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Bangash M, Mustafa L, Irshad M, Omer Q, Alam MK. Short Term Effects of Inhalation Sedation on Child Dental Fear and Anxiety. Curr Pediatr Rev 2024; 20:89-93. [PMID: 35975868 DOI: 10.2174/1573396318666220816093731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/06/2022] [Accepted: 04/22/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dental procedures profoundly affect a child's dental fear and anxiety, rendering dental treatment difficult. Inhalation sedation with a mixture of nitrous oxide and oxygen (NO2/02) breathed through a nosepiece is a form of light conscious sedation widely used in apprehensive children to help them relax and accept dental treatment. This, however, can have both shortand long-term effects on child dental fear and anxiety. This study aimed to assess the short-term immediate effect of inhalation sedation on child dental fear and anxiety scores. METHODS This analytical cross-sectional study was conducted at the Department of Paediatric Dentistry at Rehman College of Dentistry, Peshawar, Pakistan, over a period of 1.9 years (January 2019- October 2020). A total of 171 children aged 6-11 years were selected with moderate to severe dental anxiety using the Child Fear Survey Schedule-Dental Subscale (CFSS-DS), requiring pulp therapy in at least one of their deciduous molars. Baseline anxiety scores were calculated using Venham Clinical Anxiety Score (VCAS) and Venham Picture test (VPT) with a dental check-up and fluoride application. VCAS and VPT scores were then assessed at the end of their scheduled second dental visit involving dental anaesthesia and inhalation sedation. VCAS and VPT scores at the end of treatment were compared with the baseline scores. RESULTS Out of 171 children, 86 were male and 85 were female, with a mean age of 7.77. Females showed a higher range of VCAS and VPT scores (p ≤0.001) compared to males. The VCAS and VPT scores declined just at the end of the second dental visit following dental anaesthesia with inhalation sedation (mean difference = 1.96 and 3.39, respectively), which was statistically significant (p ≤0.001). CONCLUSION Inhalation sedation has a significant role in reducing child dental fear and anxiety in the short term.
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Affiliation(s)
- Madeeha Bangash
- Department of Paediatric Dentistry, Rehman College of Dentistry, Peshawar, Pakistan
| | - Laila Mustafa
- Consultant Paediatric Dentistry, Shifa College of Dentistry, Islamabad, Pakistan
| | - Muhammad Irshad
- Department of Oral Pathology, Rehman College of Dentistry, Peshawar, Pakistan
| | - Qaiser Omer
- Special Care dentistry, Dr. Qaiser & Associates Dental Practice, Islamabad, Pakistan
| | - Mohammad Khursheed Alam
- Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
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Kunta S, Arora RV, Jain R, Rawat P. The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023; 16:302-307. [PMID: 37519985 PMCID: PMC10373752 DOI: 10.5005/jp-journals-10005-2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Aim The study aimed to assess the anxiety and stress levels on acceptance of dental treatment in child patients approaching dental extraction procedures before and after nitrous oxide (N2O) inhalation sedation (IHS) by measuring serum amyloid A (SAA) and salivary cortisol (SC). Materials and methods A total of 32 children, ages ranging from 6 to 10 years, were randomly grouped as TI (before N2O IHS) and TII (after N2O IHS). Saliva samples were taken for biochemical evaluation of SAA before and after the procedure. Subjectively anxiety and stress levels were evaluated using modified child dental anxiety scale (MCDAS). Wilcoxon rank-sum test was used to compare the means of dental anxiety, SAA, and SC before and after N2O IHS. The Karl Pearson correlation coefficient was employed to determine the correlation between dental anxiety and SAA and SC before and after N2O IHS. Results There were significant differences in the dental anxiety level in child patients after administration of N2O IHS, and it also showed an increased rate of acceptance of dental treatment. Conclusion This study showed that N2O is a safe and effective method in reducing dental anxiety and increasing acceptance of dental treatment in child patients with improved behavior and with no adverse effects. Clinical significance Anxiety and stress will always hinder the acceptance of dental treatment in child patients, especially during extraction procedures. N2O IHS is a safe and effective technique to overcome anxiety and stress in child patients and as well as allows them to undergo dental treatment with improved behavior. How to cite this article Kunta S, Arora RV, Jain R, et al. The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):302-307.
