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OBJECTIVE: To determine the effectiveness of preventive interventions in children who have undergone caries-related dental extractions. METHODS: Rapid review across five databases (CENTRAL, Ovid Medline, Embase, Web of Science and Scopus). Quality was assessed using the Risk of Bias 2 tool. RESULTS: Five studies were included, all randomised controlled trials involving pre-and/or post-extractions activity. Three studies involved oral health education (computer game, motivational interviewing, visual aids), one delivered clinical prevention (fissure sealants), and one an enhanced prevention programme combining additional health education and a clinical intervention (fluoride varnish). Retention was mixed (55%-80% in the intervention groups). Of the three studies measuring caries, all reported less caries development in the test group. However, only a study involving a dental nurse-delivered structured conversation, informed by motivational interviewing, showed an improvement in oral health. Two studies reporting on plaque and gingival bleeding had conflicting results. A study reporting on subsequent dental attendance did not demonstrate a clear improvement. CONCLUSION: Few published studies have explored prevention-based interventions in high caries-risk children requiring dental extractions. Whilst evidence of clinical benefit of preventive interventions in this population is limited, the potential use of contemporary behaviour change techniques appears promising. There is an urgent need for more high-quality longer-term trials using contemporary methodologies.
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BACKGROUND: The electronic Survey of Anxiety and Information for Dentists (eSAID) allows children to tell dentists about their feelings and coping preferences. It is a computer "quiz" with 26 questions and free-text responses that produces a report for the children that they can then hand to their dentist. This is the first study to report the use of eSAID in a hospital paediatric dental clinic. METHODS: This was a randomized controlled trial to evaluate whether children thought that eSAID benefitted them, made them less anxious, and improved cooperation and their treatment satisfaction. Fifty-one children aged 8-13 years were randomized to complete either eSAID or a control version in the waiting room before their scheduled dental appointment. The study group had a 26-item questionnaire; the control had only two items. Both groups scored their anxiety on a 7-point anxiety scale at the start and again at the end of the quiz. All subjects handed the resultant eSAID report as a printout to their dentist. Dental treatment proceeded as planned. After treatment, each child reported how they thought the eSAID quiz had benefitted them by scoring on a 10 cm Visual Analogue Scale and their satisfaction on the Modified Treatment Evaluation Inventory. The operating dentists scored the children's cooperation using a 10 cm Visual Analogue Scale. RESULTS: Overall, the baseline anxiety levels were low (study: mean 1.2; control: mean 1.5). The study group's post-survey anxiety reduced by 0.4, whereas controls' increased by 0.2; this difference is statistically significant (p = .04). However, it made no difference to the children's self-reported benefit (p = .30), satisfaction (p > .05), or cooperation (p = .34). CONCLUSIONS: eSAID reduced pre-treatment anxiety but made no difference to children's perceived benefit, satisfaction, or cooperation. Future study should include known anxious children.
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Atitude Frente a Saúde , Ansiedade ao Tratamento Odontológico/prevenção & controle , Assistência Odontológica para Crianças/organização & administração , Adaptação Psicológica , Adolescente , Criança , Comunicação , Ansiedade ao Tratamento Odontológico/psicologia , Assistência Odontológica para Crianças/métodos , Assistência Odontológica para Crianças/psicologia , Relações Dentista-Paciente , Feminino , Humanos , Londres , Masculino , Satisfação do Paciente , Assistência Centrada no Paciente/organização & administração , Inquéritos e Questionários , Terapia Assistida por Computador/métodosRESUMO
BACKGROUND: Recruitment and retention are documented as two of the most difficult elements of conducting clinical trials. These issues are even more challenging in paediatric trials, particularly when the families being recruited and retained are deemed 'hard to reach'. METHODS: Through the authors' own reflection on the conduct of the trial this paper examines recruitment and retention with hard to reach families from the perspective of a recently completed clinical trial on preparatory information for children undergoing general anaesthesia for tooth extractions in which approximately 83% of those approached and eligible agreed to participate. RESULTS: The lessons learned for recruitment include: the importance of children's assent; maximising limited resources when screening and approaching potential participants; valuing families' time; and developing effective professional relationships. The retention rate was 83-85.5% at follow up time points up to 3.5 weeks following recruitment, insights into how this was accomplished include: ensuring continuity of care; determination to connect via telephone; valuing families' time; and close monitoring of appointment date changes. CONCLUSIONS: Implications for future paediatric trials with hard to reach families are discussed. TRIAL REGISTRATION: ISRCTN18265148 ; NIHR Portfolio 10,006. Date of Registration: 29 November 2013. The trial was registered after commencement but before completion of data collection.
