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Chi DL, Guinn S, Shands ME, Nemawarkar D, Hill CM, Mayhle M, Do TT, Li S, Panchal S. Socioeconomic vulnerability and access to community water fluoridation in Washington. J Am Dent Assoc 2024; 155:747-754.e2. [PMID: 39007792 DOI: 10.1016/j.adaj.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The aim of the authors was to determine whether socioeconomic vulnerability is associated with community water fluoridation (CWF). METHODS The authors used US Census Bureau data to create 4 county-level vulnerability markers (percentages non-White, Hispanic or Latino, below the federal poverty threshold, education below high school), obtained county-level CWF data from the Washington State Department of Health, and evaluated associations using Spearman rank correlation coefficient and the Kruskal-Wallis rank sum test. The authors then interviewed 122 community members in Washington (December 2022-March 2023) and analyzed the interview data inductively. RESULTS A higher percentage of non-White people at the county level was associated with a significantly higher level of CWF (Spearman rank correlation coefficient, 0.55; 95% CI, 0.29 to 0.82; P < .001), whereas county-level poverty was associated with significantly lower CWF (Spearman rank correlation coefficient, -0.36; 95% CI, -0.70 to -0.03; P = .02). High school completion was not associated with county-level CWF. Significantly larger proportions of Hispanics and Latinos lived in counties with higher CWF (P < .05). From the interviews, more participants thought tap water was healthy than unhealthy, but 41% had mixed feelings. Similarly, more participants thought CWF was acceptable than unacceptable, with 35% reporting mixed feelings. Negative views about tap water and CWF were more common among non-White participants. CONCLUSIONS People in racially and ethnically diverse communities in Washington appear to have greater access to CWF, whereas those in lower-income communities have poorer access. PRACTICAL IMPLICATIONS CWF is an important population-level strategy to prevent caries. Additional work is needed to improve access to CWF, especially for people from low-income communities.
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Cohen SP, Doshi TL, Munjupong COLS, Qian C, Chalermkitpanit P, Pannangpetch P, Noragrai K, Wang EJ, Williams KA, Christo PJ, Euasobhon P, Ross J, Sivanesan E, Ukritchon S, Tontisirin N. Multicenter, randomized, controlled comparative-effectiveness study comparing virtual reality to sedation and standard local anesthetic for pain and anxiety during epidural steroid injections. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 27:100437. [PMID: 39036653 PMCID: PMC11259926 DOI: 10.1016/j.lansea.2024.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/13/2024] [Accepted: 06/05/2024] [Indexed: 07/23/2024]
Abstract
Background The use of sedation during interventional procedures has continued to rise resulting in increased costs, complications and reduced validity during diagnostic injections, prompting a search for alternatives. Virtual reality (VR) has been shown to reduce pain and anxiety during painful procedures, but no studies have compared it to a control and active comparator for a pain-alleviating procedure. The main objective of this study was to determine whether VR reduces procedure-related pain and other outcomes for epidural steroid injections (ESI). Methods A randomized controlled trial was conducted in 146 patients undergoing an ESI at 6 hospitals in Thailand and the United States. Patients were allocated to receive immersive VR with local anesthetic, sedation with midazolam and fentanyl plus local anesthetic, or local anesthetic alone. The primary outcome was procedure-related pain recorded on a 0-10 scale. Other immediate-term outcome measures were pain from a standardized subcutaneous skin wheal, procedure-related anxiety, ability to communicate, satisfaction, and time to discharge. Intermediate-term outcome measures at 4 weeks included back and leg pain scores, function, and success defined as a ≥2-point decrease in average leg pain coupled with a score ≥5/7 on a Patient Global Impression of Change scale. Findings Procedure-related pain scores with both VR (mean 3.7 (SD 2.5)) and sedation (mean 3.2 (SD 3.0)) were lower compared to control (mean 5.2 (SD 3.1); mean differences -1.5 (-2.7, -0.4) and -2.1 (-3.3, -0.9), respectively), but VR and sedation scores did not significantly differ (mean difference 0.5 (-0.6, 1.7)). Among secondary outcomes, communication was decreased in the sedation group (mean 3.7 (SD 0.9)) compared to the VR group (mean 4.1 (SD 0.5); mean difference 0.4 (0.1, 0.6)), but neither VR nor sedation was different than control. The trends favoring sedation and VR over control for procedure-related anxiety and satisfaction were not statistically significant. Post-procedural recovery time was longer for the sedation group compared to both VR and control groups. There were no meaningful intermediate-term differences between groups except that medication reduction was lowest in the control group. Interpretation VR provides comparable benefit to sedation for procedure-related pain, anxiety and satisfaction, but with fewer side effects, superior communication and a shorter recovery period. Funding Funded in part by grants from MIRROR, Uniformed Services University of the Health Sciences, U.S. Dept. of Defense, grant # HU00011920011. Equipment was provided by Harvard MedTech, Las Vegas, NV.
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Affiliation(s)
- Steven P. Cohen
- Departments of Anesthesiology, Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Departments of Physical Medicine & Rehabilitation, Neurology, and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Departments of Anesthesiology and Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Tina L. Doshi
- Departments of Anesthesiology & Critical Care Medicine and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - COL Sithapan Munjupong
- Department of Anesthesiology, Phramongkutklao Royal Thai Army Hospital and College of Medicine, Bangkok, Thailand
| | - CeCe Qian
- Department of Anesthesiology, NYU Langone Medical Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Pornpan Chalermkitpanit
- Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok
| | - Patt Pannangpetch
- Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok
| | - Kamolporn Noragrai
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
| | - Eric J. Wang
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kayode A. Williams
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Paul J. Christo
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Pramote Euasobhon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
| | - Jason Ross
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eellan Sivanesan
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Supak Ukritchon
- Office of Research and Development, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Nuj Tontisirin
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
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LaGuardia JS, Ali-Khan S, LaBarge D, Morrison C. Pediatric Plastic Surgery Under Local Anesthesia. Ann Plast Surg 2024; 92:S352-S354. [PMID: 38689418 DOI: 10.1097/sap.0000000000003798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Increasing research has shown that select surgical procedures can be performed in an office-based environment with low complication rates. Within the field of plastic surgery, these findings have mainly been studied in adult populations. However, studies regarding the safety and efficacy of office-based plastic surgery in the pediatric population are lacking. In the present study, we demonstrate that appropriately selected office-based pediatric plastic surgery procedures can be performed under local anesthesia for a variety of common surgical indications with low complication rates. METHODS A retrospective case series of pediatric plastic surgery patients who underwent in-office procedures under local anesthesia at a single academic institution from September 2014 to June 2020 was performed. RESULTS Five hundred nine patients were treated in an office setting for various etiologies over the study period. A total of 48.9% of the patients were male and 51.1% were female. Patient age at time of procedure ranged from 24 days to 17 years of age with a median age of 13 years. A total of 778 lesions were treated. There were 10 total complications (1.29%) over the study period with only one surgical site infection that resolved with antibiotic treatment. CONCLUSIONS Our work indicates that select pediatric plastic surgery procedures can be performed under local anesthesia with low complication rates.
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Affiliation(s)
- Jonnby S LaGuardia
- From the Division of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, NY
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Almarzouq SSFS, Chua H, Yiu CKY, Lam PPY. Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:537. [PMID: 38470648 PMCID: PMC10931341 DOI: 10.3390/healthcare12050537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Non-pharmacological behavioural interventions (NPBIs) have been employed by dentists to alleviate dental fear and anxiety (DFA) among preschool and school children. The aim of this systematic review and meta-analysis was to investigate the effectiveness of different NPBIs in reducing DFA among children aged below 12. METHOD A comprehensive search was conducted using four electronic databases to identify randomised controlled trials that assess the effectiveness of NPBIs among preschool and school children. Two reviewers independently screened and selected the relevant studies, evaluated the risk of bias, and extracted relevant data for qualitative and quantitative syntheses. RESULT A total of 66 articles were included in the study. Except during more invasive dental procedures, the use of distraction techniques was found to result in significantly lower self-rated anxiety, better cooperation, and lower pulse rate compared to the tell-show-do method. However, inconsistent results were reported regarding the efficacy of virtual reality, modelling, visual pedagogies, tell-show-do and other NPBIs in reducing DFA among children. CONCLUSIONS The studies exhibited substantial heterogeneity due to varying age groups, methods of implementing NPBIs, dental treatments performed, and measurement scales employed in the evaluation of DFA.
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Affiliation(s)
| | - Helene Chua
- National Healthcare Group Polyclinics, Singapore 308433, Singapore
| | - Cynthia K. Y. Yiu
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong (C.K.Y.Y.)
| | - Phoebe P. Y. Lam
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong (C.K.Y.Y.)
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Zhang J, Zeng J, Zhou P, Deng H, Yu C. Bibliometric analysis of pediatric dental sedation research from 1993 to 2022. Heliyon 2024; 10:e25527. [PMID: 38333804 PMCID: PMC10850579 DOI: 10.1016/j.heliyon.2024.e25527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
Statement of problem Bibliometric analysis methods were used to evaluate pediatric dental sedation research and to identify topical hotspots using quantitative and qualitative methodologies. Purpose To conduct bibliometric analysis on the retrieved data and to foresee the development of trends and hotspots in this research area. Material and methods We retrieved appropriate research articles from the Web of Science Core Collection on January 1, 2023. VOSviewer, Citespace and the Bibliometrics website were used to conduct bibliometric analysis on the retrieved data. GraphPad Prism 10.0 (GraphPad, San Diego, CA, USA) was used to conduct the statistical analysis. Results A total of 396 publications on pediatric sedation in dentistry, published between 1993 and 2022, were retrieved from online databases. The USA published most papers. Furthermore, the most frequent countries who cooperated were the USA and Canada. Six of the top ten publishing establishments were USA based. Papers on the research have appeared primarily in the journals of Dentistry and Anesthesiology. Keyword co-occurrence and co-citation cluster analysis revealed that the most common topics mainly were: dental anxiety; conscious sedation; dental caries; midazolam; propofol; hypoxemia. Conclusions During the three decades, the focus of pediatric sedation research has been on drugs, dental anxiety and procedural sedation. Keyword burst detection indicated that procedural sedation; adverse event; respiratory depression is an emerging research hotspot.
