Dental general anaesthetic receipt among Australians aged 15+ years, 1998-1999 to 2004-2005

The Australian experience without formal guidelines: the projected cost impact of hospitalisations for surgical removal of impacted teeth through to 2020

In Britain there was a reduction in hospitalisations for removal of impacted teeth (in particular third molars) following the introduction of evidence-based guidelines. However, the guideline approach has not been as successful in other countries, even those with a significant historical connection. In Australia, hospitalisation (ie to undergo treatment under general anaesthesia) for the removal of impacted teeth constitutes about two thirds of all oral health-related conditions requiring treatment under general anaesthesia.

Pattern of occurrence and treatment of impacted teeth at the Muhimbili National Hospital, Dar es Salaam, Tanzania

BACKGROUND

Impacted teeth predispose to periodontal disease and dental caries of adjacent teeth resulting in pain, discomfort and loss of function. This study analyzed the pattern of occurrence of impacted teeth, associated symptoms, treatment and complications of treatment in patients who presented at the Muhimbili National Hospital, Tanzania.

METHOD

This was a crossectional descriptive study which utilized notes and x rays of patients who were treated for impacted teeth at the Oral and Maxillofacial firm in Muhimbili National Hospital over five years, from January 2005 to August 2010. These records were retrieved and examined for the major complaint of the patient at presentation to hospital, demography, impacted tooth, type of impaction (for third molars), treatment offered and complications after treatment. Similar information was collected from all patients with impacted teeth attended in the same centre from 1st September 2010 to 31st August 2011.

RESULTS

A total of 896 patients (496 males and 400 females) treated for complaints related to impacted teeth were recorded. The male to female ratio was 1.2:1, age range of 16 to 85 years and a mean age of 28.9 years (SD = 9.5). Slightly more than 84% of the patients presented with mandibular third molar impactions. Most (44.7%) of these patients had an impacted lower right third molar followed by those presenting with a lower left third molar impaction (39.7%). In 1.3% of the patients all the four third molars were impacted. Sixty nine (7.7%) patients had impacted upper 3rd molars while 2% had impacted upper canines. Of the mandibular 3rd molar impactions 738 (76%) were mesio-angular type, 87 (8.9%) horizontal type and 69 (7.1%) disto-angular. Patients presented with a variety of complaints. About 85% of the patients presented to hospital due to varying degrees of pain. In 4.9% the detection of the impacted tooth/teeth was coincidental after presenting to hospital for other reasons not related to the impaction. Majority of the patients with impacted mandibular third molars had carious lesions on the impacted teeth, neighbouring tooth or both. Four hundred and five (45.2%) patients had a carious lesion on one of the impacted teeth while 201(22.4%) patients had a carious lesion on the adjacent second molar. In 122 (13.6%) patients both the impacted third molar and the adjacent second molar were carious. In twelve patients who presented with a main complaint of fracture of the angle of the mandible there was an associated impacted 3rd molar. Eight hundred and fifteen (91%) patients with impacted teeth were treated by surgical removal. Among these only 15 (1.8%) had complications that ranged from excessive swellings, trismus and severe pain post operatively. One patient was reported to have fracture of the angle of the mandible sustained during surgical removal of an impacted 48.

CONCLUSIONS

The majority of patients with impacted teeth were young with an almost equal sex distribution. The most commonly impacted teeth were mandibular third molars followed by the maxillary third molars. Patients with impacted teeth reported for health care predominantly because of pain due to dental caries or infection.

Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service

BACKGROUND

Dental general anaesthesia (DGA) is a very efficient treatment modality, but is considered only in the last resort because of the risks posed by general anaesthesia to patients' overall health. Health services and their treatment policies regarding DGA vary from country to country. The aims of this work were to determine the reasons for DGA in the Helsinki Public Dental Service (PDS) and to assess the role of patient characteristics in the variation in reasons and in the treatments given with special focus on preventive care.

METHODS

The data covered all DGA patients treated in the PDS in Helsinki in 2010. The data were collected from patient documents and included personal background: age (<6, 6-12, 13-17, 18-68), gender, immigration, previous conscious sedation and previous DGA; medical background; reasons for DGA and treatments provided. Chi-square tests, Fisher's exact test, and logistic regression modelling were employed in the statistical analyses.

RESULTS

The DGA patients (n=349) were aged 2.3 to 67.2 years. Immigrants predominated in the youngest age group (p<0.001) and medically compromised patients among the adults (p<0.001) relative to the other age groups. The main reason for DGA was extreme non-cooperation (65%) followed by dental fear (37%) and an excessive need for treatment (26%). In total, 3435 treatments were performed under DGA, 57% of which were restorations, 24% tooth extractions, 5% preventive measures, 5% radiography, 4% endodontics and the remaining 5% periodontics, surgical procedures and miscellaneous. The reasons for DGA and the treatments provided varied according to age, immigration, previous sedation and DGA and medical background. The logistic regression model showed that previous sedation (OR 2.3; 95%CI 1.3-4.1; p=0.005) and extreme non-cooperation (OR 1.7; 95%CI 0.9-3.2; p=0.103) were most indicative of preventive measures given.

CONCLUSIONS

Extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive, conservative DGA in the Helsinki PDS. The reasons for the use of DGA and the treatments provided varied according to personal and medical background, and immigration status with no gender-differences. Preventive measures formed only a minor part of the dental care given under DGA.