Dental treatment under general anesthesia in a group of patients with cerebral palsy and a group of healthy pediatric patients

Comparison of hemodynamic changes with general or local anesthesia during dental treatment in pediatric patients: A prospective clinical study

BACKGROUND AND AIM

Severe hemodynamic fluctuations during dental treatment can trigger highly undesirable physical reactions. A study was made to determine whether the administration of propofol and sevoflurane contributes to the stabilization of hemodynamic parameters during dental treatment in pediatric patients versus the use of local anesthesia alone.

MATERIALS AND METHODS

Forty pediatric patients needing dental treatment were assigned to either general anesthesia with local anesthesia (study group [SG]) or local anesthesia alone (control group [CG]). Two percent sevoflurane in oxygen (100% oxygen, 5 L/min) and continuous propofol infusion (target-controlled infusion [TCI], 2 μg/mL) were used as general anesthesia agents in SG; and 2% lidocaine with 1:80,000 adrenaline was used as local anesthesia in both groups. Heart rate, blood pressure and oxygen saturation were measured before starting dental treatment (baseline) and every 10 min during dental treatment.

RESULTS

Blood pressure (p < .001), heart rate (p = .021) and oxygen saturation (p = .007) decreased substantially after the administration of general anesthesia. The levels of these parameters subsequently remained low and then recovered at the end of the procedure. On the other hand, the oxygen saturation values remained closer to baseline in SG versus CG. In contrast, the hemodynamic parameters experienced lesser fluctuations in CG than in SG.

CONCLUSIONS

General anesthesia affords more favorable cardiovascular parameters during the entire dental treatment in comparison to local anesthesia alone (blood pressure and heart rate decrease significantly and oxygen saturation proves more stable and with values closer to baseline), and allows dental treatment to be performed on healthy, lacking cooperative ability children who otherwise could not be treated with local anesthesia alone. No side effects were observed in either group.

Oral rehabilitation of a 14-year-old quadriplegic child with cerebral palsy under general anesthesia: A case report

Cerebral palsy is a neuromuscular disorder in which patients deal with dysfunction in motor coordination in addition to other problems like epilepsy. Due to disrupted motor functions, the oromotor coordination is also affected, leading to higher incidence of dental caries, which is also due to increased consumption of medications. This case report deals with the oral rehabilitation of a quadriplegic 14-year-old child with cerebral palsy, suffering from severe dental pain and who was treated under general anesthesia.

Oral health status and microbial load of Streptococcus mutans in children with Cerebral palsy in a tertiary care hospital in Delhi

BACKGROUND

Cerebral palsy (CP) is a childhood debilitating condition which impairs the physical and mental ability of an individual to maintain oral health.

AIM

The objective of the present study was assessment of dental neglect and burden of treatment needs of children affected with CP as compared to normal children in a tertiary care hospital in Delhi.

SETTINGS AND DESIGN

A sample size of 104 children of age group of 6-14 years was selected, in which 52 children of CP (case group) and 52 normal school children (control group) were recruited.

MATERIALS AND METHODS

Children from both groups were examined, and calculation of drug master files (DMFS), defs, oral hygiene index (OHI), and gingival index was done. The presence of trauma and malocclusion was assessed. Present caries activity was assessed by the level of Streptococcus mutans present in saliva in both groups. Treatment needs were then assessed based on intraoral findings.

STATISTICAL ANALYSIS

Data were analyzed by SPSS 20.0 software. Student's t-test and nonparametric statistical tests such as Chi-square test and Mann-Whitney test were used as per the nature of variables studied for statistical analysis with the level of significance denoted at P < 0.05.

RESULTS

The mean DMFS, gingival index, OHI, and treatment needs were observed to be higher in the CP group. Increased S. mutans levels were observed in saliva of CP patients. Defs score, trauma, and malocclusion were not statistically significantly higher in CP group as compared to the control group.

CONCLUSION

Cerebral palsy group had a poor oral and gingival health, a higher DMFT and burden of treatment needs and an increased risk of further caries progression due to high caries activity indicated by increased level of salivary Streptococcus mutans than the control group.

A prospective clinical evaluation of fixed dental prostheses made of metal alloys in patients with cerebral palsy

Background

In general, the prevalence of caries and other oral and dental issues is increased in patients with disabilities, such as those with cerebral palsy. Providing appropriate dental treatment at a primary dental clinic for patients with cerebral palsy and intellectual disability, among other conditions, is challenging.

Objective

The objective of this study was to evaluate the longevity and investigate the related prognostic factors of fixed prostheses in patients with cerebral palsy.

Methods

The records of 36 cerebral palsy patients were used for collecting and analyzing data. A total of 155 prostheses made from metal alloys were finally included in this study. Annual failure rates were calculated; patient‐ and tooth‐related variables associated with prosthesis failure were assessed by a multivariate Cox‐regression analysis and frailty models to introduce random effects.

Results

The 10‐year prosthesis survival rate was 62% and the 20‐year survival rate was 36%. In terms of prosthesis‐related variables, the type of prosthesis had a significant effect, and the hazard ratio of fixed partial dentures was 2.32 times that of single‐unit crowns. In terms of patient‐related variables, the presence of epilepsy had a significant effect on survival, and the hazard ratio for comorbid epilepsy was 3.76 times that for those without comorbid epilepsy.

Conclusions

Our findings suggested that fixed prostheses placed in patients with cerebral palsy might have a particularly low survival rate in cases with comorbid epilepsy. It might also be important to consider the type and/or design of the prosthesis carefully to ensure a better prognosis.

Ethics in Children's Dental Treatment under General Anesthesia at the Lebanese University

BACKGROUND

In pediatric dentistry, general anesthesia is required for dental treatment. The treatment modalities are often linked to the patient's medical conditions. However, ethical values might influence the decisions of the treatment.

AIMS

To compare the treatment modalities under general anesthesia between healthy children and children with special needs (CSN) and to assess the ethical principles.

MATERIALS AND METHODS

An analytical retrospective study, approximately 64 patients including 26 CSN and 38 healthy children from 3 to 12 years of age, who underwent general anesthesia (GA) for dental treatment, was performed. The treatment modalities for each tooth were noted, such as fissure sealant, composite, pulp treatment, stainless steel crowns restorations, and extraction. Statistical analysis was performed to evaluate the implementation of the four principles of ethics. Statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS), version 20, (Los Angeles, California), with 95% confidence interval of the difference. The significance level was set at P < 0.05 valued.

RESULTS

A total of 40.6% of the sample were CSN and 59.4% were healthy with extremely high dental fear and anxiety. Thirty-five children were <6 years old. Only 11.4% of them were CSN; 29 children were ≥6 years old and 75.9% were CSN. For 56 of 64 of the patients, the treatment plan has not been respected irrespective of the medical condition. A total of three of the eight treatment plans that have been respected were for the CSN and five for the healthy children.

CONCLUSION

Under general anesthesia, the medical condition of the patient did not alter the dental treatment type. The four principles of ethics were respected as well in CSN as in healthy ones.