There are many indications for treatment of children
under general anesthesia other than extensive dental caries. General anesthesia
is also indicated for anxious children who cannot be managed with traditional
behavioral management techniques and local anesthesia.(10) Behavior
management of children in the dental clinic is one of the most challenging
problems faced by pediatric dentists.(11) Despite the advances
made over the last few decades in the delivery of dental care and improved pain
management, dentistry remains feared by a great number of persons.(12)
Some children are able to cope well with potentially stressful situations, such
as a visit to the dentist; other children, however, are more vulnerable to
their fears and impulses, and hence more prone to react with emotional or
behavioral symptoms.(13)
Patients with special needs and those with medical
problems can also benefit from treatment under general anesthesia in a single visit.
The goals in the pediatric dental patient care are to eliminate cognitive,
sensory and skeletal motor activities to facilitate the delivery of good
quality comprehensive dental services.(4)
The aims of this retrospective study were to
investigate indications, the type of dental treatment provided for children and
to determine the characteristics of the patients treated under general
anesthesia at a military hospital in Zarqa
City (Jordan) in the two years period
between July 2007 and July 2009.
Methods
The records of children who were treated under general
anesthesia at Prince
Hashem Hospital
in Zarqa were reviewed, over the period from July 2007 and July 2009. The data
collected from dental records included the age of the patients at time of
treatment, gender, and indications for dental treatment under general
anesthesia, type of treatment provided and medical history of children.
Children referred for treatment were mainly from
general dental practitioner's clinics. All referred cases were examined by a
certified pediatric dentist who formulated treatment plans for the patients.
Following medical clearance regarding patients’ fitness for general anesthesia, the anticipated
treatment was explained to the parents and the consent to operate was signed. Verbal
and written instructions were given to parents, to ensure nothing by mouth from
midnight on the day before, and early attendance on the day of treatment. The
medically compromised patients were examined and referred to the specialty
consultant anesthetist for pre-anesthetic assessment.
All patients were reviewed one week after treatment,
when data were analyzed using simple descriptive statistics.
Results
Out of the 145 records of the child dental patient, 128
were available for this study. Just over
half were males (53.9%) and 46.1% were females. Patients’ age ranged from 2 to
14 years, with a mean age of 6.3 years. Patients were categorized into four age
ranges as shown in Table I. Majority of patients were in the 5 to 7 years old
group (37.5%) whereas the smallest group was the 8 to 10 years old (14.8%).
Regarding the patients indications for the treatment
under general anesthesia, the most common indication was lack of cooperation of
children (50.8%), whereas only 5.5% of reviewed children were treated for
surgical procedures. (Table II)
The majority of the children were considered healthy. Table
III illustrates the medical conditions of the patients reviewed.
The average number of carious deciduous teeth among
the children was five with a range from one to 14. There were a total of 164 treated
permanent teeth, and total of 802 treated primary teeth. Table IV illustrates
the treatment type for both dentitions. A total of 330 primary teeth were
extracted in contrast to 32 permanent teeth extracted.
For the permanent teeth, majority of treatment was
preventive (34.76%) while only 4.27% of them were treated by glass ionomer cement.
On the other hand, majority of the primary teeth were treated by compomer and glass
ionomer cement, and only 2.12% of them were treated by applying stainless steel
crowns.
Discussion
The results of this study showed that in general the
characteristics of patients who were treated under general anesthesia in Prince Hashim
Bin Al-Hussein
Hospital in Zarqa were
mostly males (53.9%) while females were 46.1% as shown in Table I. The largest
group treated under general anesthesia was the five to seven year olds (37.5%)
which is considerably more than the smallest group eight to 10 year olds
(14.8%). The larger number in the former group is similar to the findings in
other studies.(14-15) This result could be explained by the
fact that children in this age group are unable to adapt to dental treatment
under local anaesthesia.(8) This also may be partially
explained by that the great number of patients’ referrals and the waiting lists
are mostly in this age group. Oral hygiene and dietary practices may be also
counted as additional factors in comparison with the other age groups.(16-17)
On the other hand, only 14.8% patients were
between eight to 10 years old, this may be related to several factors.
One factor may be that the high caries prevalence at an early age might have
resulted in corresponding increase in demand for general anesthesia facilities
at earlier stages(18) thus obviating the need for
treatment later on. Also, as children mature, most of them are better able to
cope with dental treatment at the dental chair without the need for general anesthesia.(19)
Looking at the patients' indications for the treatment
under general anesthesia, as shown in Table II, the most common indication was lack
of cooperation which forms 50.8% and extensive caries which forms 26.5%. This
is in agreement with other reports.(8,20)
The uncooperative, high caries risk children pose a
demanding challenge to pediatric dentists.(21) Some children
had more than one reason for treatment under general anesthesia, and some of
the uncooperative and very young children also had extensive dental caries.
These findings are consistent with results described by other investigators.(9,22,23)
An important consideration for children who are unable to cooperate due to
fear, anxiety or young age is their subsequent acceptance of care using other
methods with low risk and low impact. The aim in using general anesthesia is to
restore the child's oral health at a single visit allowing behavior
modification methods to be introduced more readily afterwards.(14,24,25)
In this study, surgical
procedures were only performed for 5.5% of children.
Regarding the health status of the patients, 82.8%
were medically healthy, whilst only a minority of the patients had medical
problems. These included one case of autism and one case of achondroplasia, as
shown in Table III.
As for the treatment types that were performed to the
patients, it was noticed that there were a total of 164 treated permanent
teeth, while the treated primary teeth were 802, as shown in Table IV.
Untreated dental caries is a disease that usually progresses with time
resulting in severe destruction of tooth enamel and dentine, and it may
subsequently involve the pulp. Nevertheless many children with gross caries
present with no or very little apparent history of pain, or if dental problems
develop early, such as early childhood caries, the child may have no experience
of teeth feeling any other way.(26) Furthermore, lack of
knowledge regarding importance of primary teeth,(27) and some
parents' perception that children visit the dentist only at time of emergency
or when there is pain may have contributed to the severity of caries in those children.(28)
From this table also, it was noticed that a total of 330 primary teeth were
extracted, in contrast to 32 permanent teeth that were extracted.
In the present study, primary teeth comprised the
major bulk of extraction, which is similar to a study by Holt et al.(7)
Although dental extractions in young children can cause eruption problems of
permanent teeth due to space loss, in pediatric dental practice extraction of
primary teeth is quite common generally due to advanced caries and pulp
involvement.(2)
In the present study, extractions of primary teeth are
common and very high which reflects a high caries rate and untreated caries,
and children not visiting a dentist on regular basis for early checkup and
dental care as seen also in other studies.(29)
Regarding the type of treatment performed for the
teeth treated under general anesthesia as shown in Table IV, it was noticed
that 34.76% of permanent teeth were treated by applying fissure sealant and
fluoride varnish 5% application (as part of preventive measures). The problem of
high percentage of caries
in children was due to
the
prolonged lack of prevention for the uncooperative child. Hence, early assessments
of high caries risk subjects and primary prevention before the onset of caries is
the key in reducing the number of high caries patients(30-31)
and this should be emphasized in dental care for all children. Only 4.27% of
permanent teeth were treated by applying glass ionomer cement.
Conclusion
It was concluded that patients treated under general
anesthesia were mostly males, with the majority of them being five to seven
years old. Lack of cooperation of children was the main indication for having
dental treatment under general anesthesia and this option was very helpful for
this group of patients. The main procedures carried out were dental
restorations and extractions
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