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Affiliation(s)
- Sravanthi Kunta
- Department of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| | - Ruchi V Arora
- Department of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| | - Rashmi Jain
- Department of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| | - Parul Rawat
- Department of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
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Garret-Bernardin A, Festa P, Matarazzo G, Vinereanu A, Aristei F, Gentile T, Piga S, Bendinelli E, Cagetti MG, Galeotti A. Behavioral Modifications in Children after Repeated Sedation with Nitrous Oxide for Dental Treatment: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4037. [PMID: 36901046 PMCID: PMC10002368 DOI: 10.3390/ijerph20054037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Sedation with nitrous oxide (N2O) has been widely used as a viable alternative to general anesthesia to perform dental treatments in uncooperative or anxious children. The purpose of this retrospective study is to assess if repeated sedations with N2O can improve collaboration of uncooperative children. The medical records of 650 children, aged between 3 and 14 years, who underwent at least two sedations, were consulted. Differences in the Venham score during the first sedation and subsequent sedations were collected. After removal incomplete records, 577 children's records (309 males and 268 females) were analyzed. The Venham score decreased both during each sedation and with repeated sedations (p < 0.01 for both comparisons). In particular, a significant reduction of the Venham score was observed at the first contact with the dentist, with a mean score ranging from 1.56 ± 1.46 to 1.16 ± 1.37, comparing the first and the second sedation, and from 1.65 ± 1.43 to 1.06 ± 1.30, comparing the first with the third sedation (p < 0.01). The reduction in the Venham score was recorded in both healthy and physically impaired patients, and it was significantly greater in older children than in younger children (p < 0.01). In conclusion, uncooperative children with or without physical impairments can be successfully treated with N2O sedation in order to increase their confidence in dental procedures.
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Affiliation(s)
- Annelyse Garret-Bernardin
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Paola Festa
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Giorgio Matarazzo
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Arina Vinereanu
- Department of Pedodontics, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 032799 Bucharest, Romania
| | - Francesco Aristei
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Tina Gentile
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Simone Piga
- Unit of Clinical Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Elena Bendinelli
- Department of Surgery and Translational Medicine, University of Florence, 50121 Firenze, Italy
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Angela Galeotti
- Dentistry Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
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Baakdah RA, Turkistani JM, Al-Qarni AM, Al-Abdali AN, Alharbi HA, Bafaqih JA, Alshehri ZS. Pediatric dental treatments with pharmacological and non-pharmacological interventions: a cross-sectional study. BMC Oral Health 2021; 21:186. [PMID: 33845835 PMCID: PMC8040197 DOI: 10.1186/s12903-021-01555-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Behaviour management strategies involving pharmacological or non-pharmacological interventions during dental procedures should be considered to attain safe and successful treatment outcomes. This study compared the frequencies of use and the completeness of treatment with these interventions. Methods A total of 1725 dental records of patients up to 18 years old, who were treated in the King Abdulaziz Medical City in Jeddah City from October 2018 to June 2019, were used in this retrospective, cross-sectional study. Inferential analysis, Chi-square test, Kruskal–Wallis test, and regression model were used in the data analysis. Results About two-thirds of the patients were treated with attendant non-pharmacological interventions, while one-third, with pharmacological interventions. The application of General Anesthesia (GA) was the most frequently used intervention. Restorative procedures and extractions were done in higher frequencies with pharmacological interventions. Treatments with space maintainers and orthodontic appliances were carried out in higher frequencies with non-pharmacological strategies. The choice of intervention was significantly influenced by the systemic conditions of the patients. Patients treated with non-pharmacological intervention comprised the dominant type of patients, because they required treatments with less pain. Those treated with GA needed restorative treatments and extractions, or treatments that involve pain, but these treatments had higher frequencies of being completed. Conclusions The treatments with pharmacological intervention through GA have higher frequencies of being completed, compared to those with non-pharmacological interventions. Factors, such as age, potential to complete the treatment, and the type of dental treatment applied, influence the choice of treatment intervention.
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Affiliation(s)
- Rania A Baakdah
- King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Jihan M Turkistani
- King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia.
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Aldossari GS, Aldosari AA, Alasmari AA, Aldakheel RM, Al-Natsha RR, Aldossary MS. The long-term effect of previous dental treatment under general anaesthesia on children's dental fear and anxiety. Int J Paediatr Dent 2018; 29:177-184. [PMID: 30506997 DOI: 10.1111/ipd.12455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/11/2018] [Accepted: 11/25/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dental treatment under general anaesthesia (DGA) is deemed to contribute to children's dental fear and anxiety (DFA), both in the short term and long term. OBJECTIVE To compare DFA between children who had previous DGA and those who did not. METHODS A cross-sectional survey included 5- to 12-year-old children who had undergone DGA (n = 43) and a control group who had not (n = 55). Questionnaires were completed by parents regarding sociodemographic and dental profiles. Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Modified Child Dental Anxiety Scale (faces) (MCDASf) were completed by children. RESULTS The mean age of the control group and the DGA group was 9.5 ± 1.7 and 8.8 ± 1.5 years old, respectively (P > 0.05). The time passed since DGA was experienced ranged between 1.2 and 6.9 years ago (mean: 4.2 ± 1.1 years). The mean CFSS-DS and MCDASf scores for the DGA group (34.3 and 20.4, respectively) were significantly greater when compared to the control group (23.6 and 12.7, respectively) (P < 0.001). CONCLUSION Children who experienced DGA are a high-risk group for DFA several years after the procedure. The DGA status could be used for identifying anxious children to promote better behaviour management.
