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      Different Aspects of General Anesthesia in Pediatric Dentistry: A Review

      review-article
      1 , *
      Iranian Journal of Pediatrics
      Kowsar
      Children, Dental Care, General Anesthesia

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          Abstract

          Context

          Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further.

          Evidence Acquisition

          A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings.

          Results

          Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical.

          Conclusions

          Besides criteria for case selection of dental GA, some degree of dental practitioner’s judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes.

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          Most cited references33

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          Oral health-related quality of life after dental general anaesthesia treatment among children: a follow-up study

          Background Many young paediatric patients with severe dental caries receive dental treatment under general anaesthesia. Oral health-related quality of life (OHRQoL) can be evaluated to assess the outcome of dental general anaesthesia (DGA) treatment. The aim of our study was to examine the OHRQoL of young Lithuanian children in need of DGA treatment and analyse the impact of DGA treatment on children’s OHRQoL. Methods We carried out a prospective clinical follow-up study on OHRQoL among all young Lithuanian child patients who received DGA treatment at the Lithuanian University of Health Sciences Hospital during 2010–2012. The study consisted of clinical dental examinations of patients younger than six years, data collected from their patient files, and an OHRQoL survey completed by their parents prior to the child’s dental treatment. We conducted a follow-up OHRQoL survey one month after the DGA treatment. The Early Childhood Oral Health Impact Scale (ECOHIS) and its effect size (ES) served to evaluate children’s OHRQoL, and the Wilcoxon signed-rank test served for statistical analyses. Results We obtained complete baseline and follow-up data for 140 and 122 participants, respectively (84.7% follow-up rate). Pain and eating problems among children and parents feeling upset and guilty were the most frequently reported impacts at baseline. The parents reported greater impacts on boys than on girls. The ECOHIS score decreased significantly (69.5%, p < 0.001) after DGA treatment, revealing a large ES for the child (1.6) and family (2.4) sections of the ECOHIS. Conclusions The OHRQoL of young Lithuanian children requiring DGA treatment is seriously impaired. Dental general anaesthesia treatment results in significant improvement of the children’s OHRQoL. The children’s parents also greatly appreciate this treatment modality for its positive impact on the family’s quality of life.
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            Comprehensive dental treatment under general anesthesia in healthy and disabled children.

            Differences in dental treatment under general anesthesia (GA) in healthy and disabled children are rarely reported. This retrospective study evaluated the characteristics and treatment modalities performed under general anesthesia in pediatric dental patients at Taipei Chang Gung Memorial Hospital between 2004 and 2005, and compared the different treatment patterns performed in healthy children and children with special health care needs. The data were reviewed in pediatric patients from 1 to 18 years old who underwent dental treatment performed under general anesthesia from January 2004 to December 2005. Patients with special health care needs who had at least one type of mental or physical disability were assigned to the disabled group (Group D) and the other healthy patients were assigned to the healthy group (Group H). The treatment modalities of operative restoration, crowns, pulp therapy, sealant and extracted teeth were compared in the two groups. A total of 185 patients were assigned to group H and 112 to group D. The patients in group D were significantly older than those in group H. There were no significant differences in the mean number of teeth treated between the two groups. However, there was a significantly greater mean total number of teeth extracted in group D patients (p < 0.001). In addition, there were more stainless steel crown reconstructions (p < 0.05) and pulp therapies (p < 0.001) performed in group H patients. In group D, there were no significant differences in the total number of teeth extracted between the 1-3 year old patients and the 3-6 year-old patients (p = 0.99). For very young children or those with special health care needs, dental treatment performed under general anesthesia is beneficial and efficient. The findings of this study suggest that underlying medical or mental conditions may influence the dental condition and treatment modality provided.
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              Postoperative complications of pediatric dental general anesthesia procedure provided in Jeddah hospitals, Saudi Arabia

              Background Review of post-operative morbidity reports for pediatric dental care under general anesthesia (GA) show great variations. Until now, no morbidity data has been available to estimate the safety of pediatric patients under GA for dental rehabilitation in Saudi Arabia. The purposes of this study were to (1) investigate post-operative complications associated with dental care under GA and (2) correlate morbidity reports with patient's characteristics, dental procedures, and hospital protocol. Methods Study sample included 90 children attending GA for dental treatment at major governmental hospitals in Jeddah. Data were collected from every patient on three occasions, intra-operatively at the operating room, and post-operatively via phone calls in the first and third days after operation. Results Results showed that 99% of the children had one or more complaints in the first day in contrast to only 33% in the third day. Inability to eat (86%), sleepiness (71%), and pain (48%) were the most common complaints in the first day, followed by bleeding (40%), drowsiness (39%), sore throat (34%), vomiting (26%), psychological changes (24%), fever (21%), cough (12%), and nausea (8%). A great significant complaints reduction was reported by the third post-operative day. Age, gender, admission type of the patients and GA duration were the factors that showed a significant relationship with post-operative complaints. Conclusion Post-operative morbidity was common, but mostly of mild severity and limited to the first day. Hospital staff efforts should be directed to control commonly reported postoperative complaints.
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                Author and article information

                Journal
                Iran J Pediatr
                Iran J Pediatr
                10.5812/ijp
                Kowsar
                Iranian Journal of Pediatrics
                Kowsar
                2008-2142
                2008-2150
                05 March 2016
                April 2016
                : 26
                : 2
                : e2613
                Affiliations
                [1 ]Children and Adolescent Health Research Center, Oral and Dental Disease Research Center, Department of Pediatric Dentistry, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, IR Iran
                Author notes
                [* ]Corresponding author: Nahid Ramazani, Department of Pediatric Dentistry, School of Dentistry, Azadegan St, Khorramshahr Ave, Zahedan, IR Iran. Tel: +98-5433414005, Fax: +98-5433420927, E-mail: ramazani_nahid@ 123456yahoo.com
                Article
                10.5812/ijp.2613
                4904485
                27307962
                460b26d2-8ad9-4198-89ce-21494cb70129
                Copyright © 2016, Growth & Development Research Center

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

                History
                : 29 May 2015
                : 30 October 2015
                : 11 November 2015
                Categories
                Review Article

                Pediatrics
                children,dental care,general anesthesia
                Pediatrics
                children, dental care, general anesthesia

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