Reasons for Repeat Dental Treatment Under GA

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Anna Haritos Date: May 22, 2009
Article title: Reasons for Repeat Dental Treatment Under General Anesthesia for the Healthy Child
Author(s): Sheller, et al
Journal: Pediatic Dentistry
Volume (number): 25:6
Month, Year: Nov-Dec, 2003
Major topic: Repeat GA-based dental treatment
Minor topic(s): n/a
Type of Article: Research
Main Purpose: to investigate the reasons why healthy children required repeat dental treatment under GA
Overview of method of research: A retrospective chart review of 23 patients (ASA I, II, two GA-dental tx) was conducted between Jan 19990 and Mar 2000; these charts were labeled subjects and were matched demographically with 23 ‘control’ charts of one-time GA-dental tx patients; Parents/guardians of these subjects and controls were recruited for questionnaire/interview session – 11 subject parents and 9 control parents participated;
Findings: The chart review found that repeat patients were mostly male, with mean age of first GA-treatment at 2.6 yrs, and mean age second GA-treatment 4.7 years. For both subjects and controls, Medicaid was the most common method of payment. At the initial visit, prior to any GA, no subjects cooperated for radiographs, while 40% of controls cooperated for radiographs. All of the subjects received central incisor treatment under GA while 76% of the controls received central incisor treatment. 7% of subjects versus 43% of controls returned for post-op visits. 39% of subjects developed caries on previously untreated/unerupted teeth versus 2% of the controls. Success of SSC were similar in both groups. Interview responses by parents revealed that subject patients had a hard time with injections in the medical setting versus controls; At the time of the first GA, more subjects than controls were bottle-fed with non-water fluids. All controls had an adult brushing their teeth at the time of the first GA versus 55% of the subjects. After the first GA treatment, 45% of subjects continued to use non-water bottle-feeding at nap and bedtime versus 11% of controls. Both subject and control parents did not change frequency of type of snacks given to their child before versus after GA treatment.
Key points/Summary: patient factors associated with need for second session of GA-dental treatment: 1)100% involvement of maxillary central incisors at time of initial GA; 2)continued use of the bottle at the time of GA; 3)poor cooperation in the medical/dental setting; 4) difficult personality as described by parent; 5) parents not brushing child’s teeth; 6) parent/child had dysfunctional social situation; 7) parents failed to bring child back for post-op visit;
Assessment of article : very good article