Dental avoidance behaviour in parent and child as risk indicators for caries in 5-year-old children

Aim.  The aim of this study was to explore associations between avoidance behaviour and dental anxiety in both parents and children and caries experience in 5-year-old children. It was hypothesised that parents' dental avoidance behaviour and dental anxiety were related to dental caries in 5-year-old children.
Design.  Data were collected from dental records and by clinical and radiographic examination of 523 children. The parents completed a questionnaire regarding education, national background, dental anxiety, dental attendance, and behaviour management problems. Bivariate and multivariate logistic regression was conducted.
Results.  Children having one or more missed dental appointments (OR = 4.7), child behaviour management problems (OR = 3.3), child dental anxiety (OR = 3.1), and parents avoiding dental care (OR = 2.1) were bivariately associated with caries experience at the age of 5 years. In multivariate logistic regression, having one or more missed dental appointments (OR = 4.0) and child behaviour management problems (OR = 2.4) were indicators for dental caries in 5-year-old children, when controlling for parents education and national origin.
Conclusion.  Parents that avoid bringing their child to scheduled dental appointments and previous experiences of behaviour management problems for the child indicated risk for dental caries in 5-year-old children.     

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.     

Intraligamental analgesia for post-operative pain control in children having dental extractions under general anaesthesia.

AIM: This was to assess the effectiveness and safety of intraligamental local analgesia (ILA) for postoperative pain control in children having dental extractions under general anaesthesia (GA). The variables affecting the effectiveness of ILA were also investigated. METHODS: Data were collected from children having permanent molars extracted under GA using a randomised half mouth study design. ILA (bupivicaine 0.5% with 1:200,000 adrenaline) was used on the randomly assigned experimental side prior to extraction of the teeth, and the contralateral control side received no ILA. Children were interviewed pre- and post-operatively by the principal investigator (PA) who was blind to the side of ILA. Pre- and post-operative anxiety levels of each child were measured using the Venham Picture Test (VPT). Patients were asked to rate which side was better in terms of pain control, whether they felt numbness and whether they preferred the numbness. Their post-operative pain levels were also measured using the visual analogue scale (VAS). Self-inflicted trauma following ILA was noted. RESULTS: Thirty children, with a mean age of 11.3 years (SD+/-1.7) completed the study. None of the patients had self-inflicted soft tissue trauma following ILA. Nineteen children (63%) found that pain control was better post-operatively on the side with ILA. Twenty-one children (70%) reported numbness following ILA of whom 14 (67%) said that they preferred this. VAS scores were not significantly different between the experimental and control sides. A higher percentage of boys (85%) than girls (47%) rated the ILA side "better" (p = 0.034). VPT scores were significantly higher for girls postoperatively (p = 0.048). CONCLUSION: ILA was a useful and safe adjunct for postoperative pain control in children having permanent teeth extracted under GA. The technique was found to be more effective in boys than girls. However, less than half the children in this study preferred the side with numbness. Further research is needed to determine effective methods of pain control in children following dental GA and to investigate the reasons for gender differences of pain perception in children.     

Remembering and repeating childhood dental treatment experiences: parents, their children, and barriers to dental care

Background.  Despite improvements over the past two decades, caries and its treatment remain a problem for Scottish children.
Aim.  To investigate how the reported childhood dental care experiences of a group of Scottish parents impacted upon the dental treatment they accessed for their children.
Study design.  In-depth, semi-structured interviews were conducted with 19 parents of varied age and social background whose children were referred to Dundee Dental Hospital for the assessment of dental extractions. Parents were encouraged to discuss their own and their child's experiences of dental care. The interview data were systematically coded using key theme headings, and summary charts constructed to facilitate the analysis.
Results.  A sense of 'uneasiness' pervaded the parents' comments and perceptions of the dental care provided for their children. This was conceptualized as parents 'remembering in words' and 'repeating through actions' their own childhood dental experiences. They remembered and repeated their childhood experiences by delaying dental treatment for themselves and their children.
Conclusions.  Acknowledging the influence of parental dental experience would help ensure that parents of young children access routine care for their children and themselves.     

