Supervisors info:
Γκιζάνη Σωτηρία, Αναπληρώτρια Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Αγουρόπουλος Ανδρέας, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Βαδιάκας Γιώργος, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ.
Summary:
Introduction
Young children and patients with special needs (SNP) with extensive caries often have limited abilities to cooperate and receive quality dental care. For this reason, general anaesthesia (GA) is often required for the dental treatment in these groups (Vermeulen et al 1991). Unfortunately caries recurrence is a common finding especially in children with early childhood caries (ECC) who receive dental rehabilitation under GA (Almeida et al 2000, Gizani et al 2001) despite the frequent recalls and preventive programs (new caries lesions: 37-52% of children, 6 months after the initial GA treatment, Graves et al. 2004, Berkowitz et al. 2011). Few long term studies reported an evaluation after GA in ECC children while even fewer, long term studies reported the clinical findings in. Therefore the aim of the present study is to report data on the long term oral health and dental behavior of uncooperative children after dental rehabilitation under GA and to highlight the difficulties involved in the set-up of such a study.
Material and method
The study sample originally consisted of 120 patients of the Postgraduate clinic of Paediatric Dentistry (NKUA) who received dental treatment under general anesthesia, between 2005 and 2017, at the Children’s Hospital “Paidon Agia Sophia”. The main reasons for their admission were extensive caries/no cooperation and special needs. The children should be not older than 18 years of age at present. The protocol was approved by the Ethics Committee of the Dental School and informed consent was obtained from the children and their legal guardians. From the university’s dental archives, information was gathered about the dental situation of the patients at their initial dental visit and the treatment provided under GA. The parents were contacted from the secretary of the postgraduate clinic of paediatric dentistry by telephone, between January 2019 and October 2020. When no telephone number was available, or the number was no longer active, their current number was searched for in the telephone book or online. When communication was not possible the patients were excluded. Subjects reached via the phone were invited to attend the dental clinic for an examination, professional tooth cleaning and fluoride application. They also completed a questionnaire about the oral health and dietary habits and dental attendance during the period between GA and present. Any changes in the medical history were registered while demographic and socio-economic data of the family were obtained from the records of the dental clinic. Subjects, who were not willing to attend the dental clinic, were interviewed over the phone. During their appointment and before the clinical examination, each patient was asked to indicate, with parental help, if necessary, one of the images of the facial image scale which was considered to be the most representative of his/her dental anxiety at that moment (Buchanan et al. 2002). Oral hygiene was registered using the Hygiene index (Lindhe 1982), on four surfaces of all teeth using a periodontal dental probe and without a discoloration agent. After tooth cleaning, caries experience was recorded using the criteria of the International Caries Detection and Assessment System (ICDAS) (Ismail et al., 2007). DMFS and dmfs scores were used to indicate the caries experience for each person (DS=ICDAS 1, 2, 3).
Results
Study sample - The group of patients that could be contacted was 79 out of 120. From these, only 10 individuals refused to complete the questionnaire mainly due to lack of interest for the study. Therefore the final study sample was 69 [26 females and 43 males with mean age 11.63 (SD 3.57)]. From these, 63.77% were SNP while 36.23% were Healthy children (HC). The most frequent health disorders were: mental disorders (50%), Syndrome/chromosomal disorders (41.91%) and autism (29.54%). The mean age of HC at the time of GA was 3.2 yrs (SD 0.8) and SNP was 5.82 yrs (SD 2.43) at that time. Most of the patients were younger than 5 yrs old at the time of GA. Some 37 patients (19 males and 18 females) out of 69, with mean age of 10.47 years (SD 3.43) agreed to attend the dental clinic. The reasons for the patient who did not want to have a clinical examination were mainly the distance (28.12%) or concerns due to Covid-19 pandemic (28.12%). Questionnaire - From the 69 individuals, 37 completed the questionnaire on site while the rest of them, at the phone by interview. Since GA, most of the subjects (71.01%) reported tooth brushing at least once per day (SNP: 72.73% and HC: 96%). Use of fluoride toothpaste was reported by all patients. Regarding their diet, half of the participants (50.72%) reported daily consumption of sweet snacks. The majority of the subjects (82.61%) reported at least one visit to the dentist in the previous year of the present study. Interestingly, 13.04% had never been to the dentist since the treatment under dental GA. Approximately half of them (50.72%) consulted the dentist for professional tooth cleaning and fluoride application, while 18.84% visited him/her due to pain. Among the rest of them which received dental treatment, extractions and/or restorations were most often provided. Clinical examination - The overall mean oral hygiene index was 32.93% (SD 0.2) (SNP: mean 32%, SD 19.78 and HC: mean 34.29, SD 20.78). Considering their caries experience at the present, the mean DMFS was 9.66 (SD 9.27) and dmfs 29 (SD: 15.91). Only 3 patients were caries free. More specifically HC patients had mean DMFS 6.39 (SD 4.99) [FS: 1.54 (SD 3.27)] while the mean DMFS of SNP was almost double 12.95 (SD 13.29). The largest component was DS for HC 4.92 (SD 5.08) and FS followed by DS, for the SNP 5.41 (SD: 6.26), FS 6.18 (SD 6.17). Patients were treated in daily dental routine setting. When the elapsed time between GA and the examination was considered, patients that were treated 2-5 years ago had mean DMFS 6.64 (SD 9.33). For them for which the elapsed time was longer (5-10), the mean DMFS score was 11.67 (SD9.27). Only two children reported that very sad about their visit to the dentist (face image scale).
Conclusion
Uncooperative children with caries in the primary dentition at the time of GA are susceptible to developing caries in their permanent dentition as well as new caries in the primary teeth, especially in 5 years afterwards. Oral hygiene is a problem for all children. Absence of regular follow ups of the patients with dental rehabilitation after GA is an important parameter while difficulties in getting contact with them is a great challenge for this study.
Keywords:
Dental general anaesthesia, Uncooperative young children, ECC, Special need patients, Long term outcome
