Exploring the potential value of using data on dental extractions under general anaesthesia (DGA) to monitor the impact of dental decay in children

Childhood caries and hospital admissions in England: a reflection on preventive strategies

Dental caries is a largely preventable disease, yet the extraction of carious teeth is the most common reason for the hospital admission of children in England. This raises concern over the perceived failure of current preventive strategies. Despite a number of national and local preventive strategies, childhood caries remains most prevalent among the lower socioeconomic groups and ethnic minorities, especially in northern England. Often overlooked is the social and emotional impact of caries and dental treatment on the children and their families. More long-lasting can be the emotional, psychological and developmental impact on children of dental treatment and extractions under general anaesthesia, especially in unfamiliar hospital settings. Yet, the number of hospital admissions for the 5-9-year-old age group continues to rise and was 26,000 in England in 2018. The aim of this paper is to review the demographic and socioeconomic factors related to hospital admission of children for dental extractions, focusing on the localities with the highest proportions of hospital admissions. It is suggested that a reappraisal of the caries-preventive strategy in those areas of England with the highest proportion of hospital admissions is now urgently needed and the case is forcefully made for targeted water fluoridation.

In England, dental extractions under general anaesthesia can only be performed in hospital settings, often resulting in long delays for children experiencing pain.

Dental extractions are by far the most common reason for children to be referred to hospital and the highest proportion of referrals are mostly in relatively small areas in northern England.

Since national and local preventative programmes have failed to reduce the prevalence of childhood caries and the need for hospital referral for extractions, there is an overriding case for targeted water fluoridation schemes.

A rapid review of variation in the use of dental general anaesthetics in children

Introduction The use of dental general anaesthetics (DGAs) remains a cause for concern due to additional strains placed on health services. There are numerous factors influencing the prevalence and use of DGAs, and understanding these is an important first step in addressing the issue.Aim Conduct a rapid review of current peer-reviewed and grey literature on the variation in the use of DGAs in children.Methods Electronic searching using Medline via Ovid covering DGA articles from 1998 onwards, written in English. Publication types included primary and secondary sources from peer-reviewed journals and reports, as well as grey literature.Results From 935 results, 171 articles were included in the final review. Themes emerging from the literature included discussions of DGA variation, variations in standards of service provision by health services, and the socio-demographic and geographical characteristics of children. Prominent socio-demographic and geographical characteristics included age, other health conditions, ethnic and cultural background, socioeconomic status and deprivation, and geographical location.Conclusions This review identified numerous variations in the patterns associated with DGA provision and uptake at both a health service and individual level. The findings demonstrate the complicated and multifaceted nature of DGA practices worldwide.

Service evaluation of the paediatric dental general anaesthesia service in NHS Lothian

Objective To gain insight into the reasons for children undergoing dental treatment under general anaesthesia in NHS Lothian.Methods This service evaluation was based on a representative sample size of 294 patients, randomly selected from the 1,236 children seen for dental general anaesthesia (DGA) during 2017 in NHS Lothian. Data on patient and treatment descriptors were collected retrospectively from clinical records and analysed to identify significant correlations.Results The data indicated paediatric DGAs were mostly provided due to dental caries (88%, 260/294) and for children from the most deprived areas of Lothian. Most children were referred because they were of a very young age or had needs which precluded treatment under local anaesthesia (LA). Almost every child had teeth extracted under DGA (99%, 290/294) and a third of children received restorations (33%, 96/294).Discussion and conclusion This study highlighted the disproportionate increased risk of dental caries and DGA in children from more deprived backgrounds, despite a nationwide reduction of children with caries experience. There is a need for more holistic, whole-system approaches to reduce child dental caries, with opportunities for collaborative work with local stakeholders to follow-up children who have had DGA. More research is needed locally and nationally to inform the translation of evidence into effective interventions.

Co-design of an oral health promotion animated film with families in the South of England

Introduction Oral health promotion interventions should be evidence-based and designed with community involvement. In England, Family Hubs are attended by families from a range of social backgrounds and provide an ideal setting for co-design of health interventions.Aim To co-design and evaluate an animated film for promoting oral health in community settings.Methods Families attended two co-design workshops at a Family Hub in Portsmouth, during which they discussed oral health priorities and commented on the animation design. A before-and-after survey questionnaire assessed its impact on oral health knowledge in another Family Hub in Portsmouth. Qualitative data were analysed using the Framework method, while the survey data were analysed descriptively.Results Families prioritised evidence-based advice for inclusion in the film and contributed to the film storyline. This enabled relevant alterations to ensure the animation was engaging and age-appropriate. Although the survey response rate was low for inferential statistics, descriptive analysis indicated variation in the oral health knowledge of parents and carers.Conclusion Families can offer valuable contributions to the design of health promotion interventions. A co-design method provides an approach for communicating health advice in a form that is relevant and applicable to target audiences.

The deceptive complexity of caries

Exploring the potential value of using data on dental extractions under general anaesthesia (DGA) to monitor the impact of dental decay in childrenSocioeconomic inequality in the provision of specific preventive dental interventions among children in the UK: Children's Dental Health Survey 2003.