The Prevalence and Factors Associated with Sibling-Recurrent Dental Treatment Under General Anesthesia at an Academic Institution

Purpose: The purpose of this study was to assess the prevalence of and factors that contribute to sibling-recurrent dental general anesthesia (DGA) at the Department of Pediatric Dentistry, Virginia Commonwealth University, Richmond, Va., USA. Methods: Subjects were recruited from July 25, 2017 to March 15, 2018. The guardian of patients with siblings who attended a university pediatric dental clinic were provided a questionnaire to assess the prevalence and factors associated with recurrent DGA. A provider survey was completed to ensure inclusion/exclusion criteria were met. Results: A total of 40 families with a child presenting for general anesthesia (GA) and who had at least one sibling were included in the study. Of these, 45 percent had sibling-recurrent GA treatment; 20 percent of patients had one sibling; and 25 percent had two or more sibling-recurrent DGA (P<.05). Additionally, 13 percent of the children currently presenting for GA had already been treated under GA, and 15 percent of the siblings previously treated with GA had recurrent caries after GA. Conclusions: Sibling-recurrent general anesthesia is high at Virginia Commonwealth University's Pediatric Dentistry Clinic. This increased prevalence could be due to parental acceptance and positive experiences with DGA. Dental providers should be proactive with prevention of recurrent DGA.

Trends in General Anesthesia Utilization by Board-Certified Pediatric Dentists

PURPOSE

The purpose of this study was to explore the trends and utilization of general anesthesia services among board-certified pediatric dentists practicing in the United States.

METHODS

A 26 item survey was sent to 4,216 board-certified pediatric dentists by REDCap or mail. Results were tabulated, and trends were analyzed.

RESULTS

A response rate of 31.8 percent was obtained. All American Academy of Pediatric Dentistry districts were represented proportionally. Most respondents (87 percent) reported using general anesthesia (GA) in their practices. Those who used GA, 50.4 percent reported using a hospital setting, and 60.5 percent used a physician anesthesiologist. Endotracheal intubation was the most common (88.5 percent) method of anesthesia delivery. Most diplomates (62.6 percent) favored dental anesthesiology as a recognized specialty by the American Dental Association.

CONCLUSIONS

The majority of American Board of Pediatric Dentistry diplomates used general anesthesia in their practice. The preferred modality of delivery is oral/nasal intubation, with most services provided by physician anesthesiologists in a hospital/ambulatory setting. Physician anesthesiologists are inclined to provide care in a hospital-based setting. Dentist anesthesiologists provided care in the dental office. Most respondents support dental anesthesiology as a recognized specialty of the American Dental Association.

Dental Treatment and Expenditures Under General Anesthesia Among Medicaid-Enrolled Children in North Carolina

PURPOSE

Many studies reporting dental utilization under general anesthesia (GA) are dated. The purpose of this study was to provide contemporaneous data about children receiving dental GA by: (1) determining trends in utilization and associated expenditures; and (2) examining the effects of provider distribution.

METHODS

This time series cross-sectional study of Medicaid-eligible children ages zero to eight years old in North Carolina used aggregate Medicaid claims from State Fiscal Years (SFY) 2011 to 2015 to collect demographic and dental treatment information. Descriptive statistics were stratified by age and year to examine trends over time. Panel analysis techniques were used to explore regional effects of provider distribution on dental GA utilization.

RESULTS

For SFY 2011 to 2015, the overall dental utilization rate was 517.1 per 1,000 (total enrolled equals 632,941 children/year), and the dental GA utilization rate was 15.8 per 1,000. Total dental expenditures averaged $113 million per year, and dental GA averaged $16.7 million per year. The dental GA proportion of expenditures increased over time (P<.001). Provider distribution did not affect dental GA utilization rate (P=.178) but did increase the number of children receiving dental GA (P<.001).

CONCLUSIONS

Utilization and expenditures associated with dental treatment under general anesthesia continue to increase. While this reflects increased access to care, interventions should be examined to provide preventive care earlier in a child's life.

Does dental undergraduate education and postgraduate training enable intention to provide inhalation sedation in primary dental care? A path analytical exploration

AIM

To examine how quality standards of dental undergraduate education, postgraduate training and qualifications together with confidence and barriers could be utilised to predict intention to provide inhalation sedation.

METHODS

All 202 dentists working within primary dental care in NHS Highland were invited to participate. The measures in the questionnaire survey included demographic information, undergraduate education and postgraduate qualifications, current provision and access to sedation service, attitudes towards confidence, barriers and intention to provide inhalation sedation. A path analytical approach was employed to investigate the fit of collected data to the proposed mediational model.

RESULTS

One hundred and nine dentists who completed the entire questionnaire participated (response rate of 54%). Seventy-six per cent of dentists reported receiving lectures in conscious sedation during their undergraduate education. Statistically significantly more Public Dental Service dentists compared with General Dental Service (GDS) dentists had postgraduate qualification and Continuing Professional Development training experience in conscious sedation. Only twenty-four per cent of the participants stated that they provided inhalation sedation to their patients. The findings indicated that PDS dentists had higher attitudinal scores towards inhalation sedation than GDS practitioners. The proposed model showed an excellent level of fit. A multigroup comparison test confirmed that the level of association between confidence in providing inhalation sedation and intention varied by group (GDS vs. PDS respondents). Public Dental Service respondents who showed extensive postgraduate training experience in inhalation sedation were more confident and likely to provide this service.

CONCLUSION

The quality standards of dental undergraduate education, postgraduate qualifications and training together with improved confidence predicted primary care dentists' intention to provide inhalation sedation.

Survey of American Academy of Pediatric Dentistry on Nitrous Oxide and Sedation: 20 Years Later

PURPOSE

The purpose of this study was to survey the membership of the American Academy of Pediatric Dentistry (AAPD) and determine the current status of nitrous oxide (N2O) utilization in their dental practices while also comparing the findings to a similar survey completed 20 years ago.

METHODS

A 55-item questionnaire on the use of N2O was sent to the AAPD membership.

RESULTS

The total number of respondents was 1,632 (26 percent). Sixty-two percent are board-certified, 97 percent use N2O in their office, 18 percent indicated greater than 80 percent of their patient pool required N2O versus six percent in 1996. Fifty percent of parents expressed concerns about N2O use.

CONCLUSIONS

Changes have occurred in the use of nitrous oxide since 1996, including: (1) a greater percentage of practitioners using N2O; (2) perceptions that more pediatric patients need N2O; (3) a shift in use of N2O by duration of practitioner experience; (4) an increased percentage of board-certified respondents; and (5) possible increasing parental concerns about N2O.