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.     

An evaluation of the PALS after treatment modelling intervention to reduce dental anxiety in child dental patients

Aim.  The aim of this study was to assess the effectiveness of the passivity to activity through live symbolic (PALS) after treatment modelling intervention to reduce child dental anxiety.
Methods.  A convenience sample of consecutive 5- to 10-year-old dental patients were randomly assigned to intervention or control groups. Self-reported child dental anxiety was assessed at the start of each visit. At the end of each visit, children in the intervention group were introduced to a glove puppet, which acted as the PALS model. The intervention group children re-enacted the treatment they had just received on the puppet's teeth. At the end of each visit, the control children received motivational rewards only. The change in dental anxiety scores was examined by t -tests and analysis of covariance.
Results.  The final analysis included 27 intervention children and 26 control children. For the intervention group, there were no statistically significant changes in dental anxiety over a course of treatment, between first and second preventive visits, between first and second invasive treatment visits, or between first attendance and subsequent recall attendance. For the control group, a statistically significant decrease in dental anxiety was observed between the first and second invasive dental treatment visits.
Conclusion.  The PALS after treatment modelling intervention was ineffective in reducing child dental anxiety.     

R3Increasing the awareness of the role of the dental team in child protection

Objective:  To determine and compare the reasons and pattern of extraction of first permanent molars (FPM) in 3 UK dental hospitals.
Design:  Data were collected prospectively from 300 children attending Manchester Dental Hospital (MDH), Liverpool Dental Hospital (LDH) and Charles Clifford Dental Hospital, Sheffield (CCDH) who required extractions of at least one FPM. Information recorded included age, FPM extracted, reason for extractions, previous treatment, method of extraction, and whether patients had previous extractions.
Result:  The mean age in months was 129 (Std 22.7), 139 (Std 29.4), and 133 (Std 26.8) for MDH, LDH, CCDH respectively. 45% and 48% of children had four FPM extracted at MDH & CCDH, respectively, compared to 25% in LDH. The main reason for extraction (70%) was caries with poor prognosis, followed by caries and compensating extraction (14%). Molar Incisal Hypoplasia was the reason for extraction in 11% of cases. General anaesthesia was the main anaesthetic method used with 77%, 55%, and 47% in MDH, LDH and CCDH, respectively. Local anaesthesia was used in 43% of cases in LDH in comparison to 12% and 22% in MDH and CCDH, respectively. 68% of children had received no previous treatment to the FPM and only 5% had fissure sealants placed. 40% of children had previous extractions.
Conclusion:  The children who are attending our hospitals for extractions of FPM tend to be older than the recommended age for achieving maximum space closure. This study highlights the need for extensive prevention programs targeted at those children with high caries risk.     

A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age

Background.  The development of dental anxiety in children is poorly understood.
Aims.  The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors.
Design.  A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years.
Results.  The majority (54.3% N  = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7% N  = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7% N  = 85) than the proportion of children who were reported as being anxious at baseline (8.8% N  = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old.
Conclusions.  Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.     

The effects of a long wait for children's dental general anaesthesia

OBJECTIVES: The purpose of this study was to monitor the effect of an interruption in a service for children who were scheduled to have dental extractions under general anaesthesia (GA). The reasons for offering GA and the treatment given while the service was not available, together with the history of the pain, antibiotic usage and alterations to the number of teeth extracted were recorded. METHODS: When the GA extraction service stopped, the children who were scheduled to have their teeth extracted were placed on a waiting list. When the service recommenced 6 months later, the children were invited to attend a reassessment. Relevant data were collected at this visit using a proforma. RESULTS: A total of 321 children had their extractions delayed. Only 249 of these attended for a reassessment. During the waiting period, 102 parents (41.0%) reported that their children required analgesics, 71 (28.5%) stated that their children's sleep was disturbed and 82 (32.9%) recorded problems with eating. One hundred and twenty-three children (49.4%) had received antibiotics, with 49 (19.6%) having been prescribed two or more courses. The majority of treatment plans (85.5%) remained unchanged. CONCLUSIONS: Many children who had had their extractions delayed suffered further pain and disruption to their life.     

