Neighbourhood incidence rate of paediatric dental extractions under general anaesthetic in South West England

Abstract

Introduction Extraction of decayed teeth is the most common reason for UK children aged 5-9 years to receive a general anaesthetic. Inequalities in oral health are well recognised, but is under-explored in dental general anaesthesia (DGA).Methods Secondary analysis of routinely collected data from three local authorities in South West England was used to assess: 1) dental activities recorded for children <18 years attending NHS general dental practitioners (GDP); 2) the incidence rate of DGA and disease severity among <16-year-olds; and 3) individual and neighbourhood factors associated with higher rates of child DGA, and greater severity of disease.Results Among 208,533 GDP appointments, rates of preventive action were low where 1/7 included fluoride varnish but 1/5 included permanent fillings. The incidence rate of DGA was 6.6 admissions for every 1,000 children, rising to 12.4/1,000 among 5-9-year-olds. A total of 86 (7.6%) children had previously received a DGA at the same hospital. Area deprivation was strongly associated with higher rates of DGA, but rates of DGA remained high in less deprived areas. No associations were observed between number of teeth removed and socio-economic status.Conclusion Too many children are receiving DGA, and too few preventive actions are recorded by GDPs. Area-based inequalities in DGA were apparent, but wealthy areas also experienced substantial childhood dental decay.

‘Message to Dentist’: Facilitating Communication with Dentally Anxious Children

“…Referring dentists request that these children have sedation or even GA, for what is often simple treatment. Due to the escalating concerns about the numbers of children who are undergoing a GA for dental treatment, it is imperative that different approaches are sought for these vulnerable groups [22]. General dental care professionals have a fundamental role in identifying children with dental anxiety and proactively offering simple psychological interventions, before acute treatment needs arise [23].…”

National patterns in paediatric hospital admissions for dental extractions in England

“…While some local authorities with higher levels of dmft and deprivation also had positive associations between these variables and hospital admissions, these associations are likely more complex, and linked in a multifaceted way to the social determinants of health, as well as other structural, behavioural and health service‐related factors. For example, previous research has shown that while admissions are strongly associated with area deprivation, rates of DGA have remained high in less deprived areas, 14 and more advantaged groups 8 . Additionally, any overall national decreases in caries experience in younger children may be masking increases in inequalities as improvements in oral health are predominantly seen in more affluent groups 14 .…”

“…For example, previous research has shown that while admissions are strongly associated with area deprivation, rates of DGA have remained high in less deprived areas, 14 and more advantaged groups 8 . Additionally, any overall national decreases in caries experience in younger children may be masking increases in inequalities as improvements in oral health are predominantly seen in more affluent groups 14 . The complexity of these patterns makes analysis of these clusters challenging, specifically due to the use of aggregate data, and difficulties in drawing causal mechanisms and pathways from these types of data.…”

“…Regional research in the UK has used the Hospital Episode Statistics 3 (HES) dataset to demonstrate that nonfluoridated areas had a greater burden of disease and also experienced greater numbers of hospital‐based extractions 13 . Another regional investigation in England found geographical differences in DGA rates between the city of Bristol and more rural areas of North Somerset and Gloucestershire 14 . This demonstrated that, while area‐based inequalities in DGAs existed, wealthier areas also experienced considerable levels of dental caries that could place a burden on services 14 …”

“…Another regional investigation in England found geographical differences in DGA rates between the city of Bristol and more rural areas of North Somerset and Gloucestershire 14 . This demonstrated that, while area‐based inequalities in DGAs existed, wealthier areas also experienced considerable levels of dental caries that could place a burden on services 14 …”