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Affiliation(s)
| | | | | | | | - Reem R Al-Natsha
- Dental Department, Security Forces Hospital, Ministry of Interior, Riyadh, Saudi Arabia
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Comparing the profile of child patients attending dental general anaesthesia and conscious sedation services. Br Dent J 2017; 222:683-687. [DOI: 10.1038/sj.bdj.2017.406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 12/15/2022]
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Raja A, Daly A, Harper R, Senghore N, White D, Ravaghi V. Characteristics of children undergoing dental extractions under general anaesthesia in Wolverhampton: 2007-2012. Br Dent J 2017; 220:407-11. [PMID: 27103291 DOI: 10.1038/sj.bdj.2016.297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- A Raja
- School of Dentistry, University of Birmingham, 5 Mill Pool, Edgbaston, Birmingham, B5 7EG
| | - A Daly
- School of Dentistry, University of Birmingham, 5 Mill Pool, Edgbaston, Birmingham, B5 7EG
| | - R Harper
- Wolverhampton Special Care Dental Service, Dental Management Office, Penfields Health Centre, Wolverhampton, WV3 OJH
| | - N Senghore
- Wolverhampton Special Care Dental Service, Dental Management Office, Penfields Health Centre, Wolverhampton, WV3 OJH
| | - D White
- School of Dentistry, University of Birmingham, 5 Mill Pool, Edgbaston, Birmingham, B5 7EG
| | - V Ravaghi
- School of Dentistry, University of Birmingham, 5 Mill Pool, Edgbaston, Birmingham, B5 7EG
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Lawson J, Owen J, Deery C. How to minimize repeat dental general anaesthetics. ACTA ACUST UNITED AC 2017; 44:387-8, 390-2, 395. [DOI: 10.12968/denu.2017.44.5.387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jennifer Lawson
- Specialist Trainee in Paediatric Dentistry, Department of Paediatric Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield S10 3SZ
| | - Jayne Owen
- Specialty Doctor in Paediatric Dentistry, University Hospitals Bristol Primary Care Dental Service, Weston General Hospital, Grange Road, Uphill, Weston-Super-Mare BS23 4TQ
| | - Chris Deery
- Professor/Honorary Consultant in Paediatric Dentistry, Unit of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA, UK
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Marshman Z, Morgan A, Porritt J, Gupta E, Baker S, Creswell C, Newton T, Stevens K, Williams C, Prasad S, Kirby J, Rodd H. Protocol for a feasibility study of a self-help cognitive behavioural therapy resource for the reduction of dental anxiety in young people. Pilot Feasibility Stud 2016; 2:13. [PMID: 27965833 PMCID: PMC5154017 DOI: 10.1186/s40814-016-0054-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/19/2016] [Indexed: 11/11/2022] Open
Abstract
Background Childhood dental anxiety is very common, with 10–20 % of children and young people reporting high levels of dental anxiety. It is distressing and has a negative impact on the quality of life of young people and their parents as well as being associated with poor oral health. Affected individuals may develop a lifelong reliance on general anaesthetic or sedation for necessary dental treatment thus requiring the support of specialist dental services. Children and young people with dental anxiety therefore require additional clinical time and can be costly to treat in the long term. The reduction of dental anxiety through the use of effective psychological techniques is, therefore, of high importance. However, there is a lack of high-quality research investigating the impact of cognitive behavioural therapy (CBT) approaches when applied to young people’s dental anxiety. Methods/design The first part of the study will develop a profile of dentally anxious young people using a prospective questionnaire sent to a consecutive sample of 100 young people referred to the Paediatric Dentistry Department, Charles Clifford Dental Hospital, in Sheffield. The second part will involve interviewing a purposive sample of 15–20 dental team members on their perceptions of a CBT self-help resource for dental anxiety, their opinions on whether they might use such a resource with patients, and their willingness to recruit participants to a future randomised controlled trial (RCT) to evaluate the resource. The third part of the study will investigate the most appropriate outcome measures to include in a trial, the acceptability of the resource, and retention and completion rates of treatment with a sample of 60 dentally anxious young people using the CBT resource. Discussion This study will provide information on the profile of dentally anxious young people who could potentially be helped by a guided self-help CBT resource. It will gain the perceptions of dental care team members of guided self-help CBT for dental anxiety in young people and their willingness to recruit participants to a trial. Acceptability of the resource to participants and retention and completion rates will also be investigated to inform a future RCT.