Dental caries, age and anxiety: factors influencing sedation choice for children attending for emergency dental care

OBJECTIVES: The aim of the study was to examine how physical (dental caries) and psychosocial (age, dental anxiety and dental health behaviour) factors, associated with child and parent, influenced dentists' sedation choice when a child presents in pain. METHODS: 600 parents whose children were aged between 5 and 11 years took part: 200 attended for routine dental care (RDC); the remaining 400 attended as emergency patients and were offered either dental general anaesthesia (DGA) or relative analgesia (RA). The subjects were approached and invited to take part. The researcher was blind as to the child's pattern of dental attendance and the type of sedation offered. All parents and children completed self-reported ratings of dental anxiety. The children's teeth were examined to determine past and present dental caries experience. RESULTS: The results showed that children who were offered DGA had greater experience of dentinal caries, were younger and dentally anxious. The children offered RA were older, had a higher frequency of brushing their teeth with fluoride toothpaste and were also dentally anxious. Discriminant analysis showed that 2 canonical functions provided clear categorisation of the three treatment groups. Function 1 was a physical (dental caries) factor, which was related to the child's experience of dentinal caries. Function 2 was a psychosocial factor, which was related to the child's age, dental anxiety and frequency of tooth brushing. A greater proportion of the variance in the treatment offered was explained by Function 1, suggesting that the most important factor in the decision to offer DGA was dentinal caries. Function 2 was of lesser importance. CONCLUSIONS: The findings have implications for the type of sedation offered to children presenting for emergency care. These children may not otherwise receive treatment and the need to provide less anxiety provoking forms of sedation must be promoted. By doing so, parents who have only brought their children when in pain may take advantage of RDC and the treatments offered to prevent and control dental caries and anxiety in their children.     

Dental anxiety among survivors of childhood cancer: a cross-sectional study

Background.   Childhood cancer survivors may have experienced a high number of invasive medical and dental procedures which are known to be risk factors for dental anxiety.
Aim.  The aim of this study was to examine the prevalence of dental anxiety among children who have survived cancer.
Design.  In a cross-sectional study, we examined 51 6- to 14-year-old children who had been treated for cancer at Aalborg Hospital, and 192 children without cancer. All children answered the Dental Subscale of the Children's Fear Survey Schedule. Dental anxiety was defined as a dental anxiety score exceeding the mean dental anxiety score + 1 standard deviation for the children without cancer.
Results.  Children with cancer did not have an increased prevalence of dental anxiety compared with children without cancer: the prevalence ratio was 0.41 [95% confidence interval (CI): 0.10–1.24]. The mean dental anxiety score was 23.1 (95% CI: 21.2–25.0) among children who had been treated for cancer, and 24.7 (95% CI: 23.4–26.0) among children without cancer (mean difference: 1.6; 95% CI: 1.1–4.3).
Conclusion.  Cancer and cancer treatment during childhood were not associated with an increased risk of dental anxiety in this population.     

Association of temperament with dental anxiety and behaviour of the preschool child during the initial dental visit

The aim of this study was to investigate whether there is an association between temperament characteristics of preschool children, dental anxiety, and their dental behaviour. A total of 100 children, aged 3–5 yr, who were attending their initial dental visit accompanied by a parent, were included in this cross‐sectional study. Dental anxiety of children was measured using the Facial Image Scale. The behaviour of children during the initial oral examination and oral prophylaxis was assessed using Frankl's behaviour rating scale. Temperament was assessed using Emotionality, Activity, Shyness Temperament Survey for Children (parental ratings). Statistically significant weak linear positive correlations were seen between the following: the percentage duration of definitely negative behaviour and shyness scores (r_s = 0.28); anxiety level and emotionality scores (r_s = 0.28); and anxiety level and shyness scores (r_s = 0.26). Multinomial logistic regression analysis revealed that children with higher anxiety had higher odds of showing definitely negative behaviour, which decreased with increasing age of the child. Emotionality and shyness temperaments may be weakly associated with dental anxiety, and shyness may be weakly associated with the dental behaviour of the preschool child. Definitely negative dental behaviour is associated with dental anxiety and age of the child.     

