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Timms L, Rodd H, Deery C, Brocklehurst P, Marshman Z. Silver diamine fluoride for the management of dental caries in children in primary dental care: protocol for a feasibility study. Pilot Feasibility Stud 2024; 10:95. [PMID: 38915111 PMCID: PMC11194932 DOI: 10.1186/s40814-024-01519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/12/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Dental caries remains a significant problem in England, affecting 11% of 3-year-olds and 23% of 5-year-olds. While current approaches have been extensively investigated, their ability to (1) control pain and infection; (2) prevent hospital admissions, and (3) be implemented within the National Health Service (NHS) contractual arrangements, remains unsatisfactory. Silver diamine fluoride (SDF) is an alternative, non-invasive approach that has proven efficacy in arresting caries progression in primary teeth, principally from studies conducted outside of Europe. Its use in primary dental care in the UK is limited, despite the acknowledged need. The clinical and cost-effectiveness of SDF has not been compared to usual care in the UK. Before a pragmatic randomised controlled trial (RCT) can be conducted to compare SDF to usual care for caries management in young children, there are several uncertainties that require investigation. This study aims to establish whether such an RCT is feasible. METHODS This mixed-method parallel design study is a feasibility study with an embedded process evaluation, to compare SDF with usual treatment in primary dental care in the UK. It will be individually randomised, with 13 dentists and therapists, in 8 different dental primary care sites with a sample size of 80 child participants aged 1-8 years old. The aim will be to recruit ten participants per site with equal arm allocation. Follow-up will be for 1 year. The study will inform whether an RCT is feasible by resolving several key uncertainties. The acceptability and implementation of SDF and the research processes will be explored. Patient and Public Involvement and Engagement representatives will be involved throughout recruitment and retention strategies, participant documentation, analysis, engagement and dissemination. DISCUSSION The ability to conduct an RCT will be evaluated. If feasible, this RCT has the potential to evaluate the effectiveness of a non-invasive approach for the management of untreated caries in young children. A feasibility study also offers the opportunity to consider factors associated with the implementation of SDF at an early stage through a process evaluation that will inform the definitive trial and an implementation strategy for SDF by identifying relevant barriers and facilitators. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT06092151. Date: 19/10/2023.
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Affiliation(s)
- Laura Timms
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - Helen Rodd
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Chris Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Paul Brocklehurst
- Dental Public Health, Primary Care Division, Public Health Wales, 10 Llys Castan Parc Menai, Bangor, Wales, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Mathew MG, Jeevanandan G, Maganur PC, Tamah AA, Ayyashi YA, Tawhari AI, Vishwanathaiah S. Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia. J Contemp Dent Pract 2024; 25:85-91. [PMID: 38514437 DOI: 10.5005/jp-journals-10024-3600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIM To evaluate the risk factors associated with caries development after full-mouth rehabilitation for early childhood caries (ECC) under general anesthesia. MATERIALS AND METHODS A total of 100 children diagnosed with ECC requiring full-mouth rehabilitation under general anesthesia were recruited for the study. At baseline, caries status, plaque index, Streptococcus mutans count, and Lactobacillus count were evaluated. The risk assessment for caries was evaluated using a cariogram. Children were recalled after 12 months for evaluation. All children returned for the recall and data was recorded at the recall visit. Children were grouped into caries-free or caries recurrent based on the absence or presence of caries. Chi-square tests and student's t-test were used for statistical analysis using the statistical package for the social sciences (SPSS), version 23. RESULTS All 100 children returned for follow-up. 76% of the children developed new carious lesions in a period of 1 year. A statistically significant association between caries recurrence and S. mutans count and caries risk assessment (CRA) score was found (p < 0.001). No significant associations were seen between parental education levels and the oral health practices of the child. CONCLUSION Children treated under full-mouth rehabilitation for ECC under general anesthesia are at risk for developing new carious lesions after treatment. New carious lesions are strongly correlated with the presence of S. mutans, and high cariographic risk scores serve as an indication of future caries. Early childhood caries may be avoided if children are more diligent in practicing good dental hygiene. CLINICAL SIGNIFICANCE Relapse of caries after full-mouth rehabilitation under general anesthesia can affect the quality of life of children. Preventive measures should be initiated and reinforced to prevent the occurrence of new carious lesions after full-mouth rehabilitation. How to cite this article: Mathew MG, Jeevanandan G, Maganur PC, et al. Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia. J Contemp Dent Pract 2024;25(1):85-91.
