General Anesthesia For Dental Treatment Research Articles

The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada.

Children with special healthcare needs (SHCN) often require specialized interventions due to their disabilities. Dental general anesthesia (DGA) is a treatment modality, which improves their access to care but concerns about repeated DGAs persist. This study investigated DGA utilization in children with SHCN and identified factors associated with multiple DGAs in Alberta, Canada (2010-2020). This retrospective population-based study used administrative data encompassing all children (<18 years) undergoing DGA in publicly funded facilities. Children were identified as SHCN based on their diagnosis codes and categorized into behavioral/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions. This study analyzed 3884 DGA visits for children with SHCN, predominantly males aged 6-11 and from low-income families. Mental/intellectual disabilities were prevalent (31.8%), and autism was the leading disease. Caries was the primary dental diagnosis across all groups, whereas pulp problems were higher in psychiatric/behavioral disorders (23.6%), and periodontal problems were more common in physical-mental disabilities (13.2%). 28.7% had multiple DGAs, with younger age, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments, increasing the likelihood of multiple DGAs. This study highlights the importance of individualized prevention and less conservative treatments for younger children to reduce oral health disparities.

Consent for the paediatric patient

Introduction Obtaining valid consent is a fundamental process in dentistry. Written consent must be obtained where treatment involves conscious sedation or general anaesthesia. For children, consent may be provided by a person with parental responsibility (PR). Methods A retrospective evaluation was completed of 160 children over 2 UK hospital sites with paediatric services. Cases involving conscious sedation or general anaesthesia for dental treatment were selected. Data were obtained to establish whether it was documented that the correct person had provided consent for a child and whether all possible individuals with PR for the child were identified at the initial visit. UK national legislation and guidance was reviewed, from which a PR form (to determine PR status for a child) was created and implemented. A second evaluation was subsequently completed, again with 160 children. Results Combined data from both sites confirmed documentation of an appropriate person providing consent in 127 cases (79%) in the first evaluation. This improved to 155 cases (97%) following implementation of the PR form. All possible individuals who had PR for the child were identified at the initial visit in 35 cases (22%). This improved to 139 cases (87%) following the introduction of the PR form. Conclusions Use of a PR form improved documentation regarding valid consent for children.

Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children: A Retrospective Study.

Very young children, and those with disabilities and extensive oral pathology, who cannot be treated in the dental chair, require deep sedation or general anesthesia for dental treatment. The aim of this study is to describe and compare the oral health status in healthy and SHCN children and the treatments performed under deep sedation on an outpatient basis with a minimal intervention approach, and their impact on quality of life. A retrospective study between 2006 and 2018 was made. A total of 230 medical records of healthy and SHCN children were included. The data extracted were age, sex, systemic health status, reason for sedation, oral health status before sedation, treatments administered during sedation, and follow-up. The quality of life after deep sedation of 85 children was studied through parental questionnaires. Descriptive and inferential analyses were made. Of the 230 children, 47.4% were healthy and 52.6% were SHCN. The median age was 7.10 ± 3.40 years (5.04 ± 2.42 in healthy children and 8.95 ± 3.09 in SHCN children). The main reason for sedation was poor handling in the dental chair (99.5%). The most frequent pathologies were caries (90.9%) and pulp pathology (67.8%). Healthy children had more teeth affected by decay and with pulp involvement. Patients aged < 6 years received more pulpectomies and pulpotomies. After treatment, parents stated that children were more rested and less irascible, ate better, increased in weight, and had improved dental aesthetics. Differences in treatments carried out did not depend on the general health status or the failure rate but on age, with more pulp treatments in healthy children who were younger, and more extractions near to the age of physiological turnover in children with SHCN who were older. Intervention under deep sedation with a minimally invasive treatments approach met the expectations of parents and guardians, as it improved the children's quality of life.

National Survey on Silver Diamine Fluoride (SDF) Awareness, Knowledge, Attitude, and Use among General Dental Practitioners in the Kingdom of Saudi Arabia-An Exploratory Survey.

