Satisfaction of Parents and Caregivers with Dental Treatment of Children Under General Anesthesia in a Day Care Surgery Setting

ObjectiveThe aim of this study was to examine the satisfaction of parents and caregivers of patients who underwent dental treatment in general anesthesia (GA) in a day-care surgery setting.Material and MethodsAnonymous questionnaire was sent to parents/caregivers of patients who underwent full mouth restoration in GA. The survey consisted of 4 parts: general data, data about procedure, satisfaction with various aspects of care and the perception of parents/caregivers about the condition of their child in relation to the time before dental treatment in GA.Results66 parents/caregivers (30.5%) responded to the questionnaire. Overall satisfaction with the treatment was high (4.69). Respondents expressed the highest degree of satisfaction with communication with nurses (4.92), and the lowest with the waiting time for the procedure (3.89). Parents/caregivers of patients who reported difficulty eating expressed significantly lower overall satisfaction than the subjects whose children did not report difficulty eating. Also, the more treatments the patients underwent, the lower was the overall satisfaction than of those subjects whose children were never treated in such a manner before.ConclusionsSince patient satisfaction has a beneficial impact on treatment outcome and adherence to preventive recommendations, all health care providers should strive to achieve it.     

The Missouri Elks Mobile Dental Program–Dental Care for Developmentally Disabled Persons

This article describes the origins, funding, organization, operation, utilization, and outreach program of a statewide mobile dental program for the disabled in Missouri. The article includes information based on analysis of productivity reports and patient records. Comparisons are made between the utilization by mentally retarded (MR) and other disabled patients (MCCS), their county of residence, and the location where service was provided (rural vs urban). The mean number of dental procedures provided per client was 7.3. More procedures (8.35) were provided to urban clients than rural clients (5.81). The utilization rate of urban MR clients was 63.9 percent, compared to 60 percent for rural MR clients. Other findings show 10.7 percent urban MCCS clients utilized the mobile dental program, versus 13.5 percent of the rural MCCS clients. The budgeted expenditures for providing care to this underserved group were $46,000 less than the estimated value of dental care provided in a private practice setting.     

右美托咪定对全麻龋齿治疗患儿应激反应及苏醒质量的影响

目的:探讨右美托咪定对全麻龋齿治疗患儿围术期应激反应及苏醒质量的影响。方法:择期全麻下行复杂龋齿治疗术患儿64例,年龄3~6岁,ASAⅠ级。随机将患儿分为右美托咪定组(D组)和对照组(C组),每组32例。D组在麻醉诱导同时泵注0.5μg/kg右美托咪定15 min,然后以0.4μg·kg^-1·h^-1持续泵注至术毕前30 min。C组以同样方案泵注生理盐水。分别记录麻醉前(T0)、手术开始后1h(T1)、术毕(T2)、苏醒时(T3)的HR、MBP,以及血浆皮质醇(Cor)、去甲肾上腺素(NE)、血糖(Glu)水平,记录手术时间、术中丙泊酚总用量、自主呼吸恢复时间、拔管时间、苏醒时Ramsay镇静评分、FLACC镇痛评分与PAED躁动评分。结果:(1)围术期生命体征比较,T0时,患儿HR、MAP组间差异无统计学意义(P>0.05),T1、T2、T3时,D组HR、MAP显著低于C组(P<0.05)。(2)应激反应指标比较:T0时,两组患儿Cor、NE、Glu水平差异无统计学意义(P>0.05),T1、T2、T3时,D组Cor、NE、Glu显著低于C组(P<0.05)。(3)复苏质量与麻醉药总量比较:两组患儿自主呼吸恢复时间与拔管时间差异无统计学意义(P>0.05)。与C组相比,D组患儿丙泊酚总用量、镇静、镇痛、躁动评分值显著低于C组(P<0.05)。结论:右美托咪定持续输注用于全麻龋齿治疗患儿,围术期血流动力学更稳定,降低应激反应,提高苏醒质量。     

Dental Care Utilization and Expenditures in Children With Special Health Care Needs

BackgroundThe authors compared children with special health care needs (CSHCN) and children without special health care needs (SHCN) with respect to the odds, amount and determinants of having any dental care and dental care expenditures.MethodsThe authors assessed data from the 2004 Medical Expenditures Panel Survey, Agency for Healthcare Research and Quality, to identify a sample of 8,518 children aged 2 to 17 years. The authors used logistic regression to determine the effect of having SHCN on the probability of having any dental care expenditure, for total dental care expenditures and procedure-specific expenditures. They tested the modifying effect between CSHCN and other variables on the probability of having any dental care expenditure.ResultsCompared with children without SHCN, CSHCN did not differ in the probability (odds ratio = 0.91, 95 percent confidence interval [CI] = 0.76 to 1.09) or amount (β = 30.17, 95 percent CI = ?162.93 to 223.27) of total dental care expenditures. Likewise, CSHCN did not differ in their likelihood of having undergone a preventive, restorative, diagnostic or other procedure. Known determinants of dental care utilization did not modify the relationships between having SCHN and any dental care expenditure.ConclusionsDespite the reported difficulty in CSHCN's accessing dental care, the authors found that CSHCN had dental care utilization and expenditures that were comparable with those of children without SHCN. Furthermore, the association of CSHCN status and any dental care expenditure was not modified by known determinants of dental care utilization. Future research should focus on characterizing risk for dental disease among CSHCN more accurately and identifying factors that affect dental care utilization in CSHCN, including provider and parent characteristics.Practice ImplicationsThe study results highlight low rates of dental care utilization among all young children, including CSHCN. Efforts to increase dental care utilization among children are warranted and need to include broad-based provider and parent initiatives.     