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Affiliation(s)
- Mebin George Mathew
- Department of Pediatrics and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Ganesh Jeevanandan
- Department of Pediatrics and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, Phone: +91 9884293869, e-mail:
| | - Prabhadevi C Maganur
- Department of Preventive Dental Sciences, Division of Pediatric Dentistry, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Ahmed Ali Tamah
- Department of Pediatric Dentistry College of Denistry, Jazan University, Jazan, Saudi Arabia
| | - Yaqoub Ahmed Ayyashi
- Department of Pediatric Dentistry College of Denistry, Jazan University, Jazan, Saudi Arabia
| | | | - Satish Vishwanathaiah
- Department of Preventive Dental Sciences, Division of Pediatric Dentistry, College of Dentistry, Jazan University, Jazan, Saudi Arabia
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Mathew MG, Jeevanandan G. Evaluation of Factors Affecting Clinical Outcomes of Full Mouth Rehabilitation Under General Anaesthesia for Children With Early Childhood Caries: A Prospective Cohort Study. Cureus 2023; 15:e46778. [PMID: 37954807 PMCID: PMC10632821 DOI: 10.7759/cureus.46778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
AIM This study was designed to evaluate the factors affecting the clinical outcomes of full mouth rehabilitation under general anaesthesia for children with early childhood caries (ECCs). MATERIALS AND METHODS A prospective cohort of 200 children with early childhood caries and requiring dental rehabilitation under general anaesthesia was evaluated and treated. Children were recalled at six-month intervals for a period of two years and evaluated for the recurrence of caries and the need for repeat treatment of failed cases. RESULTS 86.5% of the patients adhered to the six-month recall visits for 24 months. An overall caries recurrence rate of 14.5% was seen. Children who did not adhere to the follow-up plan and visited ad hoc had the highest caries recurrence rate (88%). CONCLUSION Good compliance with postoperative instructions after full mouth rehabilitation resulted in good oral hygiene and a limited recurrence of caries. Patients with poor compliance with recall visits and postoperative instructions had high rates of caries recurrence. Rehabilitation under general anaesthesia can be considered a viable treatment option for children diagnosed with early childhood caries.
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Affiliation(s)
- Mebin George Mathew
- Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Chennai, IND
| | - Ganesh Jeevanandan
- Pediatric and Preventive Dentisty, Saveetha Dental College, Saveetha University, Chennai, IND
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Ludovichetti FS, Zuccon A, Cantatore D, Zambon G, Girotto L, Lucchi P, Stellini E, Mazzoleni S. Early Childhood Caries and Oral Health-Related Quality of Life: Evaluation of the Effectiveness of Single-Session Therapy Under General Anesthesia. Eur J Dent 2023; 17:834-839. [PMID: 36307112 PMCID: PMC10569832 DOI: 10.1055/s-0042-1757210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate whether the treatment of ECC, performed in a single-session dental treatment under general anesthesia, can affect the quality of life of pediatric patients. It was assessed whether risks and discomforts involved in SSGA are outweighed by its effectiveness and reliability in improving oral health-related quality of life. MATERIALS AND METHODS The quality of life that was assessed in this prospective study was oral health-related quality of life (OHRQL). Pediatric patients aged between 3 and 6 years with ECC undergoing dental treatment in SSGA were asked to fill in the Early Childhood Oral Health Impact Scale (ECOHIS) form both before and 1 month after the intervention. The data obtained were then statistically elaborated and analyzed to evaluate the actual significance of the differences found between the values before and after treatment and between the two sexes. RESULTS Mean ECOHIS score before treatment was 30.58, following a large decrease after treatment, with a mean score of 2.94. Most parameters show a significant improvement between pre- and post-SSGA treatments, mainly those related to oral-dental pain, daytime irritability, and impact on family environment. Average ECOHIS scores for males and females are 31.72 and 29.76 before treatment and 3.55 and 2.52 1 month after treatment, respectively, showing no statistically significant differences. CONCLUSION The dental treatment of young children under SSGA is associated with considerable improvement in their OHRQL. It can be considered an effective and reliable way of managing cases that cannot be dealt with by alternative methods.
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Affiliation(s)
| | - Andrea Zuccon
- Dentistry Section, Department of Neurosciences, , Università degli Studi di Padova, Padova, Italy
| | - Donatella Cantatore
- Unità Operativa di Chirurgia Orale e Odontostomatologia, Ospedale S. Lorenzo, Trento, Italy
| | - Giulia Zambon
- Dentistry Section, Department of Neurosciences, , Università degli Studi di Milano, Milano, Italy
| | - Luca Girotto
- Unità Operativa di Chirurgia Orale e Odontostomatologia, Ospedale S. Lorenzo, Trento, Italy
| | - Patrizia Lucchi
- Dentistry Section, Department of Neurosciences, , Università degli Studi di Padova, Padova, Italy
| | - Edoardo Stellini
- Dentistry Section, Department of Neurosciences, , Università degli Studi di Padova, Padova, Italy
| | - Sergio Mazzoleni
- Dentistry Section, Department of Neurosciences, , Università degli Studi di Padova, Padova, Italy
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Chen R, Schneuer FJ, Irving MJ, Chow CK, Kumar H, Tsai C, Sohn W, Spallek H, Bell J, Nassar N. Socio-demographic and familial factors associated with hospital admissions and repeat admission for dental caries in early childhood: A population-based study. Community Dent Oral Epidemiol 2022; 50:539-547. [PMID: 34837420 DOI: 10.1111/cdoe.12708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/16/2021] [Accepted: 11/10/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Dental caries remains a complex childhood condition often requiring preventable hospital admissions. There are limited population-based epidemiological studies that use large and linked data sets to quantify the clinical, socio-demographic and familial risk factors related to hospital admissions for dental caries. The aim of this study was to describe and quantify the rates, socio-demographic, clinical characteristics and familial factors including repeat admissions associated with young children admitted to hospital for dental caries. METHODS This cohort study (n = 33,438) used longitudinally linked hospital admission data among all children aged <six years in NSW, Australia. Socio-demographic and admission characteristics of children and those with one versus two or more admissions for dental caries were compared. Familial risk factors were analysed for a restricted cohort of families with two or more children (n = 18,174) using multivariable logistic regression to assess the familial factors associated with multiple hospital admissions for dental caries adjusting for other socio-demographic characteristics. RESULTS There were 33,438 children aged <six years who had 34,446 hospital admissions for dental caries between 2001 and 2014. The annual rate of 4.3 per 1000 children remained unchanged over the period. Most admissions required general anaesthesia (96%), and 8.4% of children had repeat admissions. Children living in disadvantaged or in regional and rural areas attending public hospitals were more likely to have dental extractions during the admission. Children from the same family had a 2.7-fold increased odds of admission if the first child admitted was less than three years of age (adjusted odd ratio 2.69; 95% CI: 2.36-3.07), a 1.5 fold increase for socioeconomic disadvantage (aOR 1.45; 1.19 - 1.77) and a 1.9 fold increase of admission if the family had 4 or more children (aOR1.88; 1.47 - 2.42). CONCLUSIONS Findings highlight socio-demographic inequities associated with hospital admission for dental caries. The provision of targeted dental care programs for 'at-risk' families should address these inequalities and presents an opportunity to reduce dental caries related hospitalizations.