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Affiliation(s)
- Jinhong Zhang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jie Zeng
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Pan Zhou
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Haixia Deng
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Cong Yu
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Nguyen AT, Clarkson E. One Provider Anesthesia Model in Oral and Maxillofacial Surgery. Dent Clin North Am 2024; 68:87-98. [PMID: 37951639 DOI: 10.1016/j.cden.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
The one provider anesthesia model used in oral and maxillofacial surgery (OMS) practices has been a subject of debate due to concerns about patient safety, inadequate attention, and mortality and morbidity rates. Historically, OMS specialists have made significant contributions to modern anesthesia; however, recent changes in Centers for Medicare and Medicaid Services have led to increased scrutiny of the OMS anesthesia model. Proponents argue that the model is safe and effective, thanks to well-trained Dental Anesthesia Assistants and OMS surgeons' extensive experience in dental anesthesia cases.
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Affiliation(s)
- Anh Thieu Nguyen
- Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 155 Ashland Plc, Brooklyn, NY 11201, USA.
| | - Earl Clarkson
- Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 155 Ashland Plc, Brooklyn, NY 11201, USA; Oral and Maxillofacial Surgery, Woodhull Medical Center and Attending, The Brooklyn Hospital Center, 760 Broadway, Brooklyn, New York City, NY, USA
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Rickey L, Auger K, Britto MT, Rodgers I, Field S, Odom A, Lehr M, Cronin A, Walsh KE. Measurement of Ambulatory Medication Errors in Children: A Scoping Review. Pediatrics 2023; 152:e2023061281. [PMID: 37986581 DOI: 10.1542/peds.2023-061281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children use most medications in the ambulatory setting where errors are infrequently intercepted. There is currently no established measure set for ambulatory pediatric medication errors. We have sought to identify the range of existing measures of ambulatory pediatric medication errors, describe the data sources for error measurement, and describe their reliability. METHODS We performed a scoping review of the literature published since 1986 using PubMed, CINAHL, PsycINFO, Web of Science, Embase, and Cochrane and of grey literature. Studies were included if they measured ambulatory, including home, medication errors in children 0 to 26 years. Measures were grouped by phase of the medication use pathway and thematically by measure type. RESULTS We included 138 published studies and 4 studies from the grey literature and identified 21 measures of medication errors along the medication use pathway. Most measures addressed errors in medication prescribing (n = 6), and administration at home (n = 4), often using prescription-level data and observation, respectively. Measures assessing errors at multiple phases of the medication use pathway (n = 3) frequently used error reporting databases and prospective measurement through direct in-home observation. We identified few measures of dispensing and monitoring errors. Only 31 studies used measurement methods that included an assessment of reliability. CONCLUSIONS Although most available, reliable measures are too resource and time-intensive to assess errors at the health system or population level, we were able to identify some measures that may be adopted for continuous measurement and quality improvement.
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Affiliation(s)
- Lisa Rickey
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Katherine Auger
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isabelle Rodgers
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Shayna Field
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alayna Odom
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Madison Lehr
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Hedges J, Hermes Soares G, Cadet-James Y, Dodd Z, Cooney S, Newman J, Mittinty M, Kularatna S, Larkins P, Zwolak R, Roberts R, Jamieson L. A Silver Fluoride Intervention to Improve Oral Health Trajectories of Young Indigenous Australians: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e48558. [PMID: 37917128 PMCID: PMC10654906 DOI: 10.2196/48558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Indigenous Australian children and adolescents experience profound levels of preventable dental disease. The application of silver fluoride (AgF) to active dental caries is a noninvasive alternative to traditional dental treatment approaches. There is particular utility among Indigenous children and young people with dental fear, who may not have access to timely or culturally safe dental service provisions. OBJECTIVE The aims of this study are to: (1) assess levels of active dental caries among Indigenous children and young people in 6 Australian states and territories; (2) determine if an AgF intervention reduces levels of active disease over 12-24 months; (3) measure the impact of improved oral health on social and emotional well-being (SEWB) and oral health-related quality of life; and (4) calculate the cost-effectiveness of implementing such an initiative. METHODS The study will use a 2-arm, parallel cluster randomized controlled trial design. Approximately 1140 Indigenous children and youth aged between 2 and 18 years will be recruited. Each state or territory will have 2 clusters. The intervention group will receive the AgF intervention at the start of the study, with the delayed intervention group receiving the AgF intervention 12 months after study commencement. The primary outcome will be the arrest of active carious lesions, with arrested caries defined as nonpenetration by a dental probe. Secondary outcomes will include SEWB, oral health-related quality of life, and dental anxiety, with covariates including dental behaviors (brushing and dental visits). Effectiveness measures for the economic evaluation will include the number of children and young people managed in primary oral health care without the need for specialist referral, changes in SEWB, the numbers and types of treatments provided, and caries increments. RESULTS Participant recruitment will commence in May 2023. The first results are expected to be submitted for publication 1 year after a 24-month follow-up. CONCLUSIONS Our findings have the potential to change the way in which active dental disease among Indigenous children and young people can be managed through the inclusion of specifically tailored AgF applications to improve dental health and SEWB delivered by Indigenous health care workers. Desired impacts include cost savings on expensive dental treatments; improved SEWB, nutrition, social, and learning outcomes; and improved quality of life for both children and young people and their caregivers and the broader Indigenous community. The AgF application could be easily implemented into the training program of Indigenous health workers and yield critical information in the management armamentarium of health and well-being recommendations for Australia's First Peoples. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48558.
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Affiliation(s)
- Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Gustavo Hermes Soares
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Yvonne Cadet-James
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Zell Dodd
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Sinon Cooney
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - James Newman
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Murthy Mittinty
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Sanjeewa Kularatna
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Priscilla Larkins
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Roman Zwolak
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Rachel Roberts
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
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Gandhi HA, Olson G, Lee H, Zouaidi K, Yansane A, Walji M, Kalenderian E, Tokede B. Assessing the safety of deep sedation in outpatient pediatric oral health care. J Am Dent Assoc 2023; 154:975-983.e1. [PMID: 37676186 DOI: 10.1016/j.adaj.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/12/2023] [Accepted: 07/24/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Children are the patient subgroup with the lowest error tolerance regarding deep sedation (DS)-supported care. This study assessed the safety of DS-supported pediatric dental treatment carried out in an outpatient setting through retrospective review of patient charts. METHODS An automated script was developed to identify charts of pediatric patients who underwent DS-supported dental procedures from 2017 through 2019 at a dental clinic. Charts were assessed for the presence of sedation-related adverse events (AEs). A panel of experts performed a second review and confirmed or refuted the designation of AE (by the first reviewer). AEs were classified with the Tracking and Reporting Outcomes of Procedural Sedation system. RESULTS Of the 175 DS cases, 19 AEs were identified in 15 cases (8.60%). Using the Tracking and Reporting Outcomes of Procedural Sedation classification system, 7 (36.84%) events were related to the airway and breathing category, 9 (47.37%) were related to sedation quality (including a dizzy patient who fell at the checkout desk and sustained a head laceration), and 3 (15.79%) were classified as an allergy. CONCLUSION This study suggests an AE (whether relatively minor or of potentially major consequence) occurs in 1 of every 12 DS cases involving pediatric patients, performed at an outpatient dental clinic. Larger studies are needed, in addition to root cause analyses. PRACTICAL IMPLICATIONS As dentists increasingly pivot in the use of DS services from in-hospital to outpatient settings, patients expect comparable levels of safety. This work helps generate evidence to drive targeted efforts to improve the safety and reliability of pediatric outpatient sedation.
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Wolf TG, Campus G. Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1865. [PMID: 37893583 PMCID: PMC10608526 DOI: 10.3390/medicina59101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Early childhood caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of primary dental hard tissues occurring in varying degrees of severity in infants and toddlers. Untreated ECC may lead to pain, infections, and severe systemic complications. The aim of this study was to systematically review and evaluate the scientific evidence on the cost-effectiveness of treatment decisions in ECC in infants and toddlers. Materials and Methods: Observational epidemiological studies, i.e., cohort studies, case-control studies, and randomized controlled trials, reporting cost-effectiveness of treatment decisions in ECC in infants and toddlers were included in the systematic review following the PRISMA guidelines. Using an ad hoc search with search terms or keywords (MeSH), electronic databases Embase, MEDLINE via PubMed, Scopus, and gray literature were searched. Results: The search identified 494 articles, of which 446 remained after removing duplicates. A total of 417 articles were excluded after title and abstract evaluation; 29 full-text articles were screened for eligibility, and five articles were discarded. Twenty-four full-text articles were included in the systematic review, assigning 17 to prevention and seven to restoration. Results were heterogeneous; comparability of included studies is difficult because of the different methodologies used. Conflicting efficacies were demonstrated for different interventions implemented, and cost-effectiveness data were documented. Conclusions: Socioeconomic, cultural, and ethnic differences must be considered when comparing conditions in terms of cost-effectiveness. A paradigm shift from surgical towards preventive treatment decisions can be observed. Cost-effectiveness studies on therapies for ECC in infants and toddlers are needed to identify the best practice approach and the most cost-effective therapy decisions.
