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Park S, Kim J, Kim J, Lee J, Han M, Shin J. Trends of conscious sedation in the Department of Pediatric Dentistry at the Dankook University Dental Hospital for 11 Years. J Dent Anesth Pain Med 2023; 23:265-271. [PMID: 37841516 PMCID: PMC10567542 DOI: 10.17245/jdapm.2023.23.5.265] [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] [Received: 05/15/2023] [Revised: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Background Anxiety and fear in children's dental care are major impediments to successful dental care. High-quality dental treatment can be achieved using various behavioral control methods; however, conscious sedation using drugs can be used if behavioral control is difficult, owing to excessive fear and anxiety. This study aimed to examine the trends in conscious sedation implemented in pediatric dentistry at the Dankook University Dental Hospital over the past 11 years. Methods This study included 6,438 cases of dental treatment under conscious sedation conducted over 11 years between January 2011 and December 2021 in the Department of Pediatric Dentistry at Dankook University Dental Hospital. Results Over the past 11 years, the number of dental treatments under sedation has increased. In the case of inhalation sedation using nitrous oxide, the rate of increase was approximately twice every year, and the use of midazolam gradually decreased. The average age of children who underwent sedation was 5.11 years, and the rate of sedation treatment in children aged <4 years tended to decrease, while that of children aged >5 years tended to increase. This is related to the trend of changes in drugs used. In a sex-based survey, sedation treatment rate was higher in males than that in females. Conclusion Appropriate selection of sedatives can reduce the frequency of general anesthesia and minimize complications through efficient and safe dental treatments. Trend analysis of sedation by year will help provide guidelines for the appropriate selection of sedation for dental treatment of children and patients with disability.
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Affiliation(s)
- Sohyun Park
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Jongbin Kim
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Jongsoo Kim
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Joonhaeng Lee
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Miran Han
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Jisun Shin
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
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Lee M, Chi SI, Kim H, Seo KS. Analysis of the annual changes in dental institutions that claimed dental sedatives in Korea and the types of sedatives using health care big data. J Dent Anesth Pain Med 2023; 23:101-110. [PMID: 37034843 PMCID: PMC10079767 DOI: 10.17245/jdapm.2023.23.2.101] [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] [Received: 02/25/2023] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 04/11/2023] Open
Abstract
Background Dentists make various efforts to reduce patients' anxiety and fear associated with dental treatment. Dental sedation is an advanced method that dentists can perform to reduce patients' anxiety and fear and provide effective dental treatment. However, dental sedation is different from general dental treatment and requires separate learning, and if done incorrectly, can lead to serious complications. Therefore, sedation is performed by a limited number of dentists who have received specific training. This study aimed to investigate the proportion of dentists who practice sedation and the main sedatives they use in the context of the Republic of Korea. Methods We used the customized health information data provided by the Korean National Health Insurance. We investigated the number of dental hospitals or clinics that claimed insurance for eight main sedatives commonly used in dental sedation from January, 2007 to September, 2019 at the Health Insurance Review and Assessment Service. We also identified the changes in the number of dental medical institutions by region and year and analyzed the number and proportion of dental medical institutions prescribing each sedative. Results In 2007, 302 dental hospitals prescribed sedatives, and the number increased to 613 in 2019. In 2007, approximately 2.18% of the total 13,796 dental institutions prescribed sedatives, increasing to 3.31% in 2019. In 2007, 168 institutions (55.6%) prescribed N2O alone, and in 2019, 510 institutions (83.1%) made claims for it. In 2007, 76 (25.1%) hospitals made claims for chloral hydrate, but the number gradually decreased, with only 29 hospitals (4.7%) prescribing it in 2019. Hospitals that prescribed a combination of N2O, chloral hydrate, and hydroxyzine increased from 27 (8.9%) in 2007 to 51 (9%) in 2017 but decreased to 38 (6.1%) in 2019. The use of a combination of N2O and midazolam increased from 20 hospitals (6.6%) in 2007 to 51 hospitals (8.3%) in 2019. Conclusion While there is a critical limitation to the investigation of dental hospitals performing sedation using insurance claims data, namely exclusion of dental clinics providing non-insured treatments, we found that in 2019, approximately 3.31% of the dental clinics were practicing sedation and that N2O was the most commonly prescribed sedative.