Silver diamine fluoride (SDF) has been accepted as an appropriate alternative for caries management. However, knowledge and utilization of SDF among dentists vary considerably. The authors in the present study aimed to assess the awareness, knowledge, attitudes, and use of SDF among general dentists (GD) in Saudi Arabia and to correlate the differences based on the different regions and experience levels of the dentists. In this regard, a cross-sectional web-based questionnaire was conducted, and a response was received from 311 GDs from different parts of the country. Information regarding demographic data, knowledge, attitudes, use, and barriers to SDF in dentists' professional lives were elicited. The mean age of the participants (55.3%) was between 25-35 years. Most (92.45%) of the dentists were aware of the material and (61%) agreed that SDF could arrest carious lesions. More than half of the dentists agreed/strongly agreed that SDF was a good treatment alternative for restorations in children with behavioral issues (63.1%), medically fragile patients (53.7%), patients with severe anxiety (64.5%), patients who underwent radiation or chemotherapy (47.3%), and patients needing general anesthesia for dental treatment (74%). Comparative evaluation using ANOVA revealed regional differences based on knowledge, attitudes, and use. Tukey HSD further highlighted that the practitioners in the western region are more knowledgeable regarding its benefits and utilize it more frequently in their practice compared to other regions. On the other hand, the experience level of the GDs did not have any impact on their knowledge, attitudes, and use of SDF.

Comparative Analysis of Sedative Efficacy of Dexmedetomidine and Midazolam in Pediatric Dental Practice: A Systematic Review and Meta-Analysis.

Children are particularly terrified of having dental treatment. They are physically resistant, frail, and unwilling to cooperate. This severe distress during the pre-operative phase could cause the dentist to have issues with behavior control. Additionally, it may make pediatric dental treatments less effective. In order to reduce anxiety and control behavior in children receiving dental care, sedation is a pharmacological management technique that supports the provision of effective and high-quality dental services. The aim is to compare and evaluate the efficacy of sedative agents like dexmedetomidine and midazolam in pediatric dental practice. A thorough review of the literature was conducted using electronic databases like “MEDLINE, PubMed, and CENTRAL (Cochrane Central Register of Controlled Trials), as well as the World Health Organization International Clinical Trials Registry Platform, www.clinicaltrials.gov, conference proceedings abstracts, a bibliography of pertinent references, and manual searches of journals, conferences, and books”. There were no restrictions on the language or the date of publication when searching the electronic databases.Randomized controlled trials were included which compared dexmedetomidine and midazolam in children up to 16 years of age subjected to dental treatment. Information on procedures, participants, interventions, outcome measures, and results were independently extracted by three review writers (TS, SL, and RO). Trial authors were contacted for papers that were confusing or lacking information. The risk of bias was evaluated for each study. We adhered to the Cochrane statistical recommendations. Three trials totaling 229 participants were included. All three studies were rated as having a low risk of bias, with none of them having a high or unclear risk. Meta-analysis was done for the available data for the primary outcomes like sedation level and recovery time. We searched for randomized controlled trials up to Jan 31, 2020. Participants are randomly assigned to an intervention or control group in randomized controlled trial research. While patients in the control group often get a placebo therapy or procedure, those in the interventional group receive the treatment being studied.We found three studies eligible to include in the review. One study evaluated 73 individuals who received general anesthesia for dental treatment. There were 72 and 84 individuals in the second and third investigations, respectively. All the participants of the three studies were divided randomly into two groups and were subjected to dexmedetomidine and midazolam as sedative agents. We gave the evidence an "extremely low certainty" rating. Because there are just three short trials with unusual parameters for comparison, the results are questionable. Overall, the results do not allow us to draw any firm conclusions. Three randomized controlled trials included in this systematic review reported data with varying conclusions; hence we recommend more randomized controlled trials to be conducted on this subject matter.

