Do Preventive Programmes Reduce the Need for New Sedation for the Treatment of Oral Pathology?

doi:10.21203/rs.3.rs-3601431/v1

Objetives: To analyse the need for re-interventions under deep sedation to treat new oral pathology in a population of healthy children and SHCN who followed a prevention programme during follow-up and to study the influence of parental motivation and child collaboration on the need for re-interventions under deep sedation.

Material and methods: A cross-sectional study was carried out in a private clinic in Cartagena (Murcia, Spain), with patients treated under deep sedation from 2006 to 2018, both years included, following the Strobe statement.

Results: In this study with 230 patients, 63.05% were referred for deep sedation due to inadequate behavior management in the dental chair. Most patients were between 4 and 9 years old. High rates of dental caries and pulpal pathology were observed, with 47.40% of patients being healthy and 52.60% having special needs. Parental cooperation and participation in preventive programs reduced the need for additional sedation, especially in "cooperative" children, highlighting significant improvements in their awake dental treatment.

Conclusions: Prevention programmes, including motivational interviewing, are essential to improve children's behaviour in the dental chair and reduce the need for re-interventions under general anaesthesia or deep sedation.

Clinical Relevance: Although patients with special needs do require more sedation during their lifetime due to their inability to cooperate, these programmes are necessary for the maintenance of oral health status and for the early diagnosis of caries lesions.

The World Health Organization (WHO) includes caries as one of the main health disorders worldwide and proposes a reform of health systems in oral health, in order to pay more attention to prevention and minor treatments, and to avoid invasive dental treatments [1]. The policies and guidelines of the main international paediatric dentistry associations (AAPD, EAPD, IAPD) state the need to encourage oral health professionals and caregivers to implement preventive practices that can stop caries early and improve individual and public dental health [2–4]. It is imperative that children have their first contact with a dentist by 12 months of age at the latest [5]. Caries risk assessment is the determination of the likelihood of an increase in caries incidence over a given period of time or the likelihood of a change in the size or activity of the lesion already present [6]. Repairing caries lesions does not stop the disease and our restorations do not have an infinite lifespan, so prevention along with minimally invasive treatments and individualized treatment plans based on caries risk are the three basic pillars of the new approach to the disease. This new approach to caries treatment is the basis for the various protocols developed by scientific associations [2, 7, 8].

Children with special needs (SHCN) should be treated in the same way and referred to the appropriate centers if treatment under general anaesthesia is required [9]. Prevention and follow-up programmes are also needed to motivate parents and caregivers to better control diet and hygiene. Creating a close relationship between the patient, parents, caregivers and their paediatric dentist ("dental home") will help to implement individualized preventive measures [10].

The treatment of dental pathology on a single day is justified, as it is associated with a clear increase in the patient's quality of life [11]. Despite this, reoperations under sedation or general anesthesia are not uncommon. Among the possible causes of the need for re-treatment under surgical approach, some authors point to the initial oral health status of the sample and the prevention plan [12] and others to the general health status, the treatment received in the first intervention, fewer scheduled prevention appointments or the need for more emergency appointments [13]. A recent literature review [14] found that few studies have evaluated preventive programmes implemented after treatment under general anesthesia and their effect on the need for further interventions.

The aims of our study were:

a) To analyze the need for re-interventions with deep sedation to treat new oral pathology in a population of healthy children and SHCN who followed a preventive programme during follow-up.

b) To study the influence of parental motivation and child collaboration on the need for re-interventions under deep sedation.

This article was written according to the STROBE statement (www.strobe-statement.org). A cross-sectional study was conducted in a private clinic in Cartagena (Murcia, Spain), with patients treated under deep sedation during the years 2006 to 2018, both included. Inclusion criteria were: age 2-18 years; optimal general health status, which we will refer to as "healthy children", or children with special needs [15] (SHCN). Of the 274 potential patients, the final sample is 230 children after discarding medical records that were not correctly filled in. Parents/guardians of all patients had signed an informed consent and received an information sheet. The study was approved by the Research Ethics Committee of the University of Murcia (ID:2034/2018).