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Affiliation(s)
- Rebecca Chen
- The University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, New South Wales, Australia
| | - Francisco J Schneuer
- The University of Sydney, The Charles Perkins Centre, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, New South Wales, Australia
| | - Michelle J Irving
- The University of Sydney, The Menzies Centre for Health Policy, New South Wales, Australia.,Centre for Evidence and Implementation, VIC, Australia
| | - Clara K Chow
- The University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, New South Wales, Australia
| | - Harleen Kumar
- Sydney Dental Hospital and Oral Health Services, Sydney Local Health District, Surry Hills, New South Wales, Australia.,The University of Sydney, School of Dentistry, Faculty of Medicine and Health, New South Wales, Australia
| | - Carrie Tsai
- Sydney Dental Hospital and Oral Health Services, Sydney Local Health District, Surry Hills, New South Wales, Australia.,The University of Sydney, School of Dentistry, Faculty of Medicine and Health, New South Wales, Australia
| | - Woosung Sohn
- The University of Sydney, School of Dentistry, Faculty of Medicine and Health, New South Wales, Australia
| | - Heiko Spallek
- The University of Sydney, School of Dentistry, Faculty of Medicine and Health, New South Wales, Australia
| | - Jane Bell
- The University of Sydney, The Charles Perkins Centre, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, New South Wales, Australia
| | - Natasha Nassar
- The University of Sydney, The Charles Perkins Centre, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, New South Wales, Australia
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6
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Do paediatric patient-related factors affect the need for a dental general anaesthetic? Br Dent J 2022; 233:407-412. [DOI: 10.1038/s41415-022-4922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/06/2022] [Indexed: 11/09/2022]
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Mathew MG, Jeevanandan G, Vishwanathaiah S, Hamzi KA, Depsh MAN, Maganur PC. Parental and Child Outlook on the Impact of ECC on Oral Health-related Quality of Life: A Prospective Interventional Study. J Contemp Dent Pract 2022; 23:877-882. [PMID: 37282993 DOI: 10.5005/jp-journals-10024-3397] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To evaluate the perspectives of parents and children on the impact of early childhood caries (ECC) on the oral health-related quality of life (OHQoF). MATERIALS AND METHODS About 400 children aged 3-5 years were recruited for the study. About 200 children who were caries-free were the controls for the study. The remaining 200 consisted of children who were diagnosed with ECC and required dental rehabilitation under general anesthesia. Oral health-related quality of life was recorded at baseline and 6 months after intervention using the Michigan oral health-related quality of life scale. Data were analyzed and evaluated using Statistical Package for Social Sciences (SPSS) Version 25.0. RESULTS Children with ECC were found to have a significantly lower oral health-related quality of life compared with caries-free children, and a statistically significant difference was seen between both groups. The main concern for both parents and children at baseline was pain at the first visit when the evaluation was done. After the intervention, a significant improvement in the oral health-related quality of life was seen. CONCLUSION Early childhood caries was found to have detrimental effects on the oral health-related quality of life. Full-mouth rehabilitation under general anesthesia was found to bring a significant improvement in the oral health-related quality of life. The perspectives of both parents and children were found to be similar. CLINICAL SIGNIFICANCE Early childhood caries has an impact on the lives of children and their parents. Oral health-related quality of life was low with children suffering from ECC. Full-mouth rehabilitation under general anesthesia can significantly improve the OHRQoL of children. Continuous monitoring of the children with regular follow-ups and parental education should be enforced to prevent the relapse of ECC.