Evaluation of the Cause of Dental Treatment in Children under General Anesthesia from the Perspective of Pediatric Dentists and Postgraduate Students and Parents of Children under General Anesthesia at the Dentistry School of Tehran University of Medical Science.

Nowadays, dental treatment under general anesthesia is accepted as a treatment method in children in which other common methods do not allow to achieve acceptable results. The benefits of general anesthesia in pediatric dental treatment are that the treatment is completed in one session, the person is relieved of pain, and most importantly, the child does not need to cooperate. However, it is important to determine the exact dental reasons for children under general anesthesia. In this study, the cause of dental treatment under general anesthesia in children was examined from the perspective of specialists, assistants, and parents of children under general anesthesia. In this descriptive-analytical cross-sectional study, participants were selected from among the parents of children under general anesthesia for dental treatment and pediatric dentists and assistants in a purposeful manner. After the items were prepared by the professors, the prepared checklist was read to the people. After completing the checklist, the data were entered into SPSS software version 20 and analyzed using descriptive statistics such as frequency determination, mean, and statistical rests. According to the consensus of parents and experts, the main reasons for general anesthesia for children to perform their dental operations were: young age, lack of cooperation during previous dental treatment, a large number of dental treatments, systemic disease of the child, unwillingness of parents to perform behavioral control procedures, higher quality work under anesthesia, mental and physical behavioral problems, and reduced number of treatment sessions. Therefore, reasons such as young age, lack of cooperation, and a large number of dentist's work are among the most important factors that lead to the decision to perform general anesthesia in children. In light of this decision, the consequences and disadvantages/advantages of this method are important and therefore more research should be done on this issue.

Transient ventricular bigeminy during emergence from general anesthesia in a pediatric patient with catecholaminergic polymorphic ventricular tachycardia

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare genetic disease that is characterized by ventricular arrhythmias and sudden death, induced by exogenous and endogenous catecholamine. We performed general anesthesia for dental treatment of multiple teeth in a 7-year-old boy with CPVT. To avoid sympathetic tone, anesthesia was maintained by total intravenous anesthesia, but ventricular bigeminy was induced by stimulation on emergence form general anesthesia. Although bigeminy in the present case might have been less likely to induce a fatal arrhythmia, we should keep in mind that a small amount of sympathetic tone may induce arrhythmias in a patient with CPVT.

General Anesthesia for Dental Treatment in a Patient with Subcortical Band Heterotopia: A Case Report

General Anesthesia for Dental Treatment in a Patient with Subcortical Band Heterotopia: A Case Report

Utility of a Structured Teaching Approach, Rehearsal, and Training for Patients With Autism Spectrum Disorder to Avoid Physical Restraint During Induction of Anesthesia

PurposeWe aimed to determine whether the use of a structured teaching approach, rehearsing, and training (SRT) for anesthesia induction in patients with autism spectrum disorder (ASD) could reduce the need for physical restraint. DesignRetrospective observational study MethodsWe retrospectively analyzed 63 patients (4 to 40 y old) with ASD who underwent general anesthesia for dental treatment. Patients were divided into SRT (n = 22) and non-SRT (n = 41) groups. In the SRT group, patients were presented with a visual guide based on a structured teaching approach at the pre-anesthetic consultation. The guide comprised photographs of the places, tools, and processes that the patient would experience prior to anesthesia induction. Patients then practiced these processes (rehearsal). Patients in the non-SRT group were administered anesthesia in a conventional manner without SRT. FindingsThe percentage of patients needing physical restraint was significantly lower in the SRT (3/22, 13%) than in the non-SRT group (21/41, 51%, P < .001). ConclusionsThe SRT method reduces the need for physical restraint in patients with ASD during anesthesia induction.

