To investigate positive inhibitory measures against severe caries thought to develop in nursing infants, we examined the nursing environment of intensive care infants under general anesthesia at Matsumoto Dental College\u27s Department for dental treatment from January 1989 through December 1993

IMANISHI TAKAHIRO

KUNESHITA TAKASHI

MIYAZAWA HIROO

MIZUSHIMA HIDETO

OSUGA NAOTO

English

application/pdfTo investigate positive inhibitory measures against severe caries thought to develop in nursing infants, we examined the nursing environment of intensive care infants under general anesthesia at Matsumoto Dental College's Department for dental treatment from January 1989 through December 1993.journal articl

OSUGA, NAOTO

MIZUSHIMA, HIDETO

KUNESHITA, TAKASHI

MIYAZAWA, HIROO

IMANISHI, TAKAHIRO

Matsumoto Dental University Repository

(Clinical Report] Matsumoto Shigaku 20 : 76--79, lgg4             key words : multiplex caries - enyironmental suryey - general anesthesiaEnvironmental Survey of Dental Treatment for Intensive Care Infants under General AnesthesiaCareNAOTO OSUGA HIDETO MIZUSHIMA TAKASHI KUNESHITAHIROO MIYAZAWA and TAKAHIRO IMANISHI    DePartment of Pedodontics, Matsumoto Dental College                (Chief : Prof T. Imanishi)NAOKI HAYASHI TOMOYASU TAKEUCHI and ISAO HIROSE  Dapartment of Anesthesiology. A4atsumoto Dental College                (Chief:Prof I. Hirose)Summary       To investigate positive inhibitory measures against severe caries thought to develop in    nursing infants, we examined the nursing environment of intensive care infants under    general anesthesia at Matsumoto Dental College's Department for dental treatment from    January 1989 through December 1993.                                    Introduction    According to many reports including a fact finding study of odontopathies, deciduous carieshave decreased since its peak in the 1950's"2). Deciduous caries, which involves multiple mutually-related factors from the onset, is considered to be greatly influenced by the infant's nursingenvironment and in particular, in infants with immature dental quality just after eruption. Despiterecent decreases in the number of caries, deciduous caries tends to bipolarize into severe and slight,caries to a remarkable extent in younger infants. Therefore, to investigate positive inhibitorymeasures against severe caries thought to develope in nursing infants, we examined nursingenvironments of intensive care infants under general anesthesia at our Department between January1989 and December 1993.                               Materials and Methods    The subjects included 102 infants with severe caries more than one tooth (50 males, 52 females),subjected to intensive treatment under general anesthesia for reasons of early age, non-cooperation,remote site of caries and others similar factors.    In these 102 cases, information regarding living environment, suckling nutrition in infancy,weaning period, regularity of suckling, possible unbaianced dietsnacking, quantity and severity ofcaries condition, type and duration of treatment, age at onset of treatment, and toothbrushing habits(1994{li 3 E 31 H "Ls!Åqiee)                                  zaJ4ÅqtsE=]Y!L; 20(1) 1994 77obtained from questionnaires and interviews with guardians were extracted and analyzed.                                        Results  1. Age.    The infants treated under general anesthesia were predominantly 3 years of age, followed by   those 2 years of age. These 2- and 3-year old infants represented 73.5 % of all affected infants    (Table 1).    In descending order suckling was done by breast, followed by mixed and artificial formulas.    Regularity of suckling was as low as 22.5 % overall. Automatic feeding being 61.7 O/o (Table 2,    3).  3. Weaning.    In terms of the mean month-age of weaning, generally, the latter was remarkably late, and               Table 1: Age Table 6: Characters of affected infants Unit:%' Male Female total %On-ly 1 1 2 1 .92 y 16 16 32 31 .43 y 20 23 43 40 .24 y 7 9 16 15 .75 y 2 4 6 5 .96Y over 2 1 3 2 .9Table 2 : Suckling Unit: %oInpatientOutpatientMother'smilkMixedArtifical53.340.519.130.528.629.0Table 3 : Suckling Unit: %Inpatient OutpatientRegularlyIrregularly22.577.546.553.5Table 4 : Weaning Unit : %Age(months) InpatientOut patientlessthan12m 23.0 22. o18m 45.1 49. o24m 20.9 9. o'30m 5.5 15. 530mAfter 5.5 4. 