DENTAL TREATMENT AND ANESTHESIA PROCEDURE IN PEDIATRIC PATIENTS WITH SYSTEMIC DISEASE*
Year 2025,
Volume: 34 Issue: 1, 27 - 33
Aybüke Bahadır Sezer
,
Zeynep Aslı Güçlü
,
Dilek Günay Canpolat
,
Seher Orbay Yaşlı
Abstract
This retrospective study evaluates factors influencing anesthesia selection and procedure duration for children requiring pharmacological behavior management during dental treatment.
This retrospective study involved 209 pediatric patients who underwent surgery under general anesthesia and sedation at Erciyes University, Faculty of Dentistry. Health status, age, anesthesia type, procedure time, filling number, and root canal treatment number were recorded. Logistic and linear regressions examined anesthesia type and procedure duration predictors. Increasing the number of fillings (OR (95% CI): 0.857 (0.789-0.931); p<0.001) and the number of root canal treatments (OR (95% CI): 0.546 (0.341-0.873); p=0.012) reduced the likelihood of sedation. In the presence of combined systemic disease, sedation was preferred (OR (95% CI): 45.782 (1.713-1223.446); p=0.023), and the procedure time increased significantly in the presence of mental retardation (p=0.041). Increases in age (p=0.009), number of fillings (p<0.001), and number of root canal treatments (p<0.001) significantly increased the procedure time. The procedure time was significantly shorter in the sedated patients than in the general anesthesia group (p<0.001).Sedation was preferred when combined systemic disease occurred, but general anesthesia was preferred over sedation because the increased number of teeth treated increased the procedure time. The factors affecting the choice of anesthesia and the duration of procedures in pediatric dental treatment are complex; therefore, this study can contribute to create an evidence-based clinical practice guideline based on patient characteristics to improve the safety and treatment outcomes for children.
Ethical Statement
Ethical approval was obtained from the X University Clinical Research Ethics Committee, which reviewed and approved the study procedure (Approval No. 2022/X). This study was carried out in accordance with the Helsinki Declaration.
References
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- Chi DL. Oral Health for US Children with Special Health Care Needs. Pediatr Clin North Am. 2018;65(5):981-993. doi:10.1016/j.pcl.2018.05.007.
- Monse B, Duijster D, Sheiham A, Grijalva-Eternod CS, van Palenstein Helderman W, Hobdell MH. The effects of extraction of pulpally involved primary teeth on weight, height and BMI in underweight Filipino children. A cluster randomized clinical trial. BMC Public Health. 2012;12:725. doi:10.1186/1471-2458-12-725.
- American Academy of Pediatric Dentistry. Management of dental patients with special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry. 2023;337-344.
- Norderyd J, Faulks D, Molina G, Granlund M, Klingberg G. Which factors most influence referral for restorative dental treatment under sedation and general anaesthesia in children with complex disabilities: caries severity, child functioning, or dental service organisation? Int J Paediatr Dent. 2018;28(1):71-82. doi:10.1111/ipd.12305.
- American Dental Association. Guidelines for the use of sedation and general anesthesia by dentists. Adopted by the ADA House of Delegates. https://www.ada.org/-/media/project/ada-organization/ada/ada org/files/resources/research/ada_sedation_use_guidelines.pdf?rev=3139 32b4f5eb49e491926d4feac00a14&hash=C7C55D7182C639197569D4ED8EDCDDF6. October 2016;1-15.
- Sacchetti A, Turco T, Carraccio C, Hasher W, Cho D, Gerardi M. Procedural sedation for children with special health care needs. Pediatr Emerg Care. 2003;19(4):231-239. doi:10.1097/01.pec.0000086232.54586.ce.
- Guidelines for Office-Based Anesthesia. American Society of Anesthesiologists (ASA). https://www.asahq.org/standards-and-guidelines/guidelines-for-office-based-anesthesia Accessed April 5,2023.
- Baakdah RA, Turkistani JM, Al-Qarni AM, et al. Pediatric dental treatments with pharmacological and non-pharmacological interventions: a cross-sectional study. BMC Oral Health. 2021;21(1):186. doi:10.1186/s12903-021-01555-7.
