Predictors of dental general anesthesia receipt among children attending a tertiary hospital in Saudi Arabia

Aim: Children are normally treated in a dental chair, despite that some may have their treatment done under dental general anesthesia (DGA). Factors affecting the decision on DGA include the quality and quantity of treatment needed and child's age and cooperation. This study aimed to estimate the prevalence of DGA among children with dental caries and to identify the associated factors in a tertiary care setting in Saudi Arabia. Methods: A cross-sectional study of 400 children with dental caries was conducted. Data were collected from the patients' records including demographic, behavioral, and clinical information, diagnosis using caries indexes (Decayed, Missing, Filled Teeth/decayed filled teeth [dft]), and number of DGA and its indications. Logistic regression analysis was applied to identify the predictors of DGA, and significance was considered at P ≤ 0.05. Results: The study included 400 children; 55% of them were below the age of 6 years, with a mean age of 6.4 ± 2.3 years. About one-half of children were males (51.7%) and unhealthy (48.2%). The majority were of negative behavior (70.7%) and noncomplaint to dental appointments (70.3%). More than three-fourth of children (78.5%) experienced one or more DGA. GA use was significantly associated with gender (χ² = 4.30, P < 0.04), age (t = 12.37, P < 0.0001), health status (χ² = 16.02, P < 0.0001), dft index (z = 11.44, P < 0.0001), child behavior (χ² = 48.54, P < 0.0001), age at the first dental visit (t = 11.73, P < 0.0001), number of dental treatment visits (z = 11.14, P < 0.0001) and dental preventive visits (z = 7.21, P < 0.0001) before the index dental visit, and compliance with dental appointments (χ² = 39.50, P < 0.001). However, after adjusting for confounders, using the logistic regression analysis, DGA use was predicted by unhealthy children (odds ratio [OR] = 27.35, P = 0.002), those with a negative behavior (OR = 18.28, P = 0.003), and those with higher dft index (OR = 1.68, P < 0.001). Conclusions: Noncooperation, general health status, and dental caries level (dft) were the main factors for the decision of DGA. High caries-risk children must be the target for behavioral management to minimize their need for treatment under DGA. Post-DGA appointment to guide the child back to normal dental care is recommended.

Key-words:

Caries index - child behavior - dental - dental caries - general anesthesia - oral health - Saudi - uncooperative

Financial support and sponsorship

Nil.