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Affiliation(s)
- Mebin George Mathew
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Ganesh Jeevanandan
- Department of Pedodontics and Preventive Dentistry, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India, Phone: +91 9884293869, e-mail:
| | - Satish Vishwanathaiah
- Department of Preventive Dental Sciences, Division of Pedodontics, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | | | | | - Prabhadevi C Maganur
- Department of Preventive Dental Sciences, Division of Pedodontics, College of Dentistry, Jazan University, Jazan, Saudi Arabia, Phone: +966505916621, e-mail:
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Fox F, Whelton H, Johnson OA, Aggarwal VR. Dental Extractions under General Anesthesia: New Insights from Process Mining. JDR Clin Trans Res 2022:23800844221088833. [PMID: 35403470 DOI: 10.1177/23800844221088833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Tooth extraction under general anesthetic (GA) is a global health problem. It is expensive, high risk, and resource intensive, and its prevalence and burden should be reduced where possible. Recent innovation in data analysis techniques now makes it possible to assess the impact of GA policy decisions on public health outcomes. This article describes results from one such technique called process mining, which was applied to dental electronic health record (EHR) data. Treatment pathways preceding extractions under general anesthetic were mined to yield useful insights into waiting times, number of dental visits, treatments, and prescribing behaviors associated with this undesirable outcome. METHOD Anonymized data were extracted from a dental EHR covering a population of 231,760 patients aged 0 to 16 y, treated in the Irish public health care system between 2000 and 2014. The data were profiled, assessed for quality, and preprocessed in preparation for analysis. Existing process mining methods were adapted to execute process mining in the context of assessing dental EHR data. RESULTS Process models of dental treatment preceding extractions under general anesthetic were generated from the EHR data using process mining tools. A total of 5,563 patients who had 26,115 GA were identified. Of these, 9% received a tooth dressing before extraction with an average lag time of 6 mo between dressing and extraction. In total, 11,867 emergency appointments were attended by the cohort with 2,668 X-rays, 4,370 prescriptions, and over 800 restorations and other treatments carried out prior to tooth extraction. DISCUSSION AND CONCLUSIONS Process models generated useful insights, identifying metrics and issues around extractions under general anesthetic and revealing the complexity of dental treatment pathways. The pathways showed high levels of emergency appointments, prescriptions, and additional tooth restorations ultimately unsuccessful in preventing extractions. Supporting earlier publications, the study suggested earlier screening, preventive initiatives, guideline development, and alternative treatments deserve consideration. KNOWLEDGE TRANSFER STATEMENT This study generates insights into tooth extractions under general anesthetic using process mining technologies and methods, revealing levels of extraction and associated high levels of prescriptions, emergency appointments, and restorative treatments. These insights can inform dental planners assessing policy decisions for tooth extractions under general anesthetic. The methods used can be combined with costs and patient outcomes to contribute to more effective decision-making.
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Affiliation(s)
- F Fox
- School of Dentistry, University of Leeds, Leeds, UK
| | - H Whelton
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - O A Johnson
- School of Computing, University of Leeds, Leeds, UK
| | - V R Aggarwal
- School of Dentistry, University of Leeds, Leeds, UK
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Raja A, White DA, Kerr SE, Dietrich T. Providing sealants at the general anaesthetic assessment visit for children requiring caries-related dental extractions under general anaesthetic: a pilot randomised controlled trial. Br Dent J 2021:10.1038/s41415-021-3220-8. [PMID: 34381177 DOI: 10.1038/s41415-021-3220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/02/2020] [Indexed: 11/08/2022]
Abstract
Introduction Children experiencing a caries-related dental general anaesthetic (GA) are at high risk of developing new caries. It is thus important to maximise opportunities for prevention.Aim To undertake a pilot randomised controlled clinical trial (RCT) to assess the feasibility of delivering and evaluating the effectiveness of sealing sound permanent molars at the pre-GA assessment appointment in children needing caries-related extractions under GA.Methods Children (5-15 years) scheduled for GA extractions at Birmingham Dental Hospital were randomised to control or sealant groups. At the pre-GA assessment appointment, sound permanent molars were sealed. Participants were followed up at two years.Results In total, 132 children were assessed for eligibility and 100 randomised (50 control, 50 sealant). Forty-nine children in the intervention group had sealants applied. At two years, 82 children returned for follow-up (43 control, 39 sealant). Sealants were retained on 93.5% (244/261) of surfaces sealed at baseline. Overall, 42% (n = 18) of control group participants had dentine caries in at least one permanent molar that was sound at baseline compared with none in the sealant group.Conclusion Following caries-related extractions under GA, children are at high risk of developing new caries in permanent molars that were sound at the time of the GA. Sealant placement during the pre-GA assessment visit is feasible and may reduce caries incidence in this vulnerable group. High-risk families were found to be reliable study participants.
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Affiliation(s)
- Abida Raja
- Clinical Lecturer in Paediatric Dentistry, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, UK.