The anesthetic procedures were performed by a team of anesthesiologists and nurses. Dental interventions and patient follow-up were performed by the same dentist and dental hygienist. In the first visit, as well as in the subsequent appointments, a motivational interview was carried out where we worked with the parents on hygiene habits at home (hygiene techniques, recommendation of the adequate amount of toothpaste according to age, use of toothpaste with fluoride concentrations above 1450ppm); diet (gradual changes in the child's diet after a diet study); and we insisted on the need for a rigorous follow-up of the patient in the consultation room (according to the caries risk).

The preventive caries check-up was carried out between 15-30 days. Of the 230 patients, 64 returned to their referral clinics. The 166 patients who remained in the clinic were offered to join a preventive programme. As all patients belonged to the group of children at "high risk" of caries according to the Caries Management By Risk Assessment (CAMBRA) [16], the check-up interval was three months with plaque control, fluoride application, diet control, recall of hygiene techniques, motivational interviewing, and control of fear to the dentist. The patient who did not comply with the periodicity of the check-ups (n=82) was not included in this group. The referred patients who returned to their consultations (n=64) were given a report with the treatments carried out and the recommendation to follow this same protocol in their clinics of origin.

The information extracted from the medical records was:

(I) From the first visit:

A. Demographic data: age and sex.

B. Systemic health status, differentiating between healthy child and child with special needs.

C. Reason for sedation.

D. Assessment of oral health status prior to the intervention:

- Hygiene habits. The child was considered to be hygienic when he/she brushed regularly at least twice a day.

- Presence of plaque on visual inspection (Yes or No).

- Presence of tartar on visual inspection (Yes or No).

- Presence of caries lesions and number of teeth affected. We consider caries lesions as from the loss of enamel integrity (ICDAS 3, 4, 5).

- Pulp involvement and number of teeth affected. Pulp involvement was considered to be the presence of ICDAS 6 lesions, nocturnal pain, radiolucent image in radiographs, phlegmons or abscesses.

- Existence of root debris on visual inspection and number.

- Absence of teeth due to dental pathology on visual inspection (number).

(II) On the day of the first operation:

A. Types of treatment carried out.

- Filling.

- Direct pulp protection.

- Pulpotomy.

- Pulpectomy.

- Endodontics.

- Apicoforming.

- Tartrectomy.

- Scaling and root planing (RAR).

- Fluoride application.

- Exodontia.

B. Number of teeth treated

(III) Follow-up:

A. Attendance at the post-sedation check-up (Yes or No).

B. Presence of plaque on visual inspection (Yes or No)

C. Need for medication for oral pathology (Yes or No)

D. Improvement at mealtime (Yes or No)

E. Attendance to preventive programme (Yes or No)

F. Cooperative behaviour at appointments (Yes or No): depending on whether the patient allowed the dentist and/or hygienist to perform their work.

G. Motivation of parents in the oral care of their children (Yes or No): depending on whether they are involved in the care of their children's mouth and implement at home the dietary and oral hygiene recommendations given at the consultation or not.

H. Type of treatments carried out afterwards without sedation

- Health education.

- Tartrectomy.

- Fluoride application.

- Sealant.

- Filling.

- Pulpectomy.

- Pulpotomy.

- Preformed crowns.

- Endodontics.

- Apicoforming.

- Exodontia.

- Space maintainer.

I. Year of last revision

J. Follow-up time

(IV) Reinterventions:

A. Reason for reoperation

B. Type of unsuccessful treatment

C. Type of treatment performed

- Filling.

- Sealant.

- Pulpotomy.

- Pulpectomy.

- Endodontics.

- Apicoforming.

- Tartrectomy and fluoride application.

- Preformed crowns.

- Space maintainer.

- Exodontics.

D. Number of sedations

E. Time from first to last sedation

Statistical analysis

All data were collected in an Excel sheet and were statistically analysed with R version 3.6.0. (R Core Team 2019) by the Scientific and Technical Research Area, Statistical Support Section (Edificio SACE, ground floor 30100. Espinardo Campus. University of Murcia). A descriptive analysis of all study variables was performed. Continuous quantitative variables were compared two by two using T-test, T-test with Welch's correction, or Mann-Whitney test according to the assumptions of normality and homoscedasticity. To establish the relationship between discrete qualitative or quantitative variables, contingency tables were performed with Pearson's χ2 or Fisher's exact test, depending on whether or not the assumptions were met. To determine the equality of proportions, a "test of equality of proportions without continuity correction" was used. A p<0.05 was considered significant.

