01/12/2011 Effect on Behavior of Dental Treatment Rendered under Conscious Sedation and General Anesthesia in Pediatric Patients

Resident: J. Hencler
Date: 01/12/2011

Article title: Effect on Behavior of Dental Treatment Rendered under Conscious Sedation and General Anesthesia in Pediatric Patients
Author: Fuhrer et al

Journal: Pediatric Dentistry V 31/NO 7, NOV/DEC 2009
Major topic: Changes in behavior due to different sedation techniques
Type of Article: Retrospective study/chart review

Main Purpose:
Determine if there were differences in the amount of time it took patients to exhibit positive behavior at follow up visits after receiving dental treatment under general anesthesia (GA) vs. conscious sedation (CS).

Overview of method of research:
This retrospective study examined charts of a private office between 1999 and 2003. Patients presenting before 36 months old for an initial exam who were diagnosed with EEC were included in this study. Following the initial exam, the patients were treated under GA or CS. These patients were followed to determine their behavior at the 6-, 12-, and 18-month recall appointments. The behavior index used in this investigation was the Frankl behavior scale. The CS regimen included chloral hydrate, hydroxyzine, and N2O/O2.

Findings:
39 patients who received treatment under GA were identified and 41 were treated under CS. Patients treated under GA were 3.9 times more likely to exhibit positive behavior at the 6-month recall appointment. Although not statistically significant, a trend towards positive behavior was exhibited at the 12- and 18-month appointments.

Key points in the article discussion:
There are many challenges facing pediatric dentists in behavior management today. The decision of how to treat a pediatric dental patient is influenced by society, marketing, media, communications, technology, and parenting practices. Indications for the administration of sedation include patients who are fearful and anxious; for whom basic behavior guidance techniques have not been successful; who cannot cooperate due to lack of psychological or emotion maturity and/or mental, physical, or medical disability; and for whom the use of sedation may protect the developing psyche and/or reduce medical risk. Although this study found a relationship between sedation type and behavior at future dental visits, 3 other studies cited by this article found no such evidence. Different results may be due to variation in patient ages, sedation protocols, and patient populations between the studies. As this studies results suggest, if patient behavior following treatment under GA consistently exhibits an increased likelihood of positive behavior vs. behavior seen following CS, clinicians may be more likely to select GA over CS for their patient’s initial treatment.

Summary of conclusions:
Patients were more likely to exhibit positive behavior at their 6 MRC following treatment under GA vs. CS. At the 12- and 18-month recall visits, patients were more likely to exhibit positive behavior following treatment under GA; however not statistically significant. Clinicians should consider future behavior in addition to caries when determining treatment modalities for children presenting to their office with dental caries.

Assessment of article:
There may be some bias in these results. Patients were seen by different clinicians at recall appointments. Each clinician could have different interpretations of the Frankl scale, limiting the consistency of the behavior being judged. The study design could have been better. I have not observed a noticeable increase in positive behavior following treatment under GA.