| | - Deborah Anne White
- Emeritus Professor of Dental Public Health, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, UK
| | - Sally Elizabeth Kerr
- Associate Specialist in Oral Surgery, Birmingham Dental Hospital, Birmingham Community Healthcare NHS Foundation Trust, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| | - Thomas Dietrich
- Professor and Head of Oral Surgery, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, UK
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Large JF, Keightley AJ, Busuttil-Naudi A. Participation of paediatric patients in primary dental care before and after a dental general anaesthetic. Eur Arch Paediatr Dent 2021; 22:887-897. [PMID: 34086195 PMCID: PMC8526487 DOI: 10.1007/s40368-021-00624-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
Purpose The aim of this retrospective study is to determine children’s attendance and
experience of preventative interventions and operative treatment (restorations and
extractions) with their primary care dentist (PCD) in the 12 months before and after
their caries management under dental general anaesthetic (DGA). Methods
A record of all children who had an elective DGA in 2016 across two hospital sites was
retrospectively obtained (n = 1308). A representative sample of 300 was randomly
selected encompassing 114 dental practices. An online questionnaire to the children’s
PCDs collated quantitative and qualitative data regarding participation in the pre- and
post-DGA period. Results Data was collated and analysed for 80 children (mean age: 6 years 10 months
[SD = 2.49; range: 2 years 1 month – 14 years 3 months]; equal sex distribution) with 43
responding PCDs. Attendance for examination declined significantly from 85% (n = 68)
pre-DGA to 57.5% (n = 46) post-DGA (p ≤ 0.001). Attendance at emergency
appointments pre-DGA was high (33.75% [n = 27]); a significant reduction post-DGA
was recorded (p ≤ 0.001). Over one third of children (37.5% [n = 30]) did not receive
any form of preventative intervention over 24 months. A non-significant reduction in the
provision of operative treatment was observed post-DGA (p = 0.06 [fill, primary]; p = 0.78
[fill, permanent]; p = 0.66 [ext, primary]). No statistical difference between age and
treatment experience was found. Qualitative analysis revealed challenges in providing
care included behavioural difficulties and poor attendance. Conclusion
Improvements are required in strategies employed to support high caries risk children
pre- and post-DGA to facilitate a higher incidence of attendance and preventative
intervention with PCDs.
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Affiliation(s)
- J F Large
- Paediatric Dentistry Department, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, Scotland, UK.
| | - A J Keightley
- Paediatric Dentistry Department, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, Scotland, UK
| | - A Busuttil-Naudi
- Paediatric Dentistry Department, Edinburgh Dental Institute, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, Scotland, UK
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Broomhead T, Rodd HD, Baker SR, Jones K, Davies G, White S, Marshman Z. A rapid review of variation in the use of dental general anaesthetics in children. Br Dent J 2020; 229:31-39. [PMID: 32651519 DOI: 10.1038/s41415-020-1846-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
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.
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Affiliation(s)
- Tom Broomhead
- Unit of Oral health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK.
| | - Helen D Rodd
- Unit of Oral health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
| | - Sarah R Baker
- Unit of Oral health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
| | - Kate Jones
- Consultant in Dental Public Health, Health Improvement Directorate, Health Intelligence, Public Health England, 5th Floor North, Wellington House,133-155 Waterloo Road, London, SE1 8UG, UK
| | - Gill Davies
- Consultant in Dental Public Health, Health Improvement Directorate, Health Intelligence, Public Health England, 5th Floor North, Wellington House,133-155 Waterloo Road, London, SE1 8UG, UK
| | - Sandra White
- National Lead for Dental Public Health, Health Improvement Directorate, Health Intelligence, Public Health England, 5th Floor North, Wellington House,133-155 Waterloo Road, London, SE1 8UG, UK
| | - Zoe Marshman
- Unit of Oral health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
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Zhou X, Nanayakkara S, Songsiripradubboon S, Gao J, Prabhu N. A retrospective study on paediatric dental treatment under general anaesthesia at a tertiary public facility in Australia. PEDIATRIC DENTAL JOURNAL 2020. [DOI: 10.1016/j.pdj.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Raja A, White DA, Kerr SE, Dietrich T. Prevention in the context of caries-related extractions under general anaesthesia: an evaluation of the use of sealants and other preventive care by referring dentists. Br Dent J 2019; 227:489-495. [DOI: 10.1038/s41415-019-0729-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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Marshman Z, Ainsworth H, Chestnutt IG, Day P, Dey D, El Yousfi S, Fairhurst C, Gilchrist F, Hewitt C, Jones C, Kellar I, Pavitt S, Robertson M, Shah S, Stevens K, Torgerson D, Innes N. Brushing RemInder 4 Good oral HealTh (BRIGHT) trial: does an SMS behaviour change programme with a classroom-based session improve the oral health of young people living in deprived areas? A study protocol of a randomised controlled trial. Trials 2019; 20:452. [PMID: 31337437 PMCID: PMC6651965 DOI: 10.1186/s13063-019-3538-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/26/2019] [Indexed: 11/12/2022] Open
Abstract
Background Almost one-half of 12–15 year olds living in deprived areas of the UK have dental caries (tooth decay) with few oral health promotion programmes aimed at children of this age. Mobile phone-based interventions such as short messaging service (SMS) interventions have been found effective at changing certain behaviours and improving health outcomes. This protocol describes the BRIGHT Trial, investigating the clinical and cost-effectiveness of a behaviour change intervention—classroom-based session (CBS) embedded in the curriculum and a series of SMS delivered to participants twice daily to remind them to brush their teeth, compared to usual curriculum and no SMS—to reduce the prevalence of dental caries in young people from deprived areas. Objectives To investigate the clinical and cost-effectiveness of a complex intervention to improve the oral health of young people living in deprived areas. Methods/design This is a school-based, assessor-blinded, two-arm cluster-randomised controlled trial with an internal pilot trial. Overall, the trial will involve approximately 5040 11–13 year olds in 42 schools with a 3-year follow-up. The trial will take place in secondary schools in England, Scotland and Wales. The primary outcome is the presence of carious lesions in permanent teeth at 3 years. Secondary outcomes are: number of carious teeth, frequency of twice-daily toothbrushing, plaque levels, gingivitis, child health-related quality of life and oral health-related quality of life. A cost-utility analysis will be conducted. Discussion The findings of the trial have implications for embedding oral health interventions into school curricula guidance produced by national bodies, including departments for education and dental public health and guideline-development organisations. Trial registration ISRCTN registry, ISRCTN12139369. Registered on 10 May 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3538-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Hannah Ainsworth
- York Trials Unit, Department of Health Sciences, Faculty of Sciences ARRC Building, University of York, York, YO10 5DD, UK
| | | | - Peter Day
- School of Dentistry, University of Leeds, Leeds, LS2 9LU, UK
| | - Donna Dey
- School of Education and Social Work, University of Dundee, Nethergate, Dundee, DD1 4HN, UK
| | - Sarab El Yousfi
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, Faculty of Sciences ARRC Building, University of York, York, YO10 5DD, UK
| | - Fiona Gilchrist
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Sciences ARRC Building, University of York, York, YO10 5DD, UK
| | - Claire Jones
- Health information Centre, University of Dundee, (Main Level 5 Corridor), Second Floor (Level 7), Mail Box 15, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Lifton Place, Leeds, LS2 9JT, UK
| | - Sue Pavitt
- Dental Translational & Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, LS2 9LU, UK
| | - Mark Robertson
- School of Dentistry, University of Dundee, Park Place, Dundee, DD6 8EF, UK.