Of the 230 patients operated on, 145 (63.05%) were referred from other dental clinics for treatment under deep sedation. Of the total sample 61.74% were male and 38.26% were female. The mean age was 7.10 ± 3.40 years [25th and 75th quartiles of 4 and 9 years]. The ages with the highest number of children were 4 (n = 31), 6 (n = 29), 7 (n = 25), 8 (n = 25) and 9 (n = 25) years. 47.40% were healthy patients (n = 109) and 52.60% (n = 121) with special needs. In the group of healthy children the mean age was 5.04 ± 2.42 and in the group of children with special needs it was 8.95 ± 3.09 (Table 1).

The main reason for treating the patient under sedation was poor handling in the dental chair (99.5%; 229/230). 79.57% of the sample had no dental hygiene habits at home, 90.86% had dental plaque and 90.87% had lesions of dental caries. 45.22% of the patients had 5 to 10 teeth affected by caries lesions. Pulp pathology was diagnosed in 67.83% of the patients, with 1 or 2 teeth affected in 40.86% of the children. 4.34% had missing teeth and 13.91% had root remnants. There was a significantly higher percentage of pulp involvement, a higher number of teeth with caries lesions and a higher number of teeth with affected pulp per child in the group of healthy children, and a higher percentage of children with tartar and a higher number of missing teeth in the group of children with special needs (table 2).

Of the 230 children treated under deep sedation, 175 patients (76.08%) underwent a single sedation and 23.92% (n = 55) underwent two or more sedations. The mean time elapsed between the first and the remaining sedations was 21.64 ± 15.87 months to the second, 49.43 ± 22.62 months to the third, 48.00 ± 8.06 months to the fourth, 55.50 ± 7.59 months to the fifth and 74.00 ± 0.00 months to the sixth (Table 3). The main cause for re-interventions was the occurrence of new pathology. Only 3 patients were sedated a second time due to failure of previous treatments (Fig. 1).

Considering the total sample, significantly more pulp treatments were performed in the first sedation than in the second (p = 0.013) and in the third (p = 0.007). Healthy children required fewer re-interventions under deep sedation than children with special needs (6.42% vs 39.67%, two sedations; 2.75% vs 17.35%, three sedations; 0.008% vs 7.44%, four sedations). If we analyze the treatments performed according to the patient's state of health, we observe that during the second sedation, patients with special needs undergo more obturations and endodontics and healthy patients undergo more pulpectomies and exodontics. And during the third sedation, patients with special needs undergo more pulpectomies, sealants and tartrectomies and/or fluoride application, and healthy patients undergo more obturations and extractions. There are no pulp treatments in either group during the fourth sedation (Table 4).

81 of the patients referred by other dentists and 85 of the clinic's own patients decided to follow up with us (n = 166). In 130 of them we recorded whether they were "cooperative" (n = 66) or "non-cooperative" (n = 64) and whether their parents were "motivated" (n = 48) or "non-motivated" (n = 82) with the care of their children's mouths. Patients with "motivated" parents underwent fewer second sedations than children with "non-motivated" parents (20.83% vs 46.34%; p = 0.006) and fewer third (10.41% vs 21.95%; p = 0.15) and fourth (2.08% vs 10.97%; p = 0.089) interventions (Fig. 2). Non-collaborating" children needed to be sedated a second time more often than "collaborating" children (60.93% vs 12.12%; p < 0.001). The same was true for third sedation (31.25% vs 4.54%; p = 9.9e-05) and fourth sedation (12.50% vs 3.03%; p = 0.061). In addition, "non-cooperative" patients or those with "non-motivated" parents needed to be sedated for simple treatments (tartrectomy, fluoride application and/or sealants), while "cooperative" children or those with "motivated" parents were able to receive these treatments in the dental chair.

