Analysis of Selection Criteria of Dental Patients for General Anaesthesia and Conscious Sedation

Objective: The term general anaesthesia refers to a state of unconsciousness under control using pharmacological or non pharmacological agents in which patient reflexes are compeletely or partially lost. Concious sedation is a drug-induced state in which the conscious patient is rendered free of fear, anxiety, and apprehension while remaining comfortably relaxed. Both of these methods are used for various reasons in dental clinics for many years and their use in dentistry practice is increasing. Aim of this study is to quantify the number and demographic data of patients that received a dental general anaesthesia (DGA) or conscious sedation (CS) following referral from a general dental practice. Study also aimed to determine the reasons of referral and dental treatment modalities performed during the sessions. Methods: This study includes patient records who had undergone dental general anaesthesia and conscious sedation in Medipol University Dental Hospital General Anaesthesia Clinic. Data were collected from records of the University Dental Hospital. The collected information included gender, age, type of DGA/ CS, reason for DGA, treatment modalities as tooth extraction, restorative, endodontics, periodontics and pedodontics. Results: 896 patients were referred for DGA/CS during the two-year period. The mean age was 15.5 years and 27.3% were underaged children. The most common reason for DGA was dental anxiety (46.5%). 79.4% of patientd received DGA, while only 20.6% received CS. The highest mean in treatments is for decidious pulp capping (4.57) followed by decidious pulp amputation (3.57).Conclusion: Majority of the patients receiving DGA/CS are formed by dental anxiety patients. Also, the rate of underaged children were very high (27.3%).

Keywords:

Dentistry, General Anaesthesia, conscious sedation pediatric dentistry, dental anxiety,

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Frassica JJ, Miller EC. Anesthesia management in pediatric and special needs patients undergoing dental and oral surgery. Int Anesthesiol Clin. 1989;27(2):109-15.
Lee PY, Chou MY, Chen YL, Chen LP, Wang CJ, Huang WH. Comprehensive dental treatment under general anesthesia in healthy and disabled children. Chang Gung Med J. 2009;32(6):636-42.
Nelson TM, Xu Z. Pediatric dental sedation: challenges and opportunities. Clinical, Cosmetic and Investigational Dentistry. 2015;7:97-106.
Rosenberg J, Fuchs-Buder T. Why surgeons need to know about anaesthesia. Surg Endosc. 2016 Sep;30(9):3661-4.
Nunn JH, Davidson G, Gordon PH, Storrs J. A retrospective review of a service to provide comprehensive dental care under general anesthesia. Spec Care Dentist. 1995;15(3):97-101.
Bennett CR. Conscious sedation: an alternative to general anesthesia. J Dent Res. 1984;63(6):832-3.
Rosenberg MB, Campbell RL. Guidelines for intraoperative monitoring of dental patients undergoing conscious sedation, deep sedation, and general anesthesia. Oral Surg Oral Med Oral Pathol. 1991;71(1):2-8.
Rosenberg M; American Dental Association. New guidelines for the use and teaching of general anesthesia and sedation by dentists. J Mass Dent Soc. 2010;58(4):22-7.
Varpio M, Wellfelt B. Some characteristics of children with dental behaviour problems. Five-year follow-up of pedodontic treatment. Swed Dent J. 1991;15(2):85-93.
Craig DC, Wildsmith JA; Royal College of Anaesthetists; Royal College of Surgeons of England. Conscious sedation for dentistry: an update. Br Dent J. 2007;203(11):629-31
Tyrer G L. Referrals for dental general anaesthet¬ics – how many really need GA? Br Dent J 1999; 187: 440–443.
Carter AE, Carter G, Boschen M, AlShwaimi E, George R. Pathways of fear and anxiety in dentistry: A review. World J Clin Cases. 2014;2(11):642–653.
Storjord HP, Teodorsen MM, Bergdahl J, Wynn R, Kolset Johnsen JA. Dental anxiety: a comparison of students of dentistry, biology, and psychology. J Multidiscip Healthc. 2014;7:413–418.
Pop-Jordanova N, Sarakinova O, Markovska-Simoska S, Loleska S. Anxiety and personality characteristics in children undergoing dental interventions. Contributions. MASA (Sec Med Sci) 2013;34(3):93–103.
Pop-Jordanova N, Sarakinova O, Pop-Stefanova-Trposka M, Zabokova-Bilbilova E, Kostadinovska E. Anxiety, Stress and Coping Patterns in Children in Dental Settings. Open Access Maced J Med Sci. 2018;6(4):692-697.
Pohjola V, Mattila A K, Joukamaa M, Lahti S. Anxiety and depressive disorders and dental fear among adults in Finland. Eur J Oral Sci 2011; 119: 55–60.
Hill K B, Chadwick B, Freeman R, O’Sullivan I, Murray J J. Adult Dental Health Survey 2009: relationships between dental attendance patterns, oral health behaviour and the current barriers to dental care. Br Dent J 2013; 214: 25–32.
Coric A, Banozic A, Klaric M, Vukojevic K, Puljak L. Dental fear and anxiety in older children: an association with parental dental anxiety and effective pain coping strategies. J Pain Res. 2014;7:515-21.
Wu L, Gao X. Children's dental fear and anxiety: exploring family related factors. BMC Oral Health. 2018;18(1):100.
Richards W, Razzaq K, Higgs G. An audit of dental general anaesthetic referral from a general dental practice in South Wales. Prim Dent Care. 2009;16(4):143-7.
Saxen MA, Urman RD, Yepes JF, Gabriel RA, Jones JE. Comparison of Anesthesia for Dental/ Oral Surgery by Office-based Dentist Anesthesiologists versus Operating Room-based Physician Anesthesiologists. Anesthesia Progress. 2017;64(4):212-220.
Whittle JG. The provision of primary care dental general anaesthesia and sedation in the north West region of England, 1996-1999. Br Dent J. 2000; 189(9):500-2.
Averley PA, Lane I, Sykes J, Girdler NM, Steen N, Bond S. An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment- an alternative to general anaesthesia. Br Dent J. 2004;197(9):553-8.
Lyratzopoulos G, Blain KM. Inhalation sedation with nitrous oxide as an alternative to dental general anaesthesia for children. J Public Health Med. 2003;25(4):303-12.