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Affiliation(s)
- Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA UK
| | - Annie Morgan
- Paediatric Dentistry Department, Charles Clifford Dental Hospital, Wellesley Road, Sheffield, S10 2SZ UK
| | - Jenny Porritt
- Department of Psychology, Sociology, and Politics, Sheffield Hallam University, Room 2.05 Heart of the Campus, Collegiate Crescent, Sheffield, S10 2BQ UK
| | - Ekta Gupta
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA UK
| | - Sarah Baker
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights, Reading, Berkshire, RG6 6AL UK
| | - Tim Newton
- Oral Health Services Research and Dental Public Health, King's College London, Denmark Hill Campus, Caldecot Road, London, SE5 9RW UK
| | - Katherine Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Christopher Williams
- Institute of Health and Wellbeing, Mental Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Administration Building, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - Suneeta Prasad
- Derbyshire Community Health Services, Long Eaton Dental Clinic, Midland Street, Long Eaton, Nottingham, NG10 1RY UK
| | - Jennifer Kirby
- Paediatric Dentistry Department, Charles Clifford Dental Hospital, Wellesley Road, Sheffield, S10 2SZ UK
| | - Helen Rodd
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA UK
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Shepherd AR, Ali H. A Care Pathway for Children Unable to Accept Dental Care Within the General Dental Services Involving the Use of Inhalation Sedation and General Anaesthesia. Prim Dent J 2015; 4:29-34. [PMID: 26556255 DOI: 10.1308/205016815814954894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dental treatment is the commonest reason for a child to be in hospital in the UK. This is a shocking statistic for a preventable disease. How can we reduce the high numbers of dental general anaesthetics? It is essential that dental treatment under general anaesthesia (GA) is fully justifiable, ensuring that the right patients receive the right treatment. Guidance for general dental practitioners on when to refer a child for a dental GA is discussed. Treatment planning for this dentally high-risk group of children requires a holistic approach. It is complex and requires an experienced and competent clinical team, including dental care professionals with additional postgraduate qualifications. Often, alternative treatments are successful and a GA can be avoided. An audit of 85 patients referred for GA with Oldham Community Dental Service demonstrated 35% of patients accepted treatment with local anaesthesia only, 25% required inhalation sedation and only 25% were actually referred on for GA. Treatment for this group of patients must include the availability and provision of appropriate alternative treatment modalities, with the right staff and facilities, including those for dental general anaesthetic sessions. Ongoing follow-up within the general dental services is essential for this group of patients.
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Affiliation(s)
- Allyson R Shepherd
- Dental directorate, Pennine Care Foundation Trust, Ashton-under-Lyne, Lancashire, UK
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11
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Ashley PF, Williams CECS, Moles DR, Parry J. Sedation versus general anaesthesia for provision of dental treatment to patients younger than 18 years. Cochrane Database Syst Rev 2015; 2015:CD006334. [PMID: 26413895 PMCID: PMC7387131 DOI: 10.1002/14651858.cd006334.pub4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A significant proportion of children have caries requiring restorations or extractions, and some of these children will not accept this treatment under local anaesthetic. Historically this has been managed by the use of a general anaesthetic in children; however, use of sedation may lead to reduced morbidity and cost. The aim of this review was to compare the efficiency of sedation versus general anaesthesia (GA) for provision of dental treatment to children and adolescents younger than 18 years. This review was originally published in 2009 and was updated in 2012 and again in 2015. OBJECTIVES We will evaluate morbidity and effectiveness of sedation versus GA for provision of dental treatment to patients younger than 18 years. If data become available, we will analyse the cost-effectiveness of different interventions. If data are not available, we will obtain crude estimates of cost.Morbidity can be defined as 'an undesired result or complication'. For the purposes of this review, 'postoperative morbidity' refers to undesired results or complications such as nausea following a procedure, once the patient had been restored to consciousness and could breathe unaided. 'Intraoperative morbidity' refers to any complications that occur during the procedure that may necessitate action by the anaesthetist or the sedationist, such as respiratory arrest. SEARCH METHODS In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 7); MEDLINE Ovid SP (1950 to July 2015); EMBASE Ovid SP (1974 to July 2015); System for Information on Grey Literature in Europe (SIGLE) (1980 to October July 2012); Latin American & Caribbean Health Sciences Literature (LILACS) (1982 to July 2015); and Institute for Scientific Information (ISI) Web of Science (1945 to July 2015).We also carried out handsearching of relevant journals to July 2015. We imposed no language restriction. SELECTION CRITERIA We planned to include randomized controlled clinical trials that compared sedative agents versus general anaesthesia in children and adolescents up to 18 years of age undergoing dental treatment. We excluded complex surgical procedures and pseudo-randomized trials. DATA COLLECTION AND ANALYSIS Two review authors assessed titles and abstracts for inclusion in the review. We recorded information relevant to objectives and outcome measures by using a specially designed 'data extraction form'. We will employ the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach to interpret findings. MAIN RESULTS In our original review, we identified 16 studies for potential inclusion after searching available databases and screening titles and abstracts. After retrieving full-text studies, we found none to be eligible. We identified no additional studies in the updated search of July 2012. We identified two studies for possible inclusion in the updated search of July 2015; again we found these to be ineligible. AUTHORS' CONCLUSIONS Randomized controlled studies comparing use of dental general anaesthesia versus sedation are needed to quantify differences such as morbidity and cost.