The 166 patients following up in the clinic after the first intervention were advised to follow a quarterly preventive programme, with an average time of 39.6 months. This was done by 52.23% of the healthy patients and 49.99% of the patients with special needs. Of the 84 patients who followed the preventive programme, only 35.8% required a second sedation compared to 50% of the children who did not follow the preventive programme (Fig. 3).

53.57% of the children who participated in the preventive programme became "collaborators", 100% were able to receive some treatment while awake in the dental chair, compared to 43.90% of the patients who did not follow the prevention programme (p < 0.001): dental surgery (44.04% vs 25.61%; p = 0.0127), maintenance (85.71% vs 28.04%; p < 0.001), health education (97.61% vs 35.36%; p < 0.001).

80.00% of healthy patients who followed the preventive programme were able to receive awake operative treatments, compared to 40.60% of healthy children who did not follow the programme. However, patients with SHCN who followed the preventive programme were not able to receive awake operative treatments, although they were able to receive maintenance treatments (Table 5).

Treatment of all dental pathology under general anesthesia or deep sedation on a single day is justified because it improves patients' quality of life [11]. However, these patients often require re-interventions for the treatment of new pathology or failures of previous treatments [12, 13, 17].

Of the 230 healthy SHCN patients in our study, 76.08% were sedated only once, but the remaining 23.92% (55 patients) required a second intervention under deep sedation within a mean time of 21 months. This percentage was high, higher than that of the study by Tahmassebi, Achol and Fayle (2014) [18] which had a percentage of second sedation of 12.9% at 13–24 months after the first sedation, probably because SHCN patients had more extractions than fillings in the first intervention, thus decreasing the number of teeth in the mouth also decreased the possibility of new disease. König et al (2020) [17], with a higher mean number of extracted teeth per child (3.7 vs 0.64 in healthy children and 1.35 in SHCN [19]) and a higher percentage of healthy patients than our study (71.0% vs 47.4% [19]), recorded a reintervention rate of 11%. Other studies, such as Rudie et al. (2018) [20] and Guidry et al. (2017) [13], recorded fewer second sedations (9.0% and 4.9%, respectively) possibly due to the lack of a standardised follow-up protocol, having observed, like Almeida et al. (2000) [21], that children who received more conservative restorative treatment during the first intervention tend to need more retreatments under general anesthesia. However, in our study, neither the initial oral pathology nor the treatments performed at the first deep sedation were significantly related to the need for re-operation under sedation.

Considering the health status of the child, in our study, 6.42% of healthy patients required a second sedation. Only the study by Kwok-Tung et al. (2008) [22], where exodontia accounted for 41% of the total number of treatments performed in the first intervention, had a lower percentage of healthy children who underwent a second intervention (3.5%). However, other authors [23–25] describe higher values, ranging from 11–18.8%, due to treatment failures (performing many pulp treatments without using rubber dam [Jiang et al. (2019) [23]], non-attendance of patients at check-up appointments or persistent non-cooperation of the child in the chair. A second sedation was required in 39.67% of the SHCNs in our study. This percentage is higher than in the studies reviewed, whose sample consists only of children with SHCN [12]. Bücher et al. (2016) [12] explained their low percentage (10.8%) of reinterventions because the initial sample had a very low dmft, because they rarely performed pulp treatment in the deciduous dentition and because the mean number of extractions in the first intervention was 2.5 teeth per patient, compared to 1.35 in our study [19]. In our opinion, the reason for the high percentage of second sedation in our study was the quarterly prevention programme, which allowed very close monitoring of the patients who voluntarily chose to join it. In the case of SHCN patients, increased follow-up did not necessarily mean less pathology, as preventive measures in the clinic are not effective if they are not accompanied by good hygiene and daily diet control [12]. However, carrying out check-ups did allow early detection of new oral pathology and the need for its treatment; and we were able to incorporate interventions under deep sedation as another tool for the correct maintenance of oral health, also considering that our regional Public Health system assumes all treatments performed in the operating theatre for children with SHCN, while treatments of the deciduous dentition performed without general anesthesia entail a cost for parents. Parents of children with disabilities who have received more than one treatment under general anesthesia tend to repeat this approach [26].