Risk factors for repeated general anesthesia for dental treatment of adult patients with intellectual and/or physical disabilities

AimRepeated dental treatment of patients with intellectual and/or physical disabilities under general anesthesia (GA) often becomes necessary. This study aimed to identify potential risk factors predictive of repeated dental treatment under general anesthesia.Materials and methodsData of adult patients with intellectual and/or physical disabilities receiving dental treatment under GA within a time period of 7 years were analyzed (n = 203, mean age: 41.0 ± 14.9 years). All patients received comprehensive dental treatment (professional tooth cleaning, periodontal therapy, composite restorations, and/or extractions); patients receiving extractions only for emergency dental care were not included as a second intervention for restorative treatment often followed. Demographic, anamnestic, oral health, and treatment factors were obtained from dental records. Duration of intervals without dental treatment under GA was assessed using Kaplan–Meier statistics. Potential predictive factors were tested using univariate and multivariate cox regression analyses.ResultsThirty-five patients (17.2%) received a second and five patients (2.5%) a third dental treatment under GA during that period. In the univariate analysis, patients’ age, living situation, and nutrition were associated with repeated GA. In the multivariate Cox regression analysis, only nutrition remained significant. Risk for repeated treatment increased if patients were tube-fed (HR: 7.54, p = 0.001) or received pureed/liquid food (HR: 4.32, p = 0.007) compared to nutrition without limitation.ConclusionIn adult patients with intellectual and/or physical disabilities, nutrition affects the risk for repeated dental treatment under GA.Clinical relevanceIdentification of risk factors making repeated dental treatment under GA of patients with intellectual and/or physical disabilities more likely is essential to adjust preventive measures.

A survey on dental treatments provided under general anesthesia for pediatric patients: A hospital-based retrospective audit

Aim: To evaluate the dental procedures carried out under general anesthesia (GA) on children with primary dentition in a pediatric hospital. Methods: The study comprised all children with primary dentition treated under GA at a private pediatric hospital from January 2014 to December 2017. The data was tabulated based on the dental records include reasons for dental treatment under general anesthesia (DGA), dental status, and treatment provided. Descriptive statistics were used for statistical analysis and chi-square test used for the comparison. Results: Forty-eight children with primary dentition were utilized the service of general anesthesia for dental treatment. Dental caries (78%) was the most common reason for DGA (p&lt;0.05). More than 80% of children required treatment for more than ten teeth (p&gt;0.05). Overall restorative procedures (60%), extractions (26%), and preventive procedures (14%) were performed under GA (p&lt;0.05). Among, restorative procedures stainless steel crowns (54.2%) were given more priority than other restorative materials. Conclusions: Dental caries was found to be a common reason for DGA. Restorative procedures were given priority over surgical and preventive procedures. Stainless steel crowns were extensively used compared to other materials.

Delayed awakening time from general anesthesia for dental treatment of patients with disabilities.

BackgroundPatients with disabilities often require general anesthesia for dental treatment because of their cooperative or physical problems. Since most patients with disabilities take central nervous system drugs, the management of recovery status is important because of drug interactions with anesthetics.MethodsThe anesthesia records of patients under general anesthesia for dental treatment were reviewed, and data were collected. Healthy patients under general anesthesia for dental phobia or severe gagging reflex were designated as the control group. Patients with disabilities were divided into two groups: those not taking any medication and those taking antiepileptic medications. The awakening time was evaluated in 354 patients who underwent dental treatment under general anesthesia (92 healthy patients, 183 patients with disabilities, and 79 patients with disabilities taking an antiepileptic drug). Based on the data recorded in anesthesia records, the awakening time was calculated, and statistical processes were used to determine the factors affecting awakening time.ResultsSignificant differences in awakening time were found among the three groups. The awakening time from anesthesia in patients with disabilities (13.09 ± 5.83 min) (P < 0.0001) and patients taking antiepileptic drugs (18.18 ± 7.81 min) (P < 0.0001) were significantly longer than in healthy patients (10.29 ± 4.87 min).ConclusionThe awakening time from general anesthesia is affected by the disability status and use of antiepileptic drugs.