| | - Sarwat Shah
- Department of Health Sciences, Faculty of Sciences ARRC Building, University of York, York, YO10 5DD, UK
| | - Katherine Stevens
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Sciences ARRC Building, University of York, York, YO10 5DD, UK
| | - Nicola Innes
- School of Dentistry, University of Dundee, Park Place, Dundee, DD6 8EF, UK
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Rogers J, Delany C, Wright C, Roberts-Thomson K, Morgan M. What factors are associated with dental general anaesthetics for Australian children and what are the policy implications? A qualitative study. BMC Oral Health 2018; 18:174. [PMID: 30355316 PMCID: PMC6201572 DOI: 10.1186/s12903-018-0638-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/11/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Dental general anaesthetics undertaken on young children are amongst the most common of all potentially preventable hospitalisations of children in Australia. They are costly for families and the community and entail some risk. The aim of the study was to explore the views of stakeholders about factors associated with children's dental general anaesthetics in Victoria, Australia and to identify policy implications. METHODS Interviews with stakeholders were used to develop a framework of factors. Interview data were subject to qualitative analysis, informed by Interpretative Phenomenological Analysis. RESULTS Eight themes that encompassed 30 main factors were identified through focused discussions with 16 stakeholders. While the safety of dental general anaesthetics has improved and mortality rates are low, side effects are common. Push factors for children's dental general anaesthetics include a perceived greater 'child-focus'; preferred models of care; low oral health literacy; parent guilt; convenience; and some dentists reluctance to treat high needs children in the clinic. Factors that may decrease the prevalence of dental general anaesthetics include: prevention of dental caries; using alternative approaches; an appropriate workforce mix; enhancing oral health literacy; and development of guidelines. CONCLUSION The prevalence of hospitalisation of children to treat dental caries is increasing. Many factors influence the prevalence of paediatric dental general anaesthetics - relating to the child, parent, oral health professional, financial impact, health risk, and accessibility to facilities. There are quality of care and convenience benefits but also high costs and possible health risks. Family, workforce and health system factors have been identified that could decrease the prevalence of paediatric dental general anaesthetics.
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Affiliation(s)
- John Rogers
- University of Melbourne, Melbourne, Victoria, Australia.
| | - Clare Delany
- University of Melbourne, Melbourne, Victoria, Australia
| | - Clive Wright
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Mike Morgan
- University of Melbourne, Melbourne, Victoria, Australia
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Kitsaras G, Goodwin M, Allan J, Kelly MP, Pretty IA. Bedtime routines child wellbeing & development. BMC Public Health 2018; 18:386. [PMID: 29562892 PMCID: PMC5861615 DOI: 10.1186/s12889-018-5290-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/11/2018] [Indexed: 11/24/2022] Open
Abstract
Background Bedtime routines has shown important associations with areas associated with child wellbeing and development. Research into bedtime routines is limited with studies mainly focusing on quality of sleep. The objectives of the present study were to examine the relationship between bedtime routines and a variety of factors associated with child wellbeing and to examine possible determinants of bedtime routines. Methods A total of 50 families with children between 3 and 5 years old took part in the study. Data on bedtime routines, parenting styles, school readiness, children’s dental health, and executive function were collected. Results Children in families with optimal bedtime routines showed better performance in terms of executive function, specifically working memory (t (44)= − 8.51, p ≤ .001), inhibition and attention (t (48)= − 9.70, p ≤ .001) and cognitive flexibility (t (48)= − 13.1, p ≤ .001). Also, children in households with optimal bedtime routines scored higher in their readiness for school (t (48)= 6.92, p ≤ .001) and had better dental health (U = 85.5, p = .011). Parents in households with suboptimal bedtime routines showed worse performance on all measures of executive function including working memory (t (48)= − 10.47, p ≤ .001), inhibition-attention (t (48)= − 10.50, p ≤ .001) and cognitive flexibility (t (48)= − 13.6, p ≤ .001). Finally, parents with optimal bedtime routines for their children deployed a more positive parenting style in general (i.e. authoritative parenting) compared to those with suboptimal bedtime routines (t (48)= − 6.45, p ≤ .001). Conclusion The results of the present study highlight the potentially important role of bedtime routines in a variety of areas associated with child wellbeing and the need for further research. Electronic supplementary material The online version of this article (10.1186/s12889-018-5290-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- George Kitsaras
- Dental Health Unit, Division of Dentistry, The University of Manchester, Manchester, UK.
