A Comprehensive Approach Limiting Extractions under General Anesthesia Could Improve Oral Health

Abstract

Access to dental treatment could be difficult for some patients due to dental phobia or anxiety, cognitive or sensorial disabilities, systemic disorders, or social difficulties. General anesthesia (GA) was often indicated for dental surgery, and there is almost no available data on adapted procedures and materials that can be applied during GA for maintaining functional teeth on the arches and limiting oral dysfunctions. This study evaluates changes in oral health-related quality of life and mastication in a cohort of uncooperative patients treated under GA according to a comprehensive and conservative dental treatment approach. Dental status, oral health-related quality of life, chewed bolus granulometry, kinematic parameters of mastication, and food refusals were evaluated one month preoperatively (T0), and then one month (T1) and six months post-operatively (T2). One hundred and two adult patients (mean age ± SD: 32.2 ± 9.9 years; range: 18–57.7) participated in the preoperative evaluation, 87 were treated under GA of which 36 participated in the evaluation at T1 and 15 were evaluated at T2. Preoperative and postoperative data comparisons demonstrated that oral rehabilitation under GA helped increase chewing activity and oral health-related quality of life. The conditions for providing dental treatment under GA could be arranged to limit dental extractions in uncooperative patients.

Dental decision‐making under general anesthesia for patients with disabilities: A qualitative study

“…Aside from these recommendations, this study indicates a need to address prevailing beliefs around DGA and what is possible therewith. Modern research advocates for non-extraction approaches under DGA to improve function and quality of life 43 and emphasizes the safety of DGA. 33 As part of this change in perceptions, the definitions of success and failure of dental treatment under GA need to be redefined.…”

Radiological Evaluation of Stainless Steel Crowns Placed on Permanent Teeth in Patients Treated under General Anaesthesia

“…Another limit of the current study is that occlusal adaptation could not be evaluated, as solely radiological criteria were used. SSCs are chosen as the restoration of choice for placement in special circumstances by our team because it is assumed that they restore dental function, i.e., that they maintain chewing function and provide a stable occlusion for swallowing [ 18 , 30 ]. A previous cohort study demonstrated that a comprehensive restorative approach, including SSC placement for permanent molars, helped to increase chewing activity and oral health-related quality of life following rehabilitation [ 18 ].…”

“…SSCs are chosen as the restoration of choice for placement in special circumstances by our team because it is assumed that they restore dental function, i.e., that they maintain chewing function and provide a stable occlusion for swallowing [ 18 , 30 ]. A previous cohort study demonstrated that a comprehensive restorative approach, including SSC placement for permanent molars, helped to increase chewing activity and oral health-related quality of life following rehabilitation [ 18 ]. The current results are also in accordance with a recent, large-scale study, which concluded that SSCs are a durable treatment option for the restoration of the severely carious posterior permanent dentition, in the context of GA [ 19 ].…”

“…In addition, impression-taking is complicated under GA, particularly if orotracheal intubation is used. Most patients treated in special circumstances have difficulties accessing dental care, present high levels of dental need, high levels of decayed, missing or filled teeth (DMFT) and severely damaged teeth [ 18 , 33 , 34 , 35 ]. It is known that survival rates for teeth with carious cavities on more than three surfaces are higher when restored with full or partial crowns rather than with composite restorations [ 36 ].…”

“…Special care dentistry (SCD) is concerned with the oral health of such populations and, with the development of SCD specialties around the world [ 10 , 11 , 12 , 13 ], it is increasingly urgent to define effective treatment protocols for special circumstances [ 4 , 14 ]. Endodontic treatments, whether they be root canal treatment or full pulpotomy, have been evaluated when performed under general anaesthesia [ 4 , 15 , 16 ], but few studies have reported on restorative procedures [ 17 , 18 ]. Preformed stainless steel crown (SSC) restorations represent a viable treatment choice for severely carious or fractured posterior permanent teeth [ 19 ].…”