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Affiliation(s)
- Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, 55116 Mainz, Germany
| | - Guglielmo Campus
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Viale San Pietro, 07100 Sassari, Italy;
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Young S, Osman B, Shapiro FE. Safety considerations with the current ambulatory trends: more complicated procedures and more complicated patients. Korean J Anesthesiol 2023; 76:400-412. [PMID: 36912006 PMCID: PMC10562071 DOI: 10.4097/kja.23078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
In the last quarter of a century, the backdrop of appropriate ambulatory and office-based surgeries has changed dramatically. Procedures that were traditionally done in hospitals or patients being admitted after surgery are migrating to the outpatient setting and being discharged on the same day, respectively, at a remarkable rate. In the face of this exponential growth, anesthesiologists are constantly being challenged to maintain patient safety by understanding the appropriate patient selection, procedure, and surgical location. Recently published literature supports the trend of higher, more medically complex patients, and more complicated procedures shifting towards the outpatient arena. Several reasons that may account for this include cost incentives, advancement in anesthesia techniques, enhanced recovery after surgery (ERAS) protocols, and increased patient satisfaction. Anesthesiologists must understand that there is a lack of standardized state regulations regarding ambulatory surgery centers (ASCs) and office-based surgery (OBS) centers. Current and recently graduated anesthesiologists should be aware of the safety concerns related to the various non-hospital-based locations, the sustained growth and demand for anesthesia in the office, and the expansion of mobile anesthesia practices in the US in order to keep up and practice safely with the professional trends. Continuing procedural ambulatory shifts will require ongoing outcomes research, likely prospective in nature, on these novel outpatient procedures, in order to develop risk stratification and prediction models for the selection of the proper patient, procedure, and surgery location.
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Affiliation(s)
- Steven Young
- Department of Anesthesiology, 1Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Brian Osman
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Fred E. Shapiro
- Department of Anesthesiology, 1Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Callaway Kim K, Khouja T, Burgette JM, Evans CT, Calip GS, Gellad WF, Suda KJ. Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019. Pharmacoepidemiol Drug Saf 2023; 32:625-634. [PMID: 36573575 DOI: 10.1002/pds.5589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Opioids, benzodiazepines and sedatives can manage dental pain, fear and anxiety but have a narrow margin of safety in children. General dentists may inappropriately prescribe gabapentin and stimulants. National evidence on dispensing rates of these high-alert medicines by dentists to children is limited. METHODS We utilize join-point regression to identify changes in fills for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. RESULTS From 2012 to 2019, 3.8 million children filled prescriptions for high-alert drugs from general dentists. National quarterly dispensing of high-alert drugs decreased 63.1%, from 10456.0 to 3858.8 days per million. Opioids accounted for 69.4% of high-alert prescriptions. From 2012 to 2019, fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2% (7651.8 to 2662.7), 43.4% (810.9 to 458.7), 43.6% (785.7 to 442.7) and 89.3% (825.6 to 88.6 days per million), respectively. Gabapentin increased 8.1% (121.8 to 131.7 days per million). A significant decrease in high-alert fills occurred in 2016, (-6.0% per quarter vs. -1.6% pre-2016, P-value<0.001), especially for opioids (-7.0% vs. -1.2%, P-value<0.001). Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in the South were overrepresented among top-prescribing areas in 2019. CONCLUSIONS We found promising national decreases in fills for high-alert medicines to children by general dentists from 2012 to 2019. However, older teenagers and children in some counties continued to receive dental opioids at high rates. Future efforts should address non-evidence-based pain management in these groups.
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Affiliation(s)
- Katherine Callaway Kim
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Tumader Khouja
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
| | - Jacqueline M Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Charlesnika T Evans
- Department of Preventative Medicine and Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, Illinois, USA
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Walid F Gellad
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- Center of Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Katie J Suda
- University of Pittsburgh School of Medicine, Department of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania, USA
- Center of Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Chen SC, Chen CY, Shen SJ, Tsai YF, Ko YC, Chuang LC, Lin JR, Tsai HI. Application of Bispectral Index System (BIS) Monitor to Ambulatory Pediatric Dental Patients under Intravenous Deep Sedation. Diagnostics (Basel) 2023; 13:1789. [PMID: 37238272 PMCID: PMC10216896 DOI: 10.3390/diagnostics13101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Purpose Intravenous sedation has been well accepted to allow dental restoration in uncooperative children while avoiding aspiration and laryngospasm; however, intravenous anesthetics such as propofol may lead to undesired effects such as respiratory depression and delayed recovery. The use of the bispectral index system (BIS), a monitoring system reflective of the hypnotic state, is con-troversial in the reduction in the risk of respiratory adverse events (RAEs), recovery time, the in-travenous drug dosage, and post-procedural events. The aim of the study is to evaluate whether BIS is advantageous in pediatric dental procedures. Methods A total of 206 cases, aged 2-8 years, receiving dental procedures under deep sedation with propofol using target-controlled infusion (TCI) technique were enrolled in the study. BIS level was not monitored in 93 children whereas it was for 113 children, among which BIS values were maintained between 50-65. Physiological variables and adverse events were recorded. Statistical analysis was conducted using Chi-square, Mann Whitney U, Independent Samples t and Wilcoxon signed tests, with a p value of <0.05 considered to be statistically significant. Results Although no statistical significance in the post-discharge events and total amount of propofol used was observed, a clear significance was identified in periprocedural adverse events (hypoxia, apnea, and recurrent cough, all p value < 0.05) and discharge time (63.4 ± 23.2 vs. 74.5 ± 24.0 min, p value < 0.001) between these two groups. Conclusions The application of BIS in combination with TCI may be beneficial for young children undergoing deep sedation for dental procedures.
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Affiliation(s)
- Shih-Chia Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Chun-Yu Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
| | - Shih-Jyun Shen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yung-Fong Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Chen Ko
- Department of Anesthesiology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi 613, Taiwan
| | - Li-Chuan Chuang
- Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei 112, Taiwan
- Graduate Institute of Craniofacial and Dental Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Jr-Rung Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Clinical Informatics and Medical Statistics Research Center (CIMS) and Graduate Institute of Clinical Medical Sciences, Department of Biomedical Sciences, Gung Gung University, Taoyuan 333, Taiwan
| | - Hsin-I Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
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Kakti A, Abumelha RK, Alajmi AM, Dagriri LK, Alkodari LA, Fares MJ, Cicciù M, Minervini G. Postoperative Pain of Pediatric Patients Undergoing Dental Treatment under General Anesthesia Visiting a General Hospital: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:671. [PMID: 37189920 PMCID: PMC10136541 DOI: 10.3390/children10040671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
Dental general anesthesia (GA) is a day-stay procedure and is a suitable choice for complicated cases. It is undertaken in a controlled hospital setting that ensures the quality, safety, efficacy, and efficiency of dental treatment. The purpose of this study is to determine the prevalence, severity, duration, and factors related to the occurrence of postoperative discomfort in young children following GA in a general hospital. This study includes a minimum sample size of 23 children that were undergoing GA over a 1-month period. Informed consent was obtained from the parent prior to the treatment. A preoperative questionnaire via the Survey Monkey program was used for the purposes of recording the responses of the survey population. All data related to the immediate postoperative period while the child was in the post-anesthetic recovery room (PAR) was collected and assessed by one of the investigators using the Face, Legs, Activity, Cry, and Consolability (FLACC) pain assessment scale. Postoperative data was gathered using the Dental Discomfort Questionnaire (DDQ-8) and was performed by phone 3 days after the GA procedure. The participating 23 children ranged from 4 to 9 years old (mean 5.43 ± 1.53). A total of 65.2% were girls and 34.8% were boys, with 30.4% experiencing a recent history of pain.
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Affiliation(s)
- Ateet Kakti
- Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh 13244, Saudi Arabia
| | | | | | | | | | - Mohammed. J. Fares
- October University for Modern Sciences and Arts, 6th October City 12573, Egypt
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, School of Dentistry, University of Catania, 95131 Catania, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania, Luigi Vanvitelli, 80138 Naples, Italy
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15
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Kızılcı E, Kızılay F, Mahyaddinova T, Muhtaroğlu S, Kolçakoğlu K. Stress levels of a group of dentists while providing dental care under clinical, deep sedation, and general anesthesia. Clin Oral Investig 2023:10.1007/s00784-023-04973-9. [PMID: 36995430 DOI: 10.1007/s00784-023-04973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/19/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Professionals in the health sector have higher stress than others. The aim of this study was to evaluate the stress levels of dentists while treating with children under clinical, deep sedation, and general anesthesia. MATERIALS AND METHODS Blood pressure (systolic, diastolic), pulse value, and O2 saturations were measured. Saliva samples were taken by the dentists 10 min before the treatment, at the 25th min of the treatment, and 30 min after the treatment under clinical, deep sedation, and general anesthesia. Salivary cortisol was measured by the electrochemiluminescence method. All data were analyzed statistically. RESULTS Cortisol values under the sedation were higher than clinical and general anesthesia (P < 0.05). As a result of the applied Dentist Job Stress Questionnaire, the stress level of dentists under sedation was higher than the clinical and general anesthesia (P < 0.05). Under sedation, systolic and diastolic blood pressures measured during the procedure were found to be high (P < 0.05). CONCLUSIONS Dentists who care for pediatric patients are more stressed when applying treatment under deep sedation. The results suggest the need for more training and practice to strengthen the education given on general anesthesia/sedation in pediatric dentistry training. CLINICAL REVELANCE To increase the health and treatment quality of the dentists, who spend most of the day with the dental treatment of children, should be taken precautions.