| | - Michaela Goodwin
- Dental Health Unit, Division of Dentistry, The University of Manchester, Manchester, UK
| | - Julia Allan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Iain A Pretty
- Dental Health Unit, Division of Dentistry, The University of Manchester, Manchester, UK
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Goldthorpe J, Walsh T, Tickle M, Birch S, Hill H, Sanders C, Coulthard P, Pretty IA. An evaluation of a referral management and triage system for oral surgery referrals from primary care dentists: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundOral surgery referrals from dentists are rising and putting increased pressure on finite hospital resources. It has been suggested that primary care specialist services can provide care for selected patients at reduced costs and similar levels of quality and patient satisfaction.Research questionsCan an electronic referral system with consultant- or peer-led triage effectively divert patients requiring oral surgery into primary care specialist settings safely, and at a reduced cost, without destabilising existing services?DesignA mixed-methods, interrupted time study (ITS) with adjunct diagnostic test accuracy assessment and health economic evaluation.SettingThe ITS was conducted in a geographically defined health economy with appropriate hospital services and no pre-existing referral management or primary care oral surgery service. Hospital services included a district general, a foundation trust and a dental hospital.ParticipantsPatients, carers, general and specialist dentists, consultants (both surgical and Dental Public Health), hospital managers, commissioners and dental educators contributed to the qualitative component of the work. Referrals from primary care dental practices for oral surgery procedures over a 3-year period were utilised for the quantitative and health economic evaluation.InterventionsA consultant- then practitioner-led triage system for oral surgery referrals embedded within an electronic referral system for oral surgery with an adjunct primary care service.Main outcome measuresDiagnostic test accuracy metrics for sensitivity and specificity were calculated. Total referrals, numbers of referrals sent to primary care and the cost per referral are reported for the main intervention. Qualitative findings in relation to patient experience and whole-system impact are described.ResultsIn the diagnostic test accuracy study, remote triage was found to be highly specific (mean 88.4, confidence intervals 82.6 and 92.8) but with lower values for sensitivity. The implementation of the referral system and primary care service was uneventful. During consultant triage in the active phases of the study, 45% of referrals were diverted to primary care, and when general practitioner triage was used this dropped to 43%. Only 4% of referrals were sent from specialist primary care to hospital, suggesting highly efficient triage of referrals. A significant per-referral saving of £108.23 [standard error (SE) £11.59] was seen with consultant triage, and £84.13 (SE £11.56) with practitioner triage. Cost savings varied according the differing methods of applying the national tariff. Patients reported similar levels of satisfaction for both settings, and speed of treatment was their over-riding concern.ConclusionsImplementation of electronic referral management in primary care can lead, when combined with triage, to diversions of appropriate cases to primary care. Cost savings can be realised but are dependent on tariff application by hospitals, with a risk of overestimating where hospitals are using day case tariffs extensively.Study limitationsThe geographical footprint of the study was relatively small and, hence, the impact on services was minimal and could not be fully assessed across all three hospitals.Future workThe findings suggest that the intervention should be tested in other localities and disciplines, especially those, such as dermatology, that present the opportunity to use imaging to triage.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Joanna Goldthorpe
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephen Birch
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Harry Hill
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Caroline Sanders
- Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Paul Coulthard
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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18
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Aljafari A, Gallagher JE, Hosey MT. Can oral health education be delivered to high-caries-risk children and their parents using a computer game? - A randomised controlled trial. Int J Paediatr Dent 2017; 27:476-485. [PMID: 28052471 DOI: 10.1111/ipd.12286] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Families of children undergoing general anaesthesia (GA) for caries management requested that oral health advice is delivered using audio-visual media. OBJECTIVE To compare an oral health education computer game to one-to-one education. DESIGN A blind randomised controlled trial of 4- to 10-year-old children scheduled for GA due to caries. Primary outcome measures were (1) parent and child satisfaction with education method; (2) improvements in child's dietary knowledge; and (3) changes in child's diet and toothbrushing habits. Measures were taken at baseline, post-intervention, and three months later. RESULTS One hundred and nine families took part. Both methods of education were highly satisfactory to children and parents. Children in both groups showed significant improvement in recognition of unhealthy foods immediately post-education (P < 0.001). Fifty-five per cent of all participants completed telephone follow-up after 3 months and reported improvements in diet, including reducing sweetened drinks (P = 0.019) and non-core foods (P = 0.046) intake, with no significant differences between the groups. Children reported twice-daily toothbrushing but no changes in snack selection. Attendance for a 3-month dental review was poor (11%). CONCLUSION Oral health education using a computer game can be as satisfactory and as effective in improving high-risk-children's knowledge as one-to-one education. The education received can lead to the positive dietary changes in some families.
