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

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.

Post-operative pain and morbidity in children who have tooth extractions under general anaesthesia: a service evaluation

Introduction Children find dental extractions under general anaesthesia (GA) painful despite national analgesic guidelines.Aims To report on children's post-operative pain, morbidity, families' satisfaction and analgesic regime during GA dental extractions.Design A prospective service evaluation.Setting King's College Hospital, London.Methods Children (n = 143) self-reported pain using the Faces Pain Scale-Revised (FPS-R) pre- and post-operatively and one week later by telephone as reported by the child's parent/carer. Morbidity was assessed using the Morbidity Checklist & Post Hospital Behaviour Questionnaire and each family's satisfaction using the Treatment Evaluation Inventory.Results Children were a mean age of six years and had seven primary teeth extracted. When given intravenous (IV) fentanyl (n = 69), either alone (n = 11) or in combination with paracetamol (n = 58) the children had 0.17 times odds of not having post-op pain compared to patients who received only paracetamol (logistic regression, p = 0.006). After one week 99% of families were satisfied with the service but 11% reported that their child still had post-operative morbidity.Conclusion Three quarters of children reported pain following extractions of primary teeth under GA. Use of IV paracetamol and fentanyl reduced the immediate post-operative self-reported pain. After a week most families (99%) were satisfied with the treatment their child had received and morbidity was reported by 11% of families.

Dental general anaesthetic pre-assessments completed by a specialist-does it change patient outcomes? A UK-based study

BACKGROUND

In the United Kingdom, assessments for dental general anaesthetics (DGA), completed by a Specialist in Paediatric Dentistry, are purported to be the gold standard.

AIM

To evaluate the outcome of dental assessments completed by a Specialist in Paediatric Dentistry after a referral for an exodontia DGA by the patients' General Dental Practitioner (GDP).

DESIGN

Six hundred and forty-two sets of notes were reviewed from patients referred for exodontia DGA at a community dental service in the United Kingdom. Information was gathered regarding patients' oral health and the treatment they had received at three key points; at initial assessment by the Specialist in Paediatric dentistry, hypothetically if the GDPs treatment plan had been followed, and following specialist assessment and treatment.

RESULTS

Statistically significant differences were found in the dental assessment and the subsequent treatment children received between GDP plans and specialist plans. Proposed exodontia plans were changed by the specialist in 85% of cases, with more than 12% of the sample avoiding the need for a DGA.

CONCLUSIONS

An assessment by a Specialist in Paediatric Dentistry prior to an exodontia GA significantly changed the outcome for patients. Further work is required to investigate whether there is any long-term effect of specialist DGA assessment on oral health.

Characteristics of children undergoing dental extractions under general anaesthesia in Wolverhampton: 2007-2012

INTRODUCTION

Studying characteristics of children requiring extractions under dental general anaesthesia (DGA) can help identify trends, which can be used to facilitate future planning of healthcare services.

OBJECTIVE

To report on the profile of children who underwent extractions under DGA between 2007 and 2012 at the New Cross Hospital in Wolverhampton, England.Methods Retrospective analyses of hospital records.

RESULTS

Of the 2692 patients seen between 2007 and 2012, 49.6% were boys and 50.4% were girls. The mean age was 7.1 and 7 to 12 years was the largest age group (43%). The majority of the sample was White British (67%). Of the 8,286 teeth extracted, 85% were primary teeth and 15% permanent. More teeth were extracted in boys than girls (P = 0.002) and 'Other' ethnicities had a higher mean number of extractions compared to White British (P <0.001) and South Asians (P = 0.046). The mean age of the patients has decreased over the years (P = 0.001) and the mean number of primary teeth extracted has increased (P = 0.001).

CONCLUSIONS

A clear dental public health issue has been reinforced through the relatively high level of DGA activity reported. Though rigorous caries prevention remains the ultimate goal, a better assessment and discharge process may help reduce the need for first time DGAs as well as repeats.

The impact of dental neglect on oral health: a population based study in Hong Kong

OBJECTIVE

The aim of this study was to assess dental neglect (DN) among Hong Kong citizens, to identify socio-demographic variations in DN and to determine the association between DN and oral health (self-reported).

DESIGN

Cross sectional population based study involving a random sample of 800 Hong Kong Chinese adults.

METHOD

Telephone interview incorporating the dental neglect scale, assessment of self-reported oral health including an oral health related quality of life measure.

RESULTS

The response rate was 70% (556/800). Mean dental neglect score of the population was 14.81 (S.D. 3.62) [possible range 6 to 30]. Most commonly, people were neglectful of using professional dental health care. Socio-demographic disparities in DN were apparent, in relation to age (P < 0.05), income (P < 0.05) and educational attainment (P < 0.05). DN was associated with self-reported oral health: denture status (P < 0.05), number of teeth possessed (P < 0.05) and oral health related quality of life (P < 0.05).

