Dental care under general anaesthesia in public oral health services : longitudinal perspectives

This study evaluated the dental general anaesthesia (DGA) process in Helsinki Public Dental Service (PDS). The aims were to describe the characteristics of the DGA patients, the parents descriptions of their children s previous dental care, to assess the dental care that precedes DGA, the reasons for having to resort to DGA, the treatments performed under DGA, and the long-term outcome of DGA. Three groups of DGA patients comprised the data. Study group 1 included all generally healthy (GH) patients aged 0 16 years treated under DGA in 2001 (n=102). Study group 2 included all GH patients aged 0 13 years treated under DGA in 2004 (n=199), and the study group 3 included all patients including those that were not GH treated under DGA in 2010 (n=349). The data were obtained from patient documents and from a questionnaire given to the parents of children treated under DGA in 2001. The three study groups were restricted to include 0 13-year-old GH patients for longitudinal comparisons. Most of the DGA patients in the Helsinki PDS were GH children in 2010. A comparison of the 0 5-year-old GH DGA children showed that the proportion of immigrants increased from 30% in 2004 to 51% in 2010. Conscious sedation had been used for more than half of the patients before DGA. Parents reported in 2001 that the first difficulties in the child s dental care were noticed when the child was younger than 3 years of age for 39% of that study group, and dental fear followed by pain were the most important reasons for previous unsuccessful dental care. The most frequent reasons for the referrals in 2004 and 2010 for DGA were extreme uncooperation, extreme dental fear and need for extensive treatments. The reason of avoidance of dental fear was introduced in 2010. Restorations, followed by tooth extractions, dominated the treatment-mix performed under DGA. The treatment need was extensive, even more for immigrants than for non-immigrants. The GH 0 13-year-olds that were treated under DGA in 2004 were followed-up for a mean of 47.6 (13.7 SD) months. The first visit of the patients to their home dental clinic after DGA generally occurred on a far later date than that recommended. The mean time elapsed to the first operative treatment need was 18.5 (14.1 SD) months. More than half (53%) of patients expressed dental fear and 54% were uncooperative during the follow-up. Familiarization in order to control dental fear was given to only 13% of the patients. Emergency treatment was given to 52% of the patients and 65% missed at least one appointment. DGA could probably be avoided for GH children. However, this requires earlier intervention. Special attention is needed with immigrant families. DGA is an essential part of the PDS care, even if there are some aspects of the DGA process that need more considerations and improvements.Terveyskeskuksen hammashoidon nukutuspotilaista pääosa yleisterveitä lapsia Helsingin terveyskeskuksessa tehdään hammashoitoa nukutuksessa vuosittain yli 400 potilaalle. Hammashoito tehdään nukutuksessa kun se ei muulla tavoin onnistu. Potilaista pääosa on yleisterveitä lapsia. Heillä nukutushoito voisi mahdollisesti olla vältettävissä, jos siihen johtaneet ongelmat tunnistettaisiin ajoissa. Nukutuksessa kaikki tarvittavat hoidot tehdään samalla käynnillä. Tavoitteena on, että mahdollisimman moni potilas pystytään nukutuksen jälkeen hoitamaan normaaliin tapaan. Tutkimukseni osoittaa, että useimmille nukutuspotilaille oli kertynyt paljon hoidettavaa. Pelkoa lieventävän esilääkityksen käyttö ei ollut näillä potilailla auttanut hoidon loppuun saattamisessa aiemmilla hammashoitokäynneillä. Lähes puolella lapsista hoitovaikeudet olivat alkaneet jo ennen kolmatta ikävuotta, ja vanhempien mukaan hammashoitopelko ja kipu olivat suurimpia syitä aikaisempiin epäonnistuneisiin hoitoihin. Hammaslääkärien lähetteiden perusteella yleisimmät syyt nukutushoitoon olivat vaikea yhteistyökyvyttömyys, hammashoitopelko ja laaja hoidon tarve. Nukutuksessa tehtiin yleisimmin paikkauksia ja poistoja. Hoidon tarve oli suuri, etenkin ulkomaalaistaustaisilla lapsilla. Heidän osuutensa nukutuksessa hoidetuista kasvoi vuosien 2004 ja 2010 välillä. Nukutushoidon tulosten turvaamiseksi potilaiden olisi kolmen kuukauden kuluessa pitänyt palata omaan hoitolaansa saamaan tehostettua ehkäisevää hoitoa ja totuttelemaan hammashoitoon hammashoitopelon voittamiseksi. Valitettavasti potilaat palasivat omaan hoitolaansa paljon suositeltua myöhemmin. Monilla potilaista hoitovaikeudet jatkuivat myös nukutushoidon jälkeen. Kuitenkin lähes 40 %:lla potilaista suun terveys säilyi nukutuksessa saavutetulla tasolla kahdesta viiteen vuotta nukutuksen jälkeen. Nukutushoitoon päätyminen olisi ilmeisesti ehkäistävissä osalla yleisterveistä lapsista, mikäli suun terveydenhuolto tavoittaisi heidät ja tunnistaisi heidän erityistarpeensa aikaisemmin. Erityistä huomioita tulisi kiinnittää ulkomaalaistaustaisiin perheisiin. Nukutushoitoprosessissa on edelleen kehittämistä vaativia kohtia. Silti tämä hoitomuoto on tärkeä osa terveyskeskuksessa tarjottavaa hoitoa. Väitöstutkimukseni kohdistui vuosina 2001, 2004 ja 2010 tehtyihin hoitoihin. Selvitin näiden potilaiden aiempien hoitojen sujumista potilasasiakirjoista sekä lasten vanhemmille tehdyllä kyselyllä. Lisäksi selvitin, miksi hammaslääkärit lähettivät lapsia nukutushammashoitoon ja minkälaista hammashoitoa nukutuksessa tehtiin. Lopuksi arvioin hoitoprosessin toimivuutta ja tutkin, miten lasten suunterveys ja hoidossa käynti muuttuivat nukutushoitoa seuranneiden viiden vuoden aikana.