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Affiliation(s)
- Ahmad Aljafari
- Department of Paediatric Dentistry, Orthodontics, and Preventive Dentistry, Faculty of Dentistry, The University of Jordan, Amman, Jordan.,Population and Patient Health Division, King's College London Dental Institute, London, UK
| | | | - Marie Therese Hosey
- Population and Patient Health Division, King's College London Dental Institute, London, UK
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19
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Knapp R, Marshman Z, Rodd H. Treatment of dental caries under general anaesthetic in children. ACTA ACUST UNITED AC 2017. [DOI: 10.1038/bdjteam.2017.116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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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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Li L, Wang H, Han X. Oral health-related quality of life in pediatric patients under general anesthesia: A prospective study. Medicine (Baltimore) 2017; 96:e5596. [PMID: 28079793 PMCID: PMC5266155 DOI: 10.1097/md.0000000000005596] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Our goal was to evaluate how dental treatments under general anesthesia (GA) affect the quality of life by a prospective pair-matched design. Pediatric patients, who had received dental treatments under GA, were enrolled and were asked to complete the Early Childhood Oral Health Impact Scale (ECOHIS) before the treatment and 1 month after the treatment. To shield the observed impacts, a pair-matched control group was performed. Patients in the control group were also required to complete the ECOHIS at these different points in time. In both groups, the items of troubled sleep and oral/dental pain scored highest, whereas avoiding smiling or laughing and avoiding talking scored lowest before the treatment. The total mean score in the 2 groups was 13.1 and 13.7, respectively, and there was no significant statistical difference (P > 0.05). However, the total mean score was 1.9 in the experimental group after the treatment and smaller compared with the control group (1.9 vs. 4.7, P < 0.001). The majority of the items in both groups had an apparent effect size and the total mean effect in the experimental group was greater than that in the control group (85.5% vs. 65.7%, P < 0.001). Therefore, dental treatment under GA could provide better quality of life restoration compared with treatment over multiple visits.
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Lee DH. How do You Select an Anesthesia Method Prior to Tympanostomy Tube Insertion for a Child? J Audiol Otol 2016; 20:127-130. [PMID: 27942597 PMCID: PMC5144813 DOI: 10.7874/jao.2016.20.3.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/21/2016] [Accepted: 02/13/2016] [Indexed: 12/04/2022] Open
Abstract
The use of general (face-mask inhalation and intravenous) anesthesia has been the method of choice for tympanostomy tube insertion in children. However, there is no exact guideline for the choice of anesthesia method and there is no evidence to support the use of one anesthesia method over another. Clinically, the anesthesia method used to be decided by old customs and the surgeon's blind faith that children cannot bear tympanostomy tube insertion under local anesthesia. Clinicians should keep in mind that pediatric anesthesia has a potential risk. Despite infrequent serious complications, their seriousness necessitates that sedation or general anesthesia should be done by an anesthesiologist and thus children requiring tympanostomy tube insertion should be referred to secondary or tertiary hospitals, even if they have been followed by a primary care physician for a long time. Previous evidence showed that local anesthesia is appropriate for tympanostomy tube insertion in selected children, especially in children older than 5 years are older. Proper choice of anesthesia method is helpful for both patient and medical service provider. Local anesthesia can give psychological relief to children and their parent. It is easier for the medical service providers to schedule the operation and allocate the medical resources in their hospital. Local anesthesia can reduce individual, social, and national burdens for the health care services.
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Affiliation(s)
- Dong-Hee Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Goodwin M, Pretty IA, Sanders C. A study of the provision of hospital based dental General Anaesthetic services for children in the North West of England: Part 2--the views and experience of families and dentists regarding service needs, treatment and prevention. BMC Oral Health 2015; 15:47. [PMID: 25881325 PMCID: PMC4407771 DOI: 10.1186/s12903-015-0029-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/20/2015] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Patterns of service delivery and the organisation of Dental General Anaesthesia (DGA) have been found to differ across hospitals. This paper reports on qualitative research aimed to understand the impact of such variation by exploring views and experiences of families receiving care in different hospital sites, as well as dentists involved in referral and delivery of care. METHOD Qualitative semi-structured interviews were conducted with 26 people comprising parents (n = 15), dentists working in primary care (n = 6) and operating dentists (n = 5) in relation to DGA. Participants were recruited from areas across the North West of England to ensure a variety referral and treatment experiences were captured. Field notes were made during visits to all settings included in the study and explored alongside interview transcripts to elicit key themes. RESULTS A variety of positive and negative impacts on children and parents throughout the referral process and operation day were apparent. Key themes established were clustered around three key topics: 1. Organisational and professional concerns regarding referrals, delivery of treatment and prevention. 2. The role of hospital environment and routine on the emotional experiences of children. 3. The influence of the wider social context on dental health. CONCLUSION These findings suggest the need and perceived value of: tailored services for children (such as play specialists) and improved information, such as clear guidance regarding wait times and what is to be expected on the day of the procedure. These features were viewed to be helpful in alleviating the stress and anxiety often associated with DGA. While some elements will always be restricted in part to the hospital setting in which they occur, there are several aspects where best practice could be shared amongst hospitals and, where issues such as wait times have been acknowledged, alternative pathways can be explored in order to address areas which can impact negatively on children.
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Affiliation(s)
- Michaela Goodwin
- The Dental Health Unit School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK.
| | - Iain A Pretty
- The Dental Health Unit School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK.
| | - Caroline Sanders
- Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
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