One of the main goals of preventive programmes is to avoid further interventions under general anesthesia [13, 17, 27, 28] by managing the child's behaviour in the dental chair [29, 25, 30, 31]. Few studies have analyzed the long-term effect of such programmes on the occurrence of new pathology and on the need for subsequent reoperations under general anesthesia or deep sedation, and their results are contradictory. Thus, Almeida et al. (2000) [21] who compared the evolution of healthy children with ECC treated under sedation with another group of children who did not present caries, performing check-ups every 6–9 months for 2 years, observed that only 38% of the group of children with ECC attended all check-ups, that children with a history of ECC had more recurrent caries than healthy children and that there was no relationship between the frequency of check-ups and the need for second sedation (17%) or with the appearance of new lesions. In contrast, other authors [32, 13] found that missed check-ups increased the occurrence of new caries lesions, while attendance at check-ups decreased the risk of a second operation in the operating theatre. Raja et al (2019) [33] published that, in a sample of children aged 2–5 years treated under general anesthesia for exodontia, at two years there was a high incidence of caries lesions in the first permanent molars, a low number of sealants, due to the lack of attendance of patients at their referral clinics for preventive treatment, with only 14.39% of patients attending for check-ups every 6 months.

The patients in our study who attend the preventive programme are sedated for the second time more than those who do not undergo prevention (34.5% vs 27%) due to the fact that, during check-ups, we diagnose more pathology and need for treatment. Despite our efforts to teach hygiene techniques and healthy dietary habits, this was not enough [31] and our patients continued to develop new lesions [21] Olley et al (2011) [34] showed that lack of brushing at home is one of the causes of failure [12] and that, although 78% of parents were interested in preventive programmes, they stated that they did not have the time or energy to fight with their children and felt social pressure to consume sugary food. A high periodicity of screening is very important to achieve behavioural change in a household [35].

Our quarterly preventive programme for children at high risk of caries, although it did not lead to the complete disappearance of the disease, was useful to achieve one of the necessary requirements to avoid further sedation, which is to teach the child to be cooperative in the dental chair [31]. Of the total number of patients who followed the preventive programme, 53.5% became compliant. In the case of healthy patients, 80% were able to perform operative treatments awake. In patients with special needs, the preventive follow-up was more oriented towards the maintenance of oral health status and early diagnosis of caries lesions than towards avoiding future interventions in the operating theatre [13]. Although 85% of those who attend preventive visits can perform maintenance treatments awake, compared to 32% of those who do not attend regular visits, when it comes to performing more complex treatments, the percentages are practically equal (18% vs 16%). Another important observation that justifies the need for the preventive programme is that these patients needed sedation for more complicated treatments, as they were able to perform simple treatments in the dental chair. Thus, of the patients who attended preventive appointments and required second sedation, 13.79% underwent pulpectomies compared to 9.09% of those who did not attend preventive appointments and, on the other hand, required fewer fillings (75.86% vs. 90.9%) and tartrectomy and/or fluoride application (72.41% vs. 95.45%).

The main limitation of our study was that it was a retrospective observational study with data from a private clinic where epidemiological research indices such as caod, CAOD and plaque indices are not routinely used, which would have facilitated comparison of the data with other published studies. A prospective study with exhaustive control of all variables would be ideal.

Prevention programmes that include motivational interviewing are essential to improve children's dental chair behaviour and reduce the need for re-interventions under general anesthesia or deep sedation. Although patients with special needs do require more sedation throughout their lives due to their inability to cooperate, these programmes are necessary for the maintenance of oral health and for the early diagnosis of caries lesions.

Conflict of interest The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the Research Ethics Committee of the University of Murcia (ID:2034/2018).

Funding

Not applicable

Acknowledgements

Not applicable

Availability of data and materials

All data associated with this study are presented in the paper.

Author Contribution:

Conceptualization, A.J.O.-R. and I.G.R; methodology, A.J.O.-R., C.S.M. and Y.M.B.; formal analysis, A.J.O.-R.; investigation, I.G.R. and A.P.-S.; data curation, C.S.M and A.J.O.-R.; writing—original draft preparation, I.G.R. and A.J.O.R; writing—review and editing, I.G.R, Y.M.B, A.J.O.-R., C.S.-M., A.P.-S. visualization, C.S.-M. , A.P.S and A.J.O.-R.; supervision, A.J.O.-R., Y.M.B. All authors have read and agreed to the published version of the manuscript.

