Dental Care Under General Anesthesia for Individuals with Disabilities: Challenges in Children and Adults

Öz

Abstract Aim: The high prevalence of oral health problems and barriers to dental healthcare access constitute an important health inequity for individuals with disabilities. This inequity becomes more pronounced in patients who cannot be treated in standard clinical settings and require general anesthesia (GA) for comprehensive dental care. This study aimed to evaluate the sociodemographic and clinical profiles, treatment needs, and service process indicators of children and adults with disabilities who received dental health services under GA at a faculty of dentistry. Methods: This retrospective study analyzed Hospital Information Management System (HIMS) records of 262 patients with disabilities who received dental health services under GA between March 2017 and March 2020. Evaluated variables included GA sessions, waiting times, operation durations, medical consultation requirements, referral status, out-of-pocket payment status, and dental treatment needs. Descriptive statistics, Chi-square, and Mann–Whitney U tests were performed. Results: Of the patients, 38.2% were children and 61.8% were adults. Their main diagnosis were neurodevelopmental disorders, diseases of the nervous system, and developmental anomalies. The presence of out-of-pocket payments (Children [C]: 11.0%; Adults [A]: 38.9%; p=0.000) and the rate of receiving multiple GA sessions (C: 1.0%; A: 22.2%; p=0.000) were higher in adults. Additionally, the duration of the first GA session was significantly longer in adults (C: 170 min; A: 195 min; p=0.039). The most common dental treatment needs under GA were restorative (91.0%) and surgical (88.0%) treatments in children, and periodontal (90.1%), restorative (87.2%), and surgical (66.0%) treatments in adults. Conclusion: Dental treatment needs under GA varied by age group, with a more comprehensive and complex treatment burden emerging among adults. Therefore, improvement of preventive applications and easily accessible dental care are the main domains for developing oral health policies for patients with disabilities. Keywords: Dental care for persons with disabilities, General anesthesia, Treatment needs, Health services accessibility, Hospital information management systems

Anahtar Kelimeler

• Dental care for persons with disabilities
• General anesthesia
• Treatment needs
• Health services accessibility
• Hospital information management systems

Etik Beyan

The study was approved by the Ethics Committee of the Institute of Health Sciences at Marmara University (18.10.2021-116).

Engelli Bireylerde Genel Anestezi Altında Diş Tedavisi: Çocuklar ve Yetişkinlerde Karşılaşılan Zorluklar

Öz

Özet Amaç: Ağız sağlığı sorunlarının yüksek prevalansı ve diş hekimliği hizmetlerine erişimdeki engeller, engelli bireyler için önemli bir sağlık eşitsizliği oluşturmaktadır. Bu eşitsizlik, standart klinik koşullarda tedavi edilemeyen ve kapsamlı dental bakımı için genel anestezi (GA) gereksinimi olan hastalarda daha da belirgin hale gelmektedir. Bu çalışmanın amacı, bir diş hekimliği fakültesinde genel anestezi altında dental sağlık hizmeti alan engelli çocuk ve yetişkinlerin sosyodemografik ve klinik profillerini, tedavi gereksinimlerini ve hizmet süreci göstergelerini değerlendirmektir. Yöntem: Bu retrospektif çalışmada, Mart 2017 ile Mart 2020 tarihleri arasında genel anestezi altında dental sağlık hizmeti alan 262 engelli hastanın Hastane Bilgi Yönetim Sistemi (HBYS) kayıtları analiz edilmiştir. Değerlendirilen değişkenler arasında genel anestezi seansları, bekleme süreleri, operasyon süreleri, tıbbi konsültasyon gereksinimleri, sevk durumları, cepten yapılan ödeme durumları ve diş tedavisi gereksinimleri yer almaktadır. Tanımlayıcı istatistikler, Ki-kare ve Mann–Whitney U testleri uygulanmıştır. Bulgular: Hastaların %38,2'sini çocuklar, %61,8'ini ise yetişkinlerden oluşturmaktadır. Temel tıbbi tanıları nörogelişimsel bozukluklar, sinir sistemi hastalıkları ve gelişimsel anomalilerdir. Cepten yapılan ödeme varlığı (Çocuklar [Ç]: %11,0; Erişkinler [E]: %38,9; p=0.000) ve birden fazla genel anestezi seansı alma oranı (Ç: %1,0; E: %22,2; p=0.000) yetişkinlerde daha yüksek bulunmuştur. Ayrıca ilk genel anestezi seansının süresi yetişkinlerde anlamlı derecede daha uzundur (Ç: 170 dk; E: 195 dk; p=0.039). Genel anestezi altında en sık görülen diş tedavisi gereksinimleri; çocuklarda restoratif (%91,0) ve cerrahi (%88,0) tedaviler iken, erişkinlerde periodontal (%90,1), restoratif (%87,2) ve cerrahi (%66,0) tedavilerdir. Sonuç: Genel anestezi altında diş tedavisi gereksinimleri yaş grubuna göre değişiklik göstermekte, yetişkinlerde daha kapsamlı ve karmaşık bir tedavi yükü ortaya çıkmaktadır. Bu nedenle, koruyucu uygulamaların geliştirilmesi ve kolay erişilebilir diş bakımı, engelli hastalar için ağız sağlığı politikalarının oluşturulmasında temel alanları oluşturmaktadır.