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Affiliation(s)
- Minjae Lee
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Seong In Chi
- Department of Pediatric Dentistry, Dankook University Sejong Dental Hospital, Sejong, Republic of Korea
| | - Hyuk Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Chen GY, Wu ZF, Lin YT, Cheng KI, Huang YT, Huang ST, Hargono A, Li CY. Association between General Anesthesia and Root Canal Treatment Outcomes in Patients with Mental Disability: A Retrospective Cohort Study. J Pers Med 2022; 12:jpm12020213. [PMID: 35207701 PMCID: PMC8876241 DOI: 10.3390/jpm12020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
In the population of individuals with a disability, mental illness patients can be uncooperative during dental treatment; thus, general anesthesia has been widely applied during dental procedures. This study aims to investigate the association between general anesthesia and the outcomes of root canal treatment in patients with disability. Teeth treatment records of patients with disability from Kaohsiung Medical University Hospital Research Database and electronic database from January 2005 to December 2018 were used in this retrospective cohort study. The authors conducted analysis comparing root canal treatment outcomes under general anesthesia and non-general anesthesia, indicated by endodontic re-treatment or post-treatment teeth extraction. Over the 9-year follow-up period, root canal treatment outcomes representing a cumulative survival rate of 87.68% and 74.51% in the general anesthesia group and non-general anesthesia group, respectively, were found. After adjustment for potential confounders, the teeth with general anesthesia showed a substantially and significantly reduced HR of root canal treatment failure at 0.24 (95% confidence interval, 0.12 to 0.49). Our study supported the notion that root canal treatment with general anesthesia may entail substantial reduction of treatment failure in patients with disability.
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Affiliation(s)
- Guan-Yu Chen
- Department and Graduate, Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Z.-F.W.); (K.-I.C.)
| | - Zhi-Fu Wu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Z.-F.W.); (K.-I.C.)
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Ting Lin
- Department of Dentistry, Division of Special Care Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-T.L.); (S.-T.H.)
- School of Dentistry, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Z.-F.W.); (K.-I.C.)
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yu-Ting Huang
- Department of Medical Research, Division of Medical Statistics and Bioinformatics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Shun-Te Huang
- Department of Dentistry, Division of Special Care Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-T.L.); (S.-T.H.)
- School of Dentistry, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Arief Hargono
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Chung-Yi Li
- Department and Graduate, Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
- Department of Public Health, College of Public Health, China Medical University, Taichung 40402, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Correspondence:
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Kim H, Ryoo SH, Karm MH, Seo KS, Kim HJ. Analysis of changes and trends in the use of sedatives in dental sedation using data from the National Health Insurance in Korea. J Dent Anesth Pain Med 2022; 22:49-60. [PMID: 35169620 PMCID: PMC8814723 DOI: 10.17245/jdapm.2022.22.1.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although dental sedation helps control anxiety and pain, side effects and serious complications related to sedation are gradually increasing. Due to the introduction of new drugs and sedation methods, insurance rates, legal regulations, drugs, and methods used for dental sedation are inevitably changed. In the Republic of Korea, National Health Insurance is applied to all citizens, and this study investigated changes in the use of sedatives using this big data. Methods This study used customized health information data provided by the Healthcare Insurance Review & Assessment Service of Korea. Among patients with a record of use of at least one of eight types of sedatives for dental sedation between January 2007 and September 2019 were selected; the data of their overall insurance claims for dental treatment were then analyzed. Results The number of patients who received dental sedation was 786,003, and the number of dental sedation cases was 1,649,688. Inhalational sedation using nitrous oxide (N2O) accounted for 86.8% of all sedatives that could be claimed for drugs and treatment. In particular, it was confirmed that the number of requests for sedation using N2O sharply increased each year. Midazolam showed an increasing trend, and in the case of chloral hydrate, it gradually decreased. Conclusion According to our analysis, the use of N2O and midazolam gradually increased, while the use of chloral hydrate gradually decreased.