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Affiliation(s)
- Paul F Ashley
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Grays Inn RoadLondonUKWC1X 8LD
| | - Catherine ECS Williams
- Guy's and St Thomas' NHS Foundation TrustDepartment of Paediatric DentistryFloor 22 Guys TowerLondonSE1UK
| | - David R Moles
- Peninsula Dental SchoolOral Health Services ResearchThe John Bull Building, Tamar Science Park, Research WayPlymouthUKPL6 8BU
| | - Jennifer Parry
- Sussex Community NHS Trust, Haywards Heath Health CentreSpecial Care DentistryHaywards HeathUK
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Kebriaee F, Sarraf Shirazi A, Fani K, Moharreri F, Soltanifar A, Khaksar Y, Mazhari F. Comparison of the effects of cognitive behavioural therapy and inhalation sedation on child dental anxiety. Eur Arch Paediatr Dent 2014; 16:173-9. [DOI: 10.1007/s40368-014-0152-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
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Parental acceptance of behaviour-management techniques used in paediatric dentistry and its relation to parental dental anxiety and experience. Eur Arch Paediatr Dent 2014; 15:333-9. [DOI: 10.1007/s40368-014-0119-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/31/2014] [Indexed: 11/25/2022]
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Al-Shayyab MH, Ryalat S, Dar-Odeh N, Alsoleihat F. Current sedation practice among general dental practitioners and dental specialists in Jordan: an example of a developing country. Ther Clin Risk Manag 2013; 9:223-33. [PMID: 23700369 PMCID: PMC3660132 DOI: 10.2147/tcrm.s43166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The study reported here aimed to identify current sedation practice among general dental practitioners (GDPs) and specialist dental practitioners (SDPs) in Jordan in 2010. Methods Questionnaires were sent by email to 1683 GDPs and SDPs who were working in Jordan at the time of the study. The contact details of these dental practitioners were obtained from a Jordan Dental Association list. Details on personal status, use of, and training in, conscious sedation techniques were sought by the questionnaires. Results A total of 1003 (60%) questionnaires were returned, with 748 (86.9%) GDPs and 113 (13.1%) SDPs responding. Only ten (1.3%) GDPs and 63 (55.8%) SDPs provided information on the different types of treatments related to their specialties undertaken under some form of sedation performed by specialist and/or assistant anesthetists. Approximately 0.075% of the Jordanian population received some form of sedation during the year 2010, with approximately 0.054% having been treated by oral and maxillofacial surgeons. The main reason for the majority of GDPs (55.0%) and many SDPs (40%) not to perform sedation was lack of training in this field. While some SDPs (26.0%) indicated they did not use sedation because of the inadequacy of sedative facilities. Conclusion Within the limitations of the present study, it can be concluded that the provision of conscious sedation services in general and specialist dental practices in Jordan is inconsistent and inadequate. This stresses the great need to train practitioners and dental assistants in Jordan to enable them to safely and effectively perform all forms of sedation.
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Affiliation(s)
- Mohammad H Al-Shayyab
- Department of Oral and Maxillofacial Surgery, Oral Medicine, Oral Pathology and Periodontology, Faculty of Dentistry, University of Jordan, Amman, Jordan
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A report on dental anxiety levels in children undergoing nitrous oxide inhalation sedation and propofol target controlled infusion intravenous sedation. Eur Arch Paediatr Dent 2012. [DOI: 10.1007/bf03262574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ashley PF, Williams CECS, Moles DR, Parry J. Sedation versus general anaesthesia for provision of dental treatment in under 18 year olds. Cochrane Database Syst Rev 2012; 11:CD006334. [PMID: 23152234 DOI: 10.1002/14651858.cd006334.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A significant proportion of children have caries requiring restorations or extractions, and some of these children will not accept this treatment under local anaesthetic. Historically this has been managed in children by the use of a general anaesthetic, however use of sedation may lead to reduced morbidity and cost. The aim of this review is to compare the efficiency of sedation versus general anaesthesia for the provision of dental treatment for children and adolescents aged under 18 years.This review was originally published in 2009 and updated in 2012. OBJECTIVES We evaluated the intra- and postoperative morbidity, effectiveness and cost effectiveness of sedation versus general anaesthesia for the provision of dental treatment for under 18 year olds. SEARCH METHODS In this updated review we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7); MEDLINE (Ovid) (1950 to July 2012); EMBASE (Ovid) (1974 to July 2012); System for information on Grey Literature in Europe (SIGLE) (1980 to October 2008), Latin American & Caribbean Health Sciences Literature (LILACS) (1982 to July 2012), and ISI Web of Science (1945 to October 2008). The searches were updated to July 2012. The original search was performed in October 2008.We also carried out handsearching of relevant journals to July 2012. We imposed no language restriction. SELECTION CRITERIA We planned to include randomized controlled clinical trials of sedative agents compared to general anaesthesia in children and adolescents aged up to 18 years having dental treatment. We excluded complex surgical procedures and pseudo-randomized trials. DATA COLLECTION AND ANALYSIS Two authors assessed titles and abstracts for inclusion in the review. We recorded information relevant to the objectives and outcome measures in a specially designed 'data extraction form'. MAIN RESULTS We identified 15 studies for potential inclusion after searching the available databases and screening the titles and abstracts. We identified a further study through personal contacts. Following full text retrieval of the studies, we found none to be eligible for inclusion in this review. AUTHORS' CONCLUSIONS Randomized controlled studies are required comparing the use of dental general anaesthesia with sedation to quantify differences such as morbidity and cost.
