Dental Treatments under General Anesthesia on Children with Special Health Care Needs Enrolled in the Spanish Dental Care Program

The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada

BACKGROUND

Children with special healthcare needs (SHCN) often require specialized interventions due to their disabilities. Dental general anesthesia (DGA) is a treatment modality, which improves their access to care but concerns about repeated DGAs persist.

AIM

This study investigated DGA utilization in children with SHCN and identified factors associated with multiple DGAs in Alberta, Canada (2010-2020).

DESIGN

This retrospective population-based study used administrative data encompassing all children (<18 years) undergoing DGA in publicly funded facilities. Children were identified as SHCN based on their diagnosis codes and categorized into behavioral/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions.

RESULTS

This study analyzed 3884 DGA visits for children with SHCN, predominantly males aged 6-11 and from low-income families. Mental/intellectual disabilities were prevalent (31.8%), and autism was the leading disease. Caries was the primary dental diagnosis across all groups, whereas pulp problems were higher in psychiatric/behavioral disorders (23.6%), and periodontal problems were more common in physical-mental disabilities (13.2%). 28.7% had multiple DGAs, with younger age, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments, increasing the likelihood of multiple DGAs.

CONCLUSION

This study highlights the importance of individualized prevention and less conservative treatments for younger children to reduce oral health disparities.

Pediatric Sedation in Dutch Dental Clinics: The Influence of Guideline Modifications on Adverse Events

Background: Dental fear and uncooperative behavior can hinder dental treatment quality. Pediatric Procedural Sedation and Analgesia (PPSA) is used to facilitate treatment when the coping capacity is exceeded. Out-of-hospital PPSA has been associated with more adverse outcomes compared to when it is used in hospital-based settings. The updated Dutch PPSA guidelines have increased costs and raised concerns about the accessibility of specialized high-quality dental care for children in the Netherlands. This study aimed to investigate the impact of the updated 2017 guidelines on the occurrence rate of adverse events during PPSA in twelve Dutch dental clinics. Methods: The data of 25,872 children who were treated at twelve dental clinics between 1997 and 2019 were analyzed. A logistic two-level mixed-effects model was used to estimate the updated guidelines' impacts on adverse events. Results: The OR of the occurrence rate of an adverse event adjusted for age, weight, and duration of treatment was 0.75 (95% CI 0.64-0.89) after the implementation of the updated guidelines. This outcome was significant with p = 0.001, indicating a protective effect. Conclusions: Our findings demonstrate that there was a significant reduction in adverse events after the implementation of the updated guideline and highlight the importance of adhering to evidence-based practices in out-of-hospital dental clinics.

Comparison of hemodynamic changes with general or local anesthesia during dental treatment in pediatric patients: A prospective clinical study

BACKGROUND AND AIM

Severe hemodynamic fluctuations during dental treatment can trigger highly undesirable physical reactions. A study was made to determine whether the administration of propofol and sevoflurane contributes to the stabilization of hemodynamic parameters during dental treatment in pediatric patients versus the use of local anesthesia alone.

MATERIALS AND METHODS

Forty pediatric patients needing dental treatment were assigned to either general anesthesia with local anesthesia (study group [SG]) or local anesthesia alone (control group [CG]). Two percent sevoflurane in oxygen (100% oxygen, 5 L/min) and continuous propofol infusion (target-controlled infusion [TCI], 2 μg/mL) were used as general anesthesia agents in SG; and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate, blood pressure and oxygen saturation were measured before starting dental treatment (baseline) and every 10 min during dental treatment.

RESULTS

Blood pressure (p < .001), heart rate (p = .021) and oxygen saturation (p = .007) decreased substantially after the administration of general anesthesia. The levels of these parameters subsequently remained low and then recovered at the end of the procedure. On the other hand, the oxygen saturation values remained closer to baseline in SG versus CG. In contrast, the hemodynamic parameters experienced lesser fluctuations in CG than in SG.

