An algorithm for treatment of children under general anesthesia

Introduction: Children indicated for general anesthesia are those with early childhood caries; with a high degree of anxiety from dental treatment, and those with special needs.Aim: The aim of this article is to create an algorithm for the complex treatment of children under general anesthesia.Materials and Methods: The object of observation were 992 teeth in 124 children with primary dentition, treated under general anesthesia. The treated teeth were separated into two groups with 496 teeth each, depending on the way of treatment. Observation units: count and relative share of tooth-related complications in relation to the used treatment methods.Results and Discussion: In the first examined group all the teeth diagnosed with periodontitis were extracted. The teeth diagnosed with pulpitis, which had a developed apex and no x-ray data of root resorption, were treated with extirpation and filling of the root canals with metapex, followed by obturation with glass ionomer cement (GIC). Only 1.2% (n=3) of them had complications.Conclusion: In order to prevent retreatment, a more radical therapy approach is mandatory. A basic principle in the treatment of these children is that it is consistent with a more severe differential diagnosis, in order to avoid complications.Keywords: general anesthesia, retreatment, radical approac

Study of the indications of dental treatment of children under general anesthesia

General anesthesia is a method of pharmacological behavior management of children. The children treated under general anesthesia (GA) are mainly 3 groups: children with early childhood caries (ECC);  anxious children and children with special health needs. The aim of this article is to  assess the main indications for the treatment under general anesthesia. Subject of monitoring of the retrospective  research are 396 children divided  into three age groups: up to 5 years, between 6 and 12 years and over 12 years.. The retrospective study includes determining the relative proportions of children treated under general anesthesia due to the indications, documented on medical records. Children with ECC are 95%  (188) of the children in the first group and 47.5% of all the children treated under general anesthesia. Children with specific health needs (SHN) - 67 patients (17%) of all treated children under general anesthesia and 80.64% of the children treated in the third age group. The behavioral management problem is - 78.4% of all indications for the second group and (47%) for all age groups. The relative share of children treated with narcosis due to an increased reflex for vomiting - 1.51% and surgical procedures - 2.27% is insignificant for all age groups.This result demonstrates the main indications for dental treatment under GA, which are: children with ECC- the main reason;  anxious children - the second most common indication for general anesthesia  and children with special health needs - the third most common cause of treatment under the GA

Dental status assessment of children treated under general anesthesia

Children treated under general anesthesia (GA) have a compromised dental status due to the specifics of their contingent. The aim of this article is to assess caries prevalence in a group of children treated under general anesthesia. Subject of monitoring of the clinical research are 396 children divided into three age groups: up to 5 years, between 6 and 12 years and over 12 years. The dental status was examined and registered according to WHO using the dmft/DMFT index. This index is higher in children in the group of children under 5 years (16.59±3.46) compared to 5-12 year old patients (10.66±1.79) and patients over 12 (9.96±1.74). There is a statistically significant difference in the incidence of dental caries between the first and second study groups, as between the first and third groups. The probable cause is the large number of children with early childhood caries (ECC) whose dmft index is the highest. High index values are mostly because of untreated complicated carious lesions. The number of obturated(f) and premature extracted(m) teeth is negligible. This result demonstrates more active cariogenic environment in children treated under general anesthesia. It is probably due to the reduced ability to create proper oral hygiene skills, due to physical disorders or the pain of complicated caries in children with early childhood caries and the need of prophylaxis is obvious

