Comprehensive dental treatment under general anaesthesia

Objectives

Patients unable to tolerate routine dental treatment in an ordinary dental setting may undergo a wide range of dental procedures under general anaesthesia. This report describes a practical protocol for providing full dental treatment under general anaesthesia.

Matherials and Metods

The importance of adequate treatment planning and safety measures is illustrated through the presentation of clinical cases.

Results

Suggestions are provided as to the use of techniques managing difficult treatment settings that allow the implementation of high-quality dental care in long sessions.

Conclusions

Complete treatment can be achieved in a single visit, thus avoiding repeated risk of anxiety for the patient associated with the treatment as well as subsequent further sessions with related schedule adjustment.     

Sensitivity and responsiveness of the Chinese ECOHIS to dental treatment under general anaesthesia

Lee GHM, McGrath C, Yiu CKY, King NM. Sensitivity and responsiveness of the Chinese ECOHIS to dental treatment under general anaesthesia. Community Dent Oral Epidemiol 2011; 39: 372–377. © 2011 John Wiley & Sons A/S Abstract – Objective: This study aimed to investigate the sensitivity and responsiveness of the Chinese version of the Early Childhood Oral Health Impact Scale (ECOHIS) to dental treatment under general anaesthesia (GA). Methods: A consecutive sample of primary caregivers of children (aged 5 and younger) with early childhood caries (ECC) attending a university hospital dental clinic for dental treatment under GA was recruited over a 12‐month period. Caregivers self‐completed the ECOHIS prior to and 3 months following their child dental treatment under GA. In addition, caregivers rated the change in their child’s overall health condition compared to before treatment on a global transition scale. Sensitivity of the measure was assessed by determining distribution changes in ECOHIS scores; responsiveness was assessed by investigating whether the observed changes took the form of a gradient according to the global transition judgement, in terms of the observed change in scores and effect size. Results: Following treatment under GA, there was significant changes in ECOHIS scores (P < 0.01) and many of its sub‐domains. The magnitude of change (effect size) of the total ECOHIS following treatment was 0.89 and among sub‐domains ranged from ?0.29 to 1.33. There was an observed gradient in the changes of ECOHIS scores (and effect sizes) in relation to global transition judgement of oral change following treatment, supporting the responsiveness of the measure. Conclusions: The Chinese version of ECOHIS is sensitive and responsive to dental treatment of ECC under GA.     

Changes in young children's OHRQoL after dental treatment under general anaesthesia

International Journal of Paediatric Dentistry 2012; 22: 258–264 Objective. To use the Parental‐Caregivers Perceptions Questionnaire (P‐CPQ) and Family Impact Scale (FIS) to determine whether dental treatment of young Auckland children under general anaesthesia (GA) improved oral‐health‐related quality of life (OHRQoL) for them and their families. Design. A pretest/post‐test design, with a consecutive clinical sample of parents/caregivers of children (10 years or younger) treated under GA. More than half of the children were Māori or Pacific Islanders. Results. Of the 157 children in the baseline sample, 144 (91.7%) were followed up. The overall P‐CPQ score showed a large decrease following treatment, along with an increase in the number scoring 0 (no impact). Similar relative changes were observed in the oral symptoms and emotional well‐being subscales, whereas the other two subscales showed moderate decreases. All post‐treatment FIS scores were lower than pre‐treatment ones; all showed moderate effect sizes. The greatest relative changes were seen in the parental/family activity and parental emotions subscales. Conclusions. The dental treatment of young children under GA is associated with considerable improvement in their OHRQoL. The P‐CPQ and the FIS are valid and responsive to treatment‐associated changes in young children with early childhood caries (ECC).     

Conservative dentistry for children under general anaesthesia in the dental surgery

A bstract — Young children requiring extensive dental care can be treated successfully under general anaesthesia in the dental surgery. In this survey of 1316 patients over a twelve year period, the results are presented with details of anaesthetic and dental procedures which are developed over that period. Significantly, no post-anaesthetic complications relating to intubation occurred in these out-patients.     