5Table 5 : Eating between meals Unit: %oInpatient OutpatientRegularlyIrregularlyObscure36.357.95.869.526.54.0In patientOut patient Totalspoiled 42.1 36.5 79.4selfish 39.2 32.0 71.9blubberer 43.1 51.5 95.4nervous 25.4 21.0 46.9shy 25.4 10.5 36.4reasonable 6.8 13.0 19.9courageous 3.9 o 3.9others 4.9 8.0 12.9Table 7:             .Caries contractlng condition Unit: teeth      Cl    CINC2      C2    C2-"C3      C3    C3--C4      C4secondary cariesTable 8 : Anesthesia 85101698238226 28 70The average operation timeThe average anesthesia time     Rapid mduction     Slow mduction  Nasotracheal intubation  Orotracheal intubationTable 9 : Recall system1762115Å}386Å}4126 case76 case99 case3 caseUnit:5rn7mcasesdiscontinuation contmuatlon   obscure78 Osuga, et al. : Environmental Survey of Dental Treatment for Intensive Care Infants under General Anesthesia    several infants were not yet completely weaned. At all, approxinately 20% of the infants had    an ill-defined period of weaning (Table 4).   4. Eating between meals.    In terms of dietary habits, infants with an imbalanced diet consisting mostly of vegetables, 'meat    and fish or solid materials represented one third of the whole. Infants permitted to snack more    than twice a day represented a high percentage, and those with irregular dietary habit re-    presented 57.8 % of the whole. A high frequency of cosuming various drinks such as lactic drink,    juice and the like was also noted (Table 5).   5. Characters.    A high percentage of the affected infants, as observed by their guardians tended to be selfish,    whining and spoiled (Table 6).   6. Caries contracting condition.    Treatment tended to necessarily rely on reparation because caries ranged as high as C2 -- C3 for    almost all affected infants (Table 7).   7. Anesthesia.    Treatment time averaged 211.6Å}41.7 minutes. Anesthesia was performed by endotracheal    intubation in all cases and by nasotracheal intubation and slow induction in a high percentage    (Table 8) of cases.  8. Recall system.    In terms of post-treatment control, 60 % of the post-intensive care infants under general    anesthesia continued receiving periodic check-ups, while 36 % discontinued post-treatment    (Table 9).                                      Discussion    Since early onset and progression of dental caries has a mutual complicated connection withoral and nursing environments, investigating their causes is importanti'2). Especially, a poor nursingenvironment for infants frequently leads to the onset of severe caries, and thus to particularityintensive treatment under general anesthesia. As clearly shown by the present survey, attitudes ofthe persons responsible for infant nursing to issues such as the timing of weaning are thought tohave an important influence on the degree and severity of caries. Notably, a high percentage ofinfants with long-term suckling or irregular snacking were seen to be the infants in this study. Thenecessity of the stages, of growth of oral function was also thought to be important3•`).                                      References1) Miyazawa, H., Nanba, H., Seiki, K., Karasawa, S., Kaneko, H., Imanishi, T., Takeuchi, T., Hayashi,   N. and Hirose, I. (1990) Study of the intensive care under general anesthesia at the Department of   Pedodontics of Matsumoto Dental College (in Japanese, English abstract). J. Pedodont. 28 : 1117-1129.2) Miyazawa, H., Fukaya, Y., Tsuchiya, A., Hasegawa, T. and Imanishi, T. (1990) Fact-finding in   outpatients of the Department of Pedodontics of Matsumoto Dental College (in Japanese, English   abstract). Matsumoto Shigaku, 16 : 195-208.3) Hashimoto, Y., Miyashin, M., Ishikawa, M. and Ono, H., (1985) Dental treatment for children under   general anesthesia during a 20 year period. (in Japanese, English abstract) J. Pedodont. 23 : 874-884.4 ) Kato, K., Yasufuka, Y., Otsuchi T., Morisaki, I., Ooshima, T. and Sobue, S. (1986) Dental treatment for   handicapped children under general anesthesia at the pedodontic clinic in Osaka University Dental   Hospital. (in Japanese, English abstract) J. Pedodont. 24 : 812-818.ilZ}JlsitwE:]iL4 20(1) 1994 79tessu : aijwtmTst piA.ffsea)-,Rts-wafiJJX( th es fiL yK., zKkesJit, `fÅq.tKT k tg"vit*{}Je, wtxeJM( fiLW, 6trusiS(ge, ilincffittiJki(11E]rJzX'dvJit • ijxJHLtsFl-)(tE}J4sctsJk( • ts1}Ffipt) tsiF"utre=k4=diEiir erk V bZ) E -if- 6 g Åq aWkh: 6 va7R130tEF,fk ig tO - P et\Ltw 5 en ogfiIL L tw7Jxth nthK:pu. N) 6 in. -( L N 6. \Lts 5 tw e:2 Åq o es pa io KS )wa Il[ ec ee4 L ee fi '9- 6 Ss pa ttk O ut re.. wC' to b , ag ee ff ÅrHL Wm esOX 5 ptme,=.,,etwtJS( * Åq rvsyew L, di diELKcD illptfsvaes igJtsS- 6IXt liwa}H.e2 t" )2 6DSfiNeXK- v h L 6 2tL-c LN 6. 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Environmental Survey of Dental Treatment for Intensive Care Infants under General Anesthesia

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