A summary of: Hua, L., Busuttil-Naudi, A. & Keightley, A. Do paediatric patient-related factors affect the need for a dental general anaesthetic?. Br Dent J 233, 407–412 (2022). https://doi.org/10.1038/s41415-022-4922-2
General anaesthesia (GA) is frequently used as a treatment modality in paediatric patients. There are several potential patient factors that may increase the need for treatment under GA and it is important to identify these in order to reduce the number of children requiring dental treatment under GA.
This study concluded that the “level of spoken English, languages spoken at home, ethnicity (other than White British), self-reported dental anxiety and socioeconomic deprivation” may be factors that increase the likelihood of children receiving dental treatment under GA.
To reduce the number of paediatric patients requiring treatment under GA, it is important to first understand why paediatric patients commonly undergo treatment under GA in the first place:
- Treating caries
- Treating Molar Incisor Hypo-mineralisation (MIH)
- Surgical exposure/removal of canines
- Treating dental trauma (removal of a primary incisor)
Why should we try to avoid treatment under GA where possible?
- GA is associated with many risks
- Dental treatment under GA often has a long waiting time and this can impact a child’s wellbeing
- Dental treatment under GA must be done in hospital settings which costs the NHS greatly
“NHS spending data estimated that £41.5 million was spent funding extractions of teeth in children in England in 2018-2019”
- Dental anxiety may increase after receiving treatment under GA
Variables which may increase the likelihood of children receiving dental treatment under GA:
- If English is not spoken well/not the first language, preventative advice and oral hygiene instructions (OHI) may become challenging due to communication difficulties
- Ethnic diversity could lead to differences in perceived importance of oral health, in oral health behaviours or barriers to oral healthcare access
- Deprivation can increase the risk of developing caries and thus increase the likelihood of treatment under GA
- Disadvantaged families may not attend regular appointments which may allow disease to reach a ‘crisis’ point at which point treatment under GA may be the only suitable treatment modality
- Uncontrolled dental anxiety may increase the likelihood of treatment under GA
- It is more common for younger children to receive treatment under GA due to anxiety, whereas it is more common for older children to receive GA due to the nature of the treatment, for example, surgical removal of ectopic teeth
Quality of research
A limitation of this study is the cross-sectional design, which does not allow analysis of patient-related factors over a period of time. A cohort study would better explore these patient-related factors through time. This study however is good at highlighting the potential patient-related factors which require further investigation. These include further exploring the impact of language and socioeconomic deprivation on the quality of care provided to children and the likelihood of requiring GA for dental treatment.
Research Summary Written by: Rose Vatani, University of Manchester – BDS4