Effects of video information on parental preoperative anxiety level and their perception of conscious sedation vs. general anesthesia for the dental treatment of their young child

AIM: To investigate the impact of video information on parental preoperative anxiety and perception and their preference of conscious sedation versus general anesthesia for the dental treatment of young patients. METHOD/MATERIALS: Parents were given a verbal explanation regarding the two treatment options and were then asked to fill out a prescreening questionnaire. Their preference for mode of treatment was obtained and their preoperative anxiety level was measured on a visual analog scale (VAS). A video film depicting two children under going dental treatment with conscious sedation (CS) and a third child undergoing general anesthesia (GA) for dental treatment was shown to the parent. Following the viewing of the video film a post-screening questionnaire was given. Parents' post screening anxiety was measured and they were asked if their perception and preference of the two modes of treatment remained the same or changed. RESULTS: 40 parents were included and completed the trial. The prescreening anxiety level of parents was 2.79 (+/-1.05, SD) and was not significantly different than the post screening anxiety level of 2.91 (+/- .99 SD, paired t- test p=0.432). The majority of parents preferred CS to GA for the treatment of their child prior to screening of the video. Among the few who chose GA (n=5) all but one changed their choice after viewing the video to CS. However, this difference was not found to be statistically significant due to the small number of subjects in this group (McNemar test, p = 0.125). Most parents voiced the opinion that the video film contributed to their knowledge and also considered GA as having more risks than CS. An interesting finding was that a statistically significant difference was found regarding parent's perception of the two procedures and what they actually saw in the video. The majority of parents stated that their initial perception of GA was not similar to their viewing experience, conversely, CS matched their expectations. CONCLUSION: Parents' anxiety regarding their child's dental treatment under GA or CS is not affected by the viewing of a video film depicting either method. Parent's perception of GA is different than the actual procedure and may affect their choice of treatment.     

Midazolam conscious sedation in a large Danish municipal dental service for children and adolescents

Objective.  The aim of this study was to describe the introduction and the first six years use of midazolam for conscious sedation in a municipal dental service in Denmark.
Methods.  In 1998, all dentists were introduced to midazolam conscious sedation. A sedation chart was filled in for each session, and parents' assessment was obtained. In 2004, all clinical materials were collected.
Results.  Six hundred and eighty sessions were performed; 63.7% of the children were between 2 and 6 years of age; 88.5% belonged to American Society of Anesthesiologists grade 1; 74.8% of the sedations performed used the oral route of administration. Restorations were performed during 60.3% of the sessions, and extractions during 38.4%. Complications during the sessions were rare, the most frequent being double vision (6.1%), hiccups (2.7%), and paradoxical reaction (2.0%). Using Wilton's sedation scale, 42.9% were calm and 27.7% were agitated during treatment, whereas after treatment 61.7% were calm; 80.4% of the parents were very positive towards this sedation method.
Conclusion.  Sedation with midazolam for dental treatment of children with dental fear and anxiety is a feasible and an efficient method with a low rate of complications. It can probably reduce the need for dental treatment under general anaesthesia.     