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Anestesia Dentária , Anestesia Geral , Ensaios Clínicos Fase III como Assunto , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto , Criança , Comunicação , Continuidade da Assistência ao Paciente , Família/psicologia , Humanos , Relações Interprofissionais , Pesquisadores/psicologia , Fatores de Tempo , Extração DentáriaRESUMO
OBJECTIVES: To: 1, Explore opinions of parents of children undergoing caries treatment under general anaesthesia (GA) regarding delivery of oral health advice; 2, Discover current oral health practices and beliefs; 3, Inform further research and action. METHODS: Qualitative study using semi-structured interviews and thematic data analysis, sampling parents of children aged 3-10 years undergoing GA tooth extraction due to dental caries. RESULTS: Twenty nine parents were interviewed (mean age 38.9 years, range 28-50, sd 6.4). The mean age of their children was seven years (range 3-10, sd 2.1). All children required deciduous tooth extractions (5.1 teeth on average). Those that also required permanent tooth extractions had on average 2.1 permanent teeth extracted. Many parents knew the importance of oral hygiene and sugar limitation, describing it as 'general knowledge' and 'common sense'. However, few understood that fruit juice is potentially cariogenic. Parenting challenges seemed to restrict their ability to control the child's diet and establish oral hygiene. Many reported not previously receiving oral health advice and reported never having fluoride varnish applied. There were requests for more caries prevention information and advice via the internet, schools or video games. CONCLUSION: Parental oral health knowledge, parenting skills, and previous advice received seem to all be issues related to the oral health of those children. Providing advice, especially in respect to fruit juice cariogenicity and the benefits of fluoride application through a child-friendly website, including a video game, as well as the use of school programmes might be an acceptable approach.
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Atitude Frente a Saúde , Cárie Dentária/prevenção & controle , Educação em Saúde Bucal/métodos , Pais/psicologia , Adulto , Anestesia Dentária , Anestesia Geral , Bebidas/efeitos adversos , Cariogênicos/efeitos adversos , Cariostáticos/uso terapêutico , Criança , Pré-Escolar , Cárie Dentária/terapia , Sacarose Alimentar/administração & dosagem , Feminino , Fluoretos Tópicos/uso terapêutico , Frutas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Poder Familiar , Serviços de Odontologia Escolar , Extração Dentária , Dente Decíduo/cirurgia , Jogos de VídeoRESUMO
AIMS: To evaluate the advice and preventive care provided by General Dental Practitioners (GDPs) to high-caries-risk children in Jordan. METHODS: A cross-sectional study using an open-ended questionnaire. GDPs were presented with a high-caries-risk child scenario and asked regarding: (1) oral hygiene and dietary advice they would give; (2) preventive-care they would offer; (3) barriers they face in prevention delivery. Answers were compared to an evidence-based guideline. Data were input into SPSS-20 and analysed using descriptive statistics and frequencies. Chi-square test was used to compare results by age, gender, practice location and type. RESULTS: One-hundred and sixty GDPs were approached and 128 agreed to participate (80%), of whom 87 (69%) were female. The average age was 31 years [range 22-50]. Sixty-nine percent practiced in the capital, Amman. Sixty-five percent gave advice on tooth-brushing frequency, but only 23% suggested brushing at bed-time and 24% recommended parental supervision. None provided advice on toothpaste fluoride content. Seventy-one percent advised reducing sugary-food amounts, but only 21% focused on frequency and 2% suggested using diet diaries. Most knew about fissure-sealants (77%) and fluoride-varnish (80%). Forty-two percent reported barriers to delivering preventive-care, including parental attitudes (36%), child cooperation (30%), financial reward (19%), and training (6%). Participants practicing outside of the capital were less likely to use fluoride-varnish [P = 0.002] and more likely to report barriers [P = 0.001]. CONCLUSIONS: Advice delivered by GDPs to high-caries-risk children in Jordan does not meet the standards of an evidence-based guideline. Future initiatives for oral-health-promotion should aim to address the barriers reported, especially outside the capital.
