Use of general anaesthesia in paediatric dentistry: barriers to discriminate between true and false cases
- 454 Downloads
The use of general anaesthesia (GA) has shown significant increase in child dental patients. This study aimed to assess whether behaviour management strategies can be the effective methods for decreasing the need for GA and its over-utilisation in paediatric dentistry.
The patients (n = 240) aged 3–6 years old were selected from referrals by paediatric dentists (PD) or general dentists (GD) for dental treatment under GA. Each child’s behaviour during first and subsequent appointments was assessed using the Frankl Behaviour Rating Scale. A first visit included clinical examination and fluoride therapy. In all sessions, a hierarchy of anxiety-reducing behaviour guidance strategies was implemented over nine steps in a logical treatment order.
Overall, 47.5 % of children referred for dental treatments under GA were retrained to be treated routinely. False referrals were significantly higher in GD compared to PD group. 80.0 % of the referred children by PD and 6.7 % of those referred by GD were true GA cases and still needed GA. 20.1 % of retrained children and 67.4 % of true GA cases received conscious sedation. There was no significant change in the frequency of children considered uncooperative as the years of experience increased among GD, while this value was significant for PD.
The findings may highlight the importance of using behaviour management techniques thoroughly prior to referring an uncooperative child for treatment under GA, and may discourage its over-utilisation. Specifically, these skill sets and their efficient practice should be improved among general dentists.
KeywordsAnaesthesia, general Child behaviour Dental anxiety Paediatric dentistry Referral and consultation Child, preschool
Aminabadi and Shirazi contributed to conception and design, and critically revised the manuscript. Najafpour, Aghaee, Sighary Deljavan and Jamali contributed to data acquisition, analysis and interpretation, and drafted the manuscript. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.
We are grateful to the parents and children who participated in the study. The authors declare that they have no conflict of interest.
Compliance with ethical standards
The authors declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- AAPD Clinical affairs committee—sedation and general anesthesia subcommittee. Guideline on behaviour guidance for the pediatric dental patient. Pediatr Dent. 2012;34:170–82.Google Scholar
- AAPD Clinical Affairs Committee-Behavior Management Subcommittee; American Academy on Pediatric Dentistry Council on Clinical Affairs. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent. 2014;36:179–91.Google Scholar
- Aminabadi NA, Erfanparast L, Sohrabi A, et al. The impact of virtual reality distraction on pain and anxiety during dental treatment in 4–6 year-old children: a randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects. 2012;6:117–24.Google Scholar
- Frankl S, Shiere F, Fogels H. Should the parent remain with the child in the dental operatory? J Dent Child. 1962;29:150–63.Google Scholar
- Klooz DN, Lewis DW. Ontario dentists: practice variation in referrals to pediatric dentists. J Canad Dent Assoc. 1994;60:981–6.Google Scholar
- McDonald RE, Avery DR, Dean JA. Examination of the mouth and other relevant structures. In: McDonald RE, Avery DR, editors. Dentistry for the child and adolescent. 9th ed. St Louis: Mosby; 2011. p. 17.Google Scholar
- Pinkham JR. Patient managment. In: Pinkham JR, Casa Massimo PS, editors. Dentistry for the child and adolescent. 4th ed. Philadelphia: Elsevier Saunders; 2005. pp. 395–403.Google Scholar