Assessing anxiety in pre-school dental patients with a doll placement test

The prospect of dental treatment causes many young patients to be anxious and/or afraid. Because it is helpful to know in advance how much anxiety a child is experiencing, we have devised a test in which the child places dolls in a miniature dental office. We used this model to study 48 children, aged three to five years, who visited our paediatric dental office. We prepared a doll-house-sized model of a dental office with a dental chair, a dentist, and dental hygienist. We asked children to place two dolls, one a self-doll and the other a parent/guardian-doll at a location of their choosing in the model clinic. The positions children chose to place the dolls helped us to gauge the anxiety they were experiencing as they anticipated dental treatment. The majority of children we tested were not anxious, and they placed the self-doll in the dental chair. In contrast, we observed that many children who did not place the self-doll on the dental chair were uncooperative during subsequent dental treatment. Thus, our doll-placement test is a valuable predictor of the anxiety of children who will receive dental treatment. Although how children placed the parent/guardian-doll also provided useful information, we gained the most valuable information from whether or not the child put the self-doll on the dental chair.     

The use of dental anxiety questionnaires: a survey of a group of UK dental practitioners

AIM: To determine the frequency of use of dental anxiety assessment questionnaires and factors associated with their use in a group of UK dental practitioners. METHOD: A postal questionnaire to all 328 dentists whose names appear in the British Society for Behavioural Sciences in Dentistry Directory. Information collected for each practitioner included gender, year of qualification, type of practice in which anxious dental patients were treated, treatment used to manage anxious dental patients, type and frequency of use of dental anxiety assessment indices. RESULTS: Questionnaires were returned from 275 (84%) practitioners. 269 were analyzed. Only 54 practitioners (20%) used adult dental anxiety assessment questionnaires and only 46 (17%) used child dental anxiety assessment questionnaires. Male practitioners were more likely to report questionnaire use in comparison with females (P< 0.05), when treating dentally anxious adults (26% v 14%). In addition, practitioners providing intravenous sedation were more likely to use an adult dental anxiety questionnaire (P < 0.04) than those who did not use intravenous sedation (29% v 15%). The type of treatment provided had a significant association with the use of child dental anxiety. Those providing general anaesthesia (P = 0.03) and hypnosis (P = 0.01) for dentally anxious children were more inclined to use a questionnaire. CONCLUSION: The use of pre-treatment dental anxiety assessment questionnaires was low in this group of dentists. Male practitioners and those providing intravenous sedation, general anaesthesia or hypnosis seem more likely to use dental anxiety assessment questionnaires.     

Further dental treatment needs of children receiving exodontia under general anaesthesia at a teaching hospital in the UK

OBJECTIVES: The aim of this study was to investigate the subsequent dental treatment needs of children who had dental extractions under general anaesthesia (GA) in 1997 in the Day Case Unit at Leeds Dental Institute (LDI), Leeds, UK, and the reasons for repeat dental GAs (DGAs). STUDY DESIGN: The authors conducted a retrospective longitudinal analysis. SUBJECTS AND METHODS: Information collected from hospital records for the 6-year period following the first DGA included: reasons for the DGA in 1997 and teeth extracted; the number of subsequent DGAs, reasons and treatment; incidents of and reasons for toothache or swelling after 1997; treatment under local anaesthesia (LA) or inhalation sedation (IS) at LDI during the 6 years following the DGA in 1997. RESULTS: The study population consisted of 484 children, who received GA exodontia at LDI with a mean age of 6.35 years [95% confidence interval (CI) = 6.1, 6.6] and age range of 1-16 years. The most common reason for extractions at the original DGA in 1997 was dental caries, and the mean number of extractions was 4.24 (95% CI = 4.05, 4.43). Primary teeth extractions accounted for 82% of the cases. In total, 143 children (27.5%) had a record of follow-up treatment at LDI. Of these children, 32% had treatment under LA, 7% under LA and IS, and 15% received preventive care only. The overall repeat rate for DGA was 10.7%, with caries (84%) being the main reason for this. Of the teeth subsequently extracted, 72% were recorded as caries-free or unerupted at the time of the DGA in 1997. CONCLUSIONS: A large proportion of the follow-up visits were to treat newly developed dental disease during the 6 years following the DGA in 1997. A more proactive approach towards preventive care may have resulted in the reduction of the development of new dental disease.     