Five-year follow-up of children receiving comprehensive dental care under general anesthesia

Abstract Background Dental general anesthesia (DGA) is part of public dental care in Finland, but the intention is to return the patient to routine dental care. The aims of this study were to describe the details of treatments under DGA given to generally healthy children and to explore the outcome of their dental care during a 5-year follow-up, with special focus on preventive care. In particular, we examined the return of the patients to routine dental care, of which, to our knowledge, little is known. Methods Our prospective 5-year follow-up of generally healthy children (aged 0–13 years) treated under DGA by the Helsinki Public Dental Service in 2004 was based on official dental and general anesthesia documents. The statistical analyses employed chi-square tests, t-tests, Pearson’s correlation coefficient (r), Fisher’s transformation to test r ≠ 0, and logistic regression modeling. Results The most common reason for DGA was uncooperation (82%), followed by dental fear (56%). Filling therapy predominated in the treatments given under anesthesia, and the mean number of treatments per patients was 9.5 (SD = 4.2). Throughout the follow-up, 54% of the patients continued to have co-operation problems and 53% expressed dental fear; 11% of the patients received repeat DGA. The mean follow-up time was 48 (median 52) months. The postoperative review visit was actualized within 1.5 (SD = 0.8) months and the first visit to the home dental clinic of the patients in 12.0 (SD = 11.8) months for the 0–5-year-olds and in 7.2 (SD = 5.9) months for the 6–13-year-olds (p < 0.001). The mean time elapsed to the first need for treatment was 18.5 (SD = 14.1) months. During the follow-up, the mean number of treatments per patient was 5.3 (SD = 4.9); almost all patients (97%) received preventive treatment at one of two visits, but the control of dental fear remained rare. Conclusions To return to routine dental care after DGA, most of the generally healthy children in our study still needed special attention due to their uncooperation and dental fear, thus calling for a renewal of practices to treat these patients

Five-year follow-up of children receiving comprehensive dental care under general anesthesia

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Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service

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