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Affiliation(s)
- Esra Kızılcı
- Department of Pedodontics, Faculty of Dentistry, Erciyes University, 38000, Melikgazi/Kayseri, Turkey
| | | | | | - Sabahattin Muhtaroğlu
- Department of Biochemistry, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Kevser Kolçakoğlu
- Department of Pedodontics, Faculty of Dentistry, Erciyes University, 38000, Melikgazi/Kayseri, Turkey.
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Pediatric morbidity after oral surgery procedures under general anaesthesia: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101262. [PMID: 35961509 DOI: 10.1016/j.jormas.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/06/2022] [Accepted: 08/07/2022] [Indexed: 11/21/2022]
Abstract
The aim of this study is to carry out a systematic review of the existing literature on postoperative morbidity after general anaesthesia (GA) in the dental care of paediatric patients, its frequency, characteristics and association with the intervention performed. MATERIAL AND METHODS An exhaustive search of the literature published up to 23 February 2022 was carried out in PubMed, Web of Science, Cochrane and EBSCO, with the following strategy: (infant OR child OR adolescent) AND (Oral Surgical Procedures OR Dentistry, Operative) AND Anesthesia, General AND Postoperative Complications. RESULTS The most frequent reason for the indication of general anaesthesia was dental caries and its complications (up to 91.0% of patients), followed by lack of cooperation/anxiety and/or fear for dental procedures in the office (between 39.8 and 47.9%). There is a higher prevalence for treatments in the special patient group reaching 87.7% compared to 63.3% in healthy patients. The main comorbidities recorded were: physical or mental disability, neurological, haematological, cardiac disorders, asthma, Down's syndrome; it was not possible to establish their association with the intervention performed. Regarding complications, complaints occurred between 43.0 and 98.9% of cases within the first 24 hours, the main reason being pain (between 14.0% and 95.0%). CONCLUSIONS Pediatric dental procedures under GA carry a very low risk of major complications, but have a virtually universal incidence of minor complications.
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Patel S, Fantauzzi AJ, Patel R, Buscemi J, Lee HH. Childhood caries and dental surgery under general anesthesia: an overview of a global disease and its impact on anesthesiology. Int Anesthesiol Clin 2023; 61:21-25. [PMID: 36480646 PMCID: PMC9752176 DOI: 10.1097/aia.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Children’s oral health is influenced, negatively and positively, but modifiable social determinants. For high-risk populations, severe disease burden leads to dental treatment under general anesthesia (DGA), which represents a costly and futile use of scarce resources. These clinical events, at the intersection of medicine and dentistry, often involve anesthesiologists to facilitate care. However, clinical interventions do not address the etiology of disease, which are largely rooted in health behaviors. In this review, we will summarize the scope of severe disease on a global scale and its impact on individual and population health and health systems. We will also provide insight into factors that influence DGA utilization from perspectives of families, providers, health systems, policy, and community-level environment. A child’s need for DGA may represent missed prevention opportunities at several levels. However, the surgical period may serve as a prime window to change a family’s oral health behaviors and reduce chance of recurrent disease amongst the highest risk families.
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Affiliation(s)
- Shiragi Patel
- Department of Anesthesiology, Ann & Robert H. Lurie Children's Hospital, McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Andrés J Fantauzzi
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, Illinois
| | - Raj Patel
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, Illinois
| | - Helen H Lee
- Department of Anesthesiology, Institute for Health Policy and Research, University of Illinois at Chicago, Chicago, Illinois
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Luigi C, Stefania DS. Nitrous oxide intoxication: systematic literature review and proposal of new diagnostic possibilities. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Nitrous oxide (N2O), also called “laughing gas,” is the most commonly used inhalation anesthetic in dentistry. The N2O is no longer used, because of the long-term neurologic and cardiovascular sequelae. Due to its sedative and euphoric properties, N2O is often used for recreational use or in some erotic activities. Accidental deaths are mainly associated with the uses of N2O: death can occur from sudden cardiac arrhythmia or, most commonly, acute asphyxiation due to hypoxia. This paper aims to study the literature concerning deaths due to N2O intoxication and highlight pathological findings useful for diagnosis when the crime scene investigation does not reveal any evidence.
Materials and methods
The authors conducted the literature search by PubMed and Scopus databases, searching for articles from 1 January 1970 to 1 March 2020 using the key terms: “Nitrous oxide,” “Laughing gas,” “Hypoxic damage,” “Nitrous oxide anesthesia,” and “Nitrous oxide death.”
Results and discussion
A total of 244 articles were collected. Only 26 articles were included in the systematic review. Most of the deaths from intoxication are due to asphyxiation; the diagnosis is often difficult and immunohistochemistry could be helpful. Nitrous oxide increases the intracellular adhesion molecule expression, E- and P-Selectin (markers of the early inflammatory response), and HIF-1 α (indicative of oxidative stress during ischemia-reperfusion).
Conclusion
The macroscopic and microscopic signs of N2O intoxication are non-specific, but N2O has been proven to cause hypoxic damage to the brain. The suspicion of the presence of the gas in the environment should guide the pathologist. Tissue analyzes provide important information; immunohistochemical stains can confirm hypoxic damage through the use of markers such as HIF-1 α, E-Selectin, and P-Selectin.
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D’Anna T, Argo A, Zerbo S, D’Urso D, Rini MS. Dentistry and Drug Adverse Events: Between Responsibilities and Regulations. TOXICS 2022; 10:671. [PMID: 36355962 PMCID: PMC9696188 DOI: 10.3390/toxics10110671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this paper is to renew interest and attention to the medical history, prescription, and/or use of drugs during dental practice. The work analyzes the issue of the use of drugs in dentistry from both a clinical and a medical-legal point of view. The laws governing the matter were also taken into consideration, relating them to the roles of prescriber and user that the dentist can acquire. Analysis of various aspects of this matter demonstrates that it is necessary for dentists to know the drugs and medical substances, their characteristics and properties, related effects, and interactions in order to use them appropriately and adequately. Knowledge of interferences, reactions, and adverse events or complications helps to reduce errors and protect patients' health. Furthermore, knowledge of the national and international reference standards relating to the use of drugs leads to a reduction in medico-legal questions. In conclusion, knowledge and adequate and appropriate use of drugs reduces the possibility of accidents, adverse events, medico-legal consequences, and disputes with patients. Documented and traceable choices allow the analysis and valuation of professional conduct. Authors perceived the topic of informed consent of patients as relevant to the adequate procedure of prescribing drugs related to dentistry practice; therefore, representative conditions of patients at risk should be illustrated in practice. Legal duties related to physician drug prescription and use must be considered and carefully checked.
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Affiliation(s)
- Tommaso D’Anna
- Policlinic Hospital, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Antonina Argo
- Policlinic Hospital, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Stefania Zerbo
- Policlinic Hospital, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Section of Legal Medicine, University of Palermo, 90127 Palermo, Italy
| | - Diego D’Urso
- Dentistry Faculty, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Maria Sofia Rini
- Dentistry Faculty, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
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Postoperative Morbidity of Dental Paediatric Patients Treated under General Anaesthesia at a University Hospital: An Observational Study. Int J Dent 2022; 2022:9606010. [PMID: 35795193 PMCID: PMC9251146 DOI: 10.1155/2022/9606010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022] Open
Abstract
Aims To assess prevalence of postoperative morbidity signs and symptoms in children treated under GA, and to investigate the association between pre- and intra-operative factors with postoperative morbidity. Study design and Methods Prospective, observational study supported by pre-operative, intra-operative, and postoperative questionnaire conducted on paediatric patients treated for dental reasons under general anaesthesia at a university hospital. Results Hundred and fifty patients were included with average age 5.5 years. The majority (92%) experienced at least one postoperative morbidity sign and symptom on the day of treatment under GA and the majority of symptoms subside by the third day. Dental pain (81.3%), sleepiness (70%), and poor appetite (46.7%) were the most frequently reported. Logistic regression analysis showed that age, gender, type of treatment provided, use of LA, and duration of procedure were significantly associated with postoperative morbidity. Conclusions Most patients experienced one or more morbidity sign/s or symptom/s during first postoperative day and the majority subsides by the third day. Dental pain and poor appetite were the most and long lasting reported. Factors that would predict the occurrence of postoperative morbidity were gender, patient's age, and duration of procedure.
