Parental Satisfaction with Ambulatory Anesthesia during Dental Treatment for Disabled Individuals and Their Preference for Same in Future

Pharmacological approaches and physical restraint in dental care for individuals with intellectual and neurodevelopmental disabilities and challenging behaviour: a scoping review of patients' and caregivers' experiences

PURPOSE

There is controversy and debate around the use of pharmacological and physical dental behaviour support techniques amongst practitioners treating patients with challenging behaviour and intellectual and neurodevelopmental disabilities. However, the experiences of patients and caregivers remain underexplored. This scoping review aimed to identify the experience of patients with intellectual and neurodevelopemental disabilities and challenging behaviour and their caregivers regarding the use of physical and pharmacological procedures during dental care.

METHODS

A scoping review was conducted, incorporating evidence from both quantitative and qualitative study designs to clarify concepts and identify gaps in the literature, using all the main medical databases.

RESULTS

From 1575 screened records, 13 studies were included. Ten were quantitative or mixed-method studies focusing on the acceptance of behaviour support techniques from the caregiver's perspective, particularly for children with special needs. Seven studies were from the Americas, none from Europe or Africa. Two major themes emerged: validity of consent; and the acceptance of different dental behaviour support techniques by parents and caregivers.

CONCLUSION

The most acceptable techniques for parents and caregivers were non-invasive, behaviour based support techniques. When these failed, physical support techniques seemed to be more acceptable than pharmacological approaches (sedation or general anaesthesia), although this may be related to cultural context and/or lack of financial support. No studies reported the patient perspective of behaviour support techniques so no conclusions can be drawn as to which techniques are acceptable from the patient's point of view. Further qualitative studies are essential to explore the experiences and expectations of patients with special dental care needs.

Family Presence in Pediatric Cardiac Procedural Settings: A Qualitative Study of Clinicians, A Key Stakeholder Group

BACKGROUND

With increased emphasis on healthcare transparency, parents are increasingly asking to be present for procedures performed on their children, especially in high-acuity contexts like care of children with congenital heart disease (CHD), where procedures may inform critical care decisions. In addition, observations of complex care may better communicate clinical knowledge and benefit grieving after adverse events. We examined clinicians' views on current family presence (FP) efforts and on the expansion of FP to include the observation of operative procedures.

METHODS

This is a qualitative study using semi-structured interviews and content analysis within a pediatric heart center. Participants included perioperative and ICU nurses, physicians, advanced practice providers, and child life specialists. Interviews were recorded, transcribed, and analyzed using inductive content analysis.

RESULTS

Twenty provider interviews were conducted; 70% had less than 10 years of experience, with 30% having between 10 and 20 years; 50% were physicians who work in procedural environments; 25% were nurses; 15% were advanced practice providers; 10% were child-life specialists. Four categories emerged: (1) positive impact of FP, (2) negative impact of FP, (3) limitations to achieving FP, and (4) policies and procedures for FP.

CONCLUSION

Participants reported that current FP uses reduce patient anxiety and improve patient safety, family understanding of clinical decisions, and coping. Drawbacks include parental interference in care, lack of protocols to guide FP, increased family/staff anxiety, lack of staff resources to support FP, and potential access limitations for diverse populations. Participants anticipated that these problems would occur with the expansion to intraoperative FP.

Do Preventive Programs Reduce the Need for New Sedations for the Treatment of Oral Pathologies in Healthy and Special Health Care Needs Children?