Anahtar Kelimeler

• Engelli bireylerde dental bakım
• genel anestezi
• tedavi ihtiyaçları
• sağlık hizmetlerine erişilebilirlik
• hastane bilgi yönetim sistemleri

Kaynakça

1. Akdoğan, H. N., & Çabuk, D. S. (2024). A retrospective evaluation of patients who had dental treatments under general anesthesia. Journal of Cukurova Anesthesia and Surgical Sciences, 7(3), 140-143. https://doi.org/10.36516/jocass.1512755
2. Akpınar, H. (2019). Evaluation of general anesthesia and sedation during dental treatment in patients with special needs: A retrospective study. Journal of Dental Anesthesia and Pain Medicine, 19(4), 191-199. https://doi.org/10.17245/jdapm.2019.19.4.191
3. Al-Mashhadani, S., Nasser, M., Alsalami, A., Burns, L., & Paisi, M. (2024). Barriers and facilitators to dental care services utilization among children with disabilities: A systematic review and thematic synthesis. Health Expectations, 27(5), e70049. https://doi.org/10.1111/hex.70049
4. American Academy of Pediatric Dentistry. (2025). Management of dental patients with special health care needs. In The Reference Manual of Pediatric Dentistry (pp. 364-371). American Academy of Pediatric Dentistry. https://www.aapd.org/globalassets/media/policies_guidelines/bp_shcn.pdf
5. Arapovic, L. L., Karlovic, Z., Brzovic, V. R., Bukvic, A., Coric, A., Vukojevic, K., & Verzak, Z. (2021). Dental treatment for special needs patients under general anaesthesia: A 14-year experience from South Bosnia and Herzegovina. Acta Medica Okayama, 75(3), 261-268.
6. Auerbacher, M., Gebetsberger, L., Hickel, R., & Kaisarly, D. (2023). Chairside oral prophylaxis for people with profound intellectual or multiple disabilities: A retrospective feasibility study. Clinical Oral Investigations, 27, 6747-6756. https://doi.org/10.1007/s00784-023-05287-6
7. Biasotto, M., Poropat, A., Porrelli, D., Ottaviani, G., Rupel, K., Preda, M. T. B., Di Lenarda, R., & Gobbo, M. (2024). Dental treatment in special needs patients and uncooperative young children: A retrospective study. Medicina, 60(1), 91. https://doi.org/10.3390/medicina60010091
8. Brailo, V., Janković, B., Lozić, M., Gabrić, D., Kuna, T., Stambolija, V., & Verzak, Ž. (2019). Dental treatment under general anesthesia in a day care surgery setting. Acta Stomatologica Croatica, 53(1), 64-71. https://doi.org/10.15644/asc53/1/7