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21
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Impact of Silver Diamine Fluoride Therapy on the Oral Health-Related Quality of Life of Preschool Children with Behavioral Problems after Three Months: A Pilot Study. J Clin Med 2022; 11:jcm11113071. [PMID: 35683459 PMCID: PMC9181627 DOI: 10.3390/jcm11113071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background: In Austria, almost every second child has caries. The consequences of untreated carious lesions are infections, pain, and limitations in everyday life. The aim of this study was to evaluate the influence of silver diamine fluoride (SDF) treatment on the oral health-related quality of life (OHRQoL) of uncooperative children aged 0−5 years using the German version of the Early Childhood Oral Health Impact Scale (ECOHIS-G). Methods: This prospective study was conducted at the Department of Paediatric Dentistry at the Medical University of Vienna. Preschool children with behavioral problems and carious lesions that required SDF application were included. The ECOHIS-G questionnaire was given to the caregiver before (T0) and three months (T1) after treatment. Using descriptive analysis and the Wilcoxon Signed-Rank test, changes in the ECOHIS scores were evaluated and tested for significance. Results: A total of 30 children aged 0−5 years were enrolled and received SDF treatment. At baseline, the total ECOHIS score was 21.4 (±8.5). Three months after therapy, a significant improvement was achieved (16.3 [±5.6], p < 0.05). Significantly better scores were observed in six subdomains, especially in “child function” (3.9 [±2.0]) and “child symptoms” (2.0 [±1.3]) (p < 0.05). Conclusions: Treatment of carious lesions with SDF in the primary dentition resulted in an improvement in the OHRqoL of children with behavioral problems.
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22
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Zouaidi K, Olson G, Lee HH, Kalenderian E, Walji MF. An Observational Retrospective Study of Adverse Events and Behavioral Outcomes During Pediatric Dental Sedation. Pediatr Dent 2022; 44:174-180. [PMID: 35799341 PMCID: PMC9648664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: The purpose of this study was to examine a university-based dental electronic health records (EHR) database to identify sedation-related adverse events (AEs) and assess patients' behavioral outcomes during routine pediatric dental sedations (PDSs) in a dental school clinic. Methods: A database was screened for patients younger than 18 years old who had received dental sedation in 2019. The qualifying EHRs were then accessed and sedations were reviewed for AEs, which were categorized using a 12-point classification system and the Tracking and Reporting Outcomes of Procedural Sedation Tool. Patient behaviors were assessed using provider progress notes and categorized as presence/ absence of agitation. Results: A total of 690 sedations were reviewed, yielding 28 AEs. Emesis was the most common AE observed in 1.3 percent of sedations. Respiratory and cardiovascular AEs were observed in 0.7 percent and 0.6 percent of sedations, respectively. Agitation was identified in 47.5 percent of sedations, while 34.1 percent of agitations resulted in the documented suspension of dental treatment. Agitation was mainly observed for nitrous oxide and oral sedation resulting in one failed sedation out of five sedations for each method. Conclusions: Potentially serious adverse effects were identified during pediatric dental sedations, but their incidence was low. A significant proportion of the sedated children experienced agitation, resulting in some sedation failures. Such events need to be tracked and examined for risk assessment reduction and quality-of-care improvement.
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Affiliation(s)
- Kawtar Zouaidi
- Dr. Zouaidi is a graduate research assistant in the Diagnostic and Biomedical Sciences Department, at the School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gregory Olson
- Dr. Olson is a professor and chair of the Department of Pediatric Dentistry, at the School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Helen H Lee
- Dr. Lee is an associate professor, Department of Anesthesiology, University of Illinois at Chicago, Chicago, Ill., USA
| | - Elsbeth Kalenderian
- Dr. Kalenderian is a professor, School of Dentistry, University of California at San Francisco, San Francisco, Calif., USA, and a senior lecturer, Harvard School of Dental Medicine, Boston, Mass., USA, and an adjunct professor, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Muhammad F Walji
- Dr. Walji is a professor/associate dean for Technology Services and Informatics, Diagnostic and Biomedical Sciences Department, at the School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA ;,
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Verrett C, Wittenberg BM. How can child life specialists help address dental fear and anxiety in children?: A review. PEDIATRIC DENTAL JOURNAL 2021. [DOI: 10.1016/j.pdj.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Development of a new tool for predicting the behavior of individuals with intellectual disability in the dental office: A pilot study. Disabil Health J 2021; 15:101229. [PMID: 34776386 DOI: 10.1016/j.dhjo.2021.101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/25/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The dental treatment of individuals with intellectual disability can represent a considerable professional challenge. OBJECTIVE To develop a model for predicting the behavior of patients with intellectual disability in the dental office. METHODS The study group comprised 250 patients with Down syndrome (DS), autism spectrum disorder (ASD), cerebral palsy (CP), idiopathic cognitive impairment or rare disorders. We collected their demographic, medical, social and behavioral information and identified potential predictors (chi-squared test). We developed stratified models (Akaike information criterion) to anticipate the patients'behavior during intraoral examinations and to discern whether the dental treatment should be performed under general anesthesia. These models were validated in a new study group consisting of 80 patients. Goodness of fit was quantified with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC). We developed a mathematical algorithm for executing the models and developed software for its practical implementation (PREdictors of BEhavior in Dentistry, "PREBED"). RESULTS For patients with DS, ASD and CP, the model predicting the need for physical restraint during examination achieved a PPV of 0.90, 0.85 and 1.00, respectively, and an NPV of 0.66, 0.76 and 1.00, respectively. The model predicting the need for performing treatment under general anesthesia achieved a PPV of 0.63, 1.00 and 1.00, respectively, and an NPV of 1.00, 1.00 and 0.73, respectively. However, when validating the stratified models, the percentage of poorly classified individuals (false negatives + false positives) ranged from 24% to 46.6%. CONCLUSIONS The results of the PREBED tool open the door to establishing new models implementing other potentially predictive variables.
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McAdam DB, Zhou Z. Behavior-Analytic Interventions for Oral Health Care: a Review of the Literature and Recommendations for Clinical Practice and Research. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jamieson LM, Hedges J, Ju X, Kapellas K, Leane C, Haag DG, Santiago PR, Macedo DM, Roberts RM, Smithers LG. Cohort profile: South Australian Aboriginal Birth Cohort (SAABC)-a prospective longitudinal birth cohort. BMJ Open 2021; 11:e043559. [PMID: 33619192 PMCID: PMC7903076 DOI: 10.1136/bmjopen-2020-043559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/20/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The South Australian Aboriginal Birth Cohort (SAABC) is a prospective, longitudinal birth cohort established to: (1) estimate Aboriginal child dental disease compared with population estimates; (2) determine the efficacy of an early childhood caries intervention in early versus late infancy; (3) examine if efficacy was sustained over time and; (4) document factors influencing social, behavioural, cognitive, anthropometric, dietary and educational attainment over time. PARTICIPANTS The original SAABC comprised 449 women pregnant with an Aboriginal child recruited February 2011 to May 2012. At child age 2 years, 324 (74%) participants were retained, at age 3 years, 324 (74%) participants were retained and at age 5 years, 299 (69%) participants were retained. Fieldwork for follow-up at age 7 years is underway, with funding available for follow-up at age 9 years. FINDINGS TO DATE At baseline, 53% of mothers were aged 14-24 years and 72% had high school or less educational attainment. At age 3 years, dental disease experience was higher among children exposed to the intervention later rather than earlier in infancy. The effect was sustained at age 5 years, but rates were still higher than general child population estimates. Experiences of racism were high among mothers, with impacts on both tooth brushing and toothache. Compared with population estimates, levels of self-efficacy and self-rated oral health of mothers at baseline were low. FUTURE PLANS Our data have contributed to a better understanding of the environmental, behavioural, dietary, biological and psychosocial factors contributing to Aboriginal child oral and general health, and social and emotional well-being. This is beneficial in charting the trajectory of cohort participants' health and well-being overtime, particularly in identifying antecedents of chronic diseases which are highly prevalent among Aboriginal Australians. Funding for continued follow-up of the cohort will be sought. TRIAL REGISTRATION NUMBER ACTRN12611000111976; Post-results.
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Affiliation(s)
- Lisa M Jamieson
- Faculty of Health and Medical Sciences, Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, The University of Adeliade, Adelaide, South Australia, Australia
| | - X Ju
- Australian Research Centre for Population Oral Health, The University of Adeliade, Adelaide, South Australia, Australia
| | - Kostas Kapellas
- Australian Research Centre for Population Oral Health, The University of Adeliade, Adelaide, South Australia, Australia
| | - Cathy Leane
- South Australian Government, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Dandara G Haag
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
- Better Start Child Health and Development Research Group, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Pedro Ribeiro Santiago
- Australian Research Centre for Population Oral Health, The University of Adeliade, Adelaide, South Australia, Australia
| | - Davi Manzini Macedo
- Australian Research Centre for Population Oral Health, The University of Adeliade, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa G Smithers
- School of Public Health, University of Adelaide, Australia, Adelaide, South Australia, Australia
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Peng J, Zeng X, Townsend J, Liu G, Huang Y, Lin S. A Machine Learning Approach to Uncovering Hidden Utilization Patterns of Early Childhood Dental Care Among Medicaid-Insured Children. Front Public Health 2021; 8:599187. [PMID: 33537275 PMCID: PMC7848156 DOI: 10.3389/fpubh.2020.599187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Early childhood dental care (ECDC) is a significant public health opportunity since dental caries is largely preventable and a prime target for reducing healthcare expenditures. This study aims to discover underlying patterns in ECDC utilization among Ohio Medicaid-insured children, which have significant implications for public health prevention, innovative service delivery models, and targeted cost-saving interventions. Methods: Using 9 years of longitudinal Medicaid data of 24,223 publicly insured child members of an accountable care organization (ACO), Partners for Kids in Ohio, we applied unsupervised machine learning to cluster patients based on their cumulative dental cost curves in early childhood (24–60 months). Clinical validity, analytical validity, and reproducibility were assessed. Results: The clustering revealed five novel subpopulations: (1) early-onset of decay by age (0.5% of the population, as early as 28 months), (2) middle-onset of decay (3.0%, as early as 35 months), (3) late-onset of decay (5.8%, as early as 44 months), (4) regular preventive care (67.7%), and (5) zero utilization (23.0%). Patients with early-onset of decay incurred the highest dental cost [median annual cost (MAC) = $9,499, InterQuartile Range (IQR): $7,052–$11,216], while patients with regular preventive care incurred the lowest dental cost (MAC = $191, IQR: $99–$336). We also found a plausible correlation of early-onset of decay with complex medical conditions diagnosed at 0–24 months. Almost one-third of patients with early-onset of decay had complex medical conditions diagnosed at 0–24 months. Patients with early-onset of decay also incurred the highest medical cost (MAC = $7,513, IQR: $4,527–$12,546) at 0–24 months. Conclusion: Among Ohio Medicaid-insured children, five subpopulations with distinctive clinical, cost, and utilization patterns were discovered and validated through a data-driven approach. This novel discovery promotes innovative prevention strategies that differentiate Medicaid subpopulations, and allows for the development of cost-effective interventions that target high-risk patients. Furthermore, an integrated medical-dental care delivery model promises to reduce costs further while improving patient outcomes.