A review of daycase GA services for Special Care patients at University Hospital, Bristol

This paper describes and discusses a review of adult special care dentistry day cases in a UK hospital over a two year period and makes recommendations for other such reviews and for practice. Dental public health competencies illustrated: oral health needs assessment and evaluation of dental health services.

The State of UK Dental Anaesthesia: Results From The NAP5 Activity Survey. A national survey by the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland

The National Health Service anaesthesia annual activity (2013) was recently reported by the Fifth National Audit Program of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. Within a large dataset were 620 dental cases. Here, we describe this data subset. The estimated annual dental caseload was 111,600:60% were children (< 16 y), 38.5% adults (16 - 65y) and 1.5% the elderly (> 65y). Almost all were elective day procedures (97%) and ASA 1 or 2 patients (95%).The most senior anaesthetist present was a Consultant in 82% and a non-career grade doctor in 14%.Virtually all (98%) cases were conducted during GA. Propofol was used to induce anaesthesia in almost all adults compared with 60% of children. Propofol maintenance was used in 5% of both children and adults. Almost all adults received an opioid (including remifentanil) compared with only 40% of children. Thirty one per cent of children had a GA for a dental procedure without either opioid or LA supplementation. Approximately 50% of adults and 16% of children received a tracheal tube: 20% of children needed only anaesthesia by face mask. These data show that anaesthetists almost always use general anaesthesia for dental procedures and this exposes difficulties in training of anaesthetists in sedation techniques. Dentists, however, are well known to use sedation when operating alone and our report provides encouragement for a comprehensive survey of dental sedation and anaesthesia practice in both NHS and non-NHS hospitals and clinics in the UK.

Prospective study on dental extractions carried out for paediatric patients under general anaesthetic in a district general hospital

BACKGROUND

The first line approach to managing healthy anxious children requiring dental extractions should include behavioural management and treatment under local anaesthetic. This can be coupled with conscious sedation.

AIM

To evaluate alternative methods attempted prior to treatment under general anaesthesia (GA), to establish the incidence of repeat GA procedures.

METHOD

Paediatric cases requiring dental extractions under GA were audited from October 2014 - December 2014 in the Oral and Maxillofacial Department, Great Western Hospital, Swindon.

RESULTS

78 paediatric cases requiring dental extractions were carried out during the study period. 91% of referrals came from local general dental practitioners (GDPs). The indication for the GA was included in 59% of the referral letters. The number of teeth extracted per case ranged from 1 - 14. In 18% of cases treatment under local anaesthetic had been attempted previously. Conscious sedation had not been attempted in any of the cases. There were 5 cases (6.4%) of repeat general anaesthetic procedures.

CONCLUSION

Local guidance regarding appropriate paediatric referrals should be distributed to primary care referrers. Treatment under conscious sedation should be considered for paediatric cases and an improved referral pathway to the community dental service should be developed. Preventative advice should be reinforced to the referrer and to the patient.

Short Report. Audit of Conscious Sedation Provision in a Salaried Dental Service

Clinical audit is a tool that may be used to improve the quality of care and outcomes for patients in a health care setting as well as a mechanism for clinicians to reflect on their performance. The audit described in this short report involved the collection and analysis of data related to the administration of 1,756 conscious sedations, categorised as standard techniques, by clinicians employed by an NHS Trust-based dental service during the year 2014. Data collected included gender, age and medical status of subject, the type of care delivered, the dose of drug administered and the quality of the achieved sedation and any sedation-related complications. This was the first time that a service-wide clinical audit had been undertaken with the objective of determining the safety and effectiveness of this aspect of care provision. Evaluation of the analysed data supported the perceived view that such care was being delivered satisfactorily. This on-going audit will collect data during year 2016 on the abandonment of clinical sessions, in which successful sedation had been achieved, due to the failure to obtain adequate local anaesthesia.

[Relations between extraction of wisdom teeth and temporomandibular disorders: a case/control study]

The aim of this study was to assess the impact of extraction of third molars on the occurrence of temporo-mandibular disorders (TMD). A review of the literature and a case-control study have been conducted. The case-control study compares the frequency of extraction of third molars between the sample with TMD (case) and the sample without TMD (control). The proportion of patients who had undergone extractions of wisdom teeth was higher in the case group than in the control group. The difference was statistically significant when patients had undergone extraction of all four wisdom teeth or when the extraction of four wisdom teeth underwent in one sitting or under general anesthesia. The study of patients in case sample shows that all signs of TMD were more common in patients who had undergone extractions in several sessions and under local anesthesia. The temporomandibular joint sounds are significantly more frequent with local anesthesia. In the case group, 85 to 92% of patients have parafunctions and 5 to 11% have malocclusion. This demonstrates the multifactorial etiology of temporomandibular disorders.

Treatment provided in the Public Dental Service in Finland in 2009

OBJECTIVES

To analyse treatment measures provided in the Public Dental Service (PDS) and to discuss the therapy given against treatment needs as expressed in the national clinical epidemiological studies.

METHODS

In 2009, the Chief Dentists of the PDS units collected data from their local registers on patients and treatment provided. Data were obtained from 166 PDS units (86%). Treatment patterns were compared between age groups, provider groups and geographical areas using chi-square tests.

RESULTS

Altogether 8.9 million treatments were provided for 1.7 million patients. Examinations, restorative treatment and anaesthesia accounted for 61.3% of all treatments. Preventive measures (8.4%) and periodontal treatment (6.3%) were small proportions of the total. Prosthetic treatment was uncommon (0.5%). Working age adults received half of all treatments (53.2%), the young a third (36.4%) and the elderly 10.4%. Dental hygienists or dental assistants provided 29.7% of all treatment for children and adolescents, 11.1% for adults and 14.1% for the elderly.

CONCLUSION

Relatively healthy children had plenty of examinations and preventive measures, and adults had mostly restorative care when their needs were more periodontal and prosthetic care, indicating that treatment given was not fully in line with needs.

Impact of Perioperative Fluid Administration on Postoperative Morbidity and Length of Hospital Stay Following Maxillomandibular Advancement for Obstructive Sleep Apnea

PURPOSE

The purpose of this study was to evaluate whether the volume of perioperative fluids administered to patients undergoing maxillomandibular advancement (MMA) for treatment of obstructive sleep apnea (OSA) is associated with an increased incidence of postoperative complications and prolonged length of hospital stay.

MATERIALS AND METHODS

A retrospective cohort study design was implemented and patients undergoing MMA for OSA at the Mayo Clinic were identified from 2001 through 2014. The primary predictor variable was the total volume of intravenous fluids administered during MMA. The primary outcome variable was length of hospital stay in hours. Secondary outcome variables included the presence of complications incurred during postoperative hospitalization. Additional covariates abstracted included basic demographic data, preoperative body mass index, preoperative apnea-hypopnea index, preoperative Charlson comorbidity index, preoperative American Society of Anesthesiologists score, type of intravenous fluid administered, surgical complexity score, duration of anesthesia, duration of surgery, and the use of planned intensive care unit admission. Univariate and multivariable models were developed to assess associations between the primary predictor variable and covariates relative to the primary and secondary outcome variables.

