Trends in exodontia under general anaesthesia at a dental teaching hospital

Abstract

Dental treatment under general anaesthesia should continue to be available where it is justified. A separate assessment appointment reduces the prescription of general anaesthesia and minimises its usage for orthodontic extractions and the necessity for repeat general anaesthesia.

The behaviour, social status and number of teeth extracted in children under general anaesthesia: A referral centre revisited

“…The mean number of teeth extracted in 1999 was 4.2 (median 3, range 1-16); in 2004 this had increased to 7.4 (median 8, range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. This increase from 1991 was highly significant (p < 0.001), irrespective of whether means (one-way ANOVA) or medians (Kruskal-wallis) were used in the statistical analysis, and can be seen clearly in Figure 1.…”

“…The mean age of children referred for DGA extractions remained the same, though this continues to be lower than comparable studies. 7,8 Approximately half of the children treated have been aged five years and under; this is doubtless a reflection of the poor dental health of this population in Scotland. The eldest child in the 1999 sample was just 11 years old compared with 17 years old in 1991 and the youngest in 2004 was aged three years compared to one year of age previously.…”

Assessment of children prior to dental extractions under general anaesthesia in Scotland

“…This is consistent with published work which suggests that it reduces the likelihood of the need for a repeat GA in the future. 4,9 It has been suggested that it may be appropriate to routinely refer children to the care of a service where the treatment plan can be developed by specialist staff, who could also offer full oral rehabilitation and not just extractions. 9 Thus, when considering the future of CDGA services in Scotland, the potential for the development of links between primary care practitioners and specialist paediatric teams in the community, including professionals complementary to dentistry, may be worth exploring.…”

“…Overall, the pre-GA assessment clinic in this audit prevented the need for GA in 15% of referrals from general dental practitioners (GDPs). 3 Studies have shown that referral to a specialist paediatric dentistry screening service leads to an increased number of extractions, resulting in a reduction in the need for a repeat GA. 4,5 However, a study carried out in 1991 in a Scottish secondary centre reported that 40% of the children who received a GA had only one or two teeth extracted. 6 The problem of attendance for repeat referral is a serious one, with reports of up to 31% of children requiring further GA. 7 One reason for this need for a repeat CDGA for dental extractions could be incomplete caries diagnosis or deficient management of pre-existing caries at the time of the first referral.…”

Referrals for dental general anaesthetics — how many really need GA?

“…10 A more recent paper concluded that 'A separate assessment appointment reduces the prescription of general anaesthesia and minimises its usage for orthodontic extractions and the necessity for repeat general anaesthesia' . 11 This paper describes a study of the clinical outcomes and customer satisfaction for a series of 82 child patients who had been referred to the CDS locally for DGA for a mixture of orthodontic and carious extractions, and who were required to attend for a pre-anaesthetic assessment visit. Objective criteria were used to determine need for DGA and active encouragement was given to consider treatment with local anaesthetic as opposed to general anaesthetic where this was not clinically contraindicated.…”