CONCLUSION

Dental neglect is widespread in Hong Kong, particularly neglect of professional dental care. Socio-demographic disparities in dental neglect were apparent. Dental neglect is associated with self-reported oral health status including how oral health impacts on life quality. These findings have implications in understanding the impact of dental neglect.

Indigenous children and receipt of hospital dental care in Australia

OBJECTIVE

The aim of this study was to investigate dental procedures received under hospital general anaesthetic by indigenous and non-indigenous Australian children in 2002-2003.

METHODS

Separation data from 1297 public and private hospitals were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database for 2002-2003. The dependant variable was the admission rate of children receiving four categories of dental care (i.e. extraction, pulpal, restoration or other). The explanatory variables included sex, age group, indigenous status and location (i.e. major city, regional or remote). Rates were calculated using estimated resident population counts.

RESULTS

The sample included 24 874 children aged from 2 to 14 years. Some 4.3% were indigenous (n = 1062). Admission rates for indigenous and non-indigenous children were similar, with indigenous males having 1.2 times the admission rate of indigenous females (P < 0.05). Indigenous children aged < 5 years had 1.4 times the admission rate of similarly aged non-indigenous children (P < 0.001) and 5.0 times the admission rate of 10-14-year-old indigenous children (P < 0.001). Remote-living indigenous children had 1.5 times the admission rate of their counterparts in major cities or regional areas (P < 0.001), and 1.4 times the admission rate of remote-living non-indigenous children (P < 0.01). The extraction rate of indigenous males was 1.3 times that of non-indigenous males (P < 0.01), and 1.2 times that of indigenous females (P < 0.05). Pre-school indigenous children had 2.2 times the extraction rate of similarly aged non-indigenous children (P < 0.001), and 5.3 times that of indigenous 10-14-year-olds (P < 0.001). The extraction rate of remotely located indigenous children was 1.5 times that of indigenous children in major cities (P < 0.01), and 1.8 times that of remote-living non-indigenous children (P < 0.001).

CONCLUSIONS

In certain strata - particularly males, the very young and those in remote locations - indigenous children experienced higher rates of extractions than non-indigenous children when undergoing care in a hospital dental general anaesthetic setting.

Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia

OBJECTIVE

To report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress.

DESIGN

A prospective national study.

SETTING

Twenty-five Scottish DGA centres in 2001.

SUBJECTS AND METHOD

Four hundred and seven children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, the Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24 hours and one week post-operatively. Anaesthetic induction distress was scored immediately before CDGA induction using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS).

RESULTS

The mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r=0.43, p<0.001, Pearson Product Moment Correlation Coefficient). Morbidity at 24 hours and seven days was 63% and 24% respectively; this related to MCDAS scores (r=0.15, p=0.029 and r=0.17, p=0.009, Pearson Product Moment Correlation Coefficient) and to induction distress (chi2=7.14, p=0.007 and chi2=11.70, p=0.001).

CONCLUSION

The majority of children suffered next day morbidity and many still had symptoms a week later. Most children were dentally anxious; this related to induction distress and postoperative morbidity.

The frequency of repeat general anaesthesia for teeth extractions in children

AIM

The purpose of this study was to determine the frequency of repeat extractions under general anaesthesia (GA) in children.

METHODS

The dental hospital records of patients attending for outpatient GA extractions at Liverpool University Dental Hospital, Liverpool, UK, between January and March 2003 were examined retrospectively. A data collection form was used to record the relevant information.

RESULTS

A total of 278 patients with a mean age of 6.5 years (SD = 2.2 years) were seen for GA extractions. Of those, 33 patients (11.9%) with a mean age of 4.9 years (SD = 2 years) at the time of their initial GA had had a previous or would undergo a subsequent episode of GA extraction. The mean interval between repeat GA was 2.3 years (SD = 1.6 years). Fifteen cases (45.5%) had the repeat GA within 2 years. Radiographs were available as part of the assessment process for 84 (34.3%) of the 245 patients who had had a single episode of GA. However, of the 33 patients who had had a repeat GA, only seven (21.2%) had radiographs available at the time of the initial GA. Regarding the number of teeth extracted, a significant difference (P < 0.01) was found between the number of teeth extracted in patients who had had a single GA (mean = 4.6, SD = 2.5), compared with those extracted at the initial GA for the repeat GA group (mean = 3.2, SD = 2).

CONCLUSION

The frequency of repeat GA is relatively low, but there is a need for appropriate treatment planning incorporating the use of radiographs to reduce this even further.