WHO (2022) Prevention and treatment of dental caries with mercury-free products and minimal intervention. WHO Bull 28
American Academy of Pediatric Dentistry (2020) Periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants children and adolescents. The Reference Manual of Pediatric Dentistry. Chicago, III pp 232–242
Kühnisch J, Ekstrand KR, Pretty I, Twetman S, van Loveren C, Gizani S et al (2016) Best clinical practice guidance for management of early caries lesions in children and young adults: an EAPD policy document. Eur Arch Paediatr Dent 17(1):3–12
Tinanoff N (2023) Caries management pathways for children: IAPD Global Policy Statement Int. https://doi.org/10.1111/ipd.13119. J Paediatr Dent
Beltrán Andreu M (2020) Encuesta de Salud Oral en España 2020. Revista del Ilustre Consejo General de Colegios de Odontólogos y Estomatólogos de España. RCOE
American Academy of Pediatric Dentistry (2020) Caries-risk assessment and management for infants, children, and adolescents. The reference Manual of Pediatric Dentistry. Chicago, III pp 243–247
Treuner A, Splieth CH (2012) Prevención de la caries en la primera infancia. Quintessence 25:229–235
Martignon S et al (2019) CariesCare practice guide: consensus on evidence into practice. Br Dent J 227:353–362
Willi PO (2018) Protocolo Oral Pacientes Con Minusvalia Seop. Soc. Española Odontopediatría 1–4
American Academy of Pediatric Dentistry (2020) Management of dental patients with special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, III pp 275–280
Knapp R, Gilchrist F, Rodd HD, Marshman Z (2017) Change in children’s oral health-related quality of life following dental treatment under general anaesthesia for the management of dental caries: a systematic review. Int J Paediatr Dent 27:302–312
Bücher K, Rothmaier K, Hickel R, Heinrich-Weltzienn R, Kühnisch J (2016) The need for repeated dental care under general anaesthesia in children. Eur J Paediatr Dent 17:129–135
Guidry J, Bagher S, Felemban O, Rich A, Loo C (2017) Reasons of repeat dental treatment under general anaesthesia: A retrospective study. Eur J Paediatr Dent 18:313–318
López-Velasco A, Puche-Torres M, Carrera-Hueso FJ, Silvestre FJ (2021) General anesthesia for oral and dental care in paediatric patients with special needs: A systematic review. J Clin Exp Dent 13:e303–e312
American Academy of Pediatric Dentistry (2023) Definition of Special Health Care Needs. The Reference Manual of Pediatric Dentistry. Chicago, III pp 15
Featherstone J, Crystal Y, Gomez F (2019) CAMBRA® Caries Management by Risk Assessment A Comprehensive Caries Management Guide for Dental Professionals. Journal of the California Dental Association
König T, Reicherts P, Leha A, Hrasky V, Wiegand A (2020) Retrospective study on risk factors for repeated dental treatment of children under general anaesthesia. Eur J Paediatr Dent 21:183–186
Tahmassebi JF, Achol LT, Fayle SA (2014) Analysis of dental care of children receiving comprehensive care under general anaesthesia at a teaching hospital in England. Eur Arch Paediatr Dent 15:353–360
Gómez-Ríos I, Pérez-Silva A, Serna-Muñoz C, Ibáñez-López FJ, Periago-Bayonas PM, Ortiz-Ruiz AJ (2023) Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children: A Retrospective Study. Int J Environ Res Public Health 20(4):3435. https://doi.org/10.3390/ijerph20043435
Rudie MN, Milano MM, Roberts MW, Divaris K (2018) Trends and characteristics of pediatric dentistry patients treated under general anesthesia. J Clin Pediatr Dent 42:303–306
Almeida AG, Roseman DMM, Sheff DDSM, Huntington MN, Hughes CV (2000) Future caries susceptibility in children with Early Childhood Caries following treatment under general anesthesia. Am Acad Pediatr Dentistry 22(4):302–306
Kwok-Tung L, King NM (2006) Retrospective audit of caries management techniques for children under general anesthesia over an 18-year period. J Clin Pediatr Dent 31:58–62
Jiang H, Shen L, Qin D, He S, Wang J (2019) Effects of dental general anaesthesia treatment on early childhood caries: A prospective cohort study in China. BMJ Open 9:1–11
William JJ, Kaaren V (2007) Recall Rates and Caries Experience of Patients Undergoing General Anesthesia for Dental Treatment William. Pediatr Dent 29:253–257
Savanheimo N, Vehkalahti MM (2014) Five-year follow-up of children receiving comprehensive dental care under general anesthesia. BMC Oral Health 14:154
Ohtawa Y, Yoshida M, Fukuda K (2019) Parental Satisfaction with Ambulatory Anesthesia during Dental Treatment for Disabled Individuals and Their Preference for Same in Future. Bull Tokyo Dent Coll 60:53–60
Ciftci V, Yazicioglu İ (2020) A retrospective comparison of dental treatment under general anesthesia provided for uncooperative healthy patients and patients with special health care needs. J Clin Pediatr Dent 44:196–201
Al-Ogayyel S, Ali SAH (2018) Comparison of dental treatment performed under general anesthesia between healthy children and children with special health care needs in a hospital setting, Saudi Arabia. J Clin Exp Dent 10:e963–e969
Bader RM, Song G, Almuhtaseb EY (2013) A Retrospective Study of Paediatric Dental Patients Treated under General Anesthesia. Int J Clin Med 04:18–23
Mallineni S, Yiu C (2014) A retrospective review of outcomes of dental treatment performed for special needs patients under general anaesthesia: 2-Year follow-up. Sci. World J. 2014
Savanheimo N, Vehkalahti MM (2008) Preventive aspects in children’s caries treatments preceding dental care under general anaesthesia. Int J Paediatr Dent 18:117–123
Foster T, Perinpanayagam H, Pfaffenbach A, Certo M (2006) Recurrence of Early Childhood Caries. J Dent Child 73:25–30
Raja A, White DA, Kerr SE, Dietrich T (2019) Prevention in the context of caries-related extractions under general anaesthesia: an evaluation of the use of sealants and other preventive care by referring dentists. Br Dent J 227:489–495
Olley RC, Hosey MT, Renton T, Gallagher J (2011) Why are children still having preventable extractions under general anaesthetic ? A service evaluation of the views of parents of a high caries risk group of children. Nat Publ Gr 210:1–8
Razeghi S, Amiri P, Mohebbi SZ, Kharazifard MJ (2020) Impact of Health Promotion Interventions on Early Childhood Caries Prevention in Children Aged 2–5 Years Receiving Dental Treatment Under General Anesthesia. Front Public Heal 8:1–7

