Reasons for and parental satisfaction with children's dental care under general anaesthesia.

OBJECTIVES: The aim of this study was to describe why healthy children's previous treatment experiences can be reasons for their dental treatment under general anaesthesia (GA), and to describe their parents' experiences and satisfaction with that treatment. SUBJECTS AND METHODS: The data cover those children (n=102) below 16 years of age who, being otherwise healthy, were referred for Public Dental Service GA dental care in Helsinki, Finland, over the course of one year because of serious difficulties in dental treatment. The parents were given a self-administered questionnaire inquiring about their child's previous experiences of dental care, and about their access to and satisfaction with the present GA treatment. Data on the children's dental state were taken from patient records. RESULTS: The children's mean age was 6.4 years (SD=2.6 years), and the mean number of teeth with untreated caries was 7.7 (SD=3.0). Of the total sample, 32% had undergone four or more previous unsuccessful dental visits. At the time of their first difficulties in dental care, 39% were below 3 years of age. The older the child, the more serious was her or his parents' ranking of the difficulties met during dental care (P=0.02). From the parents' point of view, dental fear was the most important reason for treatment failures, followed by pain. Seeking GA treatment had been easy for 93% of parents, and most of them were also satisfied with their child's present GA treatment. CONCLUSIONS: The most important factors leading to the use of GA, as reported by the parents, are dental fear and repeated unpleasant experiences during dental care, and therefore, these should always be properly diagnosed, prevented and controlled.

Osteotomy-osteosynthesis in displaced condylar fractures.

Nine male patients were treated for condylar fractures of the mandible by a method involving detachment of the condylar head. Pre-operatively, all patients had severe malocclusion. Radiologically, most condyles were anteromedially displaced. Open reduction was indicated but repositioning of the condyle was impossible without ramus osteotomy followed by temporary condylectomy. On follow-up roughly 32 months after surgery no permanent complications were seen. Joint function was almost completely restored. Radiographic evaluation revealed some shortening and deformation of the condyles which had been operated. Translation and rotation movements were almost normal. The method described appears useful in those rare cases of fractures in which normal repositioning of a dislocated condyle is difficult.

Rigid internal fixation of mandibular fractures--an analysis of 45 patients treated according to the ASIF method.

A report is given of 45 patients with fractures of the mandible treated by the method of rigid internal fixation. In a majority of cases, there were either absolute or relative contraindications for an IMF. Most of the fractures plated were body fractures of the mandible, followed by angular, and symphysis fractures. In 4 cases, the fractures, caused by gunshots, were compound ones. In these, extensive soft tissue reconstructions were also performed. In a majority of the patients, good primary healing was observed, and the mean hospitalization time was only 4.4 days. The infection rate of 13% was, however, relatively high, and a few disturbances were seen with respect to motor and sensory function of the lower lip. Slight occlusal dysharmonies were registered in 23%, on an average of 22 weeks postoperatively, but these could be adjusted with a minimum of grinding. It was concluded that bone plating is a useful method in the treatment of several different types of mandibular fractures including the severe compound ones. The method can be especially recommended in cases in which an IMF is contraindicated or should be avoided. The possibilities for decreasing the frequency of postoperative infections are discussed.

Autogenous costochondral grafts in temporo-mandibular joint arthroplasty. A survey of 66 arthroplasties in 60 patients.

A clinical study of 60 patients who underwent 66 costochondral arthroplasties during the period 1969-1984 is presented. In nearly half of the cases ankylosis was the main indication for operation, followed by dysplasia, tumours and osteomyelitis. The results showed that all cases in which the rib was decorticated to fit into the mandible as an inlay healed well. The mean time of IMF was 3.5 weeks. In the majority of the patients (67%) the postoperative function of the mandible was considered to be good or excellent, and nearly all patients were pain free. There were no postoperative chest infections and only one case of pneumothorax. Motor and sensory disturbances in the lower lip were each diagnosed in ten per cent of the patients.