RESULTS

Eighty-eight patients undergoing MMA for OSA were identified. Total fluid volume was significantly associated with increased length of stay (odds ratio [OR] = 1.34, 95% confidence interval [CI], 1.05-1.71; P = .020) in univariate analysis. Total fluid volume did not remain significantly associated with increased length of hospital stay in stepwise multivariable modeling. Total fluid volume was significantly associated with the presence of postoperative complications (OR = 1.69; 95% CI, 1.08-2.63; P = .021) in univariate logistic regression.

CONCLUSION

Fluid administration was not found to be significantly associated with increased length of hospital stay after MMA for OSA. Increased fluid administration might be associated with the presence of postoperative complications after MMA; however, future large multicenter studies will be required to more comprehensively assess this association.

An audit into the reasons why treatment was not completed as planned under intravenous sedation in an adult oral surgery department, and the cost implications

This audit aimed to identify the prevalence of, and reasons for failed intravenous conscious sedation in an adult oral surgery department, to develop recommendations to reduce such failures and to identify any cost implications. Data were collected prospectively for three months for all intravenous sedation appointments in the Oral Surgery department. Data were collected for 109 sedation appointments of which 83 were successful (76%). The failure rate (24%) was higher than the acceptable departmental failure rate (10%), and included reasons for failure that should have been avoided by a thorough patient assessment prior to treatment. Of the 26 failures, the most common reasons for failure were: cancellation: 8 patients (30.8%), failure to attend: 6 patients (23.1%), excessively late arrival of patient: 4 patients (15.4%) and failure to cannulate: 3 patients (11.6%). When sedation was unsuccessful, 13 of the 26 patients (50%) had their treatment successfully completed under local anaesthesia alone, 10 patients (38%) were rebooked for sedation and 3 patient. (12%) were rebooked for a general anaesthetic. Identifying and correcting the reasons for failure can result in vast savings in appointment time, clinical resources and cost. That 13 patients subsequently had their treatment completed under local anaesthesia alone opens the debate on how rigorous the patient assessment and allocation of sedation appointments was, and the potential to achieve savings.

Dental management of children with special healthcare needs

INTRODUCTION

Dental caries is a common condition amongst young children that negatively impacts on their quality of life, It is an added burden on children with special healthcare needs (CSHCN) who have an increased risk of developing caries due to the high sugar contents in their medications, regular consumption of cariogenic foods and a poor salivary flow.

AIMS AND OBJECTIVES

to analyse the management of dental caries in CSHCN at a tertiary public hospital in South Africa.

METHODS

A retrospective analysis was conducted of the dental and medical records of 374 medically compromised children presenting with dental caries. Dental treatment and anaesthetic techniques used were reviewed.

RESULTS

Results indicated that the majority of CSHCN presenting with caries were managed by extractions (96.5%) under either local anaesthesia (73.3%) or general anaesthesia (26.7%). There was a lack of restorative care provided to these compromised children,

CONCLUSIONS

Treatment by extractions may relieve discomfort and pain; however, early loss of teeth leads to functional, psychological, aesthetic and orthodontic problems, which can result in a further decline in the quality of life of these already compromised patients, Restorative treatment and prevention strategies are critical in managing caries in CSHCN in order to improve their quality of life,

Trends in pediatric dental surgery for severe early childhood caries in Manitoba, Canada

INTRODUCTION

Caries is the most common chronic disease of childhood, and severe forms may necessitate rehabilitative dental surgery. In this study, administrative data related to pediatric dental surgery performed under general anesthesia to treat severe early childhood caries in Manitoba, Canada, were reviewed to determine trends in pediatric dental surgery, as well as geographic, regional and socio-economic variations in surgical rates.

METHODS

The total number of dental surgery cases performed under general anesthesia was obtained from provincial administrative databases for fiscal years from 1997-98 to 2006-07. Codes from the International Classification of Diseases and Related Health Problems (9th or 10th revision, as appropriate) were used to identify children who underwent extractions under general anesthesia for a slightly earlier fiscal year period (1996-97 to 2005-06). Each 10-year period was divided into two 5-year periods for comparisons over time. Analyses included descriptive and bivariate statistics, with the data being disaggregated by regional health authority (RHA) or by community area (for Winnipeg). Comparisons for which p ≤ 0.05 were defined as statistically significant.

RESULTS

A total of 18,544 children had dental surgery under general anesthesia between 1997-98 and 2006-07 (mean age ± standard deviation 3.28 ± 1.02 years). Many of the children requiring surgery resided in one northern RHA (26.8%) or the Winnipeg RHA (23.8%). More than half of the RHAs (7/11) displayed significant increases in the rate of surgery, with northern RHAs having the highest rates. Within Winnipeg, 3 of the 12 community areas had significant increases in the rate of surgery. Two inner-city neighborhoods accounted for nearly 50% of surgical cases. The rate of extractions under general anesthesia increased significantly in 6 of the 11 RHAs, with northern RHAs having the highest rates. Four Winnipeg communities experienced significant increases in the extraction rate over time.

CONCLUSION

Pediatric dental surgery under general anesthesia for treatment of severe early childhood caries is common in Manitoba, and the demand increased in several communities over the study period. These results are being shared with decision-makers and communities to identify regions where oral health promotion is needed.

Sedation scales and measures--a literature review

The monitoring and assessment of the degree of conscious sedation experienced by patients is important for both clinical practice and in research. Whereas clinical monitoring remains the gold standard for safety in patient care, numerous measures are available to supplement this and to provide quantitative data on level of sedation. This manuscript provides an overview of existing measures of the degree of sedation. Scales that have been used in published research were identified from a search of Medline and Google Scholar, and for each scale we identified the characteristics of the scale and degree to which the reliability and validity of the scale had been measured.

Dental needs and management of children with special health care needs according to type of disability

PURPOSE

The purpose of this study was to investigate the dental needs and management of special health care needs children in Rio de Janeiro, Brazil, according to the type of disability.

METHODS

Records of 428 0- to 19-year-old patients who received dental treatment at the Patients Special Care Needs Clinic (Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro) from 1996-2009 were analyzed. Information about the type of disability, use of medication, dental exam findings, management during treatment, dental treatment performed, and follow-up examinations were collected. Children were divided into 2 groups: those with medical conditions and those with intellectual disability.

