Children Receiving Dental Care Under General Anesthesia
The mean age of the DGA patients treated in 2004 was 6.2 (SD = 2.7) years; half were girls and nearly 60% were under 6 years of age. Table 1 summarizes the DGA patient characteristics. One out of four patients were immigrants, the 0–5-year-olds more often than the older age group (p = 0.03). Previously received conscious sedation (80%) and DGA (23%) were more frequent among the 6–13-year-olds than among the younger patients (p < 0.001).
The vast majority of the patients had uncooperation problems as the reason for DGA and more than half showed extreme dental fear, the 6–13-year-old patients more often than the younger (p = 0.001 and p < 0.001, respectively). An excessive need for treatment was more frequent in the 0–5-year-old patients (p < 0.001).
Almost all of the patients received filling therapy under DGA (Table 2), over two-thirds received extractions, half were given endodontics, and one-fifth fissure sealants. Preventive treatment was rare at the DGA visit. The greatest differences between the age groups were in providing endodontics and fissure sealants. More than half of the 0–5-year-olds and one out of three of the 6–13-year-olds received endodontics (p < 0.001). One out of three of the 6–13-year-olds and one out of 10 of the 0–5-year-olds received fissure sealants (p < 0.001).
At the DGA visit, the mean number of treatments (filling therapy, tooth extraction, endodontics, and fissure sealants) per patient was 9.5 (SD = 4.2), being 10.5 (SD = 4.0) for 0–5-year-olds and 8.2 (SD = 4.1) for 6–13-year-olds (p < 0.001). Immigrants had more treatments performed at the DGA visit than had their non-immigrant counterparts (10.7 (SD = 4.6) vs. 9.1 (SD = 4.0); p = 0.03). Among all items of treatment, filling therapy predominated in the treatment mix, followed by extractions (Figure 2).
(Enlarge Image)
Figure 2.
Treatment mix provided (%) at the dental general anesthesia visit according to age group.
The length of the follow-up averaged 47.6 months (SD = 13.7). Most of the patients could be followed for a lengthy period: the median was 51.5 months, the upper quartile being 56.2 and the lower one 44.8 months.
A postoperative review visit was scheduled for 186 out of 199 patients; 26% missed this appointment. Those 13 patients for whom a postoperative review visit was not scheduled were instructed to contact their home dental clinic within 3 to 6 months. Immigrants attended the postoperative review visit more often than non-immigrants (85% vs. 70%; p = 0.05).
The mean time elapsed from DGA to the postoperative review visit was 1.5 (SD = 0.8) months (Table 3). After DGA, the time interval until the first visit to the patients' home dental clinic was 12.0 (SD = 11.8) months for the 0–5-year-olds and 7.2 (SD = 5.9) months for the 6–13-year-olds. The mean time that elapsed to the first treatment need after DGA was 18.5 (SD = 14.1) months. The 0–5-year-old patients appeared to remain healthy for longer than the older patients (19.6 vs. 16.9 months), but the difference was statistically non-significant. Those 11% who were treated under repeat DGA received it on average 22.5 (SD = 12.6) months after the initial DGA.
Of the patients in follow-up (n = 188), 13% needed no operative treatment during their follow-up period, while 25% were in need of operative treatment not earlier than 2 years after DGA treatment (Figure 3). During the first year after DGA, 39% needed operative treatment, half of them during the first 6 months.
(Enlarge Image)
Figure 3.
The first need for treatment following dental general anesthesia according to the length of follow-up.
There was wide variation in the time elapsed from DGA to the first recording of treatment need. To explain this, we fitted logistic regression models to the data, taking as separate outcomes a short (≤12 months) and a long (25+ months) period. None of the explanatory variables tested (the patients' background information, reasons for DGA, and treatments given under DGA) ended up with statistically significant results.
Table 4 provides the percentages of patients undertaking various types of visits during the follow-up. At their visits, more than half of the patients showed total uncooperation or dental fear, and one out of five received conscious sedation. Visits with total uncooperation were more frequent among boys than girls (62% vs. 45%; p = 0.03). Preventive treatment was given to almost all, emergency treatment to half of the patients and control of dental fear to 13% of patients. Two out of three missed one or more appointments. Of the average number of visits per patient (9.7; SD = 5.6), 4.9 included prevention and 0.2 control of dental fear. There were no differences according to age or immigrant background in the number of the preventive visits, which were more frequent when the follow-up was longer (r = 0.48; p < 0.001).
The mean number of treatments during the follow-up was 5.3 (SD = 4.9), including a mean of 4.2 (SD = 4.2) fillings, 0.8 (SD = 1.2) tooth extractions, and 0.3 (SD = 1.1) endodontics, the maximum number being 24 during 5 years. There were no differences between the age groups.
