|Year : 2020 | Volume
| Issue : 2 | Page : 80-84
Pattern of dental treatment of children under outpatient general anesthesia in children: A 6-year retrospective study in Saudi Arabia
Sharat Chandra Pani1, Reem AlKaoud2, Ghaida AlMoqbel2, Azzam AlMeshrafi2, Shahad Binateeq3, Saleh Sonbol4
1 Division of Paediatric Dentistry, Schulich School of Medicine and Dentistry, London, ON, Canada
2 College of Dentistry, King Saud Bin Abdulaziz Health Science University, Riyadh, Saudi Arabia
3 College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
4 College of Dentistry, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||24-Feb-2020|
|Date of Decision||11-Mar-2020|
|Date of Acceptance||24-Mar-2020|
|Date of Web Publication||12-Jun-2020|
Dr. Sharat Chandra Pani
Division of Paediatric Dentistry, Schulich School of Medicine and Dentistry, London, ON
Source of Support: None, Conflict of Interest: None
Background and Aim: This study aimed to assess the pattern of cases and types of dental procedures performed in an outpatient general anesthesia (GA) operatory.
Methodology: A retrospective observational study design was used. The sample comprised of children aged between 2 and 14 years of age (285 males and 267 females) who received dental treatment under GA from April 2013 to March 2019 and whose parents consented to review of dental and medical records. The American Society of Anesthesiologists (ASA) status of patient on admission, presence or absence of complications from the anesthesia, and type of dental procedures carried out in primary and permanent teeth were recorded and subjected to statistical analyses.
Results: Nearly 90% of the cases treated were ASA I (n = 498), with only four cases that were classified as being above ASA III. The mean number of teeth treated per child was 10.6 (standard deviation ± 3.89) teeth. There was a gradual reduction in mean number of teeth treated from 2013 to 2018. There were no cases of serious complications of GA or delayed postoperative recovery reported over the 6-year period.
Conclusions: Outpatient surgery is an effective means of providing dental care under GA, even for children with mild systemic disorders.
Keywords: Behavior management, dental rehabilitation, general anesthesia
|How to cite this article:|
Pani SC, AlKaoud R, AlMoqbel G, AlMeshrafi A, Binateeq S, Sonbol S. Pattern of dental treatment of children under outpatient general anesthesia in children: A 6-year retrospective study in Saudi Arabia. Saudi J Oral Sci 2020;7:80-4
|How to cite this URL:|
Pani SC, AlKaoud R, AlMoqbel G, AlMeshrafi A, Binateeq S, Sonbol S. Pattern of dental treatment of children under outpatient general anesthesia in children: A 6-year retrospective study in Saudi Arabia. Saudi J Oral Sci [serial online] 2020 [cited 2020 Jul 15];7:80-4. Available from: http://www.saudijos.org/text.asp?2020/7/2/80/286564
| Introduction|| |
Extensive dental care in children is often performed under general anesthesia (GA). The American Academy of Pediatric Dentistry suggests that the rationale for referral of patients under GA could range from medical necessity to treatment severity to behavioral reasons. It has been documented that most patients with special health-care needs are referred for GA to manage their dental problems.,, However, it has also been shown that pediatric dentists are likely to refer children for dental rehabilitation under GA for behavioral reasons or because of the complexity of the treatment.,,
Traditionally, it was considered necessary to admit the patient for at least 1 day observation following treatment under GA., Increased drug safety combined with increasing hospital costs has meant that most dental procedures are now performed in a day-care anesthesia setting.,, While this has reduced costs of treatment, it has also meant that certain types of patients and procedures requiring extensive postoperative care are referred to other hospitals and centers.,,,
There are several barriers to the access of dental care under GA for children. The primary barrier for care is often cost. It has been pointed out that very often, cases are selected on the basis of treatment to be provided rather than the actual need for GA. A pattern of cases under GA helps to understand not only the rationale for treatment but also the type of treatment rendered.
Saudi Arabia has a high incidence of dental caries, with studies showing that over 85% of children below the age of 5 years have at least one carious tooth. It is, therefore, natural to assume that some portion of these children will require dental treatment under GA. The day-care anesthesia unit at the Riyadh Elm University was established in 2012. The unit provides dental care to pediatric patients who are the American Society of Anesthesiologists (ASA) I or ASA II in an outpatient setting with patients being both admitted and discharged on the same day as the surgery.
The aim of this study was to study the type of procedures performed under GA for the dental rehabilitation of children over a 6-year period. This study also aimed to document the rationale for treatment and the type of children treated.
| Methodology|| |
The study was registered with the research center of the Riyadh Elm University, and ethical approval was obtained from the Institutional Review Board (IRB) of the university. All records screened were blinded, and consent to access records was obtained from the clinical director of the hospital. Data usage and recording was monitored by the IRB of the university.
The study did not actively engage with the participants, and data recorded were secondary data obtained from the records of the university dental clinics.
Source of data
Records of patients undergoing GA at the day-care surgery unit of the Riyadh Elm University from April 2013 to March 2019 were screened. The data of all patients aged below 14 years were included in the study. Files with incomplete documentation or cases where the parents had not consented to the use of patient data were excluded from the analysis.
Recording of variables
The age of the patient, gender of the patient, recorded behavior at the screening visit, and caries status and medical diagnosis of the patients were obtained from the file. The presence or absence of medically compromising conditions and complications of GA, if any, was recorded.
