Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children: A Retrospective Study

Abstract

Background: Very young children, and those with disabilities and extensive oral pathology, who cannot be treated in the dental chair, require deep sedation or general anesthesia for dental treatment. Objective: The aim of this study is to describe and compare the oral health status in healthy and SHCN children and the treatments performed under deep sedation on an outpatient basis with a minimal intervention approach, and their impact on quality of life. Methods: A retrospective study between 2006 and 2018 was made. A total of 230 medical records of healthy and SHCN children were included. The data extracted were age, sex, systemic health status, reason for sedation, oral health status before sedation, treatments administered during sedation, and follow-up. The quality of life after deep sedation of 85 children was studied through parental questionnaires. Descriptive and inferential analyses were made. Results: Of the 230 children, 47.4% were healthy and 52.6% were SHCN. The median age was 7.10 ± 3.40 years (5.04 ± 2.42 in healthy children and 8.95 ± 3.09 in SHCN children). The main reason for sedation was poor handling in the dental chair (99.5%). The most frequent pathologies were caries (90.9%) and pulp pathology (67.8%). Healthy children had more teeth affected by decay and with pulp involvement. Patients aged <6 years received more pulpectomies and pulpotomies. After treatment, parents stated that children were more rested and less irascible, ate better, increased in weight, and had improved dental aesthetics. Conclusions: Differences in treatments carried out did not depend on the general health status or the failure rate but on age, with more pulp treatments in healthy children who were younger, and more extractions near to the age of physiological turnover in children with SHCN who were older. Intervention under deep sedation with a minimally invasive treatments approach met the expectations of parents and guardians, as it improved the children’s quality of life.

ORIENTATE: automated machine learning classifiers for oral health prediction and research

“…All these results are put in context in the Discussion section, where we discuss our results in comparison with the findings of our previous study [ 15 , 16 ] and related works.…”

“…We have applied our tool to a dataset collected for a previous study [ 15 , 16 ]. The goal of that study was to describe the oral health condition in two populations, one with healthy children and another one with SHCN, that is, children who due to physical, medical, developmental or cognitive conditions require special consideration when receiving dental treatment [ 22 ]; and to compare the treatments performed under deep sedation in both populations.…”

“…To illustrate the use of the application and the performance of the various functionalities, we use a particular case study: a dataset that describes the oral health condition in two populations, one with healthy children and another one with SHCN, was collected to compare the treatments performed under deep sedation in both populations. The dataset was analyzed with classical statistical methods in a previous work [ 15 , 16 ]. This particular dataset is described in detail in the “ Material and methods of the previous study ” section.…”

Do Preventive Programmes Reduce the Need for New Sedation for the Treatment of Oral Pathology?

“…This percentage is higher than in the studies reviewed, whose sample consists only of children with SHCN [12]. Bücher et al ( 2016) [12] explained their low percentage (10.8%) of reinterventions because the initial sample had a very low dmft, because they rarely performed pulp treatment in the deciduous dentition and because the mean number of extractions in the rst intervention was 2.5 teeth per patient, compared to 1.35 in our study [19]. In our opinion, the reason for the high percentage of second sedation in our study was the quarterly prevention programme, which allowed very close monitoring of the patients who voluntarily chose to join it.…”

General Anesthesia in Early Childhood Significantly Reduces Asthma Incidence and Clinical Visits: A Nationwide Population-Based Cohort Study

“…Except for necessary surgery, the most common etiologies of received GA during early childhood are minor surgery, including inguinal hernia [ 19 ], redundant prepuce, phimosis [ 20 ], and hydrocele [ 21 ]. In addition, there is a steady growth of the widespread use of GA in children, such as dental treatment [ 22 , 23 ], MRI image study [ 24 ], or removal of a foreign body in the external auditory canal, nose, or esophagus [ 25 , 26 ]. The reasons for using GA in these procedures are not only that it can reduce procedure time [ 22 ] and anxiety [ 27 ] but also the possibility of constant subsiding postoperative pain [ 28 ].…”