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Cárie Dentária , Odontólogos , Adulto , Criança , Estudos Transversais , Cárie Dentária/prevenção & controle , Suscetibilidade à Cárie Dentária , Feminino , Humanos , Jordânia , Pessoa de Meia-Idade , Papel Profissional , Adulto JovemRESUMO
The purpose of this study was to determine the efficacy of a dental nurse-delivered intervention-the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI)-in reducing the recurrence of dental caries in children who have a primary tooth extracted. It was based on a 2-arm multicenter randomized controlled trial with blinded outcome assessment. Participants were 5- to 7-y-old children (n = 241) scheduled to have primary teeth extracted in 12 UK centers. Test intervention parents (n = 119) received DR-BNI led by trained dental nurses. DR-BNI is a 30-min structured conversation informed by motivational interviewing with a forward focus to prevent future caries. Preventive goals are agreed, and a review appointment is made with child's general dental practitioner, who is advised to treat the child as being at high caries risk. The control intervention (n = 122) was a parent-nurse conversation about child's future tooth eruption, with advice given to visit a general dental practitioner as usual. At baseline, the DR-BNI group's mean dmft was 6.8, and the control group's was 6.3. A median of 5 teeth were extracted, mainly under general anesthesia. Final dental assessments were conducted by a single examiner visiting 189 schools 2 y after intervention; 193 (80%) of 241 children were examined. In the control group, 62% developed new caries in teeth that were caries-free or unerupted at baseline, as compared with 44% in the test group, a significant reduction (P = 0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group as compared with control. There was a 29% decrease in the relative risk of new caries experience in the DR-BNI group as compared with control. This single low-cost, low-intensity intervention was successful in significantly reducing the risk of recurrence of dental caries in children. This trial has implications for changing pediatric dental practice internationally. Training in and implementation of a motivational interviewing-informed brief intervention provides opportunities for dental nurses to facilitate behavior change improving the oral health of children at high caries risk (ISRCTN 24958829).
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Assistentes de Odontologia , Cárie Dentária , Entrevista Motivacional , Criança , Pré-Escolar , Cárie Dentária/prevenção & controle , Odontólogos , Humanos , Pais , Papel Profissional , Recidiva , Extração DentáriaRESUMO
AIM: To evaluate the awareness, knowledge, and beliefs about early childhood caries (ECC) among a sample of expectant mothers and to determine their preferences to help design appropriate interventions. METHODS: Expectant mothers attending for antenatal care at a large public hospital were interviewed and asked to complete a questionnaire about ECC. The questionnaire was pre-tested and validated and contained questions about risk factors, presentations, management, and complications of ECC. Participants were also asked about their preferred method for oral health education about ECC. Data were analysed using SPSS for Windows release and descriptive statistics were generated. RESULTS: Four-hundred expectant mothers were approached and 380 (95%) agreed to participate. 59% reported brushing twice or more daily, but only 10% attended the dentist regularly. Only 16% thought that tooth brushing should start as soon as primary teeth erupt. Most (68%) thought that bottle feeding does not need to stop before the age of two. The majority believed that sugar is better consumed between meals (81%) and in portions throughout the day (85%). Only 12% thought that a child should have their first dental visit by the age of one. Educational level influenced knowledge on several aspects of ECC prevention. The participants suggested leaflets (38%) and social media (24%) as methods for oral-health-education delivery. CONCLUSION: Expectant mothers lack adequate knowledge about ECC prevention. There is a need for interventions that deliver advice on child toothbrushing, dietary practices, and dental attendance as part of wider general-health promotion.
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Cárie Dentária , Mães , Alimentação com Mamadeira , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Gravidez , Escovação DentáriaRESUMO
Aims To compare the profile of paediatric patients receiving dental treatment under general anaesthesia (GA) or conscious sedation (CS). A second aim was to explore whether there is an overlap between the two patient groups.Design This service evaluation study was based on sociodemographic and clinical data extracted from clinical records of patients attending dental appointments for GA or CS services at King's College Hospital. Sociodemographic and clinical differences between GA and CS groups were explored using logistic regression models.Results Data from 113 children (58 GA and 55 CS) were analysed. There were differences between groups in terms of age and numbers of quadrants and teeth treated, but not in terms of sex, ethnicity or deprivation scores. In the adjusted model, older children and those having more teeth treated were more likely to be in the GA than in the CS group. An overlap between the GA and CS groups was found, with 50% of children aged four to nine years having two to four teeth treated in both groups.Conclusion Age and number of teeth treated were the main characteristics associated with receiving care under GA or CS. Some overlap between children receiving dental treatment under GA or CS existed despite demographic and clinical differences between both groups.