Tabla 1. Sample demographic description

Sample Size (n=230)

145 referred patienrs (63.05%)

142 men (61,74%)

88 women (38,26%)

Mean age: 7.10±3.40 (median 7 años)

Healthy (n=109): 5.04±2.42 años

SHCN (n=121): 8.95±3.09 años

Tabla 2. Initial oral health status of healthy children versus children with special needs

.

	Total	Healthy	SHCN	p - value
Tooth brushing habit	20,43 %	17,43 %	23,14 %	0,36^b
Plaque	90,86 %	93,57 %	89,25 %	0,35^b
Tartar	31,30 %	7,33 %	52,89 %	< 0,001^b
Carious lesions	90,87 %	93,57 %	88,43 %	0,26^b
Pulp involvement	67,83 %	78,90 %	57,85 %	0,0011^b
Root remain	13,91 %	10,09 %	17,36 %	0,16^b
Abscenses	4,34 %	4,58 %	4,13 %	1^a
Number of teeth with caries lesions per child (mean±SD)	6,78±4,65	7,49±4,68	6,13±4,54	<0,05^c
Number of teeth with pulpal involvement per child (mean±SD)	1,84±2,04	2,25±2,01	1,47±2,00	0,0037^c
Número de dientes ausentes por niño (media±SD)	0,10±0,84	0,045±0,21	0,16±1,14	0,005^c

SHCN: Children with special needs.^aFisher´s exacts test. ^b Pearson's chi-squared test.^c Mann-Whitney U test.

