questions at baseline and the follow-up assessment after 4 weeks. “Pain in the teeth, mouth, and jaws” and “difficulty eating some foods” from the child section and parents’ ratings of “feeling upset” and “guilty” were the most frequently reported impacts at baseline. The ECOHIS total score decreased significantly from a mean of 14.60 to 9.89 (p < 0.001) after DGA treatment, revealing a large effect size for the child (0.8) section, family (0.6) section, and the total score (0.8). Parents rated their child’s overall and oral health significantly higher after the DGA treatment (p < 0.001).

Conclusions

Significant improvements in oral health-related quality of life were observed 4 weeks after DGA in children suffering from ECC.

Clinical relevance

ECC has an impact on OHRQoL. Rehabilitation under general anaesthesia makes a sustainable improvement.

Children's Pain Perception and Behavioral Feedback during Local Anesthetic Injection with Four Injection Site Preparation Methods

Introduction:An effective pain control significantly contributes to an optimal dental treatment in pediatric dentistry. This study was conducted to compare children's pain perception and behavioral feedback during local anesthetic injection accompanied with counter-irritation, refrigerant, ice precooling or topical benzocaine. Methods:This study was conducted on 99 children who needed dental treatment in bilateral maxillary primary molars by local anesthesia. Subjects were randomly assigned to three groups, in which the injection site was prepared using counter-irritation in group I, ice precooling in group II, and refrigerant spray precooling in group III. In all three groups, 20% benzocaine gel was used in the injection site of opposite quadrant as a control. The perceived pain and behavioral feedback of children during injection were evaluated using the visual analogue scale (VAS) and sound, eye, and motor (SEM) indexes. Sign and Kruskal-Wallis tests were used to analyze data at a significance level of P < 0.05. Results:The perceived pain was significantly lower when using benzocaine compared to the other three methods (P < 0.05). Behavioral feedback of children when using benzocaine was not significantly different from the counter-irritation method (P=1.00). However, behavioral feedback with counter-irritation was significantly better than precooling (P < 0.05). Counter-irritation was significantly more effective than precooling methods in reduction of pain perception and improvement of behavioral feedback (P < 0.05). Conclusions:The perceived pain was significantly lower when the benzocaine method was used. Behavioral feedback was significantly better with benzocaine and counter-irritation methods compared to precooling procedures.

Randomized Controlled Trial of Pulpotomy in Primary Molars using MTA and Formocresol Compared to 3Mixtatin: A Novel Biomaterial

OBJECTIVE

This study was conducted to compare the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) with MTA and Formocresol for the pulpotomy of primary molars.

STUDY DESIGN

114 children aged 3-6 years old with 150 primary molars were randomly allocated to three groups. MTA, Formocresol or 3Mixtatin were used for Pulpotomies. Hard setting zinc oxide eugenol was used to cover these materials. The teeth were restored with amalgam. Blinded radiographic and clinical examinations were conducted at 6, 12 and 24 months after treatment for the presence of pain, tenderness to palpation and percussion, sinus tract, swelling, presence of internal or external root resorption, inter-radicular radiolucency, and periapical lesion.

RESULTS

122 teeth were available for 24-month follow-up study. The overall success rate was 78.9% for FC, 90.5% for 3Mixtatin and 88.1% for MTA group. There was no significant difference in overall success rate among the groups after 24-month follow-up (X²=2.43, df = 2, P =0.27).

CONCLUSION

Our findings demonstrated remarkable results of 3Mixtatin in pulpotomy of primary teeth at the 24-month follow-up. Therefore, 3Mixtatin may be considered as an effective material in pulpotomy of primary teeth because of its successful results.

Trends and Characteristics of Pediatric Dentistry Patients Treated under General Anesthesia

PURPOSE

The aims of this study were to describe the demographic characteristics of pediatric dentistry patients undergoing dental rehabilitation under general anesthesia (DRGA) at UNC-Chapel Hill during the last 13 years and identify factors associated with multiple (1 versus 2 or more) DRGA visits during that timeframe.

STUDY DESIGN

Administrative claims data were used to identify children and adolescents (age <18 years) who underwent DRGA between 1/1/2002 and 12/31/2014 at the UNC Hospitals system. Information on children's age, sex and all treatment-associated CDT codes were collected. Descriptive statistics and bivariate tests of association were used for data analyses.

RESULTS

There were 4,413 DRGAs among 3,973 children (median age=4 years 8 months, males=55%) during the study period. The annual rate of DRGAs increased over time, peaking (n=447) in 2013. Overall, 9% of children had ≥2 visits with repeat rates up to 18%. There was no association between children's sex and receipt of one versus multiple DRGAs; however, craniofacial cases were more likely (p<0.0005) to have multiple DRGAs compared to non-craniofacial ones.

CONCLUSION

DRGAs are on the increase-with the exception of craniofacial and special health care needs patients, multiple DRGAs may be reflective of sub-optimal adherence to preventive and continuing care recommendations.

Comparison of the effect of pharmacotherapy and neuro-feedback therapy on oral health of children with attention deficit hyperactivity disorder

Background

Attention deficit hyperactivity disorder (ADHD) is a chronic and progressive mental disorder related to the childhood period. This study aims to compare the oral health of two groups of ADHD children: those under pharmacotherapy and those under neuro-feedback therapy.

Material and Methods

72 ADHD children (aged 6-12) were divided into two 36 member groups: The pharmacotherapy group and the neuro-feedback therapy group. Unstimulated salivary flow (USF), DMFT, and plaque index were assessed in these children. Statistical analysis was carried out on the data with the independent t-test, which was performed using SPSS 16. The significance level of the study was p<0.05.