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Affiliation(s)
- Hyuk Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Seung-Hwa Ryoo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Intranasal Dexmedetomidine Compared to a Combination of Intranasal Dexmedetomidine with Ketamine for Sedation of Children Requiring Dental Treatment: A Randomized Clinical Trial. J Clin Med 2021; 10:jcm10132840. [PMID: 34199001 PMCID: PMC8269392 DOI: 10.3390/jcm10132840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022] Open
Abstract
Outpatient pediatric sedation is challenging. This study aimed to test intranasal dexmedetomidine efficacy as a single drug or combined with ketamine (DK) to sedate children undergoing dental treatment. Children < 7 years were randomized into dexmedetomidine 2 mcg/kg and ketamine 1 mg/kg (DK) or dexmedetomidine 2.5 mcg/kg (D) groups. Videos from the dental sedation allowed the systematic assessment of children's behavior (primary outcome) according to the Ohio State University Behavioral Rating Scale (OSUBRS). Secondary outcomes were parental and dentist satisfaction, adverse events, and recovery time. The data were analyzed descriptively and through regression models. Participants were 88 children (44 per group; 50 boys). The duration of quiet behavior (OSUBRS) was higher than 50% (DK mean 58.4 [standard deviation 38.1]; D 55.2 [39.1]; p = 0.225). Parents (DK 78.0 [32.2]; D 72.7 [35.1]; p = 0.203) and dentists (KD 62.7 [41.0]; D 62.8 [40.1]; p = 0.339) were overall satisfied. Adverse events occurred in 16 cases (DK n = 10, 62.5%; D n= 6, 37.5%; p = 0.104) and were minor. The median recovery time in the DK group was 1.3 times greater than in group D (p < 0.05). Intranasal sedation with dexmedetomidine alone is equally efficacious and satisfactory for pediatric sedation with fewer adverse events and faster recovery than the DK combination.
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Chi SI, Kim H, Seo KS. Analysis of application of dental sedation in attention deficit hyperactivity disorder (ADHD) patients using the Korean National Health Insurance data. J Dent Anesth Pain Med 2021; 21:99-111. [PMID: 33880403 PMCID: PMC8039164 DOI: 10.17245/jdapm.2021.21.2.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. It has a worldwide pooled prevalence of 5.29%. The characteristics of ADHD can increase the probability of dental treatment, while special behavior management can be required to allow proper treatment. In South Korea, the use of sedation in dental treatment has rapidly increased in recent decades. The present study aimed to investigate the trend and effects of sedation in patients with ADHD undergoing dental treatment in South Korea. Methods The study used customized health information data provided by the Korean National Health Insurance Service. Among patients with the record of sedative use during the period from January 2007 to September 2019, those with International Classification of Diseases-10 codes for ADHD (F90, F91) were selected; the data of their overall insurance claims for dental treatment were then analyzed. The patients' age, gender, sedative use, and dental treatment were analyzed per year. The annual number of general anesthesia or sedation cases was also analyzed, and changes in the method of behavior management with increasing age were examined. Results The study involved 7,654 patients with ADHD (6,270 males; 1,384 females). The total number of dental treatments was 137,778, while the number of sedation cases was 16,109, among which 13,052 involved male patients and 3,057 female patients. The number of general anesthesia cases was 631, among which 538 involved male patients and 93 female patients. The most frequently used sedation method in the dental treatment of patients with ADHD was N2O inhalation. The percentage of sedation cases was highest in patients aged 4 years, and it decreased with increasing age. Conclusion In South Korea, both sedation and dental treatments were slightly more common in patients with ADHD than in the general population. With increasing age, the frequency of dental treatments and the percentage of sedation cases decreased.
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Affiliation(s)
- Seong In Chi
- Department of Pediatric Dentistry, Dankook University Sejong Dental Hospital, Sejong, Korea
| | - Hyuk Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
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