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The impact of general medical health status, demographical, and patient-specific variables on need for dental treatment of children and adolescents under general anesthesia

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Abstract

Objectives

Aim of this retrospective study was to examine the influence of general medical, demographical, and other patient-specific factors on the need for dental treatment under general anesthesia in children and adolescents at Saarland University Hospital. For assessment of the clinical treatment need, a mixed dt/DT (decayed teeth) was introduced.

Materials and methods

A total of 340 patients under 18 years of age who received restorative-surgical dental treatment between 2011 and 2022 were anonymously enrolled. Demographic and other patient-specific data, general medical health, oral health, and treatment related data were recorded. In addition to descriptive analysis, Spearman-Rho-test, Mann–Whitney-U-test, Kruskall-Wallis-test and Chi-square-test were used.

Results

More than half of the patients (52,6%) were in general health, but non-cooperative. The majority of the patients (66.8%) was between 1 and 5 years of age (p < 0,001). Mean dmft was 10.95 ± 4.118, mean DMFT was 10.09 ± 7.885, and mean dt/DT was 10.79 ± 4.273. Analysis showed that communication difficulties significantly influenced dmft (p = 0.004), DMFT (p = 0.019), and dt/DT (p < 0.001). Type of insurance significantly affected dmft (p = 0.004) and dt/DT (p = 0.001). There was no significant effect of ASA on caries experience, however on prevalence of severe gingivitis (p < 0.001), number of extractions (p = 0.002), and need for repeated treatment (p < 0.001).

Conclusions

Need for dental treatment in the present collective was high, independent of the considered variables. Non-Cooperativeness along with ECC was the main indication for dental general anesthesia. The mixed dt/DT was the most precise survey to evaluate clinical treatment needs.

Clinical relevance

Given the enormous demand for these rehabilitations with strict selection, it is imperative to create more treatment capacities for patients mandatorily requiring general anesthesia by avoiding it in healthy patients.

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Data Availability

The dataset used and analyzed in the present study is available from the corresponding author upon reasonable request.

References

  1. Schmoeckel J et al (2021) Oral health trends in children: results from the epidemiological surveys accompanying group prophylaxis in Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 64(7):772–781

    Article  PubMed  PubMed Central  Google Scholar 

  2. Benelli K et al (2022) Pattern of caries lesions and oral health-related quality of life throughout early childhood: a birth cohort study. Eur J Oral Sci 130(5):e12889

    Article  PubMed  Google Scholar 

  3. Weninger A et al (2022) Risk indicators and treatment needs of children 2–5 years of age receiving dental treatment under general anesthesia in Saskatchewan. Dent J (Basel) 10(1):8

    Article  PubMed  Google Scholar 

  4. Baghdadi ZD, Jbara S, Muhajarine N (2021) Children and parents perspectives on children’s dental treatment under general anesthesia: a narratology from Saskatoon, Canada. Eur Arch Paediatr Dent 22(4):725–737

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schulz-Weidner N et al (2022) Dental treatment under general anesthesia in pre-school children and schoolchildren with special healthcare needs: a comparative retrospective study. J Clin Med 11(9):2613

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schnabl D et al (2021) Medical diagnoses, mode of residence, and dental treatment demand under general anesthesia in special needs adults in Innsbruck, Austria. A retrospective breakdown of four and a half years. Healthcare (Basel) 9(3):279

    Article  PubMed  Google Scholar 

  7. Hempel E et al (2015) Oral health status of students with and without disabilities in Erfurt, Germany. Gesundheitswesen 77(4):263–268

    PubMed  Google Scholar 

  8. Ali HM et al (2017) Presence of plaque, gingivitis and caries in Sudanese children with congenital heart defects. Clin Oral Investig 21(4):1299–1307

    Article  PubMed  Google Scholar 

  9. Jaber MA (2011) Dental caries experience, oral health status and treatment needs of dental patients with autism. J Appl Oral Sci 19(3):212–217

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schulte AG, Schmidt P (2021) Oral health in persons with disability in Germany-an overview of the literature. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 64(7):793–801

    Article  PubMed  PubMed Central  Google Scholar 

  11. dos Santos Junior VE et al (2014) Early childhood caries and its relationship with perinatal, socioeconomic and nutritional risks: a cross-sectional study. BMC Oral Health 14:47

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lopes ABS et al (2022) Longitudinal evaluation of determinants of the clinical consequences of untreated dental caries in early childhood. Community Dent Oral Epidemiol 50(2):91–98

    Article  PubMed  Google Scholar 

  13. Jordan AR, Micheelis W (eds) (2016) Fünfte Deutsche Mundgesundheitsstudie (DMS V). IDZ-Materialienreihe, Bd. 35, ed. I.D.Z. Zahnärzte. Deutscher Zahnärzte Verlag DZV: Köln. 617

