Dental Treatment Using General Anesthesia: DISCUSSION

In: Dental treatment

19 Oct 2009

Dental Treatment Using General Anesthesia DISCUSSION

With increased patient sophistication, awareness, and access to information, patient satisfaction will play a progressively more significant role in the health care arena. For those practitioners who care for children, parental satisfaction will likely become more important over time. Obtaining parental satisfaction will involve matching children’s oral health needs with the appropriate mode of treatment.

For preschool-aged children with extensive dental needs, one option that continues to grow in favor with practitioners is treatment under GA. The first goal of our study was to determine whether parents were satisfied with their children’s dental treatment under GA. All parents surveyed responded with satisfaction to the care their children received, confirming data by Acs and colleagues who reported a similarly favorable response from parents. Based on these collective findings, it appears that the use of GA for dental care for preschool-aged children is a well-accepted means of treatment in the eyes of many parents.
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One reason parents take their children to see a dentist is to seek relief for a child’s signs and symptoms of physical discomfort related to dental pain. For most dentists, the alleviation of pain and improvement of the child’s physical quality of life is the first objective in the plan of care. For this reason, the second goal of our study was to determine the parents’ perception of the impact of GA dental treatment on their children’s physical health. Accordingly, we found that the strongest predictor of the physical quality of life in our study was the parent’s view that his or her child was dental pain-free following treatment. However, it was interesting to note that although 84% of parents felt their child to be pain-free following GA care, only 60% felt the child’s overall health had improved following treatment. This inconsistency is similar to the findings by Acs and colleagues. They noted that although 84% of parents reported their children to be dental pain-free, only 65% of parents said their child’s overall health was better following treatment. In contrast, 82% of the sample population of parents of medically compromised children in the Acs et al study reported an improvement in their child’s overall health. Based on these findings, it appears that many individuals outside the field of oral health care, including parents, may not fully appreciate the connection between oral health and general overall health. On the other hand, for those parents whose lives are structured around the health needs of their medically compromised child, the association between oral and overall health may be more apparent. It is also probable that in our study some children did not have presenting systemic signs such as chronic pain with fever or malaise, but rather only occasional sensitivity or discomfort prior to GA care. This might also explain the apparent disconnection between oral health and general health as reported by our parents.
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Low and colleagues reported less than 50% of the parents in their study felt their children were experiencing pain prior to GA treatment; however, all felt their children were pain-free following treatment. The researchers also noted that preschool-aged children may have had difficulty expressing their discomfort due to their age and inability to effectively communicate. Therefore, they may have manifested their discomfort in subtle ways, such as eating less or only eating softer foods. Although our results cannot directly corroborate these findings due to lack of baseline data, we observed similar outcomes.

For many parents of children with advanced or rampant caries, aesthetic needs are often a motivator in seeking dental care for their child. Moreover, physical appearance can play a role in confidence and social interactions for the preschool-aged child because this is a life stage when children begin to notice physical differences between themselves and others. Considering this backdrop, our third goal was to determine parents’ perception of the impact of GA on their children’s social quality of life. The majority (84%) of the parents felt their children looked better following dental treatment. Although 14% of parents expressed no change in looks and 2% felt their child looked worse, considering the age (—50 months) of our population, it seems clear that parents are focused on dental aesthetics at this age.
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We also found that social measures strongly predicted overall quality of life. Parents placed importance on social issues, and these carried equal weight with the physical issues in predicting overall quality of life. Acs and colleagues did not examine social predictors of satisfaction, but this concept was reported by Low and colleagues. They found that only a small number of parents in their study reported negative social behavior prior to dental treatment (5%), but half of those reported that the behavior was improved following treatment.

In addition to the ones examined by Low and colleagues, we included other social predictors. Sixty-two percent of parents thought their children were smiling more after treatment. Fifty-three percent of parents felt their children had improved school performance, and 51% thought their children were more social. This latter percentage may have been lower because some of the parents in our survey did not have their children in school programs, or for those who did, they may have not had any reports from teachers commenting on changes in the child’s behavior patterns either before or after treatment.
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Our final goal was to determine whether there were any sociodemographic predictors of quality of life. The only statistically significant sociodemographic predictor was the sex of the children undergoing dental treatment. Parents of girls thought their children had improved social quality of life measures (looks better, smiles more, better in school, more social) following dental treatment than did the parents of boys. This may have been associated with parents either consciously or unconsciously placing a greater emphasis on the physical appearance and social interactions of girls. Interestingly, there were no statistically significant differences in parents’ perceptions of physical quality of life measures relating to gender. This was confirmed in the study by Acs and colleagues.

Understanding parental satisfaction and its impact on children’s quality of life adds an important dimension in delivering efficient and appropriate care. Our study contributes to the existing documentation that pediatric dental treatment using GA is a satisfactory and accepted mode of treatment delivery. Our study also confirmed that dental rehabilitation improves both the physical and social quality of life of the preschool-aged child.
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Taken together, our findings suggest that it is important that dental treatment using GA remain a delivery option for children. Historically, many children receiving dental care under GA have often been denied coverage for anesthesia and related hospital charges simply because of the dental nature of the treatment rendered; however, our investigation strengthens the fact that dental care has a strong impact on overall health.

Many oral health and childcare advocates have been working to change legislation at the state level to include dental care using GA in insurance coverage. The first bill was passed in 1995, and as of September 2000, 24 states as well as Puerto Rico mandate this coverage. Currently, another 12 states are considering similar legislation. Our findings offer more evidence that GA coverage for oral rehabilitation should be a fundamental component in dental (Cyklokapron tabletes is used for short-term control of bleeding in hemophiliacs, including dental extraction procedures) insurance programs for children. Viagra Super Active

Future Research Directions

Future work should address some of the limitations in our study. We did not have preoperative data. Although we asked the parents to provide the comparison of pre-and postoperative status, our findings would have been strengthened had we made a preoperative assessment. Although it was not our intent to compare parental per¬ceptions of various modalities of care (ie, no treatment vs conventional vs CS vs GA), this would be an inter¬esting extension of our research.

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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.