Psychogenic coma after dental surgery under general anaesthesia

Delayed awakening after general anaesthesia due to psychogenic coma is a phenomenon that rarely presents to the oral and maxillofacial surgeon. A case of psychogenic coma following general anaesthesia for dental extractions is presented here. It is recommended that patients at risk of conversion disorder should be counselled about the risks of psychogenic coma. Early diagnosis of this condition could lead to better patient management.     

Comprehensive dental care for children with rampant caries under general anaesthesia

Abstract. Objective. Critical reflection on treatment strategy for dental rehabilitation of young children with rampant caries using day‐stay general anaesthesia at a university dental clinic. Design. Cross‐sectional analysis of 98 cases. Setting. The study was undertaken at the university paediatric dental clinic of Leuven, Belgium. Sample and methods. The sample consisted of 98 healthy patients referred for dental treatment under general anaesthesia with a mean age of 4·8 (± 1·1) years and mean dmft‐score of 9·3 (± 3·0). Data were obtained by history taking, clinical examination, questionnaires (filled in by parents) and standardized data records (filled in by dentists and nurses in the recovery area and day‐stay clinic). Results. Most patients were referred by their private dentist (74·5%) because of a need for extensive dental treatment in an uncooperative child. Induction of anaesthesia was upsetting in a significant number of cases (68% of children). The mean duration of the whole procedure was 80·9 (± 24·7) minutes. A mean number of 7·2 (± 2·9) primary teeth were filled and 1·8 (± 2·0) extracted per patient. Post‐operative problems (nausea/vomiting, temperature rise) were seen in only 8·2% of the patients. Conclusions. The technique used at this centre allows for extensive dental treatment of young children with a high level of acceptability and minimal morbidity, using day‐stay general anaesthesia. Based on this review, it became clear that less upsetting methods for the induction of anaesthesia need to be explored. Criteria for the administration of antibiotics need to be defined more clearly and the use of stainless steel crowns should be envisaged for restorations on primary molars. The global outcome of this treatment provision in children at high caries risk should be evaluated over a longer period, including an evaluation of oral health status, restorative treatment (conservation vs. extraction) and behavioural aspects.     

Distress related to dental extraction for children under general anaesthesia and their parents.

AIM: The aims of this study were to observe levels of distress in children and their parents before and after extractions under general anaesthesia (GA) and to assess the effect of age, gender and the number of extractions on distress. DESIGN: a randomized comparative trial. Setting University Dental Hospital of Manchester. SUBJECTS AND METHODS: Two hundred and one children, together with their parents took part in this study. Immediately before GA, the Modified Child Smiley Faces Scales (MCSFS) and Modified Adult Smiley Faces Scales (MASFS) were completed by a trained observer for children and accompanying parents respectively, and again on recovery from anaesthesia and 15 minutes postoperatively. RESULTS: There were generalised increases in mean distress scores for children when comparing the pre-operative with the postoperative scores. However, mean distress scores for parents reduced at recovery and 15 minutes postoperatively and were less than the mean distress scores for children. There was no correlation between the child and parent distress scores preoperatively, postoperatively and 15 minutes postoperatively. There were significant increase in median distress scores for younger children compared to the older children at recovery and 15 minutes postoperatively (P0.05). Children who had 8 - 14 teeth extracted demonstrated higher levels of distress than those who had 1 - 7 teeth extracted (P0.05). CONCLUSION: Extraction of teeth under general anaesthesia does produce distress in children and their parents. Child and parental distress were not related. Both age and number of teeth extracted appear to influence the level of distress in children.     

Assessment of children prior to dental extractions under general anaesthesia in Scotland

OBJECTIVE: To determine the type of dental assessment service offered to children prior to exodontia under chair dental general anaesthesia (CDGA) in the community and hospital dental services (CDS, HDS) in Scotland. DESIGN AND SETTING: Telephone interviews were conducted with CDS and HDS clinical directors in Scotland using a semi-structured questionnaire, with written follow-up confirmation. Copies of CDGA referral forms were also requested. RESULTS: All clinical directors, or their nominated deputies, participated (n = 21). Almost half of interviewees indicated that their area offered a "dedicated" pre-CDGA assessment service (n = 10). A range of grades was identified amongst assessors; a minority were described as "specialist paediatric staff". The availability of CDGA alternatives, including local analgesia and conscious sedation varied. Changes to the referral treatment plan were reported to occur "sometimes" or "often" by 11 interviewees regarding the anaesthetic used, and by 16 respondents regarding the number of teeth extracted. The content of CDGA referral forms was diverse. CONCLUSIONS: The method of referral and assessment of children for CDGA in Scotland is diverse, partly reflecting geographic limitations and local need. Guidance on pre-GA assessment, including use of standardised referral forms, may reduce variation and improve the quality of the pathway of care.     