Case Report of a Patient with Down Syndrome Who Experienced Aspiration Pneumonia after Returning Home after Undergoing Ambulatory General Anesthesia for Dental Treatment

Case Report of a Patient with Down Syndrome Who Experienced Aspiration Pneumonia after Returning Home after Undergoing Ambulatory General Anesthesia for Dental Treatment

The number and kind of antiepileptics affect propofol dose requirement for anesthesia: observational study.

The propofol dose requirement and the emergence time are affected by antiepileptic use. The effects on anesthesia of the number and kind of antiepileptic agents have not been reported. We investigated the relationship between the kind and number of antiepileptic agents and the propofol dose requirement for anesthesia and emergence time in intravenous general anesthesia for dental treatment for patients with neurological disorders. We studied 247 patients with neurological disorders who underwent dental treatment under intravenous general anesthesia. Patients were categorized according to the number of antiepileptics (none, single agent, two kinds, and three or more kinds of antiepileptics) and the kind of antiepileptic (carbamazepine, valproate, phenobarbital, phenytoin, zonisamide, clobazam, or topiramate) being received. The propofol dose requirement for anesthesia, emergence time, and predicted blood propofol concentration at emergence were evaluated. Patients on three or more kinds of antiepileptics had significantly lower propofol dose requirement (reduction in 25%, compare with no use) and predicted blood propofol concentration at emergence (reduction in 41%) and significantly longer emergence time (extension in 50%) (P < 0.05). Valproate and clobazam reduced the propofol dose (valproate 9% and clobazam 19%) and predicted blood propofol concentration at emergence (valproate 18% and clobazam 33%), while phenobarbital increased these parameters (30% and 125%) (P < 0.05). The number and kind of antiepileptics effects propofol dose requirement. In particular, valproate and clobazam reduce the propofol dose requirement, while phenobarbital increases this.Clinical trial registration UMIN No. UMIN000014179.

Parenteral Satisfaction After Dental Rehabilitation Under General Anesthesia in Children

Objectives:The aim of this study was to investigate the satisfaction levels of parents whose children had been treated under general anesthesia for dental treatment, and to determine pre-treatment factors affecting satisfaction levels. Methods:A total of 230 children treated under general anesthesia with nasal intubation due to dental phobia/ anxiety, systemic disease or physical/ mental disabilities were included in the study. There were 13 questions in the questionnaire and the data were collected from the parents on the phone (minimum a month after general anesthesia) and the answers were recorded by the same pediatric dentist. For statistical analysis of the data, Chi square, T test and Spearman correlation tests were performed.Results:Patients sample was composed of 139 male and 91 female children with ages ranging from 1,5 to 18 years (mean age: 6.4 ±2.7 year). The distribution of the patients treated under general anesthesia had various systemic conditions; 58 children had mental disabilities, 150 were healthy (with dental phobia / anxiety) and 23 had systemic disorders. There was significant difference between parental satisfaction and difficulty of dental treatment under general anesthesia, prior information about dental treatment under general anesthesia, most of the parents were satisfied with their children’s treatment under GA: 68.3% were very satisfied,and 30.3 % moderately satisfied. In addition, positive significant correlation was found between the number of unsuccessful clinical treatment experience of children and waiting periods / satisfaction status of general anesthesia.Conclusion:The level of parental satisfaction about dental care under GA in children was high. As reported by parents, dental fear was the most important reason of GA use is dental treatment. In children, this fear should always be correctly diagnosed and prevented. Dental treatments under general anesthesia should be resorted to only when absolutely necessary.

Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types.