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Affiliation(s)
- Paul F Ashley
- Unit of Paediatric Dentistry, UCL Eastman Dental Institute, 256 Grays Inn Road, London, UK, WC1X 8LD
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17
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Porritt J, Buchanan H, Hall M, Gilchrist F, Marshman Z. Assessing children's dental anxiety: a systematic review of current measures. Community Dent Oral Epidemiol 2012; 41:130-42. [DOI: 10.1111/j.1600-0528.2012.00740.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/07/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Jenny Porritt
- Academic Unit of Oral Health and Development; School of Clinical Dentistry, University of Sheffield; Sheffield; S10 2TA; UK
| | - Heather Buchanan
- Institute of Work, Health & Organisations, University of Nottingham; Nottingham; NG8 1BB; UK
| | - Melanie Hall
- Academic Unit of Oral Health and Development; School of Clinical Dentistry, University of Sheffield; Sheffield; S10 2TA; UK
| | - Fiona Gilchrist
- Academic Unit of Oral Health and Development; School of Clinical Dentistry, University of Sheffield; Sheffield; S10 2TA; UK
| | - Zoe Marshman
- Academic Unit of Oral Health and Development; School of Clinical Dentistry, University of Sheffield; Sheffield; S10 2TA; UK
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18
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George RP, Kruger E, Tennant M. Hospitalisation for the surgical removal of impacted teeth: Has Australia followed international trends? Australas Med J 2011; 4:425-30. [PMID: 23393529 DOI: 10.4066/amj.2011.688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the study was to undertake a six-year analysis from 1999/00 to 2004/05, of the demographic characteristics of hospitalisations for the surgical removal of impacted teeth in Western Australia under general anaesthesia. METHOD Data for the current analysis was obtained from the Western Australian Hospital Morbidity Data System (HMDS). Gender, age, indigenous status, place of residence, type of hospital admitted, insurance status, and Diagnostic Related Group (DRG) cost estimates for the procedure were analysed. RESULTS A total of 37.6% of all oral health-related hospitalisations in Western Australia over the six years were for the removal of impacted teeth. Admitted patients were predominantly females (58.8%) and very few Indigenous people were hospitalised (0.2%). The average age of patients was 21.4 years (sd=9.9). Metropolitan patients were hospitalised 1.5 times more than rural patients for this condition. The majority of patients were hospitalised at a private metropolitan hospital and were insured. The total cost of hospitalisation for this condition contributes to 27% of all the oral health condition-related hospitalisation costs. CONCLUSION This study suggests that the hospital-based removal of impacted teeth in Western Australia is associated with factors such as indigenous status, age, gender and private hospital access along with insurance status raising interesting questions over the equity of provision of this service.
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Hennequin M, Collado V, Faulks D, Koscielny S, Onody P, Nicolas E. A clinical trial of efficacy and safety of inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox™) in general practice. Clin Oral Investig 2011; 16:633-42. [DOI: 10.1007/s00784-011-0550-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 03/16/2011] [Indexed: 11/30/2022]
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20
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Collado V, Faulks D, Hennequin M. A survey of the difficulties encountered during routine hygiene and health care by persons with special needs. Disabil Rehabil 2009; 30:1047-54. [DOI: 10.1080/09638280701616574] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Klaassen MA, Veerkamp JSJ, Hoogstraten J. Young children’s Oral Health-Related Quality of Life and dental fear after treatment under general anaesthesia: a randomized controlled trial. Eur J Oral Sci 2009; 117:273-8. [DOI: 10.1111/j.1600-0722.2009.00627.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Ashley PF, Williams CECS, Moles DR, Parry J. Sedation versus general anaesthesia for provision of dental treatment in under 18 year olds. Cochrane Database Syst Rev 2009:CD006334. [PMID: 19160279 DOI: 10.1002/14651858.cd006334.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A significant proportion of children have caries requiring restorations or extractions, and some of these children will not accept this treatment under local anaesthetic. Historically this has been managed in children by use of a general anaesthetic; however use of sedation may lead to reduced morbidity and cost. The aim of this review is to compare the efficiency of sedation versus general anaesthesia for the provision of dental treatment for children and adolescents under 18 years. OBJECTIVES We evaluated the intra- and post-operative morbidity, effectiveness and cost effectiveness of sedation versus general anaesthesia for the provision of dental treatment for under 18 year olds. SEARCH STRATEGY We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library; Issue 4, 2008); MEDLINE (OVID) (1950 to October Week 2, 2008); EMBASE (OVID) (1974 to Week 42, 2008); System for information on Grey Literature in Europe (SIGLE) (1980 to October 2008), Latin American & Caribbean Health Sciences Literature (LILACS) (1982 to October 2008), ISI Web of Science (1945 to October 2008).We also carried out handsearching of relevant journals. There was no language restriction. SELECTION CRITERIA We included randomized controlled clinical trials of sedative agents compared to general anaesthesia in children and adolescents aged up to 18 years having dental treatment. We excluded complex surgical procedures and pseudo-randomized trials. DATA COLLECTION AND ANALYSIS Two authors assessed titles and abstracts for inclusion in the review. We recorded information relevant to the objectives and outcome measures into a specially designed 'data extraction form'. MAIN RESULTS We identified 15 studies for potential inclusion after searching the available databases and screening the titles and abstracts. We identified a further study through personal contacts. Following full text retrieval of the studies, we found none to be eligible AUTHORS' CONCLUSIONS Randomized controlled studies comparing the use of dental general anaesthesia with sedation to quantify differences such as morbidity and cost are required.