Dental treatment for children under general anaesthesia in day care facilities at a London dental hospital

Day-stay facilities are gaining in popularity in general surgery, especially in surgery for children. In dentistry, day-stay care has been shown to be of great value for the treatment of specific groups of child patients, including handicapped and those too young to tolerate treatment with local anaesthetic alone. The present study considered the characteristics of 103 patients attending for treatment in the day-care facilities of the Eastman Dental Hospital, the morbidity of the technique and the acceptability of the service to those using it. Of the 103 patients, 46 were seen in the unit because they required minor oral surgery and 22 because of particular problems with management. Ninety-four patients had one or more symptoms following treatment. In at least 53 cases this related to the treatment and not to the anaesthetic. Despite a cost to the families in terms of money and time, the service proved acceptable to almost all of those who used it.     

Morbidity following dental treatment of children under intubation general anaesthesia in a day-stay unit

Objectives. To determine which variables were best related to the overall morbidity of a child undergoing dental general anaesthetic (GA) and then to use these variables to determine those factors that might influence the extent and severity of morbidity experienced by healthy children following dental GA. Sample and methods. Data were collected on anxiety, pain and morbidity, GA procedure and dental procedure from 121 children attending a day stay GA unit for dental treatment. Patients were interviewed preoperatively, postoperatively before discharge then four further times over the next 148 h. Data were analysed using multivariate regression. Results. Thirty‐one per cent of subjects had restorative work, 60% had at least one tooth extracted, 54% had a surgical procedure. Use of local analgesia reduced postoperative pain whilst an increase in the number of surgical procedures increased it. Increase in anaesthetic time was related to increased odds of feeling sleepy and nauseous, females were more likely to complain of sleepiness or weakness. Feelings of dizziness were increased if the patient was given local analgesia during the procedure. Conclusions. Pain following dental GA was the most prevalent and long lasting symptom of postoperative morbidity in this study. Reductions in operating time and improvement in pain control have the potential to reduce reported morbidity following dental GA.     

Reasons for and parental satisfaction with children's dental care under general anaesthesia

OBJECTIVES: The aim of this study was to describe why healthy children's previous treatment experiences can be reasons for their dental treatment under general anaesthesia (GA), and to describe their parents' experiences and satisfaction with that treatment. SUBJECTS AND METHODS: The data cover those children (n=102) below 16 years of age who, being otherwise healthy, were referred for Public Dental Service GA dental care in Helsinki, Finland, over the course of one year because of serious difficulties in dental treatment. The parents were given a self-administered questionnaire inquiring about their child's previous experiences of dental care, and about their access to and satisfaction with the present GA treatment. Data on the children's dental state were taken from patient records. RESULTS: The children's mean age was 6.4 years (SD=2.6 years), and the mean number of teeth with untreated caries was 7.7 (SD=3.0). Of the total sample, 32% had undergone four or more previous unsuccessful dental visits. At the time of their first difficulties in dental care, 39% were below 3 years of age. The older the child, the more serious was her or his parents' ranking of the difficulties met during dental care (P=0.02). From the parents' point of view, dental fear was the most important reason for treatment failures, followed by pain. Seeking GA treatment had been easy for 93% of parents, and most of them were also satisfied with their child's present GA treatment. CONCLUSIONS: The most important factors leading to the use of GA, as reported by the parents, are dental fear and repeated unpleasant experiences during dental care, and therefore, these should always be properly diagnosed, prevented and controlled.     

