Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca

Perceptions of mothers of preschool children towards oral health services - a qualitative study

BACKGROUND

Poor oral health, especially dental caries in early childhood is a major public health concern. Parental oral health knowledge, behavior, and perceptions are important elements in determining the child's oral health status. The aim of the study was to investigate the perceptions of mothers of preschool children in Qatar towards their children's oral health and their experiences with oral health services provided to children.

METHODS

The study is based on qualitative methods using focus groups. Purposive sampling was used to recruit mothers of preschool children at two kindergartens in the city of Doha, Qatar. The focus group consisted of a series of open-ended questions about the oral health of children and the opinion of mothers towards the current oral health services provided in the country. An inductive thematic content analysis at the statement level approach was used to analyze the qualitative data.

RESULTS

Twelve mothers between the ages of 20 and 41 years old from two kindergartens participated in two separate focus groups. The average number of children per mother was 5 with 45 months being the mean age of children. Several themes emerged from analyzing the data retrieved from the discussion with mothers. For oral health knowledge, mothers demonstrated a different level of oral health knowledge, from good to poor. As for experiences with health services, recognized the value of oral health services in Qatar but expressed difficulties in access to oral health services for their children with almost all having had some negative experiences. Regarding the anticipated role of mothers in the oral health of their children, mothers were very positive about their potential role in supporting their children's oral health. The mothers also gave recommendations to improve oral health services for young children.

CONCLUSION

Mothers showed positive attitudes towards the oral health of their children and they recognized the importance of a good oral health care system.

Postoperative Morbidity after Dental Treatment under General Anesthesia in Children with and without Disabilities

Background and Objectives: General anesthesia induces reversible unconsciousness, eliminating sensation and enabling painless medical procedures. Vital for dental care, it addresses patients with medical conditions, those needing extensive procedures, and those unable to cooperate due to fear. Dental care for patients with disabilities is a significant unmet need, with studies showing increased oral disease prevalence. This research aims to analyze postoperative morbidity both in healthy and disabled children undergoing dental procedures under general anesthesia. Materials and Methods: This study involved 96 children aged 3 to 15 with dental caries. Two groups were formed: the control group (CTL) (52.94%) included healthy patients requiring general anesthesia due to unsatisfactory cooperation, and the other group included children with physical or intellectual disabilities (CD) (47.96%). Postoperative complications were monitored 1 h after the procedure and 1, 3, 7, and 14 days after the procedure by contacting parents/caregivers by phone. The intensity of postoperative pain was assessed using the Wong-Baker faces pain rating scale. General anesthesia was conducted following a standardized protocol for dental procedures. Results: CTL patients complained more often about postoperative pain 1 h after the procedure (p = 0.03). One day after the procedure, oral bleeding (p = 0.04), fever (p = 0.009), and diarrhea (p = 0.037) occurred more often in CD. In the same period, sore throat appeared more often in CTL (p = 0.036). Three days after the dental treatment, there were statistically significant increases in the occurrence of agitation (p = 0.043) and constipation (p = 0.043) in CD. Seven days later, CD demonstrated a higher occurrence of agitation (p = 0.037). According to the Wong-Baker faces pain rating scale, CTL experienced more frequent and intense pain. Conclusions: CD more frequently reported complications like oral bleeding, fever, and diarrhea. In contrast, the CTL group more often reported pain-related symptoms. The conclusion underscores the need for a pain control protocol for CD and emphasizes the importance of frequent monitoring to prevent unwanted consequences during tooth restoration under general anesthesia.

Analysis of Hospital-Based Dental Procedures Under General Anesthesia in Uncooperative Patients: a Retrospective Study

BACKGROUND

General anesthesia is a well-documented therapeutic option for the provision of dental treatment, particularly in patients with special healthcare needs and uncooperative pediatric patients.

OBJECTIVES

This retrospective study aimed to analyze the characteristics of dental general anesthesia (DGA) procedures for uncooperative patients of all ages in a tertiary healthcare facility, Clinical Hospital Dubrava, in Zagreb, Croatia.

MATERIAL AND METHODS

The hospital records for the patients treated for various dental reasons under GA were obtained at the Clinical Hospital Dubrava in Zagreb, Croatia.

RESULTS

Between 2014 and 2019, a total of 810 DGA procedures were performed including 607 patients. The median age was 18 years. Almost half of the patients referred to undergo DGA procedures were from the City of Zagreb and Zagreb County, 27.8% (N=225) and 21.0% (N=170), respectively. More than 90% of patients undergoing DGA procedures were referred with 1 to 3 medical conditions. 47.9% of patients had 1 to 3 dental conditions, of which caries was the most common condition (95.7%). The mean waiting time (±SD) was 113.06 (±62.62) days. 90 patients (14.8%) were referred for dental procedures under GA more than once, accounting for 203 procedures (25.1%).

CONCLUSIONS

DGA remains a single dental treatment option for specific individuals. There is an institutional and, also, an organizational need to address the long waiting times and high repeated DGA rates.

Dental Treatment under General Anesthesia in Pre-School Children and Schoolchildren with Special Healthcare Needs: A Comparative Retrospective Study

The aim of this retrospective study was to evaluate the dental treatments received under general anesthesia (GA) in pre-school children and school children with special healthcare needs (n = 263) compared with healthy controls (n = 62). In order to analyze the impact of pre-existing cofactors on oral health, children were divided into the following groups: heart disease, cancer, syndromic disease, and other diseases as well as in- and outpatient healthy children. Caries experience (dmf-t/DMF-T) before GA (impulse 1), waiting time, and dental treatment under GA (impulse 2) were determined. Pre-school children showed a higher caries experience (mean ± standard deviation; 8.3 ± 4.8) compared to schoolchildren (6.9 ± 4.3). Predominantly, early childhood caries (ECC) of type 1 were detected. From all groups with special healthcare needs, children with cancer revealed the highest Significant Caries Index (17.0 ± 2.0), followed by other diseases (14.6 ± 2.6), syndromic disease (14.3 ± 1.8), and heart disease (13.8 ± 2.7). Overall, 2607 dental procedures were performed under GA with a mean of 8.0 ± 6.5 dental measures per child. Within the limitations of this study, the data exhibited independent of pre-existing cofactors and age high caries risk in all patient groups showing a high need for treatment.

A Preliminary Study of the Treatment Outcomes of Paediatric Dental Patients Referred for General Anaesthesia or Sedation at a Regional Hospital in Trinidad

General anaesthesia and sedation are known to be useful adjuncts in the care of paediatric dental patients. There are several challenges that prevent patients from receiving care.

AIM

To assess the treatment outcomes of paediatric dental patients seen at an emergency facility who were referred for treatment under sedation or general anaesthesia at a regional hospital in Trinidad.

METHODS

Records of patients seen at the Child Dental Health Unit Emergency clinic at the University of The West Indies Dental School from 2012 to 2017 were assessed. The parents of children referred for general anaesthesia or sedation at the regional hospital were then interviewed via telephone.

RESULTS

Most children (53.4%) were younger than 6 years old and the most common reasons for referral were the treatment of multiple carious teeth and behaviour management. Furthermore, 66.1% of cases did not receive treatment and had a mean waiting time of 4.7 years, and 61.7% of referred cases needed emergency care while awaiting general anaesthesia or sedation. Limited access to these services and the high cost of treatment were the main reasons for non-treatment.

CONCLUSION

There is significant need for the timely treatment of paediatric dental patients referred for general anaesthesia or sedation. Improved availability and accessibility of these services could improve patients' quality of life.