A qualitative look at parents' experience of their child's dental general anaesthesia

OBJECTIVES: Caries relapse after treatment of early childhood caries (ECC) under general anaesthesia (GA) has been frequently reported. This research used a qualitative method of inquiry to explore parents' experience of their child's treatment under GA, and their perception of the impact of this treatment on their child. METHODS: The participants were parents whose children had recently undergone dental rehabilitation under GA. Data was collected by semistructured, open-ended interviews scheduled at the postoperative appointment. Interviews were audio-taped, transcribed, checked and coded into a qualitative computer software program for analysis. Data collection and analysis were done simultaneously, and the interview guide was modified based on responses. RESULTS: Parents were troubled that their child needed a GA and appeared aware of the complications. While some parents felt 'guilty' and struggled to accept this mode of treatment for their child, others felt 'blameless', and were convinced that the GA was 'preferable' for their child and superior to conventional treatment. Nonetheless, all parents reported some levels of anxiety during the GA; they expressed their emotions with 'fear', 'worry' and 'concern'. After the GA, improvement was reported by most parents in their child's amount of dental pain, sleeping pattern, eating habits and acceptance of parental toothbrushing. The most common changes in their child's behaviour mentioned by parents were increased toothbrushing and decreased consumption of sugary foods. Several children who had had primary teeth extracted were distressed as a result of this 'loss'. CONCLUSION: The general anaesthetic experience was troubling in a variety of ways for both parents and children. However, an 'early' and positive outcome of the GA was a reported improvement in dental health practices. Parents were more positive about maintaining the health of primary teeth and now knew how to take care of their child's teeth. Future exploration is required to reveal if and how the GA experience will affect long-term preventive behaviours.     

Reasons for repeat dental treatment under general anesthesia for the healthy child

PURPOSE: This study investigated reasons a healthy child may need repeat dental treatment under general anesthesia (GA). METHODS: Experimental subjects were 23 healthy children who received dental treatment under GA twice; controls were 23 healthy children requiring a single dental treatment session under GA. Records review determined demographics, intraoperative information, diagnosis, and treatment provided. Parents of 11 subjects and 9 controls competed a questionnaire and were interviewed. RESULTS: Many factors differed between subject and control children. Common characteristics of children requiring repeat care under GA (subjects) were: (1) 100% percent caries involvement of maxillary central incisors at time of initial treatment; (2) majority of central incisors were nonrestorable; (3) still using nursing bottle at the time of GA; (4) child responsible for brushing own teeth; (5) poor cooperation in the medical and dental setting; (6) difficult personality as described by parent; (7) dysfunctional social situation; and (8) lack of follow-up dental care. Stainless steel crowns were the most successful restoration placed. CONCLUSIONS: A number of predictors were found to help identify high-risk children. Best outcomes following dental rehabilitation under GA may result from aggressive treatment of caries, active follow-up, and education of parents.     

Behaviour guidance in dental treatment of patients with autism spectrum disorder

Background.  Autism spectrum disorder (ASD) is a neurodevelopmental disorder categorized into autism, pervasive developmental disorder – not otherwise specified (PDD-NOS) and Asperger syndrome.
Aims.  To identify factors associated with the behaviour of patients with ASD in a dental setting, use of general anaesthesia (GA), and protective stabilization.
Design.  The dental charts of 395 patients with ASD patients and 386 unaffected patients were reviewed. The following data were analysed: ASD diagnosis, age, gender, residence, seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behaviour or pica), medications, caries prevalence and severity, dental treatment history, behaviour, and behaviour guidance technique(s) used.
Results.  Within both groups, younger patients were more uncooperative. ASD patients with autism were more uncooperative than patients with PDD-NOS; patients with an additional diagnosis were also more uncooperative. ASD patients with higher caries severity, who were uncooperative or female, were more likely to require GA. Use of protective stabilization was associated with lower caries severity, presence of seizure disorder, uncooperative behaviour, male gender, or residency in a group home/institution.
Conclusions.  Autism spectrum disorder patients with autism, younger age and an additional diagnosis were more uncooperative. Factors associated with the use of GA and protective stabilization in patients with ASD were also identified.