The influence of general health on the need for dental general anaesthesia in children

Does anesthesia duration or number of cases per patient predict safety events?

BACKGROUND

The need for dental rehabilitation under general anesthesia is increasing, with varying needs between patients. Mortality has been found to be a rare event in these patients; however other perioperative events can and do occur. Previous studies have established increased incidence of perioperative events with younger, sicker children, and longer anesthetics, however, no studies to date have evaluated if the incidence of perioperative events is more closely associated with one long anesthetic or multiple anesthetics per patient.

AIMS

To evaluate the association of perioperative events related to single anesthetic duration or number of anesthetics per patient for dental rehabilitation.

METHODS

After Children's Wisconsin Human Research Protection Program determined this quality activity did not meet the definition of human subjects research, we performed an epidemiologic observational evaluation by extracting all dental related cases (dental alone or with oral surgeon vs. dental with other specialties) with an associated general anesthesia encounter from Children's Wisconsin electronic data warehouse from June 1, 2015 to December 31, 2021. These cases occurred at a free-standing children's hospital or associated pediatric-only ambulatory surgery center. The risk of perioperative safety events was analyzed for previously identified risk groups such as American Society of Anesthesiologists Physical Status (ASA-PS), patient age, anesthesia case time with the addition of number of dental cases per patient.

RESULTS

In this study, 8468 procedures were performed on 8082 patients. Of this cohort, 7765 patients underwent one procedure for dental care while 317 patients underwent a total of 703 dental-related procedures, ranging from two to five procedures per patient. Multivariable logistic regression identified increased risk of perioperative events in patients with ASA-PS 3 (n = 1459, rate 1.78%, p value .001, OR 5.7, CI 2.1-15.5) and ASA-PS 4 (n = 86, rate 5.8%, p < .001, OR 17.2, CI 4.4-67.3), anesthesia duration (p < .001, OR 1.46, CI 1.21-1.76), but no increased risk with number of anesthetics per patient (p value .54, OR 0.81, CI 0.4-1.61).

CONCLUSIONS

Limiting dental care under general anesthesia to multiple short cases may decrease the risk of perioperative events when compared to completing all treatment in one long operative session.

Investigating the scope and costs of dental treatment provided under general anaesthesia among children with congenital heart disease

AIM

To identify the types of dental treatment provided under general anaesthesia for children diagnosed with congenital heart disease (CHD), quantify the costs within a publicly funded tertiary paediatric hospital setting and identify factors which affect the cost.

METHODS

A retrospective analysis of dental records (July 2015 to June 2019) was conducted for children with CHD who had undergone a dental general anaesthetic procedure at The Children's Hospital at Westmead, Australia. Patient and treatment-related information were collected, and a costing analysis was performed on 89 dental general anaesthetic procedures.

RESULTS

Mean age at the time of the general anaesthetic was 8.15 years. About 27% of children with CHD had a history of dental infection. Dental extractions and restorations comprised the majority of treatments provided, with extractions performed in 86% of procedures. The mean number of days in hospital was 1.43 and the mean cost was $4395.14. The cost was significantly greater when children presented with a facial swelling compared to any other reason.

CONCLUSIONS

Dental extractions are performed in the majority of general anaesthetics. Not only is there an economic burden to the public health system in providing dental treatment under general anaesthesia for children with CHD, the health impacts also appear to be substantial. A considerable proportion required overnight hospitalisation and days in hospital was strongly related to the cost of the dental general anaesthetic. Systematic referral pathways for accessing dental care are an important consideration for children with CHD.

Pediatric morbidity after oral surgery procedures under general anaesthesia: A systematic review

The aim of this study is to carry out a systematic review of the existing literature on postoperative morbidity after general anaesthesia (GA) in the dental care of paediatric patients, its frequency, characteristics and association with the intervention performed.

MATERIAL AND METHODS

An exhaustive search of the literature published up to 23 February 2022 was carried out in PubMed, Web of Science, Cochrane and EBSCO, with the following strategy: (infant OR child OR adolescent) AND (Oral Surgical Procedures OR Dentistry, Operative) AND Anesthesia, General AND Postoperative Complications.

RESULTS

The most frequent reason for the indication of general anaesthesia was dental caries and its complications (up to 91.0% of patients), followed by lack of cooperation/anxiety and/or fear for dental procedures in the office (between 39.8 and 47.9%). There is a higher prevalence for treatments in the special patient group reaching 87.7% compared to 63.3% in healthy patients. The main comorbidities recorded were: physical or mental disability, neurological, haematological, cardiac disorders, asthma, Down's syndrome; it was not possible to establish their association with the intervention performed. Regarding complications, complaints occurred between 43.0 and 98.9% of cases within the first 24 hours, the main reason being pain (between 14.0% and 95.0%).

CONCLUSIONS

Pediatric dental procedures under GA carry a very low risk of major complications, but have a virtually universal incidence of minor complications.

Behaviour management problems in Finnish children with operated congenital heart disease: a practice-based study

Purpose

This retrospective, practice-based study investigates behaviour management problems (BMPs) in dental care among Finnish children with operated congenital heart disease (CHD).