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Affiliation(s)
- Jin Peng
- Research Information Solutions and Innovation, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Xianlong Zeng
- Research Information Solutions and Innovation, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Janice Townsend
- Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, GA, United States.,Department of Dentistry, Nationwide Children's Hospital, Columbus, OH, United States
| | - Gilbert Liu
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Yungui Huang
- Research Information Solutions and Innovation, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Simon Lin
- Research Information Solutions and Innovation, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
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Ludwig S, Tranby EP, Mitchell M, Fullman J, Allen G. System level interventions to reduce utilization of general anesthesia to treat dental caries: a practice brief. J Public Health Dent 2020; 80 Suppl 2:S122-S125. [PMID: 33306845 DOI: 10.1111/jphd.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Abstract
Dental caries are the most common chronic disease of childhood. Untreated caries can result in severe pain and infection; and in some cases, difficulties in eating, speech, and education. Hospitalization and general anesthesia are often necessary for treating extensive disease in young children, which adds significant risk and expense. Interventions, such as community-based preventative care, utilization of pre-authorizations for treatment, and at-risk contracts, have been deployed as innovative strategies to reduce the incidence of caries and the cost of treatment. Value-based payment structures give payors flexibility to design a multipronged system to impact the health of consumers. This practice brief will identify interventions at a systems level that reduced the utilization of general anesthesia treating dental caries in children under the age of six. Dental claims data from the period of Q1 2011 to Q2 2020 were utilized to analyze the trends in utilization of the operating room (OR) to treat dental conditions among children under 6 years. Fixed effects analysis was utilized to identify key over time changes in the reduction of children's OR utilization. A reduction in utilization of general anesthesia and hospitalization for treating dental caries in young children was seen. The expansion of the community care team, metrics to reinforce the systems of provider education and training, and the use of incentive payments were all associated with reductions in the rate of OR utilization. Between 2012 and 2017, multiple initiatives were implemented without a systematic approach to quality improvement to evaluate.
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Affiliation(s)
| | - Eric P Tranby
- DentaQuest Partnership for Oral Health Advancement, Analytics and Evaluation, Boston, MA, USA
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Wiemer SJ, Nathan JM, Heggestad BT, Fillmore WJ, Viozzi CF, Van Ess JM, Arce K, Ettinger KS. Safety of Outpatient Procedural Sedation Administered by Oral and Maxillofacial Surgeons: The Mayo Clinic Experience in 17,634 Sedations (2004 to 2019). J Oral Maxillofac Surg 2020; 79:990-999. [PMID: 33382992 DOI: 10.1016/j.joms.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE The safety of the team anesthesia model routinely used by the specialty of oral and maxillofacial surgery has recently been called into question. The purpose of this article is to measure the frequency of adverse anesthetic events related to ambulatory surgical procedures performed under intravenous (IV) sedation by the Division of Oral and Maxillofacial Surgery at the Mayo Clinic during a 15-year period using the team anesthesia model. MATERIALS AND METHODS A retrospective cohort study was designed, and a sample of subjects identified undergoing IV sedation at Mayo Clinic from 2004 to 2019. The primary outcome variable of interest was the presence of anesthetic-related adverse events (AEs) consistent with the World Society of Intravenous Anesthesia International Sedation Task Force's intervention-based definitions of adverse anesthetic events. Additional covariates included patient age, gender, American Society of Anesthesiologists (ASA) score, type of surgical procedure performed, and the type/dosage of medications administered periprocedurally. Univariate logistic regression analysis was used to assess for associations between AEs and covariates. RESULTS The study identified 17,634 sedations administered to 16,609 unique subjects. In 17,634 sedations, 16 (0.1%) AEs and no subject deaths (0%) were identified. There were no statistically significant associations between AEs and age (hazard ratio [HR], 0.4; 95% confidence interval [95% CI], 0.2 to 1.3; P = .13); gender (HR, 0.9; 95% CI, 0.3 to 2.5; P = .87); ASA 2 classification (HR, 1.6; 95% CI, 0.6 to 4.5; P = .33); ASA 3 classification (HR, 1.3; 95% CI, 0.1 to 22.0; P = .86), or types of IV sedation medications administered during the procedure: fentanyl (HR, 0.4; 95% CI, 0.02 to 6.3; P = .5); midazolam (HR, 1.0; 95% CI, 0.2 to 4.3; P = .98); propofol (HR, 1.0; 95% CI, 0.3 to 3.5; P = .99); or ketamine (HR, 1.0; 95% CI, 0.1 to 7.3; P = .97). CONCLUSIONS The frequency of AEs (0.1%) and 0% mortality rate reported in this study demonstrate that the anesthesia team model used by oral and maxillofacial surgeons compares favorably to standardized intervention-based adverse anesthetic event outcomes reported by other nonanesthesiology specialties routinely performing outpatient procedural sedation.
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Affiliation(s)
- Steven J Wiemer
- Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - John M Nathan
- Senior Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - Benjamin T Heggestad
- Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - W Jonathan Fillmore
- Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - Christopher F Viozzi
- Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - James M Van Ess
- Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - Kevin Arce
- Assistant Professor of Surgery and Division Chair, Section of Head & Neck Oncologic and Reconstructive Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN
| | - Kyle S Ettinger
- Assistant Professor of Surgery, Section of Head & Neck Oncologic and Reconstructive Surgery, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
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Hot Topics in Safety for Pediatric Anesthesia. CHILDREN-BASEL 2020; 7:children7110242. [PMID: 33233518 PMCID: PMC7699483 DOI: 10.3390/children7110242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia and efforts to ameliorate risk. Conclusions: Pediatric anesthesiology has made great strides in patient perioperative safety with initiatives including the creation of a specialty society, quality and safety committees, large multi-institutional research efforts, and quality improvement initiatives. Common pediatric peri-operative events are now monitored with multi-institution and organization collaborative efforts, such as Wake Up Safe.
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Corrêa CDTSDO, Sousa P, Reis CT. Patient safety in dental care: an integrative review. CAD SAUDE PUBLICA 2020; 36:e00197819. [PMID: 33084835 DOI: 10.1590/0102-311x00197819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/29/2020] [Indexed: 11/22/2022] Open
Abstract
Adverse events pose a serious problem for quality of healthcare. Dental practice is eminently invasive and involves close and routine contact with secretions; as such, it is potentially prone to the occurrence of adverse events. Various patient safety studies have been developed in the last two decades, but mostly in the hospital setting due to the organizational complexity, severity of the cases, and diversity and specificity of the procedures. The objective was to identify and explore studies on patient safety in Dentistry. An integrative literature review was performed in MEDLINE via PubMed, Scopus via Portal Capes, and the Regional Portal of the Virtual Health Library, using the terms patient safety and dentistry in English, Spanish, and Portuguese, starting in 2000. The research cycle in patient safety was used, as proposed by the World Health Organization to classify studies. We analyzed 91 articles. The most common adverse events were allergies, infections, diagnostic delay or failure, and technical error. Measures to mitigate the problem highlight the need to improve communications, encourage reporting, and search for tools to assist the management of care. The authors found a lack of studies on implementation and assessment of the impact of proposals for improvement. Dentistry has made progress in patient safety but still needs to transpose the results into practice, where efforts are crucial to prevent adverse events.
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Affiliation(s)
| | - Paulo Sousa
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
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Safety in dental care: Where is our surveillance imperative? J Am Dent Assoc 2020; 151:381-383. [PMID: 32450973 DOI: 10.1016/j.adaj.2020.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 01/05/2023]
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Abstract
Anesthesia care performed outside the operating room is a growing area of pediatric anesthesia practice. The anesthesiology team expects to care for children in diverse locations, which include diagnostic and interventional radiology, gastroenterology and pulmonary endoscopy suites, radiation oncology sites, and the cardiac catheterization laboratory. To provide safe, high-quality care the anesthesiologist working in these environments must understand the unique environmental, logistical, and perioperative considerations and risks involved with each remote location. This 2-part review provides an overview of safety and system considerations in pediatric nonoperating room anesthesia before describing in more detail considerations for particular remote anesthetizing locations.