Background: The goal is to analyze the need for reinterventions under deep sedation to treat oral pathologies in a population of children with special health care needs (SHCNs) and healthy children who followed a prevention program and to study the influence of parental motivation and child collaboration on the need for reinterventions under deep sedation. Methods: A retrospective study was carried out in a private clinic in Cartagena (Murcia, Spain), with patients treated under deep sedation from 2006 to 2018, both years included, following the Strobe statement. Results: In this study with 230 children who were treated under deep sedation, 23.92% underwent two or more sedations. The mean time elapsed between the first and the second sedations was 21.64 ± 15.87 months, and the main cause for reinterventions was the occurrence of new pathologies. Significantly more pulp treatments were performed in the first sedation than in the second (p = 0.013) and in the third (p = 0.007). Healthy children required fewer reinterventions under deep sedation than children with special needs (6.42% vs. 39.67%). Similarly, patients who followed the preventive program and required some type of dental treatment were reoperated fewer times than those who did not follow the preventive program (35.8 vs. 50%); than "cooperative" children as opposed to "non-cooperative" (12.12% vs. 60.93%) and than patients with "motivated" parents as opposed to those with "non-motivated" parents (20.83% vs. 46.34%). A total of 50% of the children who participated in the preventive program became "cooperative", and 100% were able to receive some treatment in the dental chair. Conclusions: Prevention programs, including motivational interviewing, are essential to improve children's behavior in the dental chair and reduce the need for reinterventions under general anesthesia or deep sedation. Although patients with special needs do require more sedation during their lifetime due to their inability to cooperate, these programs are necessary for the maintenance of oral health status and for the early diagnosis of caries lesions. Pediatric dentists should implement a quarterly preventive program because it improves patient collaboration. It is essential to achieve the motivation of parents in the oral care of their children.

Creating and Validating a Questionnaire for Assessing Dentists' Self-Perception on Oral Healthcare Management-A Pilot Study

BACKGROUND AND OBJECTIVES

Questionnaires designed to test knowledge and self-perception can be valuable tools for diagnosing a dentist's understanding of the management and administration of a practice. The objective of this study was to create and authenticate a questionnaire for assessing dentists' self-perception on oral healthcare management developed from discussions with experts in this field.

MATERIAL AND METHODS

In order to create and verify a questionnaire survey, a cross-sectional, descriptive, and analytical study was carried out. Participants' personal information and 31 statements across four categories made up the final questionnaire form. The answers to the questionnaire were in the form of a Likert scale. After refining the initial version, a total of 36 interviews were conducted at dental offices to verify the validity. For the Exploratory Factor Analysis (EFA), we used the Kaiser-Meyer-Olkin (KMO) index, the Bartlett sphericity test, and also Cronbach alpha coefficient for the validity of the questionnaire.

RESULTS

The accuracy of the instrument was measured by intrarater and interrater reliability. For the EFA, all the communalities exceeded the threshold of 0.05. With a Cronbach's alpha coefficient of 0.898, the questionnaire has sufficient internal consistency.

CONCLUSIONS

The questionnaire demonstrates robust reliability and validity, thereby affirming its suitability for its intended purpose.

The residency levels' effect on pediatric dental rehabilitation operation time

BACKGROUND

Postgraduate pediatric dental residents' competency, to perform dental rehabilitation procedures under General anesthesia (GA), at different levels of training is challenging for operation time control. An adequate operation time (OT) for children decreases morbidity risk and improves hospital time utilization efficiency. The aim of the study is to assess the effect of pediatric dental resident training level on OT for pediatric dental rehabilitation procedures under GA at King Abdulaziz Medical City (KAMC).

METHODS

A cross-sectional study included pediatric dental rehabilitation performed under GA by pediatric dental residents at (KAMC) -Jeddah from October/2015 to September/2022. The primary outcome was OT, and the predictive variable was resident training levels. A linear regression analysis was used to compare OT between procedures performed by junior (years 1-2) or senior (years 3-4) trainees, adjusting for patient and operative factors.

RESULTS

One thousand seven pediatric dental rehabilitation cases were performed under GA by junior (13) and senior (31) residents. The univariant analysis indicated that OT for senior residents was significantly longer (13 min) than for junior residents. However, the linear regression analysis showed that senior residents had a significantly shorter OT when considering the more dental procedures performed per case under GA than junior residents. Senior residents took significantly more radiographs and performed more primary pulp therapies and multi-surface anterior colored restorations under GA than junior residents.