Methods

All the heart-operated children born between the years 1997 and 1999 were identified in the national ProCardio database (n = 570). Primary dental care records were requested from this population and were eventually received from 211 patients. Information on gender, diagnosis, number of heart operations and perioperative care were collected from the ProCardio database, and the CHDs were categorised as shunting/stenotic/complex/other defects. Data on BMP/dental fear, oral conscious sedation, dental general anaesthesia (DGA) and past and present caries indices at 6, 12 and 15 years (d/D, dmft/DMFT) were assessed.

Results

Notes on behaviour management problems or dental fear were found in 19% of the study population. BMPs in dental care were more frequent among boys. Children with re-operations, longer post-operative intensive care stay and hospitalisation, and complications had not more BMP than others. Those children diagnosed with syndromes had more BMP often than the rest. Past and present caries experience were significantly associated with BMP, need of oral conscious sedation and DGA. Oral conscious sedation, nitrogen oxide sedation and dental general anaesthesia were used in 17/211, 2/221 and 24/211 CHD patients, respectively.

Conclusion

Dental caries remains a main factor associated with BMP in the CHD population. Need for oral conscious sedation and DGA were rather common. To maintain a good oral health and to avoid development of BMP, CHD children benefit from focus in health promotion and preventive care.

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.

General anesthesia for oral and dental care in paediatric patients with special needs: A systematic review

BACKGROUND

The objective of this study is to conduct a systematic review of the literature on the characteristics, needs and current situation of dental care for pediatric patients with special needs.

MATERIAL AND METHODS

An exhaustive search for literature published until June 1, 2020. It was carried out using PubMed, Web of Science, Scopus, Cochrane and EBSCO, with the following keywords: Oral Surgical Procedures and Dentistry, Operational and Anesthesia, General Y (Spanish[lang] or English[lang] ) Y (infant[MeSH] Or child[MeSH] Or adolescent[MeSH]). The research was carried out following the PRISMA research methodology.

RESULTS

The most common indication for general anesthesia (GA) was tooth decay in 16 studies (6.5-90.8% of patients), followed by lack of cooperation and/or fear of dental professionals performing dental procedures in 8 studies. There is a higher prevalence of treatment in the group of patients with special needs, reaching 87.7% compared to 69.9% in healthy patients.

CONCLUSIONS

In paediatric patients with special needs the use of GA is increasing, monitoring and preventive care are insufficient and withdrawal rates are high. Key words:Oral surgical procedures and dentistry, operational and anesthesia, general.

A rapid review of variation in the use of dental general anaesthetics in children

Introduction The use of dental general anaesthetics (DGAs) remains a cause for concern due to additional strains placed on health services. There are numerous factors influencing the prevalence and use of DGAs, and understanding these is an important first step in addressing the issue.Aim Conduct a rapid review of current peer-reviewed and grey literature on the variation in the use of DGAs in children.Methods Electronic searching using Medline via Ovid covering DGA articles from 1998 onwards, written in English. Publication types included primary and secondary sources from peer-reviewed journals and reports, as well as grey literature.Results From 935 results, 171 articles were included in the final review. Themes emerging from the literature included discussions of DGA variation, variations in standards of service provision by health services, and the socio-demographic and geographical characteristics of children. Prominent socio-demographic and geographical characteristics included age, other health conditions, ethnic and cultural background, socioeconomic status and deprivation, and geographical location.Conclusions This review identified numerous variations in the patterns associated with DGA provision and uptake at both a health service and individual level. The findings demonstrate the complicated and multifaceted nature of DGA practices worldwide.

The Analysis of Dental Treatment under General Anaesthesia in Medically Compromised and Healthy Children

Dental care under general anaesthesia (GA) is an option when normal treatment cannot be accomplished due to un-cooperation and systemic or cognitive/intellectual disabilities. The purpose of this retrospective cohort study was to analyse the dental treatment under GA in medically compromised and healthy children. The data were collected from the medical records of children who received their dental treatment under GA. The data regarding patient age, sex, general health, and type of treatment were analysed. This clinical trial included 229 study subjects (138 males, 91 females) with an average age of 8.34 (SD 3.78). Counts and relative counts were used for description of qualitative data. The association between the variables was analysed using contingency tables. The significance of the findings was tested by the chi-square test. Most of the children were older pre-school 63 (27.51%) and young school children 102 (44.54%). Medical disability (systemic or intellectual) was diagnosed in 142 children (62.01%); the remaining 87 (37.99%) were healthy children. Dental treatment of primary teeth was more commonly performed in healthy children (65.52%) compared to medically compromised children (58.45%) (p = 0.287). The total number of medically compromised children and the total number of healthy children were both considered to be 100% for the purpose of the following calculations. In terms of permanent dentition, medically compromised children required more extractions and fillings (38.03%, 57.04%) compared to healthy children (14.94%, 17.24%, respectively). The results of this study revealed that dental treatment under GA was more commonly performed in medically compromised children in permanent teeth only in comparison to healthy children. Based on these findings, both health professionals and state authorities should focus more on preventive care in medically compromised children in order to improve their oral health.