Results

In this study, the USF of ADHD children who used Ritalin was found to be significantly less than that of the neuro-feedback group (1.25 ± 1.21 vs. 1.91 ± 1.16 ml/min; p=0.002). Also, the plaque index (5.9 ± 3.1 vs. 3.94 ± 1.9; p=0.018) and DMFT scores (39% ± 9% vs. 31% ± 9%; p=0.018) were significantly higher for the pharmacotherapy group.

Conclusions

Neuro-feedback therapy is preferable to Ritalin treatment for ADHD children in terms of their oral health status. Key words:Attention deficit hyperactivity disorder, drug therapy, neurofeedback, oral health.

The relationship between children's media habits and their anxiety and behaviour during dental treatment

OBJECTIVE

The existing evidence suggests that media habits may have moderating role on children's psychological adjustment in the dental setting. The aim of this study was to investigate the relationship between children's media habits and their anxiety and behaviour management problems (BMP) during dental treatment.

MATERIALS AND METHODS

A total of 289 children aged 3-6 years old were included. Dental anxiety (DA) and BMP were assessed using Clinical Anxiety Rating Scale and Frankl's Rating Scale during the dental treatment. The parents reported their own DA, educational level and economic status; and the children's and also their own daily hours of using media. The data were analysed with the Mann-Whitney U, Kruskal-Wallis, Chi-square or Fisher exact tests, Spearman's correlation coefficient and logistic regression.

RESULTS

The children with DA had significantly higher amount of watching TV, playing e-games and surfing the Internet, and total amount of using electronic media than those without DA. The amount of watching TV and the total amount of using electronic media were significantly higher in the children with BMP than those without BMP. DA and BMP were significantly correlated with the children's hours of watching TV and total media time.

CONCLUSIONS

There was a significant relationship between the amount of electronic media usage and DA and BMP in 3- to 6-year-old children.

Does the length of dental procedure influence children's behavior during and after treatment? A systematic review and critical appraisal

The aim of this systematic review was to investigate the effect of treatment duration on children’s behavior and/or anxiety in the dental setting. To this end, a systematic search was conducted in Pubmed/Medline and Scopus from 1970 to march 2017 for English language articles that assessed the relationship between dental treatment duration or length, and fear/anxiety or behavior in children aged <12 with no confounding medical and/or psychological history and neuro-psychiatric disabilities. Four studies investigating the effect of treatment duration on children’s behavior during and/or after treatment were included. None of the reviewed studies investigated the effect of treatment duration on children’s dental anxiety or fear. There was a general tendency towards deterioration of children’s behavior with an increase in treatment duration. In conclusion, our results undermine the validity of current suggestions about the appropriate treatment duration. Further clinical trials are needed to establish appropriate treatment duration for more effective behavioral management of pediatric patients during dental proce-dures.

Pulp bleeding color is an indicator of clinical and histohematologic status of primary teeth

OBJECTIVES

This study was carried out to investigate whether the changes in hematologic characteristic and color of pulpal bleeding is associated with clinical and histologic status of the pulp in primary teeth.

MATERIALS AND METHODS

A total of 211 primary molars in 103 patients, 3-6 years old, were treated. One hundred eight teeth had pulpectomy, 57 teeth had pulpotomy after pulp exposure during caries excavation, and 46 teeth had pulpotomy after accidental pulp exposure in sound dentin. After pulpal exposure, pulpal blood was collected in capillary tubes for blood color and hematologic assessment. Coronal and radicular pulp tissues were amputated for histologic assessment.

RESULTS

Blood color was significantly darker in pulpectomy cases and samples with severe inflammation. The differences were clinically perceptible by the human eye. A significant negative correlation was detected between white blood cell (WBC) count and blood color. The counts of neutrophils and lymphocytes were significantly different between treatment groups. In addition, WBC, eosinophil, monocyte, neutrophil, and basophils counts were significantly different between degrees of inflammation in coronal pulp. Moreover, severe inflammation was higher in pulpectomy group versus pulpotomy groups. Pulp tissue calcification was also significantly higher in the pulpectomy cases.

CONCLUSIONS

Considering the significant difference in pulpal blood color between the pulpectomy and pulpotomy cases, and between the different levels of pulpal inflammation; blood color can be a valid clinical diagnostic criterion of pulpal status and can be used for the selection of appropriate pulp treatment strategy.

CLINICAL RELEVANCE

This study shows that pulp bleeding color can be used for selection of an appropriate pulp treatment method in primary teeth.

Can galvanic skin conductance be used as an objective indicator of children's anxiety in the dental setting?

Background

Assessment of procedural distress is essential at assisting children during invasive dental treatments. This study aimed to determine the validity and reliability of galvanic skin response as a measure for assessment of dental anxiety in children.

Material and Methods

151 children, aged 5-7 years, participated in this study. Similar dental treatments were rendered to all subjects. At the beginning and end of the session, modified child dental anxiety scale (MCDAS), clinical anxiety rating scale (CARS) and galvanic skin response (GSR) were used to determine children’s anxiety.

Results

GSR was significantly correlated with both MCDAS (rs=0.62, p=0.02) and CARS (rs=0.44, p=0.032). The correlation between MCDAS and CARS was also significant (rs = 0.9, P<0.001). Anxiety decreased during the session in both GSR (rs=0.52, p=0.001) and MCDAS scales (rs=0.77, p=0.001). CARS also showed a reduction between the initial and second assessment, but it was not statistically significant (rs=0.12, P=0.36).

Conclusions

The findings suggest that GSR is a reliable and valid measure for assessment of children’s dental anxiety in the clinical context. GSR may help to identify clinically anxious children before dental treatment to provide appropriate interventions.

Key words:Dental anxiety, reliability, validity, galvanic skin response.