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Affiliation(s)
- Mary Landrigan-Ossar
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
| | - Christopher Tan Setiawan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Anesthesiology, Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA
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Abstract
PURPOSE OF REVIEW Anesthesia outside the operating room is rapidly expanding for adult and pediatric patients. Anesthesia clinicians practicing in this area need a good understanding of the challenges of the NORA environment and the anesthetic risks and perioperative implications of practice so that they can deliver safe care to their patients. RECENT FINDINGS Recent reports from large patient databases have afforded anesthesiologists a greater understanding of the risk of NORA when compared to anesthesia in the operating room. Descriptions of advances in team training with the use of simulation have allowed the development of organized procedural teams. With an emphasis on clear communication, an understanding of individual roles, and a patient-centered focus, these teams can reliably develop emergency response procedures, so that critical moments are not delayed in an environment remote from usual assistance. SUMMARY With appropriate attention to organizational concerns (i.e. team environment, safety protocols) and unrelenting focus on patient safety, anesthesiologists can assist in safely providing the benefit of cutting-edge technical advancements to pediatric patients in these challenging environments.
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Wu G, Xu X, Fu G, Zhang P. General Anesthesia Maintained with Sevoflurane versus Propofol in Pediatric Surgery Shorter Than 1 Hour: A Randomized Single-Blind Study. Med Sci Monit 2020; 26:e923681. [PMID: 32572017 PMCID: PMC7333513 DOI: 10.12659/msm.923681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Sevoflurane was compared with propofol for general anesthesia maintenance in pediatric operations lasting less than 1 hour in terms of anesthetic effect and postoperative recovery. Material/Methods Children scheduled for inguinal hernia repair or hydrocele testis repair were randomly assigned to receive general anesthesia maintained with either sevoflurane (n=43) or propofol (n=43). The ilioinguinal nerve was blocked with 1% lidocaine (7 mg/kg) after intravenous administration of ketamine (2 mg/kg). At the end of the surgery in patients receiving sevoflurane, sevoflurane was stopped and a bolus of propofol of 1 mg/kg was administered. Results Sevoflurane was associated with significantly less use of ketamine (35.1±10.6 mg) than was propofol (59.0±28.0 mg; P<0.001). In addition, sevoflurane was associated with a significantly shorter time in the post-anesthesia care unit (52.1±9.0 min) than was propofol (68.8±15.3 min; P<0.001). Propofol was associated with a significantly higher incidence of intraoperative body movement (33.3%) than was sevoflurane (13.5%; P=0.045). However, the 2 groups showed no important differences in other adverse events such as hypoxia, emergence agitation, and additional use of propofol. Conclusions In pediatric surgery lasting less than 1 hour, anesthesia maintained with sevoflurane was associated with significantly less use of ketamine, shorter postoperative recovery time, and less intraoperative body movement than was propofol.
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Affiliation(s)
- Guisheng Wu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Xia Xu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Guanghua Fu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Ping Zhang
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
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Nannini VL, Tiner BD, Johnson JD, Clark RS, Indresano AT, Shafer DM, Schwartz PJ, Sacco DM, Morrison JD, Crago CA, Egbert MA. Reply. J Oral Maxillofac Surg 2020; 78:673-674. [DOI: 10.1016/j.joms.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 11/17/2022]
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Arrow P, Forrest H. Atraumatic restorative treatments reduce the need for dental general anaesthesia: a non-inferiority randomized, controlled trial. Aust Dent J 2020; 65:158-167. [PMID: 32040875 DOI: 10.1111/adj.12749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND A dental general anaesthesia (DGA) is commonly undertaken for the management of dental caries in young children. A randomized-controlled trial was undertaken to test the feasibility of using the Atraumatic Restorative Treatment and Hall Technique approaches (ART/HT) to manage the dental treatment of children recommended for a DGA. METHODS Consenting children, recommended a DGA for caries management, at the Oral Health Centre of Western Australia were randomized. Test group children were treated using the ART/HT approach and the control group under a DGA. Children were examined after 12 months by two blinded, calibrated examiners. Analysis was on an intention to treat basis; between and within group comparisons were undertaken using appropriate paired and unpaired tests. Logistic regression was used to test restorative success, controlling for clustering of teeth. RESULTS Sixty-five children participated, (Test = 32; Control = 33). At study termination, 28 children (88%) in the ART/HT group and 20 children (61%) in the DGA group had been provided with care, P < 0.01. Crown restorations were protective of restorative failure in a multivariate logistic model (OR 0.05, P < 0.01). CONCLUSION Use of the ART/HT approach enabled timely dental treatment of young children recommended for a DGA, and should be among the treatment options considered.
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Affiliation(s)
- P Arrow
- Dental Health Services, Perth, Western Australia
| | - H Forrest
- Dental Health Services, Perth, Western Australia
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38
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de Jesus VC, Shikder R, Oryniak D, Mann K, Alamri A, Mittermuller B, Duan K, Hu P, Schroth RJ, Chelikani P. Sex-Based Diverse Plaque Microbiota in Children with Severe Caries. J Dent Res 2020; 99:703-712. [PMID: 32109360 DOI: 10.1177/0022034520908595] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Severe early childhood caries (S-ECC) is a multifactorial disease that can lead to suffering and reduced oral health-related quality of life in young children. The bacterial and fungal composition of dental plaque and how children's sex is associated with S-ECC are largely unknown. In this study, V4-16S rRNA and ITS1 rRNA gene amplicon sequencing was used to compare the plaque bacteriome and mycobiome of children <72 mo of age: 40 with S-ECC (15 males, 25 females) and 40 caries-free (19 males, 21 females). Health- and nutrition-related questionnaire data were also investigated. This study aimed to analyze potential sex-based differences in the supragingival plaque microbiota of young children with S-ECC and those caries-free. Behavioral and nutritional habit differences were observed between children with S-ECC and those caries-free and between male and female children. Overall, higher levels of Veillonella dispar, Streptococcus mutans, and other bacterial species were found in the S-ECC group as compared with caries-free controls (P < 0.05). A significant difference in the abundance of Neisseria was observed between males and females with S-ECC (P < .05). Fungal taxonomic analysis showed significantly higher levels of Candida dubliniensis in the plaque of children with S-ECC as compared with those caries-free (P < 0.05), but no differences were observed with Candida albicans (P > 0.05). Significant differences in the relative abundance of Mycosphaerella, Cyberlindnera, and Trichosporon fungal species were also observed between the caries-free and S-ECC groups (P < 0.05). Machine learning analysis revealed the most important bacterial and fungal species for classifying S-ECC versus caries-free. Different patterns of crosstalk between microbial species were observed between male and female children. Our work demonstrates that plaque microbiota and sex may be important determinants for S-ECC and could be factors to consider for inclusion in caries risk assessment tools.
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Affiliation(s)
- V C de Jesus
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - R Shikder
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Computer Science, Faculty of Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - D Oryniak
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - K Mann
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - A Alamri
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - B Mittermuller
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - K Duan
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - P Hu
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Biochemistry and Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Computer Science, Faculty of Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - R J Schroth
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - P Chelikani
- Manitoba Chemosensory Biology Research Group and Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Oubenyahya H, Bouhabba N. General anesthesia in the management of early childhood caries: an overview. J Dent Anesth Pain Med 2019; 19:313-322. [PMID: 31942447 PMCID: PMC6946837 DOI: 10.17245/jdapm.2019.19.6.313] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/13/2019] [Accepted: 10/30/2019] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Hanan Oubenyahya
- Department of Dentistry, Military Hospital Agadir, Agadir, Morocco
| | - Najib Bouhabba
- Department of Anesthesiology, Military Hospital Agadir, Agadir, Morocco
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40
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Results from the Adverse Event Sedation Reporting Tool: A Global Anthology of 7952 Records Derived from >160,000 Procedural Sedation Encounters. J Clin Med 2019; 8:jcm8122087. [PMID: 31805686 PMCID: PMC6947169 DOI: 10.3390/jcm8122087] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/28/2022] Open
Abstract
Background: The incidence of sedation-related adverse events, inclusive of both adults and children, administered by multiple specialty providers from different countries and venues, using standardized definitions, has never been reported on an international level. We are reporting the outcome data of the adverse event sedation reporting tool as an important step toward a more complete risk assessment of sedation-related morbidity, mortality, and etiology. The analysis of the AE sedation reporting data include descriptive measures to evaluate the characteristics of the provider, the patient, sedations performed, adverse events, interventions, and outcomes. The primary outcome was the rate and nature of adverse events. Between 12/14/2010 and 12/11/2018 there were 7952 sedations, from an estimated total of 164,114 sedations administered, of which 622 were reported as adverse events. The mean age of the entire patient population is 33.0 years (0.02–98.7). The providers represented 39 countries across six continents. Oxygen desaturation (75%–90%) for <60 s is the most prevalent adverse event with a rate of 7.8 per 10,000, followed by airway obstruction at a rate of 5.42 per 10,000. Apnea occurred at a rate of 4.75 per 10,000. Significant predictors of adverse events are ≥ ASA score III (p = 0.0003), procedure time (6:00 pm–12:00 am: p < 0.0001, 12:00–6:00 am: p = 0.0003), and non-hospital location (p < 0.0001). The AE sedation reporting tool has demonstrated that the majority of adverse events in children and adults who receive procedural sedation from multi-specialists internationally required minor interventions and had outcomes of minor risk.