A New Classification System for Dental Treatment under General Anesthesia

The provision of comprehensive care for patients with special needs using dental general anesthesia (DGA) has changed over time, and now includes more complex procedures and the participation of many services. As a result, it is necessary to integrate, organize and describe all of the procedures that are carried out in different DGA settings. The aim of this study was to propose a systematic classification for dental treatment procedures be delivered under DGA, and to compare this classification system with an existing system. This new classification system has three distinct components: type, frequency and length of time needed to complete dental procedures for both primary and permanent teeth. A wide range of oral surgery procedures and endodontic treatment was also included. A retrospective cohort study utilizing 84 subjects was used to develop and compare the two classification systems. When comparing the different categories of procedures by both classifications, there were significant statistical differences between them (p < 0.05). Oral health care for patients with special needs has evolved, with more complex and extensive interventions that require teamwork by personnel from different dental or medical specialties. The classification system in this study includes detailed Information regarding the procedures involved in the DGA. This helps to provide a clear understanding and specific information that enables the comparison of clinical experiences across populations where a DGA has been used for patients with special needs.     

Post-Discharge Complications of Dental Treatment in General Anesthesia Performed in a Day-Care Service

ObjectiveTo review the frequency and management of post-discharge complications in patients who underwent dental treatment in general anesthesia (GA) in a day-care surgery setting and identify the factors that increase the risk for these complications.Material and methodsAnonymous questionnaire was sent to parents/caregivers of patients who underwent full mouth restoration in GA at our institution between 1^st January 2017 and 31^st July 2019. Demographic and clinical data of patients as well as the data about the occurrence and management of complications were collected.ResultsSixty-six parents/caregivers (30.5%) responded to the questionnaire. Most frequent complications were drowsiness and pain in 40(60.6%) patients. Complications were managed by parents or caregivers with conservative measures at home in 57(91.9%) cases. Phone consultation with dentist was required in 5(8.1%) cases. One patient (1.6%) was readmitted. Younger age and diagnosis were associated with increased risk for drowsiness.ConclusionPost discharge complications of dental treatment in GA in a day-care service are common and they can be managed by parent/caregiver with conservative measures at home. The rate of readmission is low. Dental treatment in GA in a day-care service is a safe procedure that can be performed with acceptable risk in carefully selected patients.     

Management of a Pediatric Patient With Epidermolysis Bullosa Receiving Comprehensive Dental Treatment under General Anesthesia

The purpose of this report was to detail clinical considerations and a general anesthetic approach for a 3-year-old pediatric dental patient with epidermolysis bullosa, a group of rare genetic disorders characterized by blister development following minor trauma or traction to the skin or mucosal surfaces. Challenges in providing comprehensive dental treatment and care under general anesthesia are discussed. Early evaluation is vital to preventing the consequences of severe early childhood caries.     

Assessing Patterns of Restorative and Preventive Care Among Children Enrolled in Medicaid,by Type of Dental Care Provider

BackgroundThe authors investigate the relationship of preventive dental treatment to subsequent receipt of comprehensive treatment among Medicaid-enrolled children.MethodsThe authors analyzed Medicaid dental claims data for 50,485 children residing in Wayne County, Mich. The study sample included children aged 5 through 12 years in 2002 who had been enrolled in Medicaid for at least one month and had had at least one dental visit each year from 2002 through 2005. The authors assessed dental care utilization and treatment patterns cross-sectionally for each year and longitudinally.ResultsAmong the Medicaid-enrolled children in 2002, 42 percent had had one or more dental visits during the year. At least 20 percent of the children with a dental visit in 2002 were treated by providers who billed Medicaid exclusively for diagnostic and preventive (DP) services. Children treated by DP care providers were less likely to receive restorative and/or surgical services than were children who were treated by dentists who provided a comprehensive mix of dental services. The logistic model showed that children who visited a DP-care provider were about 2.5 times less likely to receive restorative or surgical treatments than were children who visited comprehensive-care providers. Older children and African-American children were less likely to receive restorative and surgical treatments from both types of providers.ConclusionsThe study results show that the type of provider is a significant determinant of whether children received comprehensive restorative and surgical services. The results suggest that current policies that support preventive care–only programs may achieve increased access to preventive care for Medicaid-enrolled children in Wayne County, but they do not provide access to adequate comprehensive dental care.