CONCLUSIONS

General anesthesia affords more favorable cardiovascular parameters during the entire dental treatment in comparison to local anesthesia alone (blood pressure and heart rate decrease significantly and oxygen saturation proves more stable and with values closer to baseline), and allows dental treatment to be performed on healthy, lacking cooperative ability children who otherwise could not be treated with local anesthesia alone. No side effects were observed in either group.

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.

Dental procedures in children with or without intellectual disability and autism spectrum disorder in a hospital setting

BACKGROUND

This population-based cohort study investigated dental procedures in the hospital setting in Western Australian children with or without intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years. Considering previously reported disparities in dental disease between Indigenous and non-Indigenous Australian children, this study also investigated the effect of Indigenous status on dental procedures.

METHODS

Data on Western Australian live births from 1983 to 2010 from the Midwives Notification System were linked to the Intellectual Disability Exploring Answers database and the Hospital Morbidity Data collection. Primary admissions for relevant dental diagnoses were identified, and treatment procedures for dental hospitalization were investigated. Descriptive statistics and Pearson's chi-squared test of independence were used for analysis.

RESULTS

Overall, 76 065 episodes of dental hospitalization were recorded. Amongst children with ID and/or ASD, Indigenous children experienced more extractions and fewer restorations (68.7% and 16.2%) compared to non-Indigenous children (51.5% and 25.9%). After 6 years, extraction occurred less often in children with ID and/or ASD than in those without, where most surgical dental extractions were in the age group of 13-18 years.

CONCLUSIONS

This study indicates a need for further improvements in access to dental services and the quality of care provided in hospitals for children with ID/ASD. There is also concern that more vulnerable Indigenous and all disadvantaged children are receiving an inadequate level of dental services resulting in more emergency dental hospitalization and invasive treatment.

Characteristics of Pediatric Dental Treatment Provided under General Anesthesia in Dubai, United Arab Emirates: A Retrospective Analysis

Background

Dental general anesthesia (DGA) is a widely utilized technique in pediatric dentistry and is indicated for a variety of cases such as very young children and children with special healthcare needs (SHCN). In the United Arab Emirates (UAE), there is a paucity of studies relating to this subject.

Objective

To analyze the characteristics of DGA treatment in special healthcare needs and healthy children in the only postgraduate dental hospital in Dubai, UAE.

Materials and Methods

A retrospective analysis was conducted on the electronic records of all Dubai Dental Hospital (DDH) pediatric patients who underwent DGA in the period between January 1^st, 2016, and 29^th of February 2020.

Results

The study population consisted of 98 children. A total of 26 children had a medical condition and were categorized as SHCN. The most common justification for DGA was dental caries and a lack of cooperation due to young age. SHCN patients received significantly more preventive measures and significantly fewer pulp therapies than healthy patients.

Conclusion

We found that the services provided under DGA for healthy pediatric patients differ from those provided to SHCN patients. Frequently missing recall appointments following DGA increased the likelihood of the need for further restorative dental treatment. These results highlight the importance of robust prevention and follow-up programs for children treated under GA.

Factors affecting provision of oral health care for people with special health care needs: A systematic review

Background

Special health care needs (SHCNs) individuals experience higher levels of dental problems including accessing oral health (OH) facilities. Improving standard of OH care in SHCNs requires identifying barriers and enablers. The aim of this study was to perform a systematic review of prior researches to identify OH care barriers and enablers for SHCN individuals.

Methods

Electronic searching was conducted systematically in PubMed and Cochrane databases. The PICOS parameters were formulated for the inclusion of studies, and the PRISMA method was used to select the articles. Two reviewers independently screened the articles for eligibility and to minimise the risk of bias in the studies and also searched the contents of key articles, quality of methodology, outcomes and reference lists of all the studies included.