RESULTS

Patients with medical conditions used more medications and were older than those with intellectual disability. The most common dental treatments received were dental restorations (63%) and extractions (47%). There was no association between the type of disability and dental treatment needed. Children with intellectual disability were 3 times more likely to need general anesthesia and 7 times more likely to need physical restraint for dental care than the other group.

CONCLUSIONS

Children with intellectual disability have a greater chance of requiring advanced management techniques during dental treatment. The development of effective oral health programs is recommended as well as a specific education program for their parents.

Predictive variables for postoperative pain after 520 consecutive dental extraction surgeries

The aim of this study was to evaluate postoperative pain in patients who had a single tooth or multiple erupted teeth extracted. This research evaluated 520 consecutive dental extraction surgeries in which 680 teeth were removed. Data collection was obtained through a questionnaire of patients and of the undergraduate students who performed all procedures. Pain was evaluated through qualitative self-reported scores at seven days postsurgery. An increased pain level was statistically associated with ostectomy, postoperative complications, and tobacco consumption. Pain that persisted for more than two days was statistically associated with the amount of anesthetic solution used, with a notable increase in surgical time and development of postoperative complications. Periods of pain lasting more than two days could be expected for traumatic surgeries lasting more than 30 minutes. Both severe and prolonged pain were signs of development of postoperative complications, such as alveolar osteitis and alveolar infection.

The use of sedation in the dental outpatient setting: a web-based survey of dentists

There were 7276 e-mail requests sent to dentists in the United States and Canada requesting participation in a short web-based survey to update earlier information regarding the use of dental outpatient sedation. Participants were questioned regarding their use of dental outpatient sedation, including the frequency of use, type of sedation used, route ofadministration, medications used, physiologic monitoring employed, and availability qfantagonist medications and an automated external defibrillator In comparison to earlier studies, the use of outpatient dental sedation continues to change. The use of enteral sedation may be increasing, but now is differentiated by minimal and moderate sedation with different training requirements. The use of parenteral sedation by practitioners also appears to be increasing.

A survey to assess the provision of conscious sedation by general dental practitioners in the Republic of Ireland

AIM

To quantify and qualify how conscious sedation was used in general dental practice before the introduction of formal sedation teaching in the Republic of Ireland.

OBJECTIVES

1. To determine the extent of use of oral, inhalational and intravenous sedation; 2. to determine the training and experience of general dental practitioners providing conscious sedation; 3. to determine the perceived barriers to the practice of conscious sedation; and, 4. to gauge the level of interest in a postgraduate course in conscious sedation.

METHOD

Postal questionnaire sent to one general practitioner in seven, selected randomly from the General Dental Council register, in 2007.

RESULTS

Seventy six percent of respondents agreed that the provision of conscious sedation in general dental practice is important. However, the current provision of inhalation and intravenous sedation by respondents is low in comparison to provision in the UK. The main barrier to the use of conscious sedation in general dental practice appears to be lack of availability of training.

CONCLUSIONS

The data from this study indicated the need for postgraduate training in conscious sedation in Ireland and a need for increased awareness of the Dental Council Code of Practice on sedation.

Dental hygienists' evaluation of local anesthesia education and administration in the United States

PURPOSE

The goal of this project was to investigate the educational experiences and the use of local anesthesia by dental hygiene providers in the U.S.

METHODS

Approved by the Institutional Review Board at the University of Pittsburgh and undertaken from February to May 2009, this study was designed using a questionnaire-based survey. Using a randomized list obtained via the American Dental Hygienists' Association (ADHA), the survey questionnaires were sent via mail to 1,200 dental hygienists in the U.S. Quantitative evaluations were confined to descriptive statistics including standard summation, an estimation of means and a valid percent for identified variables.

RESULTS

A total of 432 (n=432) of the 1,200 survey questionnaires were returned, which represents a 36% response rate. The respondents represented a total of 296 dental hygiene educational programs, and included practice sites that span all 50 states. Findings indicate that the majority of responding dental hygienists perceive a need for the use of this pain control modality in their practice and administer local anesthetic injections. Additionally, the majority of respondents that administer local anesthetic injections reported that they perform local anesthetic administration for cases in which the dentist provides total care. Furthermore, the results revealed that the hygienists that received training in the administration of local anesthesia injections reported a higher rate of educational preparedness in 6 of the 7 educational topics listed in this survey: local anesthesia related topics (local anesthesia administration, local anesthetic pharmacology and local anesthetic complications), basic pharmacology, medical emergency management and special needs care.

CONCLUSION

This examination parallels the results presented in previous studies, while offering new data relating to local anesthesia administration by dental hygienists. With the majority of dental hygienists reporting a perceived need and the use of this method of pain control, this practice appears to be a significant addition to overall dental care and dental hygiene education.

Differences in pediatric dental services under general anesthesia for Medicaid and military dependent children

PURPOSE

This study's purpose was to compare pediatric dental services provided for Medicaid and military dependent children to determine if differences in dental treatment choices exist based on site and payment method.

METHODS

Subjects included 120 Medicaid patients at the University of Texas Health Science Center at San Antonio and 120 military dependents at Lackland Air Force Base, Texas. Demographic data and treatment information were abstracted for children younger than 6 years old receiving dental treatment under general anesthesia between 2002 and 2006. Data was analyzed using Wilcoxon rank sum, Kruskal-Wallis, and Fisher's exact tests.

RESULTS

The Medicaid recipients were younger (40.2 vs 49.8 months, P<.001) and more likely to be Hispanic (78% vs 30%, P<.001). The means of decayed teeth, fillings, and stainless steel crowns did not differ between sites. Medicaid children received more composite fillings (P<.001), fewer amalgam fillings (P<.001), fewer pulp therapies (P<.001), more extractions (P=.01), and fewer sealants (P<.001). Age and gender did not affect decay rates, but those of Hispanic ethnicity did experience more decay than non-Hispanics (9.5 vs 8.6, P=.02).

CONCLUSION

This study found no difference in the number of less conservative, albeit more costly, procedures performed with Medicaid children at a university compared to military dependents at a military base.

Trends in demand for general anaesthetic care for paediatric caries in Western Australia: geographic and socio-economic modelling of service utilisation

AIMS

This study aimed to assess the temporal and spatial changes in the demand for general anaesthesia, relative to disease incidence, in 0-19-year-olds.

METHODS

Hospitalisation data were obtained from the Western Australian Morbidity Data System for the financial years 1999/2000 to 2004/2005, and principal diagnosis was obtained from every patient discharged from a public or private hospital. Hospitalisation data was correlated with socioeconomic status and the geographical location of primary residence.