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Anestesia Dentária/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Sedação Consciente/estatística & dados numéricos , Assistência Odontológica para Crianças/estatística & dados numéricos , Adolescente , Fatores Etários , Anestesia Dentária/métodos , Anestesia Geral/métodos , Criança , Pré-Escolar , Sedação Consciente/métodos , Assistência Odontológica para Crianças/métodos , Cárie Dentária/cirurgia , Feminino , Humanos , Masculino , Fatores Sexuais , Extração Dentária/métodosRESUMO
Objectives To assess the demographic, socioeconomic, behavioural and clinical factors associated with use of dental general anaesthesia (DGA) among British children.Methods This study used data from 3053 children who participated in the 2013 Children's Dental Health Survey in England, Wales and Northern Ireland. Data were collected through parental questionnaires and clinical examinations. The crude and adjusted association of demographic (sex, age, ethnicity and country of residence), socioeconomic (socioeconomic classification and area deprivation), behavioural (age toothbrushing started, age when first went to the dentist, usual reason for dental visit and dental anxiety) and clinical factors (numbers of decayed and filled teeth) with DGA was assessed in logistic regression models.Results The lifetime prevalence of DGA use was 9.1%. Older children and those living in Wales, with higher levels of dental anxiety and more dental fillings, who visited the dentist only when in trouble, and who had parents in routine/manual occupations and parents who never worked have greater odds of reporting having ever used DGA.Conclusion This study shows that family socioeconomic background, usual reason for dental visit and country of residence were associated with DGA use among British children, over and above the effect of child age, dental anxiety and dental status.
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Anestesia Geral , Assistência Odontológica , Criança , Cárie Dentária , Inglaterra , Humanos , Irlanda do Norte , País de GalesRESUMO
OBJECTIVE: To report on the changing profile of children attending for Dental General Anaesthetic extractions (DGA) at the same centre in 1998 and again in 2004 compared to 1991. DESIGN: Prospective clinical. SETTING: Glasgow Dental Hospital DGA service during August 1999 and August/September 2004. SUBJECTS AND METHOD: Children presenting for DGA extractions. Data recorded: age, gender, number of teeth extracted and level of behaviour using the Frankl scale. RESULTS: In 1999: 190 children (97 boys) mean age five years. In 2004: 106 children (55 boys) mean age five years. There was a significant increase in the mean number of teeth extracted (p < 0.001), 4.2 (1-16) and 7.8 (1-17) in 1999 and 2004 respectively, compared to 3.7 in 1991. Twenty-six per cent of children had between six and 16 teeth extracted in 1999 compared to 74% in 2004. Significantly fewer children demonstrated "definitely positive" behaviour compared to 1991. Children were in the poorest socioeconomic groups, reflecting the geographic area. CONCLUSION: Over half of the children were aged five years and under. Fewer highly co-operative children were treated. More teeth were extracted per child, suggesting that there should be greater opportunities to carry out restorations, not just extractions under general anaesthesia.
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Anestesia Dentária , Anestesia Geral , Comportamento Cooperativo , Assistência Odontológica para Crianças/estatística & dados numéricos , Extração Dentária/estatística & dados numéricos , Fatores Etários , Criança , Pré-Escolar , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Masculino , Escócia , Distribuição por Sexo , Fatores SocioeconômicosRESUMO
OBJECTIVE: To report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress. DESIGN: A prospective national study. SETTING: Twenty-five Scottish DGA centres in 2001. SUBJECTS AND METHOD: Four hundred and seven children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, the Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24 hours and one week post-operatively. Anaesthetic induction distress was scored immediately before CDGA induction using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). RESULTS: The mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r=0.43, p<0.001, Pearson Product Moment Correlation Coefficient). Morbidity at 24 hours and seven days was 63% and 24% respectively; this related to MCDAS scores (r=0.15, p=0.029 and r=0.17, p=0.009, Pearson Product Moment Correlation Coefficient) and to induction distress (chi2=7.14, p=0.007 and chi2=11.70, p=0.001). CONCLUSION: The majority of children suffered next day morbidity and many still had symptoms a week later. Most children were dentally anxious; this related to induction distress and postoperative morbidity.