  14. Lampert T et al (2019) Gesundheitliche ungleichheiten bei kindern und jugendlichen in Deutschland – zeitliche entwicklung und trends der KiGGS-studie. J Health Monit 4(1):16–40

    Google Scholar 

  15. McCullough ML et al (2022) Association of socioeconomic and geographic factors with diet quality in US adults. JAMA Netw Open 5(6):e2216406

    Article  PubMed  PubMed Central  Google Scholar 

  16. Campbell RL et al (2018) Pediatric dental surgery under general anesthesia: non-cooperative children. Anesth Prog 65(4):225–230

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dougherty N (2009) The dental patient with special needs: a review of indications for treatment under general anesthesia. Spec Care Dentist 29(1):17–20

    Article  PubMed  Google Scholar 

  18. Schnabl D et al (2019) Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12 years. Clin Oral Investig 23(11):4157–4162

    Article  PubMed  Google Scholar 

  19. El Batawi HY (2014) Factors affecting clinical outcome following treatment of early childhood caries under general anaesthesia: a two-year follow-up. Eur Arch Paediatr Dent 15(3):183–189

    PubMed  Google Scholar 

  20. Doyle DJ, Goyal A, Garmon EH (2022) American Society of Anesthesiologists Classification. In: StatPearls. StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC., Treasure Island (FL)

  21. Hocevar LA, Fitzgerald BM (2022) American Society of Anesthesiologists Staging. In: StatPearls. StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC., Treasure Island (FL)

  22. Klein H, Palmer CE (1938) Studies on dental caries: V. familial resemblance in the caries experience of siblings. Public Health Rep (1896–1970) 53(31):1353–1364

  23. Moradi G et al (2019) Evaluation of oral health status based on the decayed, Missing and Filled Teeth (DMFT) Index. Iran J Public Health 48(11):2050–2057

    PubMed  PubMed Central  Google Scholar 

  24. Radic M et al (2015) Presentation of DMFT/dmft Index in Croatia and Europe. Acta Stomatol Croat 49(4):275–284

  25. Wyne AH (1999) Early childhood caries: nomenclature and case definition. Commun Dent Oral Epidemiol 27(5):313–315

    Article  Google Scholar 

  26. König T et al (2020) Retrospective study on risk factors for repeated dental treatment of children under general anaesthesia. Eur J Paediatr Dent 21(3):183–186

    PubMed  Google Scholar 

  27. Maes MS et al (2022) Risk factors for repeated general anesthesia for dental treatment of adult patients with intellectual and/or physical disabilities. Clin Oral Investig 26(2):1695–1700

    Article  PubMed  Google Scholar 

  28. Schnabl D et al (2020) Is dental general anaesthesia in children an outdated concept? A retrospective analysis. Eur J Paediatr Dent 21(4):283–286

    PubMed  Google Scholar 

  29. Boukhobza S et al (2021) Changes in oral health-related quality of life among Austrian preschool children following dental treatment under general anaesthesia. Clin Oral Investig 25(5):2821–2826

    Article  PubMed  Google Scholar 

  30. Jockusch J et al (2021) Outpatient, dental care of adult vulnerable patients under general anaesthesia-a retrospective evaluation of need for treatment and dental follow-up care. Clin Oral Investig 25(4):2407–2417

    Article  PubMed  Google Scholar 

  31. Grindefjord M et al (2018) Dental treatment and caries prevention preceding treatment under general anaesthesia in healthy children and adolescents: a retrospective cohort study. Eur Arch Paediatr Dent 19(2):99–105

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pecci-Lloret MP et al (2021) Dental treatments under general anesthesia on children with special health care needs enrolled in the Spanish dental care program. J Clin Med 10(2):182

    Article  PubMed  PubMed Central  Google Scholar 

  33. Choi J, Doh RM (2021) Dental treatment under general anesthesia for patients with severe disabilities. J Dent Anesth Pain Med 21(2):87–98

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sevekar S, Jha MN, Avanti A (2021) Characteristics and comparison of dental treatment under general anesthesia in healthy children and children with special healthcare needs: a retrospective study. Int J Clin Pediatr Dent 14(Suppl 2):S157-s161

    PubMed  PubMed Central  Google Scholar 

  35. Jordan RA et al (2014) The fifth german oral health study (Funfte Deutsche Mundgesundheitsstudie, DMS V) - rationale, design, and methods. BMC Oral Health 14:161

    Article  PubMed  PubMed Central  Google Scholar 

  36. Schmoeckel J et al (2019) Introducing a specific term to present caries experience in populations with low caries prevalence: Specific Affected Caries Index (SaC). Caries Res 53(5):527–531

  37. Chen CY et al (2014) Oral health status of children with special health care needs receiving dental treatment under general anesthesia at the dental clinic of Taipei Veterans General Hospital in Taiwan. J Chin Med Assoc 77(4):198–202

    Article  PubMed  Google Scholar 

  38. Wang N, Zhao YM (2018) Retrospective study of dental treatment under general anesthesia of 62 disabled children and adolescents. Beijing Da Xue Xue Bao Yi Xue Ban 50(2):293–299

    PubMed  Google Scholar 

  39. Lebrun-Harris LA et al (2021) Oral health among children and youth with special health care needs. Pediatrics 148(2)

  40. Alsaleh I et al (2012) Is endodontic treatment performed under general anaesthesia technically acceptable? Clin Oral Investig 16(6):1599–1606

    Article  PubMed  Google Scholar 

  41. Chung SH et al (2019) Periapical healing in single-visit endodontics under general anesthesia in special needs patients. J Endod 45(2):116–122

    Article  PubMed  Google Scholar 

  42. Linas N et al (2019) Conservative and endodontic treatment performed under general anesthesia: a discussion of protocols and outcomes. Spec Care Dentist 39(5):453–463

    Article  PubMed  Google Scholar 

  43. Bennett JD, Kramer KJ, Bosack RC (2015) How safe is deep sedation or general anesthesia while providing dental care? J Am Dent Assoc 146(9):705–708

    Article  PubMed  Google Scholar 

  44. Caputo AC (2009) Providing deep sedation and general anesthesia for patients with special needs in the dental office-based setting. Spec Care Dentist 29(1):26–30

    Article  PubMed  Google Scholar 

  45. El-Mowafy A et al (2019) Mortality and morbidity in office-based general anesthesia for dentistry in Ontario. Anesth Prog 66(3):141–150

    Article  PubMed  PubMed Central  Google Scholar 

  46. Michels S, Bansal N, Greene C (2021) Impact of follow-up visit timing recommendations after dental rehabilitation under general anesthesia. Pediatr Dent 43(6):470–474

    PubMed  Google Scholar 

  47. Armfield JM, Heaton LJ (2013) Management of fear and anxiety in the dental clinic: a review. Aust Dent J 58(4):390–407; quiz 53

  48. Delli K et al (2013) Management of children with autism spectrum disorder in the dental setting: concerns, behavioural approaches and recommendations. Med Oral Patol Oral Cir Bucal 18(6):e862–e868

    Article  PubMed  PubMed Central  Google Scholar 

  49. Thosar NR et al (2022) Effectiveness of two different behavior modification techniques for anxiety reduction in children. Cureus 14(8):e28141

    PubMed  PubMed Central  Google Scholar 

  50. Guney SE et al (2018) Dental anxiety and oral health-related quality of life in children following dental rehabilitation under general anesthesia or intravenous sedation: a prospective cross-sectional study. Niger J Clin Pract 21(10):1304–1310

    PubMed  Google Scholar 

  51. Inverso G et al (2016) Complications of moderate sedation versus deep sedation/general anesthesia for adolescent patients undergoing third molar extraction. J Oral Maxillofac Surg 74(3):474–479

    Article  PubMed  Google Scholar 

  52. Becker DE, Rosenberg M (2008) Nitrous oxide and the inhalation anesthetics. Anesth Prog 55(4):124–30; quiz 131–2

  53. Galeotti A et al (2016) Inhalation conscious sedation with nitrous oxide and oxygen as alternative to general anesthesia in precooperative, fearful, and disabled pediatric dental patients: a large survey on 688 working sessions. Biomed Res Int 2016:7289310

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study was statistically advised by the Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Saarland University, Homburg/Saar, Germany (S.W.)

Author information

Authors and Affiliations

  1. Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University Hospital, Homburg, Germany

    Tilman Kries, Stefan Rupf, Matthias Hannig, Jusef Naim & Madline P. Gund

  2. Chair of Synoptic Dentistry, Saarland University, Homburg, Germany

    Stefan Rupf

  3. Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University Hospital, Kirrberger Str. 100, Building 73, 66421, Homburg, Germany

    Madline P. Gund

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  1. Tilman Kries
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  2. Stefan Rupf
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Contributions

M.P.G. planned the study. T.K. and M.P.G conducted the study and defined inclusion and exclusion criteria. T.K. conducted the data collection.

M.P.G., T.K., M.H., S.R., J.N. analyzed and interpreted the data. T.K. and M.P.G. were major contributors in writing the manuscript. All authors edited and reviewed the draft manuscript and read and approved the final manuscript.

Corresponding author

Correspondence to Madline P. Gund.

Ethics declarations

Ethics approval

This study was approved by the Ethics Committee of the Saarland Medical Association (289/21).

Consent to participate

As this study was designed as retrospective analysis of anonymized data, formal consent was not required.

Conflict of interests

Tilman Kries, Stefan Rupf, Matthias Hannig, Jusef Naim and Madline P. Gund declare no conflict of interests.

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Kries, T., Rupf, S., Hannig, M. et al. The impact of general medical health status, demographical, and patient-specific variables on need for dental treatment of children and adolescents under general anesthesia. Clin Oral Invest 27, 4245–4257 (2023). https://doi.org/10.1007/s00784-023-05041-y

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