Analysis of variables
Descriptive analyses of the types of procedures were subjected to nonparametric tests of significance. The descriptive statistics were subjected to the Chi-square test, and multiple comparisons were performed using the Kruskal–Wallis test. All analyses were performed using the SPSS version 25 data processing software (IBM-SPSS, IBM Inc. Armonk, NY, USA).
| Results|| |
A total of 575 records of patients treated between April 2013 and March 2019 were analyzed in the study. Of 575 files analyzed, a total of 547 complete records were analyzed. The sample comprised children aged between 2 and 14 years of age (mean age: 5.16, standard deviation [SD] ± 2.21 years). There were 285 males and 267 females, and the males (mean age 5.19, SD ± 2.12 years) were slightly higher than those of females.
Nearly 90% of the cases treated were ASA I (n = 498), with only four cases that were classified as being above ASA III [Table 1]. Despite this, there were 75 patients who had some form of medical condition. Most of the patients (n = 470) were undergoing GA for the first time; however, 50 patients had received GA for other conditions and 27 patients had undergone dental treatment under GA previously [Table 1].
When the patients with medical conditions were analyzed, it was observed that patients with a medical condition (n = 75) comprised 15.8% of the total patients treated. When the trend of patients treated was analyzed, it was observed that the percentages ranged from 11% to 16% [Figure 1]. The Friedman test showed that there was no significant change in the pattern of cases treated (Chi-square = 5.252, P = 0.214).
When the patients were classified according to the International Classification of Diseases 10, it was observed that disorders of the respiratory tract, especially bronchial asthma (J45, n = 16), were the most common medical condition among those treated under GA. The disorders and the systems involved are summarized in [Table 2].
Overall, the mean number of teeth treated per child was 10.6 (SD ± 3.89) teeth. There was a gradual reduction in mean number of teeth treated from 2013 to 2018 [Figure 2]. The Friedman test showed the reduction to be statistically significant (Chi-square = 18.23, P = 0.041).
When the treatment in primary teeth was analyzed, it was observed that there was a significant reduction in the number of extractions from 2013–2014 to 2018–2019 (Chi-square = −34.35, P = 0.012). There was no placement of anterior zirconia crowns before 2015; however, there was a significant increase in the number of crowns placed from 2015 to 2018 (Chi-square = 2.303, P = 0.367). There was no discernible change in pattern for the restorations, stainless steel crowns, or pulpotomies done [Figure 3].
Of the 575 files screened, there were 105 children who had treatment of the permanent teeth with a total of 256 procedures performed on these teeth. Of these, the most common treatment was the placement of restorations (n = 124), whereas the least common procedure was extraction of supernumerary teeth (n = 11). Other procedures performed included pulp capping, apexification/apexogenesis, extraction due to dental caries, and the placement of stainless steel crowns [Table 3].
There were no cases of serious complications of GA or delayed postoperative recovery reported over the 6-year period. All the 575 children recovered within 2 h of the surgery and were discharged the same day. There were no cases where the child had to be shifted to an intensive care facility for observation or monitoring.
| Discussion|| |
The dental treatment of children under GA has been practiced for over half a century, and the documentation of the type of cases has served to highlight both the scope and limitations of this practice., 10, ,,, The type of dental procedures performed also helps to provide a snapshot of the nature of dental disease in children, with long-term trends being previously used as a tool to map trends in oral disease, especially dental caries., The rationale for this study was to explore the pattern of dental procedures performed under GA over a 6-year period.
The main reasons for treating young children under GA world over have been the inability of the child to co-operate in the dental chair and the extent of dental work needed.,, Most of the patients treated at this center had no underlying medical condition and were classified as ASA I or ASA II. However, among those classified as ASA II, nearly 15% of the children had special health-care needs. This confirms the findings of studies that have shown that children with special health-care needs can, in many cases, be managed safely under 1-day anesthesia. This is a significant observation as repeated studies have shown that one of the greatest barriers to access to dental care under GA in children with special health-care needs is the increased cost that is associated with hospitalization., A limitation of the current study is that the number of patients with special health-care needs who were screened but not treated or referred to hospital-based dental treatment units was not included in this study. Despite this limitation, the results of this study highlight the need for effective screening of patients with special health-care needs to assess their eligibility for 1-day dental surgery under GA.
The necessity to repeat dental treatment under GA has often been cited as an example of dentists treating the dental caries lesion rather than the disease., In this study, 27 of the 575 patients screened (5.1%) were undergoing dental treatment under GA for the second time. The low rate of repeat anesthesia is in keeping with a recent study  but is considerably lower than previously reported literature.,, It must, however, be remembered that the decision to repeat dental procedures under GA is more an indicator of available resources, practitioner preference, and economic viability than an indicator of the success or failure of the treatment. The success or failure of the different treatments provided is beyond the scope of the current study.
The trends mapped over the period of study showed a decrease in the number of extractions and an increase in the number of teeth treated with pulp therapy and stainless steel crowns. This is in keeping with trends observed by several authors, who have associated an increased willingness to save teeth under GA over the past decade.,,
The results of the study should be viewed keeping in mind certain limitations. While retrospective trends have proven to be useful in analyzing the type of service provided, they do not reflect the actual success or failure of treatment. Furthermore, the current study was a single-center study conducted in a university hospital providing subsidized dental care.
| Conclusions|| |
Within the limitations of the current study, we can conclude that:
- Day-care surgery is an effective means of providing dental care under GA, even for children with mild systemic disorders
- The reduction in the number of teeth being treated per patient over the past 6 years seems to suggest that the reduction of costs can increase access to dental care under GA
- Over the past 6 years, there has been a reduction in the number of extractions and an increase in advanced restorative procedures per person.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]