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Zajtsev AY, Svetlov VA, Dubrovin KV, Nazaryan DN. [Practical aspects of sedation in dentistry]. STOMATOLOGII︠A︡ 2019; 98:96-102. [PMID: 31513159 DOI: 10.17116/stomat20199804196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In modern dental practice, the use of sedation to eliminate the fear and anxiety of the patient has become frequent. Unfortunately, according to the legislation, the concept of sedation is inseparable from anesthesia and it can only be performed by an anesthesiologist in a group or Department of Anesthesiology and Resuscitation. The article is devoted to a detailed comprehensive review of sedation in dental and surgical interventions in the maxillofacial area. It details the physiological and pathophysiological data of stress and psycho-emotional discomfort. The article indicates drugs for sedation, methods of their administration, features of application, possible complications. Such methods of parenteral sedation as intranasal, inhalation, intravenous are described in detail. Specific problems of sedation, for example, psychomotor agitation in the application of propofol or cough in deep sedation are indicated. It describes the modern data on intraoperative monitoring as an important component of patient safety during sedation. In addition to the Harvard standard the use of capnography and monitoring the depth of sedation by using bispectral index (BIS) is recommended.
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Affiliation(s)
- A Yu Zajtsev
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia; Boston Institute of Aesthetic Medicine, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - V A Svetlov
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - K V Dubrovin
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia; Boston Institute of Aesthetic Medicine, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - D N Nazaryan
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia; Boston Institute of Aesthetic Medicine, Moscow, Russia
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42
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Özşin Özler C, İleri Keçeli T, Uzamış Tekçiçek M. Pediatric Dentistry and General Anesthesia. ANKARA MEDICAL JOURNAL 2019. [DOI: 10.17098/amj.624720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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43
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AAOMS Response to Recent Challenges to OMS Office-Based Anesthesia for Pediatric Patients. J Oral Maxillofac Surg 2019; 77:2372-2376. [PMID: 31525330 DOI: 10.1016/j.joms.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 11/20/2022]
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Eichmiller F. Third-Party Perspective of Dental Caries Management. Dent Clin North Am 2019; 63:731-736. [PMID: 31470926 DOI: 10.1016/j.cden.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Caries management could provide a unique opportunity to model reform to the dental reimbursement system. To be successful we must first understand the scope and basis of many of the obstacles to reform. Reform must also provide value to all the players involved in benefit determination, provision of care, and payment for care. Value is viewed as outcomes achieved per dollar from the patient's perspective and over a complete cycle of care or management. Reimbursing for value requires measurement of value, and one hypothetical model for caries management is presented based on Michael Porter's hierarchy of outcome measures.
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Minoli M, Zechini G, Capparé P, Landoni G. Dental deaths in Italy as reported by online press articles. Oral Dis 2019; 26:858-864. [PMID: 31310434 DOI: 10.1111/odi.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Mortality on the dental chair is a rare and underreported event. This study aimed to identify all deaths that occurred during dental procedures in Italy. METHODS We searched PubMed/Medline, Scopus, and Internet archives looking for patients who died before, during, or after a dental procedure in Italy from 1990 to 2019. RESULTS All the 36 identified fatal events were reported by national or regional newspapers, and none was reported by scientific databases. Interestingly, no cases regarding patients ≤16 years old were found and there was no variation in the number of reported deaths over the years. Most of the cases (n = 29) occurred in out-of-hospital private dental offices. Tooth extraction represented the most frequent culprit operation (39%), while myocardial infarction (28%) was the leading cause of death, followed by cardiac arrest (25%), allergies (11%), and infections (8%). In four cases, death was preprocedural, in 10 intraprocedural and in 21 postprocedural. In 17 cases, a temporal association between injection of anesthesia/sedation and death was observed. CONCLUSION This is the first report on Italian dental procedure-related deaths. Most of these deaths were only temporally associated with a dental procedure and could not to be attributed to malpractice.
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Affiliation(s)
- Margherita Minoli
- Dental School, Vita-Salute San Raffaele University of Milan, Milano, Italy
| | - Giacomo Zechini
- Dental School, Vita-Salute San Raffaele University of Milan, Milano, Italy
| | - Paolo Capparé
- Dental School, Vita-Salute San Raffaele University of Milan, Milano, Italy.,Vita-Salute San Raffaele University of Milan, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University of Milan, Milan, Italy
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46
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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. Pediatrics 2019; 143:peds.2019-1000. [PMID: 31138666 DOI: 10.1542/peds.2019-1000] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [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 appropriately trained 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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Saxen MA, Tom JW, Mason KP. Advancing the Safe Delivery of Office-Based Dental Anesthesia and Sedation: A Comprehensive and Critical Compendium. Anesthesiol Clin 2019; 37:333-348. [PMID: 31047133 DOI: 10.1016/j.anclin.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The provision for and administration of dental office-based sedation and anesthesia requires considerations and preparations that are unique to dentistry and unlike that of any other office-based and nonoperating room procedures. Anesthesia providers who have only performed dental cases in an operating room are often unaware of the idiosyncrasies and risks associated with performing sedation and anesthesia in the dental office. This article explores the demographics, patient characteristics, morbidity, mortality, and clinical concerns with an in-depth discussion of the dental operating environment. The content is integrated with the current medical and dental guidelines for office-based anesthesia.
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Affiliation(s)
- Mark A Saxen
- Anesthesia, Oral Surgery and Hospital Dentistry, Indiana University School of Dentistry, Indianapolis, IN, USA; Private Practice, Indiana Office-Based Anesthesia, 3750 Guion Road, Suite 225, Indianapolis, IN 46222, USA.
| | - James W Tom
- Section on Dental Anesthesiology, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA; Divisions 1 & 3, Herman Ostrow School of Dentistry, University of Southern California, 925 West 34th Street, Los Angeles, CA 90089, USA
| | - Keira P Mason
- Department of Anesthesiology, Critical Care and Pain Medicine, Bader 3, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Mason KP, Seth N. Future of paediatric sedation: towards a unified goal of improving practice. Br J Anaesth 2019; 122:652-661. [PMID: 30916013 DOI: 10.1016/j.bja.2019.01.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 12/11/2022] Open
Abstract
This review offers a perspective on the future of paediatric sedation. This future will require continued evaluation of adverse events, their risk factors, and predictors. As the introduction of new sedatives with paediatric applications will remain limited, the potential role of mainstay sedatives administered by new routes, for new indications, and with new delivery techniques, should be considered. The role of non-pharmacological strategies for anxiolysis, along with the application of non-mainstay physiologic monitoring, may aid in the improvement of targeted sedation delivery. Understanding the mechanism and location of action of the different sedatives will remain an important focus. Important developments in paediatric sedation will require that large scale studies with global data contribution be conducted in order to support changes in sedation practice, improve the patient experience, and make sedation safer.
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Affiliation(s)
- Keira P Mason
- Harvard Medical School, Boston Children's Hospital, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, MA, USA.
| | - Neena Seth
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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49
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Johhnson B, Serban N, Griffin PM, Tomar SL. Projecting the economic impact of silver diamine fluoride on caries treatment expenditures and outcomes in young U.S. children. J Public Health Dent 2019; 79:215-221. [PMID: 30741498 DOI: 10.1111/jphd.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 01/07/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To quantify the economic impact of using silver diamine fluoride (SDF) to arrest the progression of dental caries in Medicaid-enrolled children (aged 1-5 years) relative to the standard restorative treatment from the Medicaid programs' perspective. METHODS We used Monte Carlo simulation to estimate averted restorative visits and associated expenditures for varying SDF effectiveness and intervention penetration levels. We compared the current standard of care for treating caries to applying SDF. We estimated expenditures from the 2010-2012 Medicaid Analytic Extract files for seven US states and the incremental cost effectiveness ratio for SDF application on averted restorative visits. RESULTS Across the seven states, averted restorative visits ranged from 2,049 (Vermont) to 60,542 (North Carolina), assuming an SDF penetration level of 50%. Averted per-restorative visit costs ranged from $100 to $350 per-visit. There were higher averted per-restorative visit costs in nonmetropolitan counties than metropolitan counties. CONCLUSIONS Providing SDF as a caries management strategy can reduce Medicaid program dental care expenditures by averting expensive caries treatment options. It could also prevent stressful restorative procedures. State Medicaid programs should consider reimbursing for SDF to arrest the progression of dental caries in young children.
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Affiliation(s)
- Ben Johhnson
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Nicoleta Serban
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Paul M Griffin
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
| | - Scott L Tomar
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
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50
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Bach A, Vanner EA, Warman R. Efficacy of Office-Based Nasolacrimal Duct Probing. J Pediatr Ophthalmol Strabismus 2019; 56:50-54. [PMID: 30371916 DOI: 10.3928/01913913-20180925-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 08/03/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the efficacy of nasolacrimal duct probing conducted in the office for nasolacrimal duct obstruction. METHODS A retrospective chart review was conducted of 1,294 patients. Of those, 1,227 patients who underwent office-based nasolacrimal probings of the nasolacrimal duct at a single tertiary care center were included. RESULTS A total of 82 (6.7%) patients needed reprobing. Of the 82 patients who underwent a second procedure, 35 (43%) underwent a second in-office probing with a success rate of 77%. The 8 (22%) patients who failed the second in-office probing underwent probing and Crawford stent placement in the operating room and their symptoms resolved. For the 47 (57%) patients who failed the primary in-office probing and underwent operating room probing and stent placement, only 1 (2%) needed a second operating room probing and stent placement. Logistic regression analyses indicated an increased likelihood of needing a secondary procedure with increased age at the time of the first probing. CONCLUSIONS This large, retrospective analysis of office-based probings demonstrated a success rate of 93.3% with increased likelihood of not needing a second procedure with probing at a younger age. This study demonstrates an excellent success rate for in-office probings for patients both younger and older than 12 months. This not only shows a high rate of efficacy, but is also highly cost efficient when compared to primary probing in the operating room. [J Pediatr Ophthalmol Strabismus. 2019;56(1):50-54.].
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