Results
Patients
The mean age of the DGA patients treated in 2004 was 6.2 (SD = 2.7) years; half were girls and nearly 60% were under 6 years of age. Table 1 summarizes the DGA patient characteristics. One out of four patients were immigrants, the 0–5-year-olds more often than the older age group (p = 0.03). Previously received conscious sedation (80%) and DGA (23%) were more frequent among the 6–13-year-olds than among the younger patients (p < 0.001).
DGA Visit
The vast majority of the patients had uncooperation problems as the reason for DGA and more than half showed extreme dental fear, the 6–13-year-old patients more often than the younger (p = 0.001 and p < 0.001, respectively). An excessive need for treatment was more frequent in the 0–5-year-old patients (p < 0.001).
Almost all of the patients received filling therapy under DGA (Table 2), over two-thirds received extractions, half were given endodontics, and one-fifth fissure sealants. Preventive treatment was rare at the DGA visit. The greatest differences between the age groups were in providing endodontics and fissure sealants. More than half of the 0–5-year-olds and one out of three of the 6–13-year-olds received endodontics (p < 0.001). One out of three of the 6–13-year-olds and one out of 10 of the 0–5-year-olds received fissure sealants (p < 0.001).
At the DGA visit, the mean number of treatments (filling therapy, tooth extraction, endodontics, and fissure sealants) per patient was 9.5 (SD = 4.2), being 10.5 (SD = 4.0) for 0–5-year-olds and 8.2 (SD = 4.1) for 6–13-year-olds (p < 0.001). Immigrants had more treatments performed at the DGA visit than had their non-immigrant counterparts (10.7 (SD = 4.6) vs. 9.1 (SD = 4.0); p = 0.03). Among all items of treatment, filling therapy predominated in the treatment mix, followed by extractions (Figure 2).
(Enlarge Image)
Figure 2.
Treatment mix provided (%) at the dental general anesthesia visit according to age group.
Follow-up
The length of the follow-up averaged 47.6 months (SD = 13.7). Most of the patients could be followed for a lengthy period: the median was 51.5 months, the upper quartile being 56.2 and the lower one 44.8 months.
A postoperative review visit was scheduled for 186 out of 199 patients; 26% missed this appointment. Those 13 patients for whom a postoperative review visit was not scheduled were instructed to contact their home dental clinic within 3 to 6 months. Immigrants attended the postoperative review visit more often than non-immigrants (85% vs. 70%; p = 0.05).
The mean time elapsed from DGA to the postoperative review visit was 1.5 (SD = 0.8) months (Table 3). After DGA, the time interval until the first visit to the patients' home dental clinic was 12.0 (SD = 11.8) months for the 0–5-year-olds and 7.2 (SD = 5.9) months for the 6–13-year-olds. The mean time that elapsed to the first treatment need after DGA was 18.5 (SD = 14.1) months. The 0–5-year-old patients appeared to remain healthy for longer than the older patients (19.6 vs. 16.9 months), but the difference was statistically non-significant. Those 11% who were treated under repeat DGA received it on average 22.5 (SD = 12.6) months after the initial DGA.
Of the patients in follow-up (n = 188), 13% needed no operative treatment during their follow-up period, while 25% were in need of operative treatment not earlier than 2 years after DGA treatment (Figure 3). During the first year after DGA, 39% needed operative treatment, half of them during the first 6 months.
(Enlarge Image)
Figure 3.
The first need for treatment following dental general anesthesia according to the length of follow-up.
There was wide variation in the time elapsed from DGA to the first recording of treatment need. To explain this, we fitted logistic regression models to the data, taking as separate outcomes a short (≤12 months) and a long (25+ months) period. None of the explanatory variables tested (the patients' background information, reasons for DGA, and treatments given under DGA) ended up with statistically significant results.
Table 4 provides the percentages of patients undertaking various types of visits during the follow-up. At their visits, more than half of the patients showed total uncooperation or dental fear, and one out of five received conscious sedation. Visits with total uncooperation were more frequent among boys than girls (62% vs. 45%; p = 0.03). Preventive treatment was given to almost all, emergency treatment to half of the patients and control of dental fear to 13% of patients. Two out of three missed one or more appointments. Of the average number of visits per patient (9.7; SD = 5.6), 4.9 included prevention and 0.2 control of dental fear. There were no differences according to age or immigrant background in the number of the preventive visits, which were more frequent when the follow-up was longer (r = 0.48; p < 0.001).
The mean number of treatments during the follow-up was 5.3 (SD = 4.9), including a mean of 4.2 (SD = 4.2) fillings, 0.8 (SD = 1.2) tooth extractions, and 0.3 (SD = 1.1) endodontics, the maximum number being 24 during 5 years. There were no differences between the age groups.
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