CONCLUSIONS

The OT for pediatric dental rehabilitation procedures under GA is associated with resident training level. The total OT was significantly longer based on procedure number, type, and resident level. The study indicated that senior residents could manage more complex cases in a shorter time. The finding emphasizes the importance of assigning GA cases to residents based on their level and the case's complexity. Additionally, it helps standardize the resident privileges under GA and understand the impact of residency training on hospital efficiency.

Evaluation of children's oral diagnosis and treatment using imaging examination using AI based Internet of Things

BACKGROUND

Although cone beam computed tomography (CBCT) plays an important role in the diagnosis and treatment of oral diseases, its image segmentation method needs to be further improved, and there are still objections about the clinical application effect of general anesthesia (GA) on children's dental fear (CDF).

OBJECTIVE

This study aimed to investigate the application value of CBCT based on intelligent computer segmentation model in oral diagnosis and treatment of children in the context of biomedical signals, and to analyze the alleviating effect of GA on CDF.

METHODS

Based on the regional level set (CV) algorithm, the local binary fitting (LBF) model was introduced to optimize it, and the tooth CBCT image segmentation model CV-LBF was established to compare the segmentation accuracy (SA), maximum symmetric surface distance (MSSD), average symmetric surface distance (ASSD), over segmentation rate (OR), and under segmentation rate (UR) between these model and other algorithms. 82 children with CDF were divided into general anesthesia group (GAG) (n= 38) and controls (n= 44) according to the voluntary principle of their families. Children in GAG were treated with GA and controls with protective fixed intervention. Children's fear survey schedule-dental subscale (CFSS-DS) and Venham scores were counted before intervention in the two groups. CFSS-DS scores were recorded at 2 hours after intervention and after recovery in children in GAG. CFSS-DS and Venham scores were performed in all children 1 week after surgery.

RESULTS

The results showed that the S⁢A value of CV-LBF algorithm was higher than that of region growing algorithm (P< 0.05). OR, UR, MSSD, and ASSD values of CV-LBF algorithm were evidently lower than those of other algorithms (P< 0.05). CFSS-DS scores were lower in GAG than in controls 2 hours after intervention and at return visits after 1 week of intervention (P< 0.001), and Venham scores were lower in GAG than in controls after intervention (P< 0.001). After intervention, the proportion of children with Venham grade 0, 1, 2, and 3 was obviously higher in GAG than in controls (P< 0.001), while the proportion of children with Venham grade 4 and 5 was clearly higher in controls than in GAG (P< 0.001).

CONCLUSION

The results revealed that the computer intelligent segmentation model CV-LBF has potential application value in CBCT image segmentation of children's teeth, and GA can effectively alleviate anxiety of children with CDF and can be used as biomedical signals.

Comparison of parental and practitioner's acceptance for dental treatment under general anaesthesia in paediatric patients

BACKGROUND

Practitioner's knowledge and parental perspectives on dental general anaesthesia (GA) have been surveyed separately in the past. But in daily routine both need to collaborate for the benefit of the child. The aim of this paper was to compare parental and practitioner's acceptance of GA with special focus on identifying factors which influence their differences in decision making.

METHODS

Questionnaires were conducted among 142 participants in a specialized paediatric dental clinic in Germany from February 2020 to February 2021. 51 German practitioners from private practices and clinics participated. Data collection included: age, gender, experience with GA, fear of GA, risk evaluation and indications for GA.

RESULTS

There were no gender related differences in decision making. Emotional factors are present in parents of younger children. Parents are more likely to express fear and uncertainty regarding GA than dentists. Prior experience with GA significantly decreases fears in GA for parents. Both agree that extent of the treatment and low compliance are a suitable indication for GA. Dentists are more likely to accept GA due to a mental disability than parents. Parents were more likely to accept GA than dentists when multiple extractions were needed (regardless of compliance) or acute pain was present.

CONCLUSIONS

A significant divergence in risk evaluation, acceptance and decision-making could be found in parents compared to dentists. Influencing factors are previous experience, younger age of the child, lack of knowledge and indication for GA.