Results

A total of 1316 (PubMed 956, Cochrane 360) studies were found initially and after title and abstract screening and also removal of duplication, reviewers selected 53 papers from PubMED and 19 articles from Cochrane to go through full articles and led to the final confirmation of 21 studies. Common challenges included lack of OH knowledge and awareness, difficulty in accessing treatment, transportation problem, treatment cost, and lack of inter-professional collaboration for specialized services. Potential solutions included OHE training and services for patients and caregivers, easy access to dental services, specialized dental practitioners and use of a combination of expertise to meet the demands of SHCN individuals.

Conclusion

This brief analysis will establish dental obstacles to the provision of information to policymakers for SHCN population at organizational, individuals and policy levels. It will help in effective planning for providing and improving OH care quality in caregivers.

Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services—A Retrospective, Comparative Study

In special care dentistry, general anesthesia (GA) is considered as an alternative option to facilitate treatment for uncooperative patients with special needs (PSN) who require invasive dental interventions. Objective: to evaluate the profile of dental treatment procedures performed and the characteristics of PSN who underwent dental treatment under GA, provided by private and public healthcare providers. Methods: A retrospective, observational study involving a sample of 100 PSN treated in hospital and specialist secondary care settings. Demographic data and clinical information were collected. The analysis of data was performed using descriptive analysis and frequency statistical tests. Results: out of 100 participants, 63% of the PSN who received care in the private sector and the remaining 37% of PSN registered with public-funded care providers, aged 6 to 80 years old, were treated under GA. Autistic spectrum disorder was the most common medical diagnosis recorded (33%). More than half (52%) of the PSN treated by private care providers sought specialist care in an outpatient setting prior to GA vs. 5% of the PSN treated by public-funded providers. The utilization of sedation prior to GA was more common in the private sector. A vast majority (86%) of all subjects underwent multiple dental extractions (86%) and restorations (62%). Conclusions: comprehensive dental care under GA, which composes an integral part of special care dentistry, can be safely provided in a hospital setting, in both private and public sectors. While early intervention using sedation and behavioral management partially mitigates the need for dental care under GA, the vast majority of PSN may require dental treatment under GA in future to facilitate complex dental care.

Genetic Pattern, Orthodontic and Surgical Management of Multiple Supplementary Impacted Teeth in a Rare, Cleidocranial Dysplasia Patient: A Case Report

Background: Cleidocranial dysplasia (CCD) is a rare, autosomal dominant skeletal dysplasia with a prevalence of one per million births. The main causes of CCD are mutations in the core-binding factor alpha-1 (CBFA1) or runt-related transcription factor-2 (RUNX2), located at the 6p21 chromosomal region. RUNX2 plays important roles in osteoblast differentiation, chondrocyte proliferation and differentiation, and tooth formation. The disease is characterized by clavicular aplasia or hypoplasia, Wormian bones, delayed closure of cranial suture, brachycephalic head, maxillary deficiency, retention of primary teeth, inclusion of permanent teeth, and multiple supernumerary teeth. Materials and Methods: A 22-year-old girl suffering from cleidocranial dysplasia with short stature, narrow shoulders, craniofacial manifestations (short face, broad forehead, etc.) and dental anomalies (different lower dental elements under eruption, supernumerary and impacted multiple teeth, etc.) was examined at our service (Complex Operative Unit of Odontostomatology of Policlinico of Bari). RX Orthopantomography (OPG) and cone beam computed tomography (CBCT) were requested to better assess the position of the supernumerary teeth and their relationships with others and to evaluate the bone tissue. Results: Under eruption was probably caused by dental interferences with supernumerary teeth; hence, extractions of supernumerary upper canines and lower premolars were performed under general anaesthesia. Surgery outcome was excellent with good tissue healing and improvements in the therapeutic possibilities with future orthodontics. Conclusions: The objective of this article is to give an update about radiological, clinical, and molecular features of CCD and to alert the health team about the importance of establishing an early diagnosis and an appropriate treatment in these patients to prevent impacted teeth complications and to offer them a better quality of life.