RESULTS

In the public hospital sector, there were greater rates of people residing in Statistical Local Areas (SLAs) with decreasing accessibility to healthcare services utilising the option of treatment of dental caries under general anaesthetic (GA) compared to people living within highly accessible areas. In the private sector, children who resided in SLAs with the greatest access to healthcare facilities had a greater rate of being hospitalised for the treatment of dental caries under GA.

CONCLUSIONS

The results demonstrated distinct patterns of trends in demand for general anaesthetic care among different SES groups and geographical location of primary residence. There was an overall emerging trend of increasing demand placed on public sector both among dental care users among high and low SES. Moreover, the results demonstrated the potential application of geographic modelling as a service planning tool for estimating the future demand for GA care for dental caries in addition to the timely need for focused attention on preventive services for early identification, prevention and control of dental caries among children.

Educational experiences and preparedness in dental anesthesia: five-year outcome assessment and conclusions

A mail survey of 2003-07 dental school graduates was undertaken by the Department of Anesthesiology at the University of Pittsburgh School of Dental Medicine to assess the strengths and weaknesses of the predoctoral curriculum in anesthesia and to determine the preparedness of practicing dentists to provide anesthesia services for their dental patients. Subsets of the survey responses were created to specifically evaluate the effectiveness of an advanced selective program in sedation offered to approximately twenty third- and fourth-year predoctoral students. This fourteen-month Anesthesia Selective Program provides advanced didactic instruction and clinical experiences needed to establish competence in minimal to moderate sedation. Overall, graduates reported being best prepared in assessment of medical histories, physiology, and pharmacology, while being least prepared in oral sedation, intravenous sedation, and general anesthesia. For graduates currently in general practice, those who had participated in the Anesthesia Selective Program reported being better prepared in most subjects relating to anesthesia and patient care. Participants in the selective were also more likely to treat special needs patients in their private practices. Respondents' written comments indicated a desire for a greater number of clinical experiences involving sedation procedures within the predoctoral curriculum. This outcome assessment indicated that a greater emphasis should be placed on instruction and training experiences for enteral sedation within the predoctoral dental curriculum. Advanced training and increased clinical experiences in anesthesia may also be an effective means to better prepare graduates to assess medical histories, to manage medical emergencies, and to be willing to treat medically complex patients as well as patients with special health care needs.

Survey of local anesthetic use by Ontario dentists

OBJECTIVE

Local anesthetics are believed to be the most frequently used drugs in clinical dentistry, and although they are generally regarded as safe, some adverse reactions can be expected and do occur. The purpose of this study was to obtain, by means of a mail survey, information on the types and amounts of local anesthetics used by Ontario dentists during 2007.

MATERIALS AND METHODS

A survey requesting data on the annual use of injectable local anesthetics was mailed to all 8,058 dentists licensed by the Royal College of Dental Surgeons of Ontario in 2007.

RESULTS

The effective response rate to the single mailing was 17.3% (1,395 respondents). By extrapolation, the estimated use of local anesthetics by all Ontario dentists during 2007 was determined to be about 13 million cartridges, which represents an average of 1,613 cartridges per dentist per year. Lidocaine with epinephrine 1:100,000 was the most commonly used formulation with 37.31% of total anesthetic use, followed by articaine with 1:200,000 epinephrine (27.04%) and articaine with 1:100,000 epinephrine (17.16%). Overall, local anesthetics combined with a vasoconstrictor accounted for more than 90% of total anesthetic use. A minority of survey respondents (15.68%) indicated that their pattern of anesthetic use had changed significantly in the past few years. Patterns of use were similar for early and late survey respondents. These data provide a current account of the use of local anesthetics by Ontario dentists.

Retrospective review of voluntary reports of nonsurgical paresthesia in dentistry

OBJECTIVE

Paresthesia is an adverse event that may be associated with the administration of local anesthetics in dentistry. The purpose of this retrospective study was to analyze cases of paresthesia associated with local anesthetic injection that were voluntarily reported to Ontario"s Professional Liability Program (PLP) from 1999 to 2008 inclusive, to see if the findings were consistent with those from 1973 to 1998 from this same source.

MATERIALS AND METHODS

All cases of nonsurgical paresthesia reported from 1999 to 2008 were reviewed; cases involving surgical procedures were excluded. Variables examined included patient age and gender, type and volume of local anesthetic, anatomic site of nerve injury, affected side and pain on injection or any other symptoms.

RESULTS

During the study period, 182 PLP reports of paresthesia following nonsurgical procedures were made; all but 2 were associated with mandibular block injection. There was no significant gender predilection, but the lingual nerve was affected more than twice as frequently as the inferior alveolar nerve. During 2006-2008 alone, 64 cases of nonsurgical paresthesia were reported to PLP, a reported incidence of 1 in 609,000 injections. For the 2 local anesthetic drugs available in dental cartridges as 4% solutions, i.e., articaine and prilocaine, the frequencies of reporting of paresthesia were significantly greater than expected (chi2, exact binomial distribution; p < 0.01) based on their level of use by Ontario dentists. These data suggest that local anesthetic neurotoxicity may be at least partly involved in the development of postinjection paresthesia.

Retrospective audit of Taranaki children undergoing dental care under general anaesthetic from 2001 to 2005

A retrospective audit of trends in day-stay treatment for dental caries at a New Zealand hospital dental unit showed that demand for treatment has risen. The annual number of children undergoing a GA increased by over 13%, although the average waiting time after the initial consultation decreased. The cost of treatment also dramatically increased with time, as the numbers and complexity of cases increased. The type of treatment under GA changed over the five years, with more extractions occurring over the course of the audit. Restorations were still the most common treatment item provided, although the use of SSC trebled in 2004 and 2005. Socio-economic status, sex and ethnic differences were observed, with more boys and Măori receiving GA care and having a higher number of extractions. These children were identified as being high users of other hospital services (such as the Emergency Department).

The effects of general anesthesia legislation on operating room visits by preschool children undergoing dental treatment

PURPOSE

The purpose of this study was to examine the impact of state-level general anesthesia (GA) legislation on operating room visits for the treatment of dental caries on preschool-aged children.

METHODS

The North Carolina Ambulatory Surgery Discharge Database was used to observe GA visits for fiscal years (FY) 1997 to 2001. A pretest/post-test design with concurrent comparison groups was used for 2 analyses: (1) all children treated for dental caries were compared to those treated for otitis media; and (2) those whose treatment for dental caries was reimbursed by Medicaid were compared to those whose treatment for dental caries was not reimbursed by Medicaid.