Tabla 3. Number of sedations and time elapsed between the first and the subsequent ones.

Number of sedations		time media±sd [median] (months)
One	76,08% (175/230)
Two	13,47% (31/230)	Second	21.64±15.87 [21.00]
Three	6,08% (14/230)	Third	49.43±22.62 [41.50]
Four	2,17% (5/230)	Fourth	48.00±8.06 [51.00]
Five	1,73% (4/230)	Fifth	55.50±7.59 [57.50]
Six	0,43% (1/230)	Sixth	74.00±0.00 [74.00]

Tabla 4. Dental treatment modalities performed in healthy children and children with special health care needs (SCHN)) in second, third and fourth sedation.

Treatments	Total Number of sedations (n)				SHCN Number of sedations (n)				Healthy Number of sedations (n)
Treatments	1(230)*	2(55)	3(24)	4(10)	1(121)*	2 (48)	3 (21)	4 (9)	1(109)*	2 (7)	3 (3)	4 (1)
Filling	91.73%	81,81%	83,33%	50.00%	88.43%	85,41 %	80,95 %	44.44%	95.41%	57,14 %	100 %	25.00%
Direct Pulp Capping	1.3%	–	–	–	1.65%	–	–	–	0.91%	–	–	–
Pulpectomy	33.91%	12,72%	16,66%	–	14.05%	10,41 %	19,04 %	–	55.96%	28,57 %	–	–
Pulpotomy	13.04%	1,81%	–	–	9.91%	2,08 %	–	–	16.51%	–	–	–
Endodontic	13.04%	14,54%	4,16%	–	19.00%	16,6 %	–	–	6.42%	–	33,33 %	–
Exodontias	38.7%%	36,36%	45,83%	60.00%	45.45%	35,41 %	42,85 %	55.55%	31.19%	42,85 %	66,66 %	25.00%
DTT + Fluoride	86.95%	81,81%	91,66%	90.00%	97.52%	87,5 %	95,23 %	88.88%	75.23%	42,85 %	66,66 %	25.00%
Fissure sealant	40.87%	38,18%	58,33%	10.00%	44.63%	41,66 %	61,90 %	–	36.70%	14,28 %	33,33 %	25.00%
Scaling and root planing	0.86%	0.00%	–	–	1.65%	–	–	–	–	–	–	–
Stainless Steel crown	–	3,63%	–	–	–	2,08 %	–	–	–	14,28 %	–	–
Space maintenance	–	1,81%	–	–	–	2,08 %	–	–	–	–	–	–
MTA apexification	1.30%	5,45%	–	–	1.65%	6,25 %	–	–	0.91%	–	–	–

These data come from the reference [Gómez-Ríos, I.; Pérez-Silva, A.; Serna-Muñoz, C.; Ibáñez-López, F.J.; Periago-Bayonas, P.; Ortiz-Ruiz, A.J. Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children. A Retrospective Study. Int. J. Environ. Res. Public Health 2023, 20, 3435. https://doi.org/10.3390/ijerph20043435.]

Tabla 5. Treatments performed awake according to the patient's health status and whether or not they attend prevention follow-up appointments.

	SHCN				Healthy
	Total	Educ. Health	Maint.	Other treatments	Total	Educ. Health	Maint.	Other treatments
Prevention program	100%	100%	85,71%	18,4%	100%	97,14%	85,71%	80%
Prevention program	n=49	49	42	9	n=35	34	30	28
No prevention program	100%	40%	32%	16%	100%	28,12%	21,87%	40,6%
No prevention program	n=50	20	16	8	n=32	9	7	13
p-value		<0,001^f	<0,001^f	0,755^f		<0,001^f	<0,001^f	<0,001^f

^fTest de proporciones. Educ. Health (Education for health); Mant. (Maintenance).

No competing interests reported.

Do Preventive Programmes Reduce the Need for New Sedation for the Treatment of Oral Pathology?

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Abstract

Figures

INTRODUCTION

MATERIAL AND METHODS

RESULTS

DISCUSSION

CONCLUSIONS

Declarations

References

Tables

Additional Declarations

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