BackgroundWe aimed to assess the dose needed to achieve the propofol effect-site concentration using target-controlled infusion in intellectually disabled patients and to detail the most effective method for achieving a safe level of consciousness without hemodynamic changes as well as detail any resulting adverse effects.MethodsWe performed a retrospective review of sedation service records of 138 intellectually disabled patients (51, mental retardation; 36, autism; 30, brain lesion, 12 genetic diseases, 9 dementia) aged over 15 years and weighing over 30 kg. These patients had received propofol via target-controlled infusion in the special care dental clinic of Seoul National University Dental Hospital from May 2008 to September 2018 for restorative treatment (112), minor surgery (13), prosthodontics (7), periodontics treatment (5), and implant (1).ResultsFor all groups, the duration of dental treatments was 43 ± 18 minutes, total sedation time was 73 ± 23 minutes, and total BIS values was 57 ± 12. The propofol maintenance dosage values for each group were: mental retardation, 3 ± 0.5 (2–4) µg/ml; autism, 3.1 ± 0.7 (2–5) µg/ml; brain lesion, 2.8 ± 0.7 (1.5–5) µg/ml; genetic disease, 2.9 ± 0.9 (1–4) µg/ml; and dementia 2.3 ± 0.7 (1–3.4) µg/ml.ConclusionsThe dementia group needed a lower dosage to reach a safe, effective propofol effect-site concentration than the other groups. Since there were no complications, deep sedation is a great alternative to general anesthesia for dental treatment of intellectually disabled patients.

Anesthetic management of a patient with 15q tetrasomy for dental treatment

15q tetrasomy is a chromosomal abnormality that is a part of the heterogeneous group of extra structurally abnormal chromosomes. This syndrome is characterized by epilepsy, central hypotonia, developmental delay and intellectual disability, and autistic behavior. This is the first report of the anesthetic management of a patient with this syndrome. We administered general anesthesia for dental treatment in a patient with 15q tetrasomy. Appropriate planning for the prevention of complications such as seizures and hypotonia, and for delayed emergence from anesthesia, is required. Specifically, choosing short-acting drugs that do not induce seizures, together with suitable monitoring, resulted in successful anesthetic management of the patient with 15q tetrasomy.

Comparison of Oral Melatonin and Midazolam as Premedication in Children Undergoing General Anesthesia for Dental Treatment.

BackgroundDental anxiety is prevalent in children. This condition may cause uncooperative behavior and need a treatment under general anesthesia. The perioperative period, especially for children, is a stressing event. Premedication is commonly used to reduce perioperative anxiety and facilitate the induction of anesthesia.Methods132 children candidates for dental treatment under GA were enrolled in this study and randomly divided into 3 groups. Oral melatonin, midazolam, and normal saline were administered as premedication. Patient’s sedation score before GA, the ease of intravenous line establishment, patient’s need for painkillers, and duration of recovery were evaluated and compared.ResultsRegarding the sedation score and response to IV access establishment, comparisons showed statistically significant differences between melatonin and midazolam groups (P < 0.05) as well as between midazolam and placebo groups (P < 0.001). The difference between melatonin and placebo groups was not significant (P > 0.05). The need for painkiller administration was statistically different between midazolam and placebo, melatonin and placebo, and midazolam and melatonin groups (P < 0.05). A statistically significant difference was also found between melatonin and midazolam as well as between melatonin and placebo groups (P < 0.05) with regard to the recovery duration while no significant difference was observed between midazolam and placebo groups (P > 0.05).ConclusionMidazolam is superior to melatonin for premedication regarding the patients’ sedation score before anesthesia and the ease of IV access establishment. Premedication with midazolam decreases the need for painkillers and increases the rate of recovery in children undergoing GA for dental treatment.

A Conversion Disorder Case Study of a Patient Who Underwent General Anesthesia for Dental Treatment as It Was Suspected That She Was Allergic to the Drugs Used in Local Anesthesia

A Conversion Disorder Case Study of a Patient Who Underwent General Anesthesia for Dental Treatment as It Was Suspected That She Was Allergic to the Drugs Used in Local Anesthesia

İleri Derecede Kifoskolyotik Çocukta Lateral Pozisyonda Fiberoptik Entübasyon

Kyphoscoliosis is a serious anatomical abnormality in the form of lateral curvature and rotation of the spine. Kyphoscoliosis that may be accompanied by syndromes can also cause difficulty with airway management during general anesthesia. In this report, we aimed to present our experience of difficult airway management with a child patient who could not be put in the supine position due to advanced kyphoscoliosis and underwent general anesthesia for dental treatment.