RESULTS

In the prelegislation period (FY 1997 and 1998), there were 3,857 GA visits for dental core and 21,038 for otitis media. Postlegislation (FY 2000 and 2001) dental visits increased to 5,511(43%), and otitis media visits increased to 22,279 (6%)-a statistically significant difference (P<.05). Before the legislation, there were 1,370 non-Medicaid dental visits and 2,487 Medicaid dental visits. Non-Medicaid and Medicaid dental visits postlegislation increased to 2,195 (60%) and 3,316 (33%), respectively. This difference was significant (P<.05).

CONCLUSIONS

General anesthesia legislation resulted in an increase in access to care for children needing dental care in North Carolina.

A review of repeat general anesthesia for pediatric dental surgery in Alberta, Canada

PURPOSE

The purpose of this study was to review data from the province of Alberta, Canada for First Nations children who required more than 1 general anesthesia (GA) procedure for dental surgery from 1996 to 2005.

METHODS

This study was limited to First Nations and Inuit children younger than 18 years old in Alberta who received 2 or more GA procedures to facilitate dental treatment Data spanning 1996 to 2005 were provided from the Alberta Regional Office of First Nations & Inuit Health Branch, Health Canada.

RESULTS

The entire database contained claims for 339 children who received repeat GA procedures for rehabilitative dental core. Seventy-six percent received 2 procedures, while the remainder underwent 3 or more surgeries. Twenty-four percent of First Nations children in this cohort were subjected to >2 GA procedures. Retreatment of previously restored teeth was a common observation. The majority of children were treated by general practitioners instead of pediatric dentists. Seventy-four percent who had 2 or more surgeries were treated by general dentists at the time of the first GA procedure. The mean age of children at the time of the first GA procedure was not associated with whether children received 2 or more GA procedures for dental care (P=.07).

CONCLUSIONS

These data suggest that there may be on over-reliance on GA to treat dental caries for First Notions children in Alberta.

The use of compound topical anesthetics

BACKGROUND

The author reviewed the history of, federal regulations regarding, risks of and adverse drug reactions of five compound topical anesthetics: tetracaine, adrenaline/epinephrine and cocaine (TAC); lidocaine, adrenaline/epinephrine and tetracaine (LET); lidocaine, tetracaine and phenylephrine (TAC 20 percent Alternate); lidocaine, prilocaine and tetracaine (Profound); and lidocaine, prilocaine, tetracaine and phenylephrine with thickeners (Profound PET).

TYPES OF STUDIES REVIEWED

The author reviewed clinical trials, case reports, descriptive articles, and U.S. Food and Drug Administration (FDA) regulations and recent public advisory warnings regarding the federal approval of and risks associated with the use of compound topical anesthetics.

RESULTS

Compound topical anesthetics are neither FDA-regulated nor -unregulated. Some compounding pharmacies bypass the new FDA drug approval process, which is based on reliable scientific data and ensures that a marketed drug is safe, effective, properly manufactured and accurately labeled. Two deaths have been attributed to the lay use of compound topical anesthetics. In response, the FDA has announced the strengthening of its efforts against unapproved drug products.

CLINICAL IMPLICATIONS

Compound topical anesthetics may be an effective alternative to local infiltration for some minimally invasive dental procedures; however, legitimate concerns exist in regard to their safety. Until they become federally regulated, compound topical anesthetics remain unapproved drug products whose benefits may not outweigh their risks for dental patients.

Use of local anesthesia in restorative treatment for adults in Finland

OBJECTIVE

In this survey we investigated the frequency of use of local anesthesia (LA) in restorative treatment for vital teeth in adults in Finland.

MATERIAL AND METHODS

A postal questionnaire was mailed to 592 dentists selected by systematic sampling from the membership list of the Finnish Dental Association; 57% responded. The questionnaire inquired "How often do you use local anesthesia when restoring vital teeth in adults?" for three types of primary restorations: class III for incisors, class II for premolars or molars, and class V on gingival margin for premolars or molars. Statistical evaluation included chi-square and logistic regression modeling.

RESULTS

For restorative treatment of class III primary restoration for incisors, 21% of the dentists used LA always or almost always, 47% fairly often, 30% occasionally, and 2% rarely or never. For class II restoration for premolars or molars, 25% of dentists used LA always or almost always, 58% used LA fairly often, 16% occasionally, and 1% rarely or never. Controlling for gender and time elapsed since graduation, public dentists were more likely to use LA always or almost always for Class II (OR=2.0) and Class III (OR=1.8) restorations. No such difference appeared for Class V restorations.

CONCLUSION

The majority of dentists have accepted LA as part of their everyday practice, with more widespread use among public dentists. Still, to prevent future dental fear among patients, dentists should emphasize pain-free treatment.

Illinois Dental Anesthesia and Sedation Survey for 2006

This is a 10-year follow-up survey of a 1996 study of all dentists in Illinois holding a permit to administer sedation or general anesthesia. The survey describes the scope of sedation and anesthesia services provided in dental offices in Illinois. A mail survey was sent to 471 dentists who were registered with the department of professional regulation to administer sedation or general anesthesia. Classification by specialty area of practice showed: 63% (84% in 1996) are oral and maxillofacial surgeons, 20% (11% in 1996) general dentists, 6% (5% in 1996) periodontists, 9% (0% in 1996) pediatric dentists, 1% (less than 1% in 1996) dentist anesthesiologists. Advanced cardiovascular life support (ACLS) training was reported by 90% (85% in 1996) of the respondents. The total number of sedations and general anesthetics administered for the year was 115,940. Two mortalities and two cases of long-term morbidity were reported for the 10-year period. Respondents reported that 30 patients required transfer to a hospital but suffered no long-term morbidity. Other practice characteristics were detailed.

Predictors of Dental Pain and General Anesthetic Receipt for Hospital Dental Procedures Among New Zealand Children

OBJECTIVES

To predict experience of dental pain and hospital dental general anesthetic receipt among Mäori, Pacific and New Zealand European or Other (NZEO) children in New Zealand.

METHODS

Data were from the 2002 National Child Nutrition Survey. Models representing demographic, socio-economic status (SES), lifestyle, dietary, food security and oral health paradigms were tested using logistic regression.

RESULTS

Some 3275 children participated; 37.4% Mäori, 32.3% Pacific and 30.3% NZEO. Mäori children had higher odds of dental pain experience than NZEO children after adjusting for age, sex and length of time lived in New Zealand and with addition of household SES or physical factors. There were no differences in Pacific and NZEO child dental pain experience when the same factors were accounted for. The prevalence of dental general anesthetic receipt was similar among Mäori, Pacific and NZEO children after adjusting for demographic, lifestyle, dietary, food security and dental factors in separate models. When such factors were investigated together, Pacific children were less likely to have received a dental general anesthetic than NZEO children.

CONCLUSIONS

Mäori children were more likely to experience dental pain and Pacific children were less likely to have received a dental general anesthetic than NZEO children after accounting for various behavioral and material factors. The latter may reflect issues pertaining to access and culturally insensitive services rather than demand for care per se.