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Anestesia Dentária/métodos , Anestesia Geral/psicologia , Ansiedade ao Tratamento Odontológico/psicologia , Complicações Pós-Operatórias/psicologia , Extração Dentária/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Escala de Ansiedade Manifesta , Pais/psicologia , Estudos Prospectivos , Escócia , Inquéritos e QuestionáriosRESUMO
Introduction Few studies have assessed the preventive needs of children treated under conscious sedation or their parents'/guardians' views regarding oral health education.Aim To report on the profile of children who required treatment under conscious sedation. Also to obtain the views of the parents or guardians of these children on their experiences of oral health preventive services and the support they would like in order to improve their child's oral health.Method A researcher-administered questionnaire was used to collect quantitative and qualitative responses from a consecutive sample of 123 parents/guardians during their child's sedation appointment at King's College Hospital.Results Caries was the main reason for the child's sedation treatment and 77.2% of them were high caries risk. Parents reported that their general dentist had given advice about sugar (80%) and tooth-brushing (74%), but few had prescribed fluoride varnish (15%), fissure sealants (12%) or a fluoride rinse (36%). Parents felt challenged by the ready availability of sugar, and others suggested difficulty in maintaining healthy oral habits in complex families. Overall, the majority of parents thought leaflets, health professionals' advice, and Internet websites could be informative, and they requested school- and hospital-based prevention programmes.Discussion The majority of children had high caries risk. They had received advice but not professional preventive treatment such as fluoride varnish and fissure sealants. Their parents requested preventive education using new technologies and media and better access through school-based and hospital prevention programmes.
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Cárie Dentária/prevenção & controle , Educação em Saúde Bucal , Adulto , Criança , Sedação Consciente , Feminino , Humanos , Masculino , Pais , Educação de Pacientes como Assunto , Selantes de Fossas e Fissuras , Escovação DentáriaRESUMO
OBJECTIVE: To investigate the relative importance of a range of explanatory variables concerning why child patients in Scotland enter pathways for tooth extractions under either Dental General Anaesthesia (DGA) or local anaesthesia (LA). BASIC RESEARCH DESIGN: A cross-sectional study was carried out involving DGA centres across Scotland. Data collected related to demographic characteristics of child DGA patients, reported anxiety and dental attendance levels of patients and parents, reasons given by referring practitioners for requesting DGA, number and type of teeth extracted and parental beliefs and attitudes to DGA. Similar data were collected relating to children having teeth extracted in primary care under LA. Multivariate analysis was performed to determine which factors were the best predictors of anaesthetic choice. RESULTS: 425 and 121 children having dental extractions under DGA and LA respectively participated. Ninety-six percent of DGA cases and 48% of LA patients had extractions for caries. For DGA cases, the mean age was 6.7 years, an average of 5.3 teeth were extracted and dental anxiety levels were higher than population norms. Multivariate analysis found the number of teeth extracted was the major predictor of anaesthetic type. On removing this variable, age became the most important factor, with 99% of children under 5.5 years receiving a DGA. Among DGA patients, 25% were reported to have had a previous DGA for tooth extraction. CONCLUSIONS: Future reductions in DGA numbers will be dependent on decreasing the number of young children presenting with advanced caries in multiple teeth. Consequently, guidelines are required concerning the prevention and appropriate management of caries in the primary dentition.
