European Archives of Paediatric Dentistry

, Volume 17, Issue 2, pp 89–95 | Cite as

Use of general anaesthesia in paediatric dentistry: barriers to discriminate between true and false cases

  • N. A. Aminabadi
  • E. Najafpour
  • S. Aghaee
  • A. Sighari Deljavan
  • Z. Jamali
  • S. ShiraziEmail author
Original Article



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.


Anaesthesia, general Child behaviour Dental anxiety Paediatric dentistry Referral and consultation Child, preschool 


Author contribution

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

Ethical approval

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.


  1. 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
  2. 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
  3. Adair SM, Rockman RA, Schafer TE, Wilson CF. Survey of behavior management teaching in pediatric dentistry advanced education programs. Pediatr Dent. 2004;26:151–8.PubMedGoogle Scholar
  4. Aminabadi NA, Farahani RM. Correlation of parenting style and pediatric behavior guidance strategies in the dental setting: preliminary findings. Acta Odontol Scand. 2008;66:99–104.CrossRefPubMedGoogle Scholar
  5. 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
  6. Bimstein E, Azari AF, Riley JL. Predoctoral and postdoctoral students’ perspectives about pediatric dental behavior guidance. J Dent Educ. 2011;75:616–25.PubMedGoogle Scholar
  7. Cotton KT, Seale NS, Kanellis MJ, et al. Are general dentists’ practice patterns and attitudes about treating Medicaid-enrolled preschool age children related to dental school training? Pediatr Dent. 2001;23:51–5.PubMedGoogle Scholar
  8. Dailey YM, Milsom KM, Pilkington L, et al. A qualitative investigation of the influence of time since graduation on English dentists’ approach to the care of young children. Int J Paediatr Dent. 2007;17:336–44.CrossRefPubMedGoogle Scholar
  9. Eaton JJ, McTigue DJ, Fields HW Jr, Beck M. Attitudes of contemporary parents toward behavior management techniques used in pediatric dentistry. Pediatr Dent. 2005;27:107–13.PubMedGoogle Scholar
  10. 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
  11. Ghasemi H, Murtomaa H, Torabzadeh H, Vehkalahti MM. Knowledge of and attitudes towards preventive dental care among Iranian dentists. Eur J Dent. 2007;1:222–9.PubMedPubMedCentralGoogle Scholar
  12. Hicks CG, Jones JE, Saxen MA, et al. Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies. Anesth Prog. 2012;59:3–11.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Hosey MT. Managing anxious children: the use of conscious sedation in paediatric dentistry. Int J Paediatr Dent. 2002;12:359–72.CrossRefPubMedGoogle Scholar
  14. Hunter ML, Oliver R, Lewis R. The effect of a community dental service outreach programme on the confidence of undergraduate students to treat children: a pilot study. Eur J Dent Educ. 2007;11:10–3.CrossRefPubMedGoogle Scholar
  15. Klooz DN, Lewis DW. Ontario dentists: practice variation in referrals to pediatric dentists. J Canad Dent Assoc. 1994;60:981–6.Google Scholar
  16. Landier W, Tse AM. Use of complementary and alternative medical interventions for the management of procedure-related pain, anxiety, and distress in pediatric oncology: an integrative review. J Pediatr Nurs. 2010;25:566–79.CrossRefPubMedGoogle Scholar
  17. Lynch CD, Ash PJ, Chadwick BL, Hannigan A. Evaluation of a U.K. community-based clinical teaching/outreach program by former dental students two and five years after graduation. J Dent Educ. 2010;74:1146–52.PubMedGoogle Scholar
  18. Massey CS, Skelton J, Wrightson AS, Smith TA. Advanced general dentistry program directors’ attitudes and behaviors regarding pediatric dental training for residents. J Dent Educ. 2008;72:344–51.PubMedGoogle Scholar
  19. 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
  20. McQuistan MR, Kuthy RA, Daminano PC, Ward MM. General dentists’ referrals of 3- to 5-year-old children to pediatric dentists. J Am Dent Assoc. 2006;137:653–60.CrossRefPubMedGoogle Scholar
  21. Oliveira MM, Colares V. The relationship between dental anxiety and dental pain in children aged 18 to 59 months: a study in Recife, Pernambuco State, Brazil. Cad Saude Publica. 2009;25:743–50.CrossRefPubMedGoogle Scholar
  22. Paryab M, Hosseinbor M. Dental anxiety and behavioral problems: a study of prevalence and related factors among a group of Iranian children aged 6-12. J Indian Soc Pedod Prev Dent. 2013;31:82-6.CrossRefPubMedGoogle Scholar
  23. 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
  24. Rosenberg M; American Dental Association. New guidelines for the use and teaching of general anesthesia and sedation by dentists. J Mass Dent Soc. 2010;58:22–7.PubMedGoogle Scholar
  25. Sharath A, Rekka P, Muthu MS, Prabhu VR, Sivakumar N. Children’s behavior pattern and behavior management techniques used in a structured postgraduate dental program. J Indian Soc Pedod Prev Dent. 2009;27:22–6.CrossRefPubMedGoogle Scholar
  26. Tyrer GL. Referrals for dentals general anaesthetics -how many really need GA? Br Dent J. 1999;187:440–3.PubMedGoogle Scholar
  27. Wilson S. Pharmacological management of the pediatric dental patient. Pediatr Dent. 2004;26:131–6.PubMedGoogle Scholar
  28. Wilson S, Alcaino EA. Survey on sedation in paediatric dentistry: a global perspective. Int J Paediatr Dent. 2011;21:321–2.CrossRefPubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2015

Authors and Affiliations

  • N. A. Aminabadi
    • 1
  • E. Najafpour
    • 1
  • S. Aghaee
    • 1
  • A. Sighari Deljavan
    • 2
  • Z. Jamali
    • 3
  • S. Shirazi
    • 2
    Email author
  1. 1.Department of Paediatric Dentistry, Faculty of DentistryTabriz University of Medical ScienceTabrizIran
  2. 2.Dental and Periodental Research Centre, Faculty of DentistryTabriz University of Medical ScienceTabrizIran
  3. 3.Department of Oral Science, Faculty of DentistryTabriz University of Medical ScienceTabrizIran

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