- Blayney MR, Malins AF, Cooper GM. Cardiac arrhythmias in children during outpatient general anaesthesia for dentistry: a prospective randomised trial. Lancet. 1999;354(9193):1864-1866. doi:10.1016/s0140-6736(99)02485-x.
- Sinclair RCF, Faleiro RJ. Delayed recovery of consciousness after anaesthesia. CEACCP. 2006;6:114-118. doi:10.1093/bjaceaccp/mkl020.
- Campbell RL, Shetty NS, Shetty KS, Pope HL, Campbell JR. Pediatric Dental Surgery Under General Anesthesia: Uncooperative Children. Anesth Prog. 2018;65(4):225-230. doi:10.2344/anpr-65-03-04.
- Mangione F, Bdeoui F, Monnier-Da Costa A, Dursun E. Autistic patients: a retrospective study on their dental needs and the behavioural approach. Clin Oral Investig. 2020;24(5):1677-1685. doi:10.1007/s00784-019-03023-7.
- Loyola-Rodriguez JP, Zavala-Alonso V, Gonzalez-Alvarez CL, Juarez-Lopez LA, Patiño-Marin N, Gonzalez CD. Dental treatment under general anesthesia in healthy and medically compromised developmentally disabled children: a comparative study. J Clin Pediatr Dent. 2009;34(2):177-182. doi:10.17796/jcpd.34.2.u665328k4g467pg2.
- Escanilla-Casal A, Aznar-Gómez M, Viaño JM, López-Giménez A, Rivera-Baró A. Dental treatment under general anesthesia in a group of patients with cerebral palsy and a group of healthy pediatric patients. Med Oral Patol Oral Cir Bucal. 2014;19(5):e490-e494. doi:10.4317/medoral.19568.
- Fiske J, Boyle C. Epilepsy and oral care. Dent Update. 2002;29(4):180-187. doi:10.12968/denu.2002.29.4.180.
- Malamed SF. Handbook of Local Anesthesia. 4th ed. St. Louis, MO: CV Mosby Co; 1997.
- Gallagher S, Weiss S, Oram Cardy J, Humphries T, Harman KE, Menascu S. Efficacy of very high dose steroid treatment in a case of Landau-Kleffner syndrome. Dev Med Child Neurol. 2006;48(9):766-769. doi:10.1017/S0012162206001630.
- Lerman J. Perioperative management of the paediatric patient with coexisting neuromuscular disease. Br J Anaesth. 2011;107 Suppl 1:i79-i89. doi:10.1093/bja/aer335.
- Wass CT, Warner ME, Worrell GA, et al. Effect of general anesthesia in patients with cerebral palsy at the turn of the new millennium: a population-based study evaluating perioperative outcome and brief overview of anesthetic implications of this coexisting disease. J Child Neurol. 2012;27(7):859-866. doi:10.1177/0883073811428378.
- Fromer I, Belani K. Anesthesia for children with cerebral palsy. In: Goudra B, et al., eds. Anesthesiology. Cham, Switzerland: Springer; 2018:429-434. doi:10.1007/978-3-319-74766-8_45.
- Rada RE. Treatment needs and adverse events related to dental treatment under general anesthesia for individuals with autism. Intellect Dev Disabil. 2013;51(4):246-252. doi:10.1352/1934-9556-51.4.246.
- Cremers MJ, Bol E, de Roos F, van Gijn J. Risk of sports activities in children with Down's syndrome and atlantoaxial instability. Lancet. 1993;342(8870):511-514. doi:10.1016/0140-6736(93)91644-2.
- Kraemer FW, Stricker PA, Gurnaney HG, et al. Bradycardia during induction of anesthesia with sevoflurane in children with Down syndrome. Anesth Analg. 2010;111(5):1259-1263. doi:10.1213/ANE.0b013e3181f2eacf.
