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

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

The Analysis of Dental Treatment under General Anaesthesia in Medically Compromised and Healthy Children

Dental care under general anaesthesia (GA) is an option when normal treatment cannot be accomplished due to un-cooperation and systemic or cognitive/intellectual disabilities. The purpose of this retrospective cohort study was to analyse the dental treatment under GA in medically compromised and healthy children. The data were collected from the medical records of children who received their dental treatment under GA. The data regarding patient age, sex, general health, and type of treatment were analysed. This clinical trial included 229 study subjects (138 males, 91 females) with an average age of 8.34 (SD 3.78). Counts and relative counts were used for description of qualitative data. The association between the variables was analysed using contingency tables. The significance of the findings was tested by the chi-square test. Most of the children were older pre-school 63 (27.51%) and young school children 102 (44.54%). Medical disability (systemic or intellectual) was diagnosed in 142 children (62.01%); the remaining 87 (37.99%) were healthy children. Dental treatment of primary teeth was more commonly performed in healthy children (65.52%) compared to medically compromised children (58.45%) (p = 0.287). The total number of medically compromised children and the total number of healthy children were both considered to be 100% for the purpose of the following calculations. In terms of permanent dentition, medically compromised children required more extractions and fillings (38.03%, 57.04%) compared to healthy children (14.94%, 17.24%, respectively). The results of this study revealed that dental treatment under GA was more commonly performed in medically compromised children in permanent teeth only in comparison to healthy children. Based on these findings, both health professionals and state authorities should focus more on preventive care in medically compromised children in order to improve their oral health.

Dental characteristics and according treatments of children under GA in Germany

PURPOSE

Due to rising numbers of dental referral to general anesthesia, more specialized dental treatments under GA were needed in the last decades in Germany. However, there are few studies about it. Therefore, the present study aimed to assess dental treatment and characteristics of the children underwent GA at Greifswald University Clinic in comparison with specialized pediatric private practices in Germany.

MATERIALS AND METHODS

This analytical comparative research reviewed the records of all children younger than 18 years old, whose underwent GA at the university dental clinic and three private practices in 2011. All cases were analyzed anonymously, including age, gender, caries levels, diagnostics and dental treatments.

RESULTS

About 54% and 50%, respectively, of children who underwent GA at both the university clinic and private practices were under 5 years old. Dental caries were mostly diagnosed among referred children (47.4% and 33.8% at university and private practices, resp.) followed by irreversible pulpitis (19.2% and 22.4%, resp.) and ECC (14.1% and 20.1%, resp.). Dental extractions were often performed at university clinic (40.2%) followed by fillings (33.9%), while more restorations and less extractions were supplied at private practices (47.8% and 16.3%, resp.).

CONCLUSIONS

Dental caries and its complications like pulpal problems were the most important reason for children who underwent GA combined with young age (< 5 years). Therefore, a primary preventive approach would be preferable to decrease the number of children in need of comprehensive dental treatment under GA.

The influence of general health on the need for dental general anaesthesia in children

AIM

To analyse the occurrence and causes of dental general anaesthesia (DGA) in healthy and medically compromised children, and to investigate if there are differences between those groups considering factors associated with DGA and DGA procedures.

METHODS

The data was collected from medical records of children under 7 years of age treated under DGA in the years 2009 and 2010 at the Oulu University Hospital, Finland. The children were divided into two groups: 0-35-month-olds and ≥36-month olds. Background information (year, age, gender, dental diagnosis, health) and the procedures performed were registered. The procedures were analysed considering the child's age and tooth types.

RESULTS

The number of children treated under DGA increased between 2009 (58) and 2010 (82), particularly in the group of healthy children. The two main diagnoses leading to DGA were dental caries and dental fear. Dental caries as the first dental diagnosis leading to DGA was more common among the medically compromised children (61.5%) compared to the healthy children (38.6%). The procedures performed were similar among the two groups. However, they varied between the age groups and tooth types and even between upper and lower teeth. The medically compromised children had been treated more frequently under DGA in the past.

CONCLUSIONS

The threshold for treating medically compromised children under DGA seems to be lower than for healthy children. However, the occurrence of DGA among healthy children has increased recently. To avoid unnecessary DGA, the control of caries should be carried out according to individual needs and independent of whether the child is healthy or has a chronic disease.

A new primary dental care service compared with standard care for child and family to reduce the re-occurrence of childhood dental caries (Dental RECUR): study protocol for a randomised controlled trial

BACKGROUND

In England and Scotland, dental extraction is the single highest cause of planned admission to the hospital for children under 11 years. Traditional dental services have had limited success in reducing this disease burden. Interventions based on motivational interviewing have been shown to impact positively dental health behaviours and could facilitate the prevention of re-occurrence of dental caries in this high-risk population. The objective of the study is to evaluate whether a new, dental nurse-led service, delivered using a brief negotiated interview based on motivational interviewing, is a more cost-effective service than treatment as usual, in reducing the re-occurrence of dental decay in young children with previous dental extractions.

METHODS/DESIGN

This 2-year, two-arm, multicentre, randomised controlled trial will include 224 child participants, initially aged 5 to 7 years, who are scheduled to have one or more primary teeth extracted for dental caries under general anaesthesia (GA), relative analgesia (RA: inhalation sedation) or local anaesthesia (LA). The trial will be conducted in University Dental Hospitals, Secondary Care Centres or other providers of dental extraction services across the United Kingdom. The intervention will include a brief negotiated interview (based on the principles of motivational interviewing) delivered between enrollment and 6 weeks post-extraction, followed by directed prevention in primary dental care. Participants will be followed up for 2 years. The main outcome measure will be the dental caries experienced by 2 years post-enrollment at the level of dentine involvement on any tooth in either dentition, which had been caries-free at the baseline assessment.

DISCUSSION

The participants are a hard-to-reach group in which secondary prevention is a challenge. Lack of engagement with dental care makes the children and their families scheduled for extraction particularly difficult to recruit to an RCT. Variations in service delivery between sites have also added to the challenges in implementing the Dental RECUR protocol during the recruitment phase.

TRIAL REGISTRATION

ISRCTN24958829 (date of registration: 27 September 2013), Current protocol version: 5.0.