9. Bücher, K., Rothmaier, K., Hickel, R., Heinrich-Weltzien, R., & Kühnisch, J. (2016). The need for repeated dental care under general anaesthesia in children. European Journal of Paediatric Dentistry, 17(2), 129-135.
10. Chiao, C., Tuncer, A. H., Jin, M., Shanmugham, J. R., & Discepolo, K. E. (2022). Accuracy of parent-reported health history in a dental setting. The Journal of the American Dental Association, 153(11), 1053-1059. https://doi.org/10.1016/j.adaj.2022.07.007
11. Choi, J., & Doh, R.-M. (2021). Dental treatment under general anesthesia for patients with severe disabilities. Journal of Dental Anesthesia and Pain Medicine, 21(2), 87-98. https://doi.org/10.17245/jdapm.2021.21.2.87
12. Ciftci, V., & Yazicioglu, İ. (2020). A retrospective comparison of dental treatment under general anesthesia provided for uncooperative healthy patients and patients with special health care needs. Journal of Clinical Pediatric Dentistry, 44(3), 196-201. https://doi.org/10.17796/1053-4625-44.3.11
13. da Rosa, S. V., Moysés, S. J., Theis, L. C., Soares, R. C., Moysés, S. T., Werneck, R. I., & Rocha, J. S. (2020). Barriers in access to dental services hindering the treatment of people with disabilities: A systematic review. International Journal of Dentistry, 2020, 9074618. https://doi.org/10.1155/2020/9074618
14. Da Silva, K., Lionel, A., O'Brien, J. M., Wright, K. D., & Raazi, M. (2022). The use of general anesthesia for pediatric dentistry in Saskatchewan: A retrospective study. Journal of the Canadian Dental Association, 88, m9.
15. Devinsky, O., Boyce, D., Robbins, M., & Pressler, M. (2020). Dental health in persons with disability. Epilepsy & Behavior, 110, 107174. https://doi.org/10.1016/j.yebeh.2020.107174
16. Dziedzic, A. (2017). The role of general anaesthesia in special care and paediatric dentistry: Inclusion criteria and clinical indications. SAAD Digest, 33, 48-54.
17. Geddis-Regan, A. R., Gray, D., Buckingham, S., Misra, U., Boyle, C., & British Society for Disability and Oral Health. (2022). The use of general anaesthesia in special care dentistry: A clinical guideline from the British Society for Disability and Oral Health. Special Care in Dentistry, 42(1), 3-32. https://doi.org/10.1111/scd.12652
18. Hendzel, B. (2014). The structure of a group of adult disabled patients treated dentally under general anesthesia. Polish Journal of Public Health, 124(3), 130-133. https://doi.org/10.2478/pjph-2014-0029
19. Jockusch, J., Hopfenmüller, W., Ettinger, R., & Nitschke, I. (2021). Outpatient, dental care of adult vulnerable patients under general anaesthesia: A retrospective evaluation of need for treatment and dental follow-up care. Clinical Oral Investigations, 25(4), 2407-2417. https://doi.org/10.1007/s00784-020-03564-2
20. Jockusch, J., Sobotta, B. A. J., & Nitschke, I. (2020). Outpatient dental care for people with disabilities under general anaesthesia in Switzerland. BMC Oral Health, 20, 225. https://doi.org/10.1186/s12903-020-01203-6
21. Kaynar, Z. B., & Akbal Dinçer, G. (2025). Navigating dental care under anesthesia: A comparative analysis of patients with dental anxiety and intellectual disabilities dental treatments under general anesthesia in adult patients. BMC Oral Health, 25(1), 1687. https://doi.org/10.1186/s12903-025-07110-y
22. Kim, N.-H., & Ryu, J.-I. (2023). Is there a sexual difference in the relationship between sociodemographic information and the unmet dental care needs of disabled adults? An analysis from a national survey on persons with disabilities. BMC Oral Health, 23, 830. https://doi.org/10.1186/s12903-023-03576-w
23. Köksal, C., Özdemir, İ., Beyhan, T. E., Akmansoy, Ş. C., Sırma, S., Doğru, B., Köksal, L., Berkel, G., Karaçaylı, Ü., Mumcu, G., & Özkan, Y. (2021). Sağlık yönetimi perspektifinden engelli ve özel hizmet alımına ihtiyaç duyan bireylerde diş hekimliği hizmetlerinin yönetimi. Hacettepe Sağlık İdaresi Dergisi, 24(4), 959-970.
24. Kuper, H., Gatta, D. R., Rotenberg, S., Banks, L. M., Smythe, T., & Heydt, P. (2024). Building disability-inclusive health systems. The Lancet Public Health, 9(5), e316-e325. https://doi.org/10.1016/S2468-2667(24)00042-2
25. Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12(1), 18. https://doi.org/10.1186/1475-9276-12-18
26. Lima, C. P. O. de S., Couto, G. R., Barros, A. L. de O., Gutierrez, G. M. D., & Santos, M. T. B. R. (2021). Epidemiological profile of patients with disabilities undergoing dental treatment under general anesthesia. Revista de Odontologia da UNESP, 50, e20210012. https://doi.org/10.1590/1807-2577.01221
27. Lima, R. B., de Freitas Miranda-Filho, A. E., Moura, A. P. G. E., Nelson-Filho, P., da Silva, L. A. B., & da Silva, R. A. B. (2024). Territorial disparities in dental care for disabled persons and oral health-related indicators: A population-level approach in Brazil's public healthcare system from 2014 to 2023. International Journal of Environmental Research and Public Health, 21(5), 632. https://doi.org/10.3390/ijerph21050632