Publikationsverlauf

Eingereicht: 18. Oktober 2020

Angenommen: 15. November 2020

Artikel online veröffentlicht:
14. Juli 2022

• References

• 1 Knapp R, Gilchrist F, Rodd HD, Marshman Z. Change in children's oral health-related quality of life following dental treatment under general anaesthesia for the management of dental caries: A systematic review. Int J Paediatr Dent 2017;27:302-12.
• 2 Farsi N, Merdad L, Mirdad S. Caries risk assessment in preschool children in Saudi Arabia. Oral Health Prev Dent 2013;11:271-80.
• 3 Nsour H, Almoherat F. Characteristics of children undergoing dental treatment under general anesthesia. J R Med Serv 2013;20:45-9.
• 4 Pitts N, Chadwick B, Anderson T. Children's Dental Health Survey 2013 Report 2: Dental Disease and Dam Age in Children England, Wales and Northern Ireland; 2015. Available from: http://content.digital.nhs.uk/catalogue/PUB17137/CDHS2013-Report2-Dental-Dis-ease.pdf. [Last accessed on 2017 Dec].
• 5 American Academy of Pediatrics. Recommendations for preventive pediatric health care. Pediatrics 2014;133:568-70.
• 6 Murshid EZ. Children's ages and reasons for receiving their first dental visit in a Saudi community. Saudi Dent J 2016;28:142-7.
• 7 Meera R, Muthu MS, Phanibabu M, Ratnaprabhu V. First dental visit of a child. J Indian Soc Pedod Prev Dent 2008;26:68-71.
• 8 Oliva MG, Kenny DJ, Ratnapalan S. Nontraumatic dental complaints in a pediatric emergency department. Pediatr Emerg Care 2008;24:757-60.
• 9 Wyne AH, Khan NB. Caries prevalence in 2 and 3 year old children of Adelaide, Australia. J Odontostomatol Tropic 1998;21:22-3.
• 10 Al-Shalan TA. Factors affecting Saudi parents' perception of their children's first dental visit. J Contemp Dent Pract 2003;15:54-66.
• 11 American Academy of Pediatric Dentistry (AAPD), Clinical Affairs Committeed Behavior Management Subcommittee. Guideline on behavior guidance for the pediatric dental patient. AAPD Reference Manual 2015;37:180e93.
• 12 Coté CJ, Wilson S; American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics 2019;143:e20191000.
• 13 Noura H, Hibah G, Aisha H, Reema N, Mohammad A. Dental general anesthesia in pediatric dentistry departments of all Dubai health authority sectors: Solutions to meet with the rising demands. EC Dent Sci 2018;17:913-20.
• 14 Chen YP, Hsieh CY, Hsu WT, Wu FY, Shih WY. A 10-year trend of dental treatments under general anesthesia of children in Taipei Veterans General Hospital. J Chin Med Assoc 2017;80:262-8.
• 15 Alcaino E, Kilpatrick NM, Smith ED. Utilization of day stay general anaesthesia for the provision of dental treatment to children in New South Wales, Australia. Int J Paediatr Dent 2000;10:206-12.
• 16 Savanheimo N, Miira M Vhkalahti. Preventive aspects in children's caries treatments preceding dental care under general anesthesia. Int J Paediatr Dent 2008;18:117-23.
• 17 Savanheimo N, Sundberg SA, Virtanen JI, Vehkalahti MM. Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service. BMC Oral Health 2012;12:45.
• 18 Dziedzic A. The role of general anaesthesia in special care and paediatric dentistry; inclusion criteria and clinical indications. SAAD Dig 2017;33:47-530.
• 19 Ramazani N. Different aspects of general anesthesia in pediatric dentistry: A review. Iran J Pediatr 2016;26:e2613.
• 20 Jamjoom MM, Al-Malik MI, Holt RD, El-Nassry A. Dental treatment under general anaesthesia at a hospital in Jeddah, Saudi Arabia. Int J Paediatr Dent 2001;11:110-6.
• 21 Jankauskienė B, Virtanen JI, Kubilius R, Narbutaitė J. Treatment under dental general anesthesia among children younger than 6 years in Lithuania. Medicina (Kaunas) 2013;49:403-8.
• 22 Savanheimo N, Vehkalahti MM, Pihakari A, Numminen M. Reasons for and parental satisfaction with children's dental care under general anaesthesia. Int J Paediatr Dent 2005;15:448-54.
• 23 Eidelman E, Faibis S, Peretz B. A comparison of restorations for children with early childhood caries treated under general anesthesia or conscious sedation. Pediatr Dent 2000;22:33-7.
• 24 Kakaounaki E, Tahmassebi JF, Fayle SA. Further dental treatment needs of children receiving exodontia under general anaesthesia at a teaching hospital in the UK. Int J Paediatr Dent 2006;16:263-9.
• 25 Grindefjord M, Persson J, Jansson L, Tsilingaridis G. Dental treatment and caries prevention preceding treatment under general anaesthesia in healthy children and adolescents: A retrospective cohort study. Eur Arch Paediatr Dent 2018;19:99-105.
• 26 Frankl SN, Shiere FR, Fogels HR. Should the parent remain with the child in the dental operatory? J Dent Child 1962;29:150-63.
• 27 Rajavaara P, Rankinen S, Laitala ML, Vähänikkilä H, Yli-Urpo H, Koskinen S, et al. The influence of general health on the need for dental general anaesthesia in children. Eur Arch Paediatr Dent 2017;18:179-85.
• 28 Albadri SS, Jarad FD, Lee GT, Mackie IC. The frequency of repeat general anaesthesia for teeth extractions in children. Int J Paediatr Dent 2006;16:45-8.
• 29 Yasir A, Kareem Y, Almunaiseer N, Aldosari M, Alturki Y. The experience of pediatric patients undergoing dental rehabilitation under general anesthesia in King Abdulaziz Medical City, Riyadh, Saudi Arabia. CPQ Med 2019;5:01-14.
• 30 Vinckier F, Gizani S, Declerck D. Comprehensive dental care for children with rampant caries under general anaesthesia. Int J Paediatr Dent 2001;11:25-32.
• 31 Bücher K, Rothmaier K, Hickel R, Heinrich-Weltzien R, Kühnisch J. The need for repeated dental care under general anaesthesia in children. Eur J Paediatr Dent 2016;17:129-35.
• 32 Lee PY, Chou MY, Chen YL, Chen LP, Wang CJ, Huang WH. Comprehensive dental treatment under general anesthesia in healthy and disabled children. Chang Gung Med J 2009;32:636-42.
• 33 Ba'akdah R, Farsi N, Boker A, Al Mushayt A. The use of general anesthesia in pediatric dental care of children at multi-dental centers in Saudi Arabia. J Clin Pediatr Dent 2008;33:147-54.
• 34 Savanheimo N, Vehkalahti MM. Five-year follow-up of children receiving comprehensive dental care under general anesthesia. BMC Oral Health 2014;14:154.
• 35 Klaassen MA, Veerkamp JS, Hoogstraten J. Dental treatment under general anaesthesia: The short-term change in young children's oral-health-related quality of life. Eur Arch Paediatr Dent 2008;9:130-7.
• 36 Heft MW, Meng X, Bradley MM, Lang PJ. Gender differences in reported dental fear and fear of dental pain. Community Dent Oral Epidemiol 2007;35:421-8.
• 37 Rodríguez Vázquez LM, Rubiños López E, Varela Centelles A, Blanco Otero AI, Varela Otero F, Varela Centelles P. Stress amongst primary dental care patients. Med Oral Patol Oral Cir Bucal 2008;13:E253-6.
• 38 Oosterink FM, de Jongh A, Aartman IH. What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting. Eur J Oral Sci 2008;116:44-51.
• 39 Savanheimo N, Vehkalahti MM. Preventive aspects in children's caries treatments preceding dental care under general anaesthesia. Int J Paediatr Dent 2008;18:117-23.