Dental Extractions under General Anesthesia: New Insights from Process Mining

Abstract

Introduction: Tooth extraction under general anesthetic (GA) is a global health problem. It is expensive, high risk, and resource intensive, and its prevalence and burden should be reduced where possible. Recent innovation in data analysis techniques now makes it possible to assess the impact of GA policy decisions on public health outcomes. This article describes results from one such technique called process mining, which was applied to dental electronic health record (EHR) data. Treatment pathways preceding extractions under general anesthetic were mined to yield useful insights into waiting times, number of dental visits, treatments, and prescribing behaviors associated with this undesirable outcome. Method: Anonymized data were extracted from a dental EHR covering a population of 231,760 patients aged 0 to 16 y, treated in the Irish public health care system between 2000 and 2014. The data were profiled, assessed for quality, and preprocessed in preparation for analysis. Existing process mining methods were adapted to execute process mining in the context of assessing dental EHR data. Results: Process models of dental treatment preceding extractions under general anesthetic were generated from the EHR data using process mining tools. A total of 5,563 patients who had 26,115 GA were identified. Of these, 9% received a tooth dressing before extraction with an average lag time of 6 mo between dressing and extraction. In total, 11,867 emergency appointments were attended by the cohort with 2,668 X-rays, 4,370 prescriptions, and over 800 restorations and other treatments carried out prior to tooth extraction. Discussion and Conclusions: Process models generated useful insights, identifying metrics and issues around extractions under general anesthetic and revealing the complexity of dental treatment pathways. The pathways showed high levels of emergency appointments, prescriptions, and additional tooth restorations ultimately unsuccessful in preventing extractions. Supporting earlier publications, the study suggested earlier screening, preventive initiatives, guideline development, and alternative treatments deserve consideration. Knowledge Transfer Statement: This study generates insights into tooth extractions under general anesthetic using process mining technologies and methods, revealing levels of extraction and associated high levels of prescriptions, emergency appointments, and restorative treatments. These insights can inform dental planners assessing policy decisions for tooth extractions under general anesthetic. The methods used can be combined with costs and patient outcomes to contribute to more effective decision-making.

Predictors of Intra-Operative and Post-Operative Pain Associated with Routine Dental Procedures in Children: A Systematic Review and Meta-Analysis

“…Dental treatment under GA is considered expensive and resource-intensive, which places a considerable financial burden on the National Health Service (NHS) in the UK and other countries [3,13]. For example, it was reported that about 43,700 children aged ≤16 years were admitted to hospitals in England in 2015-2016 for the extraction of multiple teeth under GA, which cost GDP 30 million [3].…”

“…For example, it was reported that about 43,700 children aged ≤16 years were admitted to hospitals in England in 2015-2016 for the extraction of multiple teeth under GA, which cost GDP 30 million [3]. In 2018-2019, 44,685 surgical procedures were carried out in English hospitals to remove more than one tooth in children aged 18 years and under, which cost GDP 41.5 million [13].…”

“…Long waiting times for paediatric dental procedures under GA are another significant issue [3,13]. It has been found that children may wait over a year to be treated under GA [14].…”

“…It has been found that children may wait over a year to be treated under GA [14]. These children may experience multiple episodes of pain, distress, and infection during this time [13,15]. Several visits to primary dental care may be necessary for placing a number of temporary dressings or prescribing courses of antibiotics to relieve pain and infection during this period [13,15].…”