In: Dental treatment16 Oct 2009
Except for the occasional use of nitrous oxide/oxygen inhalation analgesia for the mildly anxious child, the overwhelming majority of pediatric dental patients can be treated in the conventional dental (Cyklokapron canadian is used for short-term control of bleeding in hemophiliacs, including dental extraction procedures) environment. Pharmacologic management may be essential during invasive dental procedures for children who are developmental or medically compromised, and this approach is often the treatment of choice for preschool-aged children who have not developed the language skills or attention span to cope with conventional dental care. In these cases, the 2 most popular modalities of pharmacologic management are conscious sedation (CS) and general anesthesia (GA). GA involves rendering a child unconscious, wherein often is undertaken in hospitals, surgical centers, or dental offices in areas where dental anesthesiologists are available. For most parents, GA is seen as a dramatic departure from the traditional office-based approach for children’s dental treatment; however, at times GA may be essential for the compassionate and efficient delivery of care. This is true especially for young, uncooperative children with early childhood caries. Because GA carries a risk for morbidity and mortality, this approach can be emotionally challenging for parents who choose this option.
Little is known of parents’ perceptions and satisfaction of the outcome of dental treatment under GA or the perceived impact this treatment has on the quality of life of their children.
Measuring Parental/Consumer Satisfaction
Defining and understanding the role consumer satisfaction plays in the health care arena has become an important topic of interest over the past 2 decades. Hulka and Zyzanski determined that both providers and investigators are becoming increasingly aware of patient satisfaction as an important outcome of health care services as well as a potential determinant of utilization and compliance behavior. For example, it is likely that satisfaction has an impact on health-related decisions and behaviors, beginning with the decision to seek care and continuing through the completion of the treatment process. It is probable that satisfaction plays a role in physiologic and functional outcomes. However, these satisfaction-related dimensions have had little research attention. buy vardenafil online
Investigators have begun to address the relationship of parental satisfaction with dental care for children. Ready and colleagues focused on parental attitudes toward the use of GA during dental treatment in a study performed between 1975 and 1985. Of those surveyed, 97% were satisfied with the care their children received through this treatment modality; however, since the time of the Ready et al study, there has been a revolution in the health care arena, especially in the realm of consumer choice.
Recently Acs and colleagues reported results from data collected over a 24-month period from parents of children treated under GA for dental care. These investigators separated parental survey data into 2 useful categories: those relating to parental satisfaction and those relating to quality of life in the health dimension. Parents indicated that the treatment experience was positive and their expectations had been met. This study found that parents were overwhelmingly satisfied with the treatment their children received.
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Quality of Life Measures
The definition of quality of life may vary according to social, cultural, and practical contexts in which the concept is being utilized and measured. Definitions of health and quality of life are not only about illness, disease, or sickness, but also involve personal and social judgments about what is normal and worthwhile.
Strauss and Hunt concluded that research to determine how health problems influence life quality, impairment, disability, and function suggest that the presence or absence of health complaints alone is an insufficient explanation for subjective health status evaluation. Following the full health models, Strauss and Hunt recommended using subcomponents to evaluate oral health impact including eating, health/well-being, and social relations.
Physical Quality of Life Measures. Most often the instruments to assess oral health rely on a diseasebased clinical approach. Slade and colleagues examined different dimensions of disease that included functional limitation, physical pain, and physical disability. Kressin and colleagues assessed the impact of oral health on quality of life by using the Oral Health Quality of Life Instrument (OHQOL) that measured oral discomfort and dysfunction. Resine utilized a modified version of the Sickness Impact Profile (SIP), which also measured dysfunction and disease.
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As previously mentioned, Acs and colleagues addressed quality of life issues as related to improvement in pain, eating, sleeping, and overall health. The majority of parents surveyed felt their children had an improved quality of life following GA for dental care. In the Acs et al study, pain relief was the greatest predictor of parents’ perception that their child’s quality of life was improved following treatment. All previous studies based research on the theory that the absence of disease equals health. This is limiting because it does not take into account the psychological and social aspects of health.
Social Quality of Life Measures. Over the past 20 years the socio-environmental model of health has challenged the medical model. In this model, health is defined not just in terms of absence of disease, but in terms of optimal functioning and social and psychological well-being. Little research related to the social impact of dental treatment for preschool-aged children has been reported; however, several investigators have studied social outcomes on children and young adults with craniofacial syndromes following surgical intervention. Phillips and Whitaker found that prior to surgery, facial deformity played a greater role in the social interactions of patients, and following surgery there was an improvement in patients’ social functioning. In a study by Pille-mer and Cook, postoperative psychosocial adjustment data were collected from children, parents, and teachers of 25 craniofacial patients. The evaluations performed by teachers revealed that they had a higher degree of concern regarding their students with craniofacial deformities in relation to overall task competence, peer relations, and adult relations.
In their preliminary study of parental perceptions of the outcome of dental rehabilitation under GA, Low and colleagues gave parents a short questionnaire on the morning of the operating room visit and then followed up 4-8 weeks later with the same questionnaire by phone. Parents were asked to respond with a “yes/no” qualifier as to whether they had received any reports from a daycare program or school concerning their child’s behavior (being quiet, aggressive, tired, agitated, etc). Low et al determined that there was no statistical significance in pre- and postsurgical evaluation of behavioral changes in the sample patient population. This introductory work offered limited insight into the social impact of dental rehabilitation for the preschool-aged child.
With this background in mind, our investigation had 4 specific goals: (a) to examine parental satisfaction with GA; (b) to determine the parents’ perception of the impact of GA dental treatment on the child’s quality of life as related to physical health (pain-free, eating better, sleeping more, better overall health); (c) to determine the impact of GA dental treatment on the child’s quality of life in the social dimension (looks better, smiles more, better in school, is more social); and (d) to identify any health and/or social predictors related to overall health.
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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.