Removal of third molars in Scottish oral and maxillofacial surgery units: A review of practice in 1995 and 2002

We audited the practice of removal of third molars in Scottish oral and maxillofacial (OMFS) units in 1995 and in 2002. We collected data from anonymous structured postal questionnaires from 12 Scottish OMFS units about patients referred for removal of third molars in 1995 and 11 units in 2002. The percentage of patients who had no treatment increased from 11% in 1995 (102/928) to 16% in 2002 (66/412). The incidence of prophylactic removal of third molars decreased between the two periods. Removal of third molars under local anaesthesia with or without sedation increased from 35% (325/928) in 1995 to 54% (223/412) in 2002. Removal of third molars under general anaesthesia decreased from 54% in 1995 to 30% in 2002.

Survey of sedation techniques used Among pediatric dentists in New York State

The purpose of this study was to evaluate pediatric dentists in New York State who use oral sedation. Results indicated that fewer than 50% of pediatric dentists used oral sedatives in their office, but that of these dentists, more than 50% reported that their sedations are successful.

Dental therapeutic practice patterns in the U.S. I. Anesthesia and sedation

For this first of a two-part article, anesthetic treatment modalities and specific drugs administered for third molar extractions were assessed to determine current office-based therapeutic practices. Questionnaires were mailed to a random national sample of 850 practicing oral surgeons. Survey design and pilot testing was conducted to assure clarity of questions and usefulness of responses. To maximize the response rate, two follow-up letters were sent to non-responders after the initial mailing. Completed questionnaires were returned by 563 practitioners (66.2% response rate). Practicing oral and maxillofacial surgeons were estimated to have performed an average of 52.7 third molar extraction surgery cases per month, using either general anesthesia (46.3%), intravenous conscious sedation (33.4%), nitrous oxide sedation (5.8%), oral sedation (1.7%), or local anesthesia alone (12.9%). For intravenous conscious sedation, a three-drug technique using midazolam, fentanyl, and propofol was reported most commonly. The most frequently selected local anesthetic formulations were 2% lidocaine, 1:100,000 epinephrine for surgical anesthesia and 0.5% bupivacaine, 1:200,000 epinephrine for postoperative pain management.

A survey of local anaesthetic use among general dental practitioners in the UK attending postgraduate courses on pain control

OBJECTIVE

The aim of this study was to identify which local anaesthetic solutions were used by general dental practitioners in the United Kingdom and to determine selection criteria. In addition, differences in anaesthetic choice between recent graduates (< or = 5 years) and more experienced practitioners were investigated.

MATERIAL AND METHODS

Five hundred and six general dental practitioners attending postgraduate courses on pain control in dentistry completed a questionnaire. Participants were asked to indicate year and place of qualification, anaesthetic solutions available in their surgeries and criteria used in the choice of anaesthetic. In addition, the respondents were asked to indicate choice of local anaesthetic in a number of common medical conditions. Questionnaires were distributed and collected immediately prior to the start of the course presentation and participants were not asked to indicate whether the selection decisions were teaching, experience or evidence based. Data were analysed by using the Chi-square test.

RESULTS

Lidocaine with epinephrine was the most widely available solution among this group of practitioners (94%), the second most common solution was prilocaine with felypressin (74%). The majority of practitioners had two or more solutions available. Practitioners who qualified within the last five years (14%) were more likely to have articaine available, the most recently introduced local anaesthetic into the UK (p = 0.04, one degree of freedom). Common medical conditions lead to a modification in anaesthetic selection: the use of prilocaine/felypressin increases in the majority of circumstances, although it is avoided in pregnant females by recent graduates.

CONCLUSIONS

Lidocaine/epinephrine continues to be the most common anaesthetic solution used by this group of UK general practitioners. The primary criterion for selection of an anaesthetic agent was perceived efficacy. Prilocaine/felypressin is commonly selected as an alternative solution in the presence of common medical conditions.

The practice of conscious sedation by Senior Dental Surgeons in the Health Board Dental Service in the Republic of Ireland

OBJECTIVE

To establish the nature and extent of the practice of conscious sedation by Senior Dental Surgeons in the Health Board Dental Service (HBDS) in the Republic of Ireland and to determine the barriers to the use of conscious sedation.

DESIGN

Postal questionnaire survey.

SETTING

The Health Board Dental Service in the Republic of Ireland in 2002.

SUBJECTS AND MATERIALS

Questionnaires were sent to fifty-five Senior Dental Surgeons working in the HBDS.

RESULTS

Fifty questionnaires (90.9%) were returned. Less than a quarter of Senior Dental Surgeons reported current sedation use in their area. Oral sedation was the most commonly used method with few using relative analgesia and less using intravenous sedation. Forty percent of Senior Dental Surgeons surveyed reported receiving training in conscious sedation as an undergraduate. Nearly 60% of those surveyed reported using conscious sedation in a previous employment. All respondents said the main barrier to the use of conscious sedation in the HBDS was the lack of training opportunities on the subject in Ireland.

CONCLUSIONS

Conscious sedation techniques other than oral, are used to a very limited extent in the HBDS in Ireland. There is great interest amongst Senior Dental Surgeons in the increased use of conscious sedation techniques. A lack of training opportunities is the main barrier to the expansion of their use.

Emergency Dental Clinic Patients in South Devon, their Anxiety Levels, Expressed Demand for Treatment under Sedation and Suitability for Management under Sedation

Objective

To assess the anxiety levels of patients attending two salaried dental service emergency clinics, their expressed demand for treatment under sedation, and their medical suitability for dental sedation.

Design

A questionnaire survey, incorporating the Modified Dental Anxiety Scale (MDAS) and assessment of American Society of Anesthesiologists’ (ASA) physical status classification, of all adult patients attending two emergency dental clinics in Torquay and Newton Abbot.

Results

513 patients returned questionnaires. Only five declined to take part in the study. The mean MDAS for patients attending the two emergency dental clinics was 14.09 (SD 6.04) and 41.9% of patients were classified as dentally anxious (MDAS >15). A preference for treatment under sedation was expressed by 56.3%, of all patients, of whom 50.5% were classified as ASA 1 (without health problems) and would have been suitable for sedation in primary dental care.

Conclusions

The reported dental anxiety levels of patients attending the two emergency dental clinics were found to be much higher than those found by previous studies in general dental practice and at dental school emergency clinics. There was a high expressed demand for treatment under sedation. Further studies are needed to assess the levels of dental anxiety seen at other dental emergency clinics and a health needs assessment to determine need as opposed to expressed demand.