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Affiliation(s)
- Paul F Ashley
- Unit of Paediatric Dentistry, UCL Eastman Dental Institute, 256 Grays Inn Road, London, UK, WC1X 8LD.
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23
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Klaassen MA, Veerkamp JSJ, Hoogstraten J. Dental treatment under general anaesthesia: the short-term change in young children's oral-health-related quality of life. Eur Arch Paediatr Dent 2009; 9:130-7. [PMID: 18793595 DOI: 10.1007/bf03262624] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This was to assess the short-term change in children's oral-health-related quality of life (OHRQoL) and family impact after dental treatment under general anaesthesia (GA) in the Netherlands. STUDY DESIGN A pretest-posttest design was used. METHODS Children (< 8 years) referred to a clinic for specialized paediatric dentistry and who needed treatment under GA were selected to participate and divided across two groups. Fifty out of 80 parents/children couples participated, one group of parents filled out the questionnaires on behalf of their child before and after treatment (N = 31), and the other group only after treatment (N = 19). The questionnaires used were the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and Parental Perceptions Questionnaire and Family Impact Scale (PPQ and FIS, forming the OHRQoL score). The oral health was assessed using the decayed-missing-filled surfaces or teeth index (dmfs/dmft) for the primary dentition from the status praesens after treatment. RESULTS There was a significant difference between the pre- and posttest-scores in group A for both the short version and the long version (short: t = 5.088, df = 20, p < 0.001 and long: t = 6.279, df = 20, p < 0.001). There was no statistically significant difference in CFSS-DS scores before and after treatment (group A) (t = 1.815, df = 13, p = 0.093). CONCLUSIONS The children's OHRQoL improved after treatment under GA according to their parents. As expected, dental fear did not change and should be dealt with after treatment to avoid a child's dental fear to persist in the future. A shorter version of the PPQ and FIS seems useful to assess OHRQoL in very young children.
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Affiliation(s)
- M A Klaassen
- Dept of Cariology, Endodontology, Pedodontology, Academic Centre for Dentistry (ACTA), The Netherlands.
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Faulks D, Hennequin M, Albecker-Grappe S, Manière MC, Tardieu C, Berthet A, Wolikow M, Droz D, Koscielny S, Onody P. Sedation with 50% nitrous oxide/oxygen for outpatient dental treatment in individuals with intellectual disability. Dev Med Child Neurol 2007; 49:621-5. [PMID: 17635209 DOI: 10.1111/j.1469-8749.2007.00621.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Persons with intellectual disability have difficulty in cooperating with outpatient care, and many are referred for general anaesthesia. Intellectual disability has traditionally been a contraindication for conscious sedation. We evaluated the behavioural impact, effectiveness, and tolerance of sedation in this population using a fixed 50% nitrous oxide/oxygen mixture as a single agent. We used dental treatment as a model of outpatient care; 349 patients (192 males, 157 females; mean age 22y [SD 14]; range 3-81y) were recruited over a 12-month period at seven centres. Sedation was deemed successful if planned dental treatment was completed. Behaviour was scored with the modified Venham scale. Out of 605 sessions, 91.4% were successful. No serious adverse effects occurred. Minor adverse events (such as nausea) occurred in 10.1% of sessions. We conclude that the use of safe and effective conscious sedation may reduce the indications for general anaesthesia.
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Affiliation(s)
- Denise Faulks
- Service d'Odontologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
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Jameson K, Averley PA, Shackley P, Steele J. A comparison of the 'cost per child treated' at a primary care-based sedation referral service, compared to a general anaesthetic in hospital. Br Dent J 2007; 203:E13. [PMID: 17632457 DOI: 10.1038/bdj.2007.631] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2006] [Indexed: 11/09/2022]
Abstract
AIM To compare the cost-effectiveness of dental sedation techniques used in the treatment of children, focusing on hospital-based dental general anaesthetic (DGA) and advanced conscious sedation in a controlled primary care environment. METHODS Data on fees, costs and treatment pathways were obtained from a primary care clinic specialising in advanced sedation techniques. For the hospital-based DGA cohort, data were gathered from hospital trusts in the same area. Comparison was via an average cost per child treated and subsequent sensitivity analysis. RESULTS Analysing records spanning one year, the average cost per child treated via advanced conscious sedation was pound245.47. As some treatments fail (3.5% of cases attempted), and the technique is not deemed suitable for all patients (4-5%), DGA is still required and has been factored into this cost. DGA has an average cost per case treated of pound359.91, 46.6% more expensive than advanced conscious sedation. These cost savings were robust to plausible variation in all parameters. CONCLUSION The costs of advanced conscious sedation techniques, applied in a controlled primary care environment, are substantially lower than the equivalent costs of hospital-based DGA, informing the debate about the optimum way of managing this patient group.