28. Mallineni, S. K., & Yiu, C. K. Y. (2016). Dental treatment under general anesthesia for special-needs patients: Analysis of the literature. Journal of Investigative and Clinical Dentistry, 7(4), 325-331. https://doi.org/10.1111/jicd.12174
29. Mallineni, S. K., & Yiu, C. K. Y. (2018). A retrospective audit of dental treatment provided to special needs patients under general anesthesia during a ten-year period. Journal of Clinical Pediatric Dentistry, 42(2), 155-160.
30. Marinho, M. A., Ramos, F. C. T., Cardoso, A. L., Silva-Junior, G. O., Faria, M. D. B., Bastos, L. F., Dziedzic, A., & Picciani, B. L. S. (2022). Dental treatment under general anesthesia in patients with special needs provided by private and public healthcare services: A retrospective, comparative study. Healthcare, 10(6), 1147. https://doi.org/10.3390/healthcare10061147
31. Márquez-Arrico, C.-F., Talaván-Serna, J., Silvestre, F.-J., Viñoles, J., Rodríguez-Martínez, S., & Silvestre-Rangil, J. (2022). Dental treatment under general anesthesia in mentally disabled patients based on an ambulatory surgery model: A case-control study. Journal of Clinical and Experimental Dentistry, 14(2), e192-e198. https://doi.org/10.4317/jced.59266
32. McGeown, D., Mac Giolla Phádraig, C., Van Harten, M., Stapleton, S., & Nunn, J. (2024). Dental extractions do not predict further use of dental general anesthesia in people with disabilities: A longitudinal analysis. Special Care in Dentistry, 44(4), 845-851. https://doi.org/10.1111/scd.12925
33. McGeown, D., Mac Giolla Phádraig, C., Whelehan, D., & Nunn, J. H. (2022). Dental decision-making under general anesthesia for patients with disabilities: A qualitative study. Special Care in Dentistry, 42(1), 20-27. https://doi.org/10.1111/scd.12631
34. Pecci-Lloret, M. P., Guerrero-Gironés, J., López-González, B., Rodríguez-Lozano, F. J., Oñate-Cabrerizo, D., Oñate-Sánchez, R. E., & Pecci-Lloret, M. R. (2021). Dental treatments under general anesthesia on children with special health care needs enrolled in the Spanish dental care program. Journal of Clinical Medicine, 10(2), 182. https://doi.org/10.3390/jcm10020182
35. Polat, Y., Çelenk, S., & Tümen, E. C. (2025). Retrospective evaluation of pediatric dental treatments performed under general anesthesia and sedation [Preprint]. Preprints.org. https://doi.org/10.20944/preprints202505.0915.v1 Republic of Türkiye. (2006, June 16). Social Insurance and General Health Insurance Law (Law No. 5510). Official Gazette, No. 26200.
36. Sarı, M. E., Özmen, B., Koyutürk, A. E., & Tokay, U. (2014). A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities. Nigerian Journal of Clinical Practice, 17(3), 361-365. https://doi.org/10.4103/1119-3077.130243
37. Schulz-Weidner, N., Schlenz, M. A., Jung, L. G., Uebereck, C. F., Nehls, A., & Krämer, N. (2022). Dental treatment under general anesthesia in pre-school children and schoolchildren with special healthcare needs: A comparative retrospective study. Journal of Clinical Medicine, 11(9), 2613. https://doi.org/10.3390/jcm11092613
38. Social Security Institution. (2013, March 24). Health Implementation Communiqué (Sağlık Uygulama Tebliği). Official Gazette, No. 28597.
39. Wilson, N. J., Lin, Z., Villarosa, A., Lewis, P., Philip, P., Sumar, B., & George, A. (2019). Countering the poor oral health of people with intellectual and developmental disability: A scoping literature review. BMC Public Health, 19, 1530. https://doi.org/10.1186/s12889-019-7863-1
40. World Health Organization. (2022). Global report on health equity for persons with disabilities. World Health Organization. https://www.who.int/publications/i/item/9789240063600
41. World Health Organization. (2024). Health equity for persons with disabilities: Guide for action. World Health Organization. https://www.who.int/publications/i/item/9789240101517
42. Yang, J., Zheng, X., He, Y., Cao, D., Zhang, X., Chen, Y., & Tu, Y. (2026). A narrative review of dental general anaesthesia in children with special health care needs. International Dental Journal, 76(2), 109368. https://doi.org/10.1016/j.identj.2025.109368
43. Yazdanbakhsh, E., Bohlouli, B., Patterson, S., & Amin, M. (2025). The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada. International Journal of Paediatric Dentistry, 35(2), 347-358. https://doi.org/10.1111/ipd.13237
44. Yen, Y.-F., Lin, S.-H., & Hsu, H.-M. (2024). Dental treatments in patients with special needs provided by university medical center in Southern Taiwan: A retrospective study. Clinical Oral Investigations, 28(7), 398. https://doi.org/10.1007/s00784-024-05795-z
45. Yılmaz, M. A., Berkel, G., Özalp, M., Kıraç, S. B., & Kargül, B. (2023). Analysis of dental treatment under general anesthesia in special health care needs and uncooperative healthy children. Meandros Medical and Dental Journal, 24(4), 262-267. https://doi.org/10.4274/meandros.galenos.2022.98216
46. Zare, Z., Bahrami, M. A., Bastani, P., & Kavosi, Z. (2024). Oral and dental health utilization determinants in special health care needs: A systematic review of reviews. BMC Oral Health, 24, 965. https://doi.org/10.1186/s12903-024-04734-4