SİSTEMİK HASTALIĞI BULUNAN ÇOCUK HASTALARIN DENTAL TEDAVİSİ VE ANESTEZİ PROSEDÜRÜ
Year 2025,
Volume: 34 Issue: 1, 27 - 33
Aybüke Bahadır Sezer
,
Zeynep Aslı Güçlü
,
Dilek Günay Canpolat
,
Seher Orbay Yaşlı
Abstract
Bu retrospektif çalışma, diş tedavisi sırasında farmakolojik davranış yönetimi gerektiren çocuklar için anestezi seçimini ve işlem süresini etkileyen faktörleri değerlendirmektedir. Çalışmaya Erciyes Üniversitesi Diş Hekimliği Fakültesi'nde genel anestezi ve sedasyon altında tedavi edilen 209 çocuk hasta dahil edildi. Sağlık durumu, yaşı, anestezi türü, işlem süresi, dolgu sayısı ve kanal tedavi sayısı kaydedildi. Lojistik ve lineer regresyonlar anestezi tipi ve işlem süresinin belirleyicilerini inceledi. Dolgu sayısının arttırılması (OR (%95 GA): 0.857 (0.789-0.931); p<0.001) ve kök kanal tedavilerinin sayısının arttırılması (OR (%95 GA): 0.546 (0.341-0.873); p=0.012) sedasyon olasılığını azalttı. Kombine sistemik hastalık varlığında sedasyon tercih edildi (OR (%95 GA): 45.782 (1.713-1223.446); p=0.023), zeka geriliği varlığında işlem süresi anlamlı olarak arttı (p=0.041). Yaş (p=0.009), dolgu sayısı (p<0.001) ve kanal tedavi sayısı (p<0.001) arttıkça işlem süresi anlamlı derecede arttı. Sedasyon uygulanan hastalarda işlem süresi genel anestezi uygulanan gruba göre anlamlı olarak daha kısaydı (p<0.001). Kombine sistemik hastalık oluştuğunda sedasyon tercih edildi ancak tedavi edilen diş sayısının artması işlem süresini arttırdığı için sedasyon yerine genel anestezi tercih edildi. Çocuk hastalarda dental tedavi sürecinde anestezi seçimini etkileyen birçok faktör vardır; bu çalışma çocuklarda işlem güvenliği ve tedavi sonuçlarını iyileştirmek için hazırlanacak hasta özelliklerine dayalı kanıta dayalı klinik uygulama kılavuzu oluşturulmasına katkıda bulunabilir.
References
- Petersen PE. Challenges to improvement of oral health in the 21st century--the approach of the WHO Global Oral Health Programme. Int Dent J. 2004;54(6 Suppl 1):329-343. doi:10.1111/j.1875-595x.2004.tb00009.x.
- Chi DL. Oral Health for US Children with Special Health Care Needs. Pediatr Clin North Am. 2018;65(5):981-993. doi:10.1016/j.pcl.2018.05.007.
- Monse B, Duijster D, Sheiham A, Grijalva-Eternod CS, van Palenstein Helderman W, Hobdell MH. The effects of extraction of pulpally involved primary teeth on weight, height and BMI in underweight Filipino children. A cluster randomized clinical trial. BMC Public Health. 2012;12:725. doi:10.1186/1471-2458-12-725.
- American Academy of Pediatric Dentistry. Management of dental patients with special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry. 2023;337-344.
- Norderyd J, Faulks D, Molina G, Granlund M, Klingberg G. Which factors most influence referral for restorative dental treatment under sedation and general anaesthesia in children with complex disabilities: caries severity, child functioning, or dental service organisation? Int J Paediatr Dent. 2018;28(1):71-82. doi:10.1111/ipd.12305.
- American Dental Association. Guidelines for the use of sedation and general anesthesia by dentists. Adopted by the ADA House of Delegates. https://www.ada.org/-/media/project/ada-organization/ada/ada org/files/resources/research/ada_sedation_use_guidelines.pdf?rev=3139 32b4f5eb49e491926d4feac00a14&hash=C7C55D7182C639197569D4ED8EDCDDF6. October 2016;1-15.
- Sacchetti A, Turco T, Carraccio C, Hasher W, Cho D, Gerardi M. Procedural sedation for children with special health care needs. Pediatr Emerg Care. 2003;19(4):231-239. doi:10.1097/01.pec.0000086232.54586.ce.
- Guidelines for Office-Based Anesthesia. American Society of Anesthesiologists (ASA). https://www.asahq.org/standards-and-guidelines/guidelines-for-office-based-anesthesia Accessed April 5,2023.