Effectiveness and Safety of Intravenous Sedation with Propofol in Non-Operating Room Anesthesia (NORA) for Dental Treatment in Uncooperative Paediatric Patients

Background: Uncooperative children require sedative approach for dental treatment. The aim was to assess the effectiveness of Propofol in “Non-Operating Room Anesthesia” (NORA) for paediatric dental treatment; intraoperative side effects; postoperative side effects; post-discharge effects. Methods: a prospective study, involving 109 uncooperative children undergoing sedation in NORA using Propofol for dental treatment, was performed. Working sessions, success/failure, intraoperative and postoperative side effects, number of treatment; type of procedure were assessed. Parents completed a post-discharge questionnaire on: pain; crying; fever; vomiting; headache; drowsiness; excitability; irritability; ability to eat; drugs and medical care needing. Results: Success: 96.7%. Intraoperative side effects: 33.3%. Postoperative side effects: 6.4%. Statistically significant association between: intraoperative side effects and age (p = 0.001), health status (p = 0.0007), weight (p = 0.038), respectively; intraoperative side effects and number/ type of dental treatment (p = 0.0055) and scaling (p = 0.0001), respectively. For post-discharge questionnaires, statistically significant association between: age and crying (p = 0.0001) and headache (p = 0.002), respectively; health status and crying (p = 0.015) and drugs needing (p = 0.04), respectively; weight and crying (p = 0.0004); extraction and pain (p = 0.0001) and crying (p= 0.0073), respectively; scaling and crying (p = 0.04), excitability and irritability (p = 0.03), respectively. Conclusion: Propofol in NORA was effective with minimal side effects.

Distribution and Polarization of Caries in Adolescent Populations

The aim of this study was to determine the proportion of adolescents with severe caries to analyze the prevalence of caries and to visualize the unequal distribution. Data from three epidemiological studies (10- and 15-year-olds: GINIplus and LISA cohorts in Munich, Bavaria; 12-year-olds: LAGZ survey in Bavaria, Germany) with 2875 adolescents were available for analysis. All individuals were examined according to the WHO standard. Statistics included the calculation of mean dmft/DMFT values (standard deviation), Significant Caries Index (SiC) values, Specific Affected Caries Index (SaC) values, and Lorenz curves. Overall caries-free status was 58.6% in primary and 83.9% in secondary teeth (10-year-olds), 61.5% (12-year-olds), and 64.6% (15-year-olds). The proportion of 12- and 15-year-olds with at least four DMFTs was 9.4% and 8.3%, respectively. In addition, eight 15-year-olds with DMFT values ≥8 (0.6%) were registered. The SaC/SiC values amounted to 1.8/0.9 DMFT (10-year-olds), 2.6/2.8 DMFT (12-year-olds), and 2.5/2.5 DMFT (15-year-olds). The mean DMFT values in the upper 1% of subjects were 4.2 DMFT (10-year-olds), 8.5 DMFT (12-year-olds), and 8.5 DMFT (15-year-olds). Thus, caries is not equally distributed throughout adolescence, but individuals with severe caries are rare. Nevertheless, further interdisciplinary research seems to be needed to clarify potential risk factors.

The Influence of Age on the Development of Dental Caries in Children. A Radiographic Study

Dental caries is a chronic disease that can be influenced by a multitude of factors. Poor oral hygiene and unhealthy eating habits are the most incriminating factors in the onset of dental caries, but age has been proven to impact the disease. The aim of this study was to find correlations between age and the evolution of dental caries in the first permanent molars in children. The retrospective study was conducted based on 400 panoramic radiographs, belonging to Romanian children between the ages of 6 and 14 years. All first permanent molars were investigated, and the carious lesions were classified according to their depth. The chronological age was calculated by subtracting the patient's date of birth from the date when the radiograph was performed, while for the assessment of dental age, the Demirjian method was used. The gender of the patients did not significantly influence the number of superficial, medium, and deep carious lesions. Most of the identified carious lesions were superficial. Regarding correlations between age and dental caries, there was an association between the decrease in the chronological age and the increase in the number of superficial carious lesions on the first permanent molars and also an association between the increase in the chronological age or dental age and the increase in the number of medium and deep carious lesions on the first permanent molars. Age can impact the development of dental caries in first permanent molars.