Prioritization for elective dental treatment under general anesthesia

This paper describes the process and outcomes of an initiative to develop a system to prioritize operating room bookings for children who require elective dental treatment. This initiative had 3 objectives: to improve the timeliness of treatment in the operating room based on medical and dental need, to provide a means to identify and expedite the highest-priority cases when operating room time became available, and to document the prioritization of cases as a quality assurance measure. Each patient booked for treatment in the operating room was assigned a priority ranking based on a combination of their medical risk and dental status. Measures of interrater reliability between clinician raters were moderate to good. Use of the prioritization system demonstrated improved timeliness of treatment for urgent cases and the effects of additional measures taken to reduce the waiting list.     

Changes in aspects of children's oral-health-related quality of life following dental treatment under general anaesthesia

OBJECTIVES: This study was intended to examine the treatment-associated change in aspects of oral-health-related quality of life (QoL) among children (and their families) undergoing dental rehabilitation under general anaesthesia (GA). METHODS: The parents or caregivers of a consecutive clinical sample of children receiving comprehensive dental treatment under GA at the University of Otago School of Dentistry, Dunedin, and the Christchurch Oral Health Centre, Christchurch, New Zealand, were interviewed by telephone before and after the treatment. Questions were asked relating to the impact of the condition on the child and the family. The post-treatment questionnaire also sought information related to parental satisfaction with the care provided under GA. RESULTS: The parents or caregivers of 95 children participated in the study: 49 had treatment completed at the University of Otago School of Dentistry; and 46 were treated at the Christchurch Oral Health Centre. The child sample comprised 55.8% males and 44.2% females with a mean age of 5.1 years. Their mean dmft was 8.2. A consistent pattern of improvement was found with each indicator used. Complaints of pain, problems with eating and sleeping, and behaviour concerns showed significant improvements, with 100% improvement for children for whom frequent pre-GA problems associated with eating, sleeping and behaviour were reported. Sixty-six parents had to arrange time away from employment on the day of the GA and almost half of those incurred a loss of income. The majority of parents reported a high degree of satisfaction with the care received. CONCLUSIONS: Treating young children with high disease experience in a single session under GA results in immediate improvement in oral health and aspects of their QoL for both the children and their families.     

Principles of dental treatment of handicapped children in general anaesthesia

The long experience and practice in the treatment of handicapped children determined the appropriate general type of anaesthesia as well as the method and order of dental operations under general anaesthesia. A wide variety of dental treatment in such conditions concerns the "serial work per quadrants", strong measures of preventive extension and pulp protection, and selection of indications for extraction of teeth. It is emphasized that during the postoperative period frequent control examinations and intensified preventive measures by parents and dentists are necessary.     

Factors influencing referral of children for dental extractions under general and local anaesthesia

OBJECTIVE: To investigate the relative importance of a range of explanatory variables concerning why child patients in Scotland enter pathways for tooth extractions under either Dental General Anaesthesia (DGA) or local anaesthesia (LA). BASIC RESEARCH DESIGN: A cross-sectional study was carried out involving DGA centres across Scotland. Data collected related to demographic characteristics of child DGA patients, reported anxiety and dental attendance levels of patients and parents, reasons given by referring practitioners for requesting DGA, number and type of teeth extracted and parental beliefs and attitudes to DGA. Similar data were collected relating to children having teeth extracted in primary care under LA. Multivariate analysis was performed to determine which factors were the best predictors of anaesthetic choice. RESULTS: 425 and 121 children having dental extractions under DGA and LA respectively participated. Ninety-six percent of DGA cases and 48% of LA patients had extractions for caries. For DGA cases, the mean age was 6.7 years, an average of 5.3 teeth were extracted and dental anxiety levels were higher than population norms. Multivariate analysis found the number of teeth extracted was the major predictor of anaesthetic type. On removing this variable, age became the most important factor, with 99% of children under 5.5 years receiving a DGA. Among DGA patients, 25% were reported to have had a previous DGA for tooth extraction. CONCLUSIONS: Future reductions in DGA numbers will be dependent on decreasing the number of young children presenting with advanced caries in multiple teeth. Consequently, guidelines are required concerning the prevention and appropriate management of caries in the primary dentition.