The frequency of repeat general anaesthesia for teeth extractions in children

AIM

The purpose of this study was to determine the frequency of repeat extractions under general anaesthesia (GA) in children.

METHODS

The dental hospital records of patients attending for outpatient GA extractions at Liverpool University Dental Hospital, Liverpool, UK, between January and March 2003 were examined retrospectively. A data collection form was used to record the relevant information.

RESULTS

A total of 278 patients with a mean age of 6.5 years (SD = 2.2 years) were seen for GA extractions. Of those, 33 patients (11.9%) with a mean age of 4.9 years (SD = 2 years) at the time of their initial GA had had a previous or would undergo a subsequent episode of GA extraction. The mean interval between repeat GA was 2.3 years (SD = 1.6 years). Fifteen cases (45.5%) had the repeat GA within 2 years. Radiographs were available as part of the assessment process for 84 (34.3%) of the 245 patients who had had a single episode of GA. However, of the 33 patients who had had a repeat GA, only seven (21.2%) had radiographs available at the time of the initial GA. Regarding the number of teeth extracted, a significant difference (P < 0.01) was found between the number of teeth extracted in patients who had had a single GA (mean = 4.6, SD = 2.5), compared with those extracted at the initial GA for the repeat GA group (mean = 3.2, SD = 2).

CONCLUSION

The frequency of repeat GA is relatively low, but there is a need for appropriate treatment planning incorporating the use of radiographs to reduce this even further.

Anaesthesiological risk assessment in young/adult and elderly dental patients

OBJECTIVE

Analysing the differences in number of diseases reported, medicines taken and American Society of Anaesthesiologists (ASA) scores in young/adult and elderly dental patients.

SUBJECT

Forty-seven young/adult and 47 elderly dental patients living in the community.

SETTING

Private dental practice.

MAIN OUTCOME MEASURES

Age, number of systemic diseases reported during anamnesis, number of medicines taken, seriousness of pre-existent diseases measured according to the ASA (American Society of Anaesthesiologist) scale.

STUDY DESIGN

Analytical study.

RESULTS

The differences between young/adult and elderly dental patients as far as self-reported medical conditions, medicines taken and ASA scores were statistically significant (p < 0.001).

CONCLUSION

The number of elderly patients' medical conditions are greater than young/adults'. It is therefore necessary to adequately assess the elderly patient before starting any dental treatment.

Conscious sedation services provided in secondary care for restorative dentistry in the UK: a survey

OBJECTIVES

To assess the views of consultants in restorative dentistry on sedation services in secondary care for restorative dentistry and their involvement in the provision of this.

DESIGN

Postal questionnaire survey in the UK.

SETTING

Consultants in restorative dentistry.

RESULTS

There was an 80% response rate from 179 consultants. Among consultants in restorative dentistry there was a perceived need for sedation services in restorative dentistry within NHS hospitals other than for teaching purposes. Anxiety and level of trauma of dental treatment affected whether consultants felt it appropriate for patients to have such treatment under sedation. One third (48) of consultants treated patients under conscious sedation, a significant number of these held NHS posts and had graduated more recently. Of those (41) who provided treatment under conscious sedation in an NHS setting, most (38, 93%) provided treatment under intravenous sedation of whom only eight (21%) acted as operator/sedationist. Nearly all consultants (135, 94%) felt that specialist registrars in restorative dentistry should undergo some form of training in sedation.

CONCLUSIONS

Although consultants in restorative dentistry recognise the need for training in and the provision of sedation in secondary care for restorative dentistry, only one third of respondents currently provide this service.

Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population

The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population.

Danish dentists' knowledge, attitudes and management of procedural dental pain in children: association with demographic characteristics, structural factors, perceived stress during the administration of local analgesia and their tolerance towards pain

OBJECTIVE

The aim of the present study was to describe Danish dentists' knowledge of, attitudes towards and management of procedural pain during paediatric dental care, and to assess the importance of demographic characteristics, structural factors, perceived stress during administration of local analgesia and the dentists' own tolerance towards procedural dental pain.

DESIGN

A cross-sectional questionnaire study was conducted in Denmark in May 2001.

SUBJECTS AND METHODS

The subjects were a random sample of 30% of Danish dentists treating children. Usable information was obtained from 327 (80.3%) of the dentists in the sample.

RESULTS

One-quarter of the respondents answered that a 3-5-year-old child could report pain only with uncertainty. More than 80% of the dentists stated that they never compromised on painlessness. Very few agreed to the statement that children forget pain faster than adults. One-third agreed to, or were neutral to, the statement that all restorative care in primary teeth could be performed painlessly using N2O-O2 sedation alone. The majority of the respondents reported using three or more methods to assess the effect of their pain control methods. Almost 90% reported using local analgesia for restorative work 'always' or 'often'. A similar proportion reported using topical analgesia before injection 'always' or 'often'. Administering a mandibular block to preschool children was the procedure perceived as the most stressful (33.6%) pain control method. Demographic factors (gender), structural factors (always working alone and treating 3-5-year-old children daily), perceived stress during the administration of a mandibular block in preschool children and the dentists' own willingness to accept potentially painful dental treatment without local analgesia were associated with knowledge of, attitudes towards and management of procedural dental pain in children.

CONCLUSIONS

Danish dentists treating children demonstrate concern about procedural dental pain in children. Factors amenable to change via training and reorganization into larger clinical units seem to determine their knowledge of, attitudes towards and management of procedural dental pain in children.

Contemporary dental practice in the UK: demographic data and practising arrangements

OBJECTIVES

To investigate, by questionnaire, various aspects of primary dental care provision in the North West of England and Scotland.

METHOD

A questionnaire containing 79 questions was sent to 1,000 practitioners, selected at random, in the North West of England and Scotland. Non-responders were sent another questionnaire after a period of 4 weeks had elapsed.

RESULTS

Overall a response rate of 70% was achieved. The majority of practitioners were practice principals (65%), working in a group NHS practice (80%) located in a city or town centre (49%). On average 10-20 patients were treated each session with fewer patients treated per session under private arrangements. Many practitioners were found to lack hygienist support (44%) and to employ unqualified dental nurses (82%). Younger practitioners were more likely than senior colleagues to have access to up-to-date computers whilst 37% and 74% of respondents never used CAL programmes or magnification respectively. Contemporary cross-infection control standards were used by the majority of practitioners, although 3% of practitioners reported only autoclaving their handpiece once a day.

CONCLUSIONS

The majority of practitioners, involved in this study, worked under National Health Service (NHS) regulations as principals in a group practice where the workload was greater than the private/independent sector. Contemporary cross-infection procedures were used routinely. In contrast computer-aided learning programmes and magnification were not used routinely. The practitioners in this study employed significant numbers of unqualified dental nurses.