Acceptability of a Mobile Application in Children's Oral Health Promotion-A Pilot Study

The aim of this pilot study was to investigate the acceptability of an oral health-related mobile application developed for young children based on the feedback given by the children and their parents. Another aim was to evaluate the self-reported change in children’s oral health behaviors during a short test period. The application—a virtual pet integrated into a child’s daily routines—aimed to promote oral hygiene and dietary behaviors in children. A total of 36 4–12-year-old voluntary children were given a mobile phone with the installed application. After the 5-week testing period, the feasibility of the application and possible changes in the children’s oral health behaviors were asked using an electronic questionnaire. Most of the children considered the application clear (n = 34), amusing (n = 31), and useful (n = 29). The children’s tooth brushing manners improved both qualitatively and quantitatively: the time used for tooth brushing increased and the children learned how to brush different tooth surfaces. Mobile applications can be fun and useful in oral health promotion; while playing, children can learn good oral health-related behaviors. Mobile applications integrate oral health promotion into children’s daily environment and routines.

Halitosis in Children Undergoing Full Mouth Rehabilitation under General Anesthesia

Interventions and management modalities of pediatric halitosis have been suggested in the literature, however, the effect of full mouth rehabilitation (FMR) under general anesthesia (GA) on pediatric halitosis was not reported. Therefore, the present study was conducted to investigate parents' perceptions of their child's halitosis before and after FMR under GA; and to evaluate the effect of FMR on clinical halitosis. Fifty-seven children between 3-8 years old, scheduled for FMR under GA, were included after satisfying the inclusion criteria and upon parental consent. Parents' perception of halitosis in their children was evaluated using a standardized questionnaire and a breath sample was collected to assess the level of volatile sulfur compounds (VSCs) using OralChroma^TM before and after FMR under GA. Sixty percent (n = 34) of the parents perceived halitosis in their children before FMR and about 80% (n = 27) of them reported improvement in halitosis after FMR. Clinical halitosis was detected in 84.2% (n = 48) of the sample before treatment. A statistically significant reduction in halitosis was found in 56.3% (n = 27) of the children after treatment (p < 0.001). In conclusion, majority of parents perceived an absence or reduction of halitosis in their children following FMR and significant improvement of clinical halitosis.

Influence of the COVID-19 Pandemic on Dental Emergency Admissions in an Urgent Dental Care Service in North Italy

A retrospective study was performed to verify if the number of admissions for urgent dental care in the Urgent Dental Care Service of San Paolo Hospital in Milan (Italy) was directly related to the different phases of the COVID-19 pandemic. Different periods were analyzed: 25 March-5 April 2019 (pre-COVID); 23 March-3 April 2020 (lockdown); 8 June-19 June 2020 (reopening); and November 9-November 20 (second wave). Raw data regarding admissions, diagnoses, and treatments were extracted. Descriptive and bivariate analyses were performed. The survey included 901 admissions, 285 in pre-COVID, 93 during lockdown, 353 in reopening, and 170 in the second wave. In each time period, statistically significant differences were found in the prevalence of each kind of diagnoses (χ2(3) = 20.33 p = 0.01 for endodontic emergencies, χ2(3) = 29.05 p < 0.01 for cellulitis/phlegmon, χ2(3) = 28.55 p < 0.01 for periodontal emergencies, Fisher's Exact Test p < 0.01 for trauma, and χ2(3) = 59.94 p < 0.01 for all other kinds of diagnosis). A remarkable increase in consultations (+186.36%) and other treatments (+90.63%) occurred during reopening. Tooth extraction was the most frequently delivered treatment, but suffered the largest reduction during lockdown (-79.82%). The COVID-19 pandemic has highly affected dental activity in north Italy, underling the weaknesses of a private dental system in a pandemic scenario.