A Retrospective Audit of Dental Treatment Provided to Special Needs Patients under General Anesthesia During a Ten-Year Period

Objective: The purpose of this study was to perform a comprehensive audit of dental treatment provided to special needs patients (SNP) under general anesthesia (GA) over a ten-year period. Study design: Special needs patients who received dental treatment under GA as an in-patient at Queen Mary Hospital, Hong Kong SAR during the time period January 2002 and December 2011 were included in the study. The study population was divided into three groups, based on age (<6years, 6–12 years, >12 years). One-way ANOVA was used to evaluate the effect of “age group” on duration of treatment, post-recovery time, treatment procedures and utilization of different restorative materials. Kappa statistics were used for intra-examiner reliability. Results: A total of 275 patients (174 males and 101 females) were included in the study. The mean age of the patients at the time they received GA was 12.37±10.18 years. Dental procedures performed were mostly restorative in nature (47%). The >12 years group had significantly shorter treatment duration (p<0.05). No significant difference in post-operative recovery time was observed among the three age groups (p>0.05). The <6 years group received significantly less preventive, but more restorative procedures (p<0.05). Significantly fewer extractions were performed in the 6–12 years group (p<0.05). The use of composite restorations was significantly higher in the <6 years group; while amalgam restorations were more frequently used in the >12 years group (P<0.05). Stainless steel crowns were more frequently employed in SNP under 12 years of age (p<0.05). Intra-examiner reliability was good (k=0.94). Conclusions: Most of the dental procedures performed under GA on SNP were restorative procedures. For children less than 6 years of age, had longer treatment time under GA. Composite restorations and stainless steel crowns were more frequently used in the primary dentition and amalgam restorations were more frequently employed in the permanent dentition.

Special needs patients. Dental treatment, General Anesthesia

1. American Academy of Pediatric Dentistry. Council on Clinical Affairs. Guideline on management of dental patients with special health care needs. Pediatr Dent, 34:160-165, 2012.

2. Voytus ML. Evaluation, scheduling, and management of dental care under general anesthesia for special needs patients. Dent Clin North Am, 53: 243-254,2009.

3. Roeters J, Burgersdijk R. The need for general anesthesia for the dental treatment of mentally handicapped patients: a follow-up study. J Dent Child, 52:344-346, 1985.

4. Loyola-Rodriguez JP, Zavala-Alonso V, Gonzalez-Alvarez CL, Juarez-Lopez LA, Patino-Marin N, Gonzalez CD. Dental treatment under general anesthesia in healthy and medically compromised develop-mentally disabled children: a comparative study. J Clin Pediatr Dent, 34:177-182,2009.

5. Grytten J, Holst D, Dyrberg L, Faehn O. Some characteristics of patients given dental treatment under general anesthesia. Acta Odontol Scand, 47:1-5.1989.

6. Messieha Z. Risks of general anesthesia for the special needs dental patient. Spec Care Dentist, 29:21-25,2009.

7. de Nova García MJ, Gallardo López NE, Martín Sanjuán C, Mourel-leMartínez MR, Alonso García Y, CarracedoCabaleiro E. Criteria for selecting children with special needs for dental treatment under general anesthesia. Med Oral Patol Oral Cir Bucal, 12:e496-503,2007a.

8. Mallineni SK, Yiu CKY. A retrospective review of outcomes of dental treatment performed for special needs patients under general anaesthesia: 2 year followup. ScientificWorldJournal 2014:748353, 6 pages, 2014.

9. Kwok-Tung L, King NM. Retrospective audit of caries management techniques for children under general anesthesia over an 18-year period. J Clin Pediatr Dent, 31:58-62,2006.

10. Madan C, Kruger E, Perera I, Tennant M. Trends in demand for general anaesthetic care for paediatric caries in Western Australia: geographic and socio-economic modelling of service utilisation.Int Dent J, 60:190-196,2010

11. Mitchell L, Murray JJ. Management of the handicapped and the anxious child: a retrospective study of dental treatment carried out under general anesthesia. J Paediatr Dent 1985;1:9-14.

