A Cost Analysis of Treating Pediatric Dental Patients

In: Dental treatment

17 Jan 2010

Conscious sedation

An overwhelming majority of pediatric dental patients can be treated in the conventional dental environment without the use of pharmacologic agents, except for the occasional use of nitrous oxide or oxygen inhalation analgesia for the mildly anxious child. Pharmacologic management may be essential to provide invasive dental procedures for children who are develop-mentally or medically compromised, and sometimes this modality is the treatment of choice for preschool-aged children who have not developed the language skills or attention span to cope with conventional dental care. For such children, the 2 most popular modalities of pharmacologic management are general anesthesia (GA) and conscious sedation (CS).

General anesthesia is a controlled state of unconsciousness that is accompanied by loss of protective reflexes, including the ability to maintain an airway independently and to respond purposefully to physical stimulation or verbal commands. Conscious sedation is a minimally depressed level of consciousness that does not affect a patient’s abilities to maintain a patent airway independently and continuously or to respond appropriately to physical stimulation or verbal commands. canada drugs online

Both GA and CS have higher levels of risks and costs than does conventional care. Although GA is viewed as the more expensive modality of treatment when direct costs only are assessed, this is not clear when societal costs are considered. Economists generally agree that to calculate societal costs one must also consider opportunity cost. A broad definition of opportunity cost might be as follows: an action that represents the value of next most valuable action forgone or the value of the next best alternative that a decision forces the decision maker to forgo. For example, if a dentist decides to take a vacation from practice, the opportunity cost for this time off is the wage lost for the time out of the office. Gold and colleagues state that “the best approximation of the opportunity cost for adults is the wage they are, or could be making at work.” For the purposes of this study, opportunity cost is defined as income forgone due to dental treatment. The societal cost perspective is indeed even larger than the parents’ or family’s perspective. For example, income forgone for parents’ wages is relatively easy to calculate, but there is also a societal cost for children missing school due to pain or dental appointments or for school nurses or teachers who must take time with such children. Although such societal costs are incalculable for the purposes of this study, the authors offer this as a part of the rationale for the importance of taking the societal perspective into account.

Little has been reported in the literature relative to societal cost comparisons for children’s dental care. A recent study compared the use of inhalation sedation via nitrous oxide or oxygen versus outpatient general anesthesia for extractions and minor oral surgery in pediatric dental patients. The patients were scheduled for 1 sedation appointment and 1 GA appointment. In examining the parents’ satisfaction and costs of both treatments, the investigators concluded that for extraction-only treatment, it was more cost-effective to use inhalation sedation than GA. The costs in the study were based on direct cost only, excluding indirect and opportunity costs.

Many factors can influence a parent’s decision to choose GA or CS for their child. Consideration might include risks and safety of the procedure, their child’s perceived comfort, the parent’s assessment of the child’s cooperation, the impact of the procedure on the child’s developing psyche, the amount of care needed, the probability that treatment can be completed with the given modality, and the cost of care. Despite the widespread use of both GA and CS, there have been few cost analysis studies of either modality, and there are no reports of cost analyses from the societal perspective for pediatric dental patients.

The specific aims of this study were as follows: (a) to determine the societal costs for treating pediatric dental patients using GA and CS, (b) to determine the relationship between cost and treatment need for GA and CS, and (c) to determine the relationship between GA versus CS cost models.
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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.