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Anestesia Dentária , Anestesia Geral , Anestesia Local , Encaminhamento e Consulta , Extração Dentária , Adolescente , Fatores Etários , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Criança , Pré-Escolar , Estudos Transversais , Ansiedade ao Tratamento Odontológico/classificação , Assistência Odontológica , Cárie Dentária/terapia , Feminino , Humanos , Masculino , Ortodontia Corretiva , Relações Profissional-Família , Escócia , Dente Decíduo/cirurgia , Odontalgia/terapiaRESUMO
BACKGROUND: Atraumatic Restorative Treatment (ART) was introduced a decade ago as a minimal intervention treatment for caries in unindustrialised countries, but UK general dental practitioners (GDPs) may also be using this technique. OBJECTIVE: This study aimed to determine the materials and techniques used by a group of UK GDPs to treat caries in primary teeth. METHOD: A questionnaire, designed to determine GDPs' use of materials and techniques in the restoration of caries in primary teeth, was distributed to 600 GDPs in Scotland and England, with an explanatory letter and reply-paid envelope. The questionnaire included colour illustrations of two carious cavities in primary molar teeth and a request that respondents draw the cavity outline that they would use on the illustrations. The cavity outlines were assessed independently by two examiners. All other data were collated and analysed. RESULTS: 390 usable replies were received, a response rate of 65%. Of the respondents, 99% treated child patients and 42% of respondents were aware of ART. For treatment of a small Class II cavity, 37% drew a cavity outline without extension beyond removal of caries and a majority suggested use of an adhesive material (51% glass ionomer, 13% compomer). For cavity preparation, 47% of respondents used a drill, 10% an excavator and 41% used both. For treatment of a large occluso-lingual cavity, again most used an adhesive technique (44% glass ionomer, 12% compomer) for its restoration, while 50% used a drill, 7% an excavator and 42% used both for cavity preparation. CONCLUSION: Most respondents used adhesive materials for restoration of caries in primary molars, but, despite 42% of respondents stating that they were aware of the treatment, "true" ART was adopted by fewer than 10% of respondents.
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Cárie Dentária/terapia , Preparo da Cavidade Dentária/métodos , Restauração Dentária Permanente/métodos , Odontólogos/psicologia , Padrões de Prática Odontológica/estatística & dados numéricos , Atitude do Pessoal de Saúde , Pré-Escolar , Demografia , Preparo da Cavidade Dentária/instrumentação , Preparo da Cavidade Dentária/psicologia , Restauração Dentária Permanente/instrumentação , Restauração Dentária Permanente/psicologia , Feminino , Odontologia Geral , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Inquéritos e Questionários , Dente Decíduo , Reino UnidoRESUMO
OBJECTIVE: To determine the type of dental assessment service offered to children prior to exodontia under chair dental general anaesthesia (CDGA) in the community and hospital dental services (CDS, HDS) in Scotland. DESIGN AND SETTING: Telephone interviews were conducted with CDS and HDS clinical directors in Scotland using a semi-structured questionnaire, with written follow-up confirmation. Copies of CDGA referral forms were also requested. RESULTS: All clinical directors, or their nominated deputies, participated (n = 21). Almost half of interviewees indicated that their area offered a "dedicated" pre-CDGA assessment service (n = 10). A range of grades was identified amongst assessors; a minority were described as "specialist paediatric staff". The availability of CDGA alternatives, including local analgesia and conscious sedation varied. Changes to the referral treatment plan were reported to occur "sometimes" or "often" by 11 interviewees regarding the anaesthetic used, and by 16 respondents regarding the number of teeth extracted. The content of CDGA referral forms was diverse. CONCLUSIONS: The method of referral and assessment of children for CDGA in Scotland is diverse, partly reflecting geographic limitations and local need. Guidance on pre-GA assessment, including use of standardised referral forms, may reduce variation and improve the quality of the pathway of care.
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Anestesia Dentária , Anestesia Geral , Assistência Odontológica para Crianças , Cuidados Pré-Operatórios , Extração Dentária , Criança , Odontologia Comunitária , Indicadores Básicos de Saúde , Humanos , Entrevistas como Assunto , Encaminhamento e Consulta , Escócia , Inquéritos e QuestionáriosRESUMO
Recently published guidelines on the use of conscious sedation in dentistry have published varying recommendations on the lower age limit for the use of intravenous conscious sedation. There are a large number of dentists currently providing dental treatment for paediatric patients under intravenous conscious sedation. The 18 cases reported here (age range 11-15 years), were successfully managed with intravenous conscious sedation. The experience in this paper is not sufficient evidence to recommend the wholesale use of intravenous conscious sedation in patients who are under 16 years. The fact that a range of operators can use these techniques on paediatric patients would suggest that further study should be carried out in this population. The guidance should be modified to say there is insufficient evidence to support the use of intravenous conscious sedation in children, rather than arbitrarily selecting a cut off point at age 16 years.
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Anestesia Dentária , Sedação Consciente/métodos , Adolescente , Anestesia Intravenosa , Criança , Ansiedade ao Tratamento Odontológico/prevenção & controle , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Midazolam