- Baakdah RA, Turkistani JM, Al-Qarni AM, et al. Pediatric dental treatments with pharmacological and non-pharmacological interventions: a cross-sectional study. BMC Oral Health. 2021;21(1):186. doi:10.1186/s12903-021-01555-7.
- Blayney MR, Malins AF, Cooper GM. Cardiac arrhythmias in children during outpatient general anaesthesia for dentistry: a prospective randomised trial. Lancet. 1999;354(9193):1864-1866. doi:10.1016/s0140-6736(99)02485-x.
- Sinclair RCF, Faleiro RJ. Delayed recovery of consciousness after anaesthesia. CEACCP. 2006;6:114-118. doi:10.1093/bjaceaccp/mkl020.
- Campbell RL, Shetty NS, Shetty KS, Pope HL, Campbell JR. Pediatric Dental Surgery Under General Anesthesia: Uncooperative Children. Anesth Prog. 2018;65(4):225-230. doi:10.2344/anpr-65-03-04.
- Mangione F, Bdeoui F, Monnier-Da Costa A, Dursun E. Autistic patients: a retrospective study on their dental needs and the behavioural approach. Clin Oral Investig. 2020;24(5):1677-1685. doi:10.1007/s00784-019-03023-7.
- Loyola-Rodriguez JP, Zavala-Alonso V, Gonzalez-Alvarez CL, Juarez-Lopez LA, Patiño-Marin N, Gonzalez CD. Dental treatment under general anesthesia in healthy and medically compromised developmentally disabled children: a comparative study. J Clin Pediatr Dent. 2009;34(2):177-182. doi:10.17796/jcpd.34.2.u665328k4g467pg2.
- Escanilla-Casal A, Aznar-Gómez M, Viaño JM, López-Giménez A, Rivera-Baró A. Dental treatment under general anesthesia in a group of patients with cerebral palsy and a group of healthy pediatric patients. Med Oral Patol Oral Cir Bucal. 2014;19(5):e490-e494. doi:10.4317/medoral.19568.
- Fiske J, Boyle C. Epilepsy and oral care. Dent Update. 2002;29(4):180-187. doi:10.12968/denu.2002.29.4.180.
- Malamed SF. Handbook of Local Anesthesia. 4th ed. St. Louis, MO: CV Mosby Co; 1997.
- Gallagher S, Weiss S, Oram Cardy J, Humphries T, Harman KE, Menascu S. Efficacy of very high dose steroid treatment in a case of Landau-Kleffner syndrome. Dev Med Child Neurol. 2006;48(9):766-769. doi:10.1017/S0012162206001630.
- Lerman J. Perioperative management of the paediatric patient with coexisting neuromuscular disease. Br J Anaesth. 2011;107 Suppl 1:i79-i89. doi:10.1093/bja/aer335.
- Wass CT, Warner ME, Worrell GA, et al. Effect of general anesthesia in patients with cerebral palsy at the turn of the new millennium: a population-based study evaluating perioperative outcome and brief overview of anesthetic implications of this coexisting disease. J Child Neurol. 2012;27(7):859-866. doi:10.1177/0883073811428378.
- Fromer I, Belani K. Anesthesia for children with cerebral palsy. In: Goudra B, et al., eds. Anesthesiology. Cham, Switzerland: Springer; 2018:429-434. doi:10.1007/978-3-319-74766-8_45.
- Rada RE. Treatment needs and adverse events related to dental treatment under general anesthesia for individuals with autism. Intellect Dev Disabil. 2013;51(4):246-252. doi:10.1352/1934-9556-51.4.246.
- Cremers MJ, Bol E, de Roos F, van Gijn J. Risk of sports activities in children with Down's syndrome and atlantoaxial instability. Lancet. 1993;342(8870):511-514. doi:10.1016/0140-6736(93)91644-2.
- Kraemer FW, Stricker PA, Gurnaney HG, et al. Bradycardia during induction of anesthesia with sevoflurane in children with Down syndrome. Anesth Analg. 2010;111(5):1259-1263. doi:10.1213/ANE.0b013e3181f2eacf.