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Affiliation(s)
- K Jameson
- Department of Economics and Related Studies, University of York.
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Collado V, Hennequin M, Faulks D, Mazille MN, Nicolas E, Koscielny S, Onody P. Modification of behavior with 50% nitrous oxide/oxygen conscious sedation over repeated visits for dental treatment a 3-year prospective study. J Clin Psychopharmacol 2006; 26:474-81. [PMID: 16974188 DOI: 10.1097/01.jcp.0000236660.01039.eb] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In various medical domains, inhalation of nitrous oxide (N2O) in oxygen (O2) is indicated to alleviate pain and anxiety during routine treatment. Repeat treatment may often be indicated. Little data are available, however, to evaluate the long-term efficacy and side effects of reiterated N2O/O2 sedation. The aim of this study was to compare behavior during dental treatment under a premix of 50% N2O/O2 between first experience and repeat experiences of sedation in a cohort of uncooperative patients. Five hundred forty-three patients (age range, 1-94 years; mean, 17 +/- 16 years) experiencing conscious sedation for dental treatment for the first time were recruited at a special care unit during 3 years. A modified Venham scale was used to evaluate patient behavior at 5 steps during each session. Completion of planned treatment and occurrence of adverse side effects of sedation were additional criteria. Patients experienced sedation for the first time for 378 sessions, and the session was a repeat experience in 843 cases (number of visits: range, 1-6). Patient cooperation significantly improved during visits at first contact with the dentist and when applying the mask (P < 0.0001, between sessions 1 and 2). Between the first and the third sessions, the percentage of very uncooperative patients decreased from 23% to 3.7% at first contact with the dentist and from 22.3% to 8.5% on application of the mask. Experience of reiterated dental treatment under sedation with 50% N2O/O2 premix helps uncooperative patients to cope with dental treatment in the long term.
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Affiliation(s)
- Valérie Collado
- Univ Clermont1, UFR d'Odontologie, Clermont-Ferrand, France.
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Hosey MT, Macpherson LMD, Adair P, Tochel C, Burnside G, Pine C. Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia. Br Dent J 2006; 200:39-43; discussion 27; quiz 50. [PMID: 16415835 DOI: 10.1038/sj.bdj.4813123] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2005] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- M T Hosey
- University of Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
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Hunter L. Anxiety, distress and morbidity: children and GA. Br Dent J 2006. [DOI: 10.1038/sj.bdj.4813120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVES To assess the outcomes of treatment with nitrous oxide/oxygen inhalation sedation (IS). To relate these to the age and previous dental experience of the child and the experience of the operator. To provide base-line information and identify training needs. METHODS A retrospective examination of the clinical records of all children treated with IS within the Community Dental Service of Harrow and Hillingdon NHS Trust (HHHT) over a 3-month period was made. Personal details and previous dental experience were recorded. The outcome of the planned treatment was identified. RESULTS Two hundred and eleven sets of records were reviewed from eight clinicians. The average age of the children was 7.2 years. Treatment plans were successfully completed in 83.9% of cases. Records showed that 18.5% of the children had previously had general anaesthesia (GA) for dental treatment, 27.5% had received IS and 5.2% had no previous dental experience. Of the 'failed' treatments, 50% were under 7 years of age and 31.3% were referred for GA. There was no difference in the proportion of failures in relation to the experience of the operator. CONCLUSION This review shows that inhalation sedation with nitrous oxide/oxygen is a very successful adjunct to the clinical management of children within the Community Dental Service.
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Affiliation(s)
- R A E Bryan
- Senior Clinician in Paediatric Dentistry, Harrow and Hillingdon Healthcare NHS Trust, Ruislip, UK
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Abstract
OBJECTIVES Firstly to determine the current provision of sedation in primary dental care in an area of Scotland without local secondary care support and secondly, to investigate dental practitioners' desire for formal postgraduate training in sedation techniques. DESIGN A prospective postal questionnaire-based study. SETTING Grampian Primary Care NHS Trust, UK, 2001. SUBJECTS Questionnaires were sent to all NHS dental practitioners and community dental service clinicians (N = 194] employed through Grampian Primary Care NHS Trust, Scotland during March - April 2001. The questionnaires sought details about personal status and the use and perceived need for conscious sedation techniques in practice in addition to the stated desire for postgraduate training in sedation techniques. RESULTS One hundred and thirty-six questionnaires were returned (70%). Forty-nine per cent of respondents reported current sedation use, with intravenous sedation the favoured technique (82%), followed by oral sedation (33%) and inhalation sedation (19%). Seventy-four per cent of participants considered that there was a need for sedation in their own practice and 68% were interested in further postgraduate training in sedation techniques. CONCLUSION Nearly three-quarters of practitioners who responded felt that there was a need for sedation in their own practice, although less than half were able to offer sedation to their patients. Nearly 70% of practitioners felt there was a need for postgraduate training in sedation techniques.
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Affiliation(s)
- J Foley
- Department of Paediatric Dentistry, Dundee Dental Hospital.
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