12. Machuca-Portillo MC, Hanke Herrero R, del Lopez Valle L, Machu-ca-Portillo G, Bullon Fernandez P. General anesthesia: as a challenge and treatment need option in pediatric dentistry. P R Health Sci J, 24:291-296,2005.

13. Loyola-Rodriguez JP, Zavala-Alonso V, Patino-Marin N, Friedman C. A new classification system for dental treatment under general anesthesia. Spec Care Dentist, 26:25-29, 2006.

14. Stanková M, Bucek A, Dostalova T, Ginzelova K, Pacakova Z, Seydlova M. Patients with special needs within treatment under general anesthesia–meta-analysis. Prague Med Rep, 112:216-225, 2011.

15. Peretz B, Spierer A, Spierer S, Rakocz M. Dental treatment of patients with systemic diseases compared to patients with developmental disabili-ties under general anesthesia. Spec Care Dentist, 32:21-25, 2012.

16. Harrison MG, Roberts GJ. Comprehensive dental treatment of healthy and chronically sick children under intubation general anaesthesia during a 5-year period. Br Dent J, 184:503-506, 1998.

17. Rodriguez-Vazquez C, Garcillan R, Rioboo R, Bratos E. Prevalence of dental caries in an adult population with mental disabilities in Spain. Spec Care Dentist, 22:65-69, 2002.

18. Casas MJ, Kenny DJ, Barett EJ, Brown L. Prioritization for elective dental treatment under general anesthesia. J Can Dent Assoc,73:a321, 2007.

19. Chung SS, Casas MJ, Kenny DJ, Barrett EJ. Clinical relevance of access targets for elective dental treatment under general anesthesia in pediatrics. J Can Dent Assoc. 2010; 76:a116.

20. Lo GL, Soh G, Vignehsa H, Chellappah NK. Dental service utilization of disabled children. Spec Care Dentist, 11:194-196, 1991.

21. Ananthanarayan C, Sigal M, Godlewski W. General anesthesia for the provision of dental treatment to adults with developmental disability. Anesth Prog, 45:12-17, 1998.

22. de Nova-García MJ, Martínez MR, Sanjuán CM, López NE, Cabaleiro EC, García YA. Program for coordinated dental care under general anes-thesia for children with special needs. Med Oral Patol Oral Cir Bucal, 12:e569-575,2007b.

23. Alcaino E, Kilpatrick NM, Smith ED. Utilization of day stay general anesthesia for the provision of dental treatment to children in New South Wales, Australia. Int J Paediatr Dent,10:206-212, 2000.

24. O’Brien HD, Suthers WD. Conservative dentistry for children under general anesthesia in the dental surgery. Aust Dent J, 28:73-78, 1983.

25. Nazif MM. Nasal intubation in complete oral rehabilitation: a survey of eighty cases. J Dent Child, 43:25-27, 1976.

26. Foley J, Soldani F. The use of theatre time for paediatric dentistry under general anesthesia. Int J Paediatr Dent,17:29-33, 2007.

27. Watson AO. Treatment of cerebral palsied patients. A report on 33 years of treatment from 1946 to 1978. Aust Dent J, 24:290-300, 1979.

28. Robertson JR, Ball HC. Dental treatment with general anaesthesia for handicapped patients. Br Dent J, 134:151-153, 1973.

29. Nunn JH, Davidson G, Gordon PH, Storrs J. A retrospective review of a service to provide comprehensive dental care under general anesthesia. Spec Care Dentist, 15:97-101, 1995.

30. Peretz B, Gluck G. Early childhood caries (ECC): a preventive-con-servative treatment mode during a 12-month period. J CliPediatrDent, 30:191-4, 2006.

31. Collins CJ, Bryant RW, Hodge KL. A clinical evaluation of posterior composite resin restorations: 8-year findings. J Dent, 26:311-317, 1998.

32. Raskin A, Michotte-Theall B, Vreven J, Wilson NHF. Clinical evaluation of a posterior composite 10-year report. J Dent, 27:13-19,1999.