Medical Diagnoses, Mode of Residence, and Dental Treatment Demand under General Anesthesia in Special Needs Adults in Innsbruck, Austria. A Retrospective Breakdown of Four and a Half Years

Retrospective Evaluation of 20 Years of Outpatient Dental Services to Adults with Disabilities at the Dental Hospitals of the Medical University of Innsbruck, Austria

Disabled persons' chairside dentistry is challenging. We aimed for a retrospective breakdown of dental services delivered to disabled patients by dental students and to discuss feasibility of a chairside approach. Consecutive patients, who received scheduled dental treatment by dental students from 2002 to 2021, were included. Demographic data, medical diagnoses, number of treatment sessions, performed treatments, and treatment break-offs were collected and analyzed with descriptive statistics. In total, 224 individuals with various disabilities (mean age 36.4 ± 14.6 years) received dental services in 2282 sessions altogether (10.3 ± 11. sessions per patient). Professional tooth cleaning was the most frequently provided treatment (55.8% of sessions). A total of 654 teeth were restored with fillings, 97 teeth were extracted, 56 teeth had endodontic treatment, and 25 removable dentures were fitted. Treatment break-off due to incompliance and referral to dental general anesthesia occurred in 74 patients (33%). Chairside treatment of disabled persons by dental students is feasible in many cases. Our study may serve as an incentive for clinicians/researchers to report on treatment modalities and outcomes of chairside dentistry in patients with special oral health care needs, preferably by the use of prospective study designs, to contribute data and strategies in the fight for control of oral health inadequacies.

The impact of general medical health status, demographical, and patient-specific variables on need for dental treatment of children and adolescents under general anesthesia

OBJECTIVES

Aim of this retrospective study was to examine the influence of general medical, demographical, and other patient-specific factors on the need for dental treatment under general anesthesia in children and adolescents at Saarland University Hospital. For assessment of the clinical treatment need, a mixed dt/DT (decayed teeth) was introduced.

MATERIALS AND METHODS

A total of 340 patients under 18 years of age who received restorative-surgical dental treatment between 2011 and 2022 were anonymously enrolled. Demographic and other patient-specific data, general medical health, oral health, and treatment related data were recorded. In addition to descriptive analysis, Spearman-Rho-test, Mann-Whitney-U-test, Kruskall-Wallis-test and Chi-square-test were used.

RESULTS

More than half of the patients (52,6%) were in general health, but non-cooperative. The majority of the patients (66.8%) was between 1 and 5 years of age (p < 0,001). Mean dmft was 10.95 ± 4.118, mean DMFT was 10.09 ± 7.885, and mean dt/DT was 10.79 ± 4.273. Analysis showed that communication difficulties significantly influenced dmft (p = 0.004), DMFT (p = 0.019), and dt/DT (p < 0.001). Type of insurance significantly affected dmft (p = 0.004) and dt/DT (p = 0.001). There was no significant effect of ASA on caries experience, however on prevalence of severe gingivitis (p < 0.001), number of extractions (p = 0.002), and need for repeated treatment (p < 0.001).

CONCLUSIONS

Need for dental treatment in the present collective was high, independent of the considered variables. Non-Cooperativeness along with ECC was the main indication for dental general anesthesia. The mixed dt/DT was the most precise survey to evaluate clinical treatment needs.

CLINICAL RELEVANCE

Given the enormous demand for these rehabilitations with strict selection, it is imperative to create more treatment capacities for patients mandatorily requiring general anesthesia by avoiding it in healthy patients.

Unmet Dental Treatment Needs and Barriers to Dental Care of Patients with Special Needs Attending a Dental Teaching Hospital

<b><i>Objectives:</i></b> This work attempted to determine the unmet dental treatment needs and self-reported barriers to continued care, in patients with special needs, attending a dental teaching hospital in the English-speaking Caribbean. <b><i>Methods:</i></b> A chart audit of patients who were planned for comprehensive treatment for the period from August 1, 2015 to July 31, 2017 was used to determine the types of treatment required for the sample of patients. Treatment was classified as either urgent, preventive, or restorative. Restorative treatment was further divided into operative, endodontic, periodontic, and prosthodontic treatment. Reasons for not returning to the clinic to complete planned treatment care were ascertained via a telephone interview. A non-parametric McNemar change test for related samples at an alpha level of 0.05 was used to compare planned treatment with completed treatment. <b><i>Results:</i></b> 34% of patients with special needs had comprehensive treatment plans developed for the period under investigation. Preventive dental treatment was included in most comprehensive plans (96.1%). Large proportions of patients also required care for periodontal disease (65.7%) and operative management of caries (52.9%). While there was no significant difference between preventive treatment planned and received, there were significant differences in treatment planned and received for all types of restorative care. Major identified barriers included cost, accessibility, and psychosocial issues. <b><i>Conclusions:</i></b> There was an unmet need for restorative and periodontal treatment. Major self-reported barriers to dental care included cost, accessibility to care in terms of transportation issues, and psychosocial issues.

The use of general anaesthesia in special care dentistry: A clinical guideline from the British Society for Disability and Oral Health

Background

General anaesthesia (GA) may be required to support the care of those seen in Special Care Dentistry (SCD) services for various reasons, such as enabling extensive dental care for people with severe learning disabilities or severe dental phobia. Guidance is needed for teams delivering SCD using GA due to the potential risks, implications, and costs of using GA to deliver dental care.

Aim

To present evidence‐based recommendations, where possible, for teams involved in providing GA for dental care for adults within SCD services.

Methods

A multidisciplinary working group, supported by a formal literature search and stakeholder involvement, iteratively produced and refined the recommendations presented.

Results

There was little evidence to inform the guidelines. Recommendations are therefore based mainly on the working group's expert consensus opinion. Clinical guidelines are presented as a set of overarching principles followed by six key sections reflecting patients' pathways from referral to dental services through to their care during and after GA.

Conclusion

Guidelines are presented to support those providing GA to provide SCD. The need for comprehensive and person‐centered assessment and planning is emphasized.