Evaluation of the dental status in special needs children

Introduction: Contemporary literature suggests that individuals with chronic diseases or special needs tend to have worse oral health, compared to the healthy population.Aim: The aim of this study is tо research the distribution of caries lesions in children with special needs.Materials and Methods: The observation was performed using the dmft/DMFT index.Results and Discussion: The total average dmft/dmf(T+t)/DMFT index was 14.28± 2.95. The final value of the index was higher in children from the youngest group 12 years (0.37 ± 0.59). The results from the registration of the dental status described a high prevalence of carious lesions in special needs children (SNC) treated under general anesthesia, which was a result of the main systemic disease and the side effects, experienced from the prescribed medicaments. Other reasons for the high carious lesion count in these children were the absence of proper oral hygiene habits due to sensory impairment and pain from complicated carious lesions, as well as neglected oral health due to care for the main systemic disorder.Conclusion: In SNC it is very important to focus on prophylaxis and special care for control of oral hygiene

Demographic characteristics of children treated under general anesthesia

General anesthesia is a method of pharmacological behavior management of children.The aim of this study is to assess the demographic characteristics of children treated under general anesthesia.Subject of monitoring are 396 children treated under general anesthesia divided into three age groups - up to 5 years; between 6 and 12 years, and from 12 to 18 years. Three periods of time: 2015 - 2016, 2016 - 2017, and 2017 - 2018 were studied. The relative share of girls and boys, the number of treated children from Varna and other regions, and the mean age of children treated under general anesthesia were calculated. Results: Girls treated under general anesthesia were fewer than boys in the three studied periods of time, with a relative share of 34% (n=133). The distribution by studied periods was as follows: n=10 (8%) for the period 2015-2016, n=30 (23%) for the period 2016-2017, n= 93 (69%) for the period 2017-2018. The mean age of the patients involved was 4.86 ± 3.27 years. Most of the surveyed population n=198 (50.12%) belonged to the youngest age group (1-5 years). The second age group (6-12) included 167 (42.27%) of the children surveyed and only 31 (7.6%) were over 12 years of age.Conclusion: The number of children treated under general anesthesia, both boys and girls, increased with each passing year. For the period 2016-2017, the number of these children was 2.5 times higher than in the previous period and about three times lower than the next (2017-2018)

Indications for dental treatment under general anesthesia

Pain control is a part of behavior management. If the pain is not controlled, it will affect the quality of work the dental practitioner can achieve. Dental treatment performed under general anesthesia allows dental practitioners to benefit from improved treatment conditions and provide better treatment. In addition, it also allows dentists to treat patients who otherwise cannot be treated in private dental offices, including children with high anxiety and/or phobias, poorly cooperative and non-cooperative children, patients with developmental disorders, patients with muscular control problems, patients with increased vomiting reflex. Many parents choose to treat their children under general anesthesia to reduce stress and increase comfort, and some children need this kind of treatment due to lack of cooperation due to early age, lack of maturity or physical/mental disorders

Assessment of fluoridе prophylaxis in children with mixed dentition in connection with the risk of early tooth loss

Properly implemented fluoride provides up to 80 percent reduction of dental caries, its complications and respectively premature tooth loss. The aim of the study is to assess fluoridе prophylaxis in children with mixed dentition in connection with the risk of early tooth loss. Subject of monitoring of the clinical research were 140 school children with mixed dentition. The clinical group consists of 90 children with prematurely extracted teeth. The patients from the clinical group were divided into three groups of 30 patients. The control group consists of 50 children with intact denture. А special questionnaire was filled from the parents of the examined child about the usage of fluoride prophylaxis (endogenous and exogenous intake of fluoride). The results show that a very small percentage of children had received optimal fluoride prophylaxis (endogenous and exogenous) - 20%. They are all in the control group. The children from the clinical groups use only fluoride toothpaste as a fluoride prophylaxis - about 78%. About 31% of them do not use any form of fluoride, even in the toothpaste, especially the children from the third group - 33,3%. Conclussion: The lack of fluoride prophylaxis leads to more premature extractions among the children with mixed dentition

Premature loss of primary teeth of children with mixed dentition

Временните зъби играят ключова роля в растежа и развитието на децата. Освен неоспоримото им значение за естетиката, храненето, говора, друга тяхна основна функция е запазване на място за постоянните зъби до техния пробив, както и правилното развитие на зъбните дъги и оклузията (6). Цел на настоящия литературен обзор е да разгледа рисковите фактори, водещи до преждевременна загуба на временни. Обзорът ни дава насоки за комплексна профилактика и лечение при деца с ранна загуба на временни зъби в зависимост от рисковия им профил.Primary teeth have a critical role in the growth and development of the children. In addition to their role in esthetics, eating, speech, the other main function of a primary tooth is to hold space for the permanent successor until it is ready to erupt, such as the normal development of the dental arches and the occlusion..The aim of the literature review is to present the risk factors of the early tooth loss .Тhe review can give a guidance for the complex treatment and prophylaxis of children with premature teeth loss, depending on their risk profile

Abnormal changes in the occlusion and the order of the teeth аs a result of the premature loss of one or a group of teeth

Съхранението на функционалната пълноценност на временните зъби до периода на физиологичната им смяна е условие за оформяне на нормална зъбно-челюстна система. За съжаление, въпреки превенцията и съвременните методи за лечение на пулпната патология понякога временните зъби не могат да бъдат запазени и тяхната ранна загуба е обективна необходимост. Преждевременната загуба на временни зъби е рисков фактор за възникване на зъбно-челюстни деформации. Целта на литературния обзор е да се проучат промените в нареждането на зъбите и оклузията, които настъпват след преждевременна загуба на временните зъби. Анализът на промените би начертал правилния комплексен подход на лечение на децата с преждевременна загуба на временни зъби.The preservation of the primary teeth to the period of their physiological exfoliation is necessary for forming a normal tooth-jaw system. Unfortunately, despite prevention and modern methods of the pulp pathology treatment, sometimes temporary teeth cannot be saved and their early loss is an objective necessity. The premature loss of the deciduous teeth is a risk factor for the occurrence of an orthodontic deformations. The aim of the literature review is to examine the changes in the order of teeth and occlusion that occur after premature temporary teeth loss. The analysis of this changes show the right holistic approach of treating the children with premature loss of deciduous teeth

Prevalence of dental decay among children suffering from congenital heart diseases

Introduction: In general, dental decay and periodontal diseases have low mortality, but both have high levels of distribution and are responsible for pain in the oral cavity region, loss of teeth, and represent risk factors for other systemic complications, especially among children.Aim: The aim of this article is to assess dental decay prevalence in a group of children with congenital heart diseases (CHDs) and to compare it with the same indicator in a group of healthy, age- and gender-matched controls.Materials and Methods: Subject of monitoring of the prospective clinical research are 100 children from Varna region. Half of them (n=50) were diagnosed with CHDs and the other half (n=50) were healthy controls. Both groups were also divided into two age groups: from 4 to 7 years of age (n CHDs = 25; n Ctr. = 25) and from 8 to 17 years of age (n CHDs = 25; n Ctr. = 25). The dental status was examined and registered according to WHO, using the dmft/DMFT index. Possible risk factors for dental caries development were also registered.Results: Children with CHDs had statistically significant higher mean values of dmft/DMFT indices than healthy controls (age group 4-7 years: 5.5±3.2 vs. 4.3±1.2; age group 8-17 years: 5.6±2.9 vs. 3.6±2.3). The registered fillings among patients with CHDs were scarce. A total of 71% of patients with CHDs were subjected to regular oral medications intake due to the main chronic disease. Children with heart anomalies were mainly of low socio-economic status and had not received more intensive dental prophylaxis than healthy controls. A total of 98% of all examined patients (n=100) were affected by dental decay (dmft/DMFT > 0).Conclusion:  The findings from this research clearly show that the group of children with CHDs are more severely affected by dental decay than the control group of healthy children. Children with CHDs are at disadvantage, because the development of oral diseases in these patients may affect their overall medical condition. Prolonged oral pharmacotherapy and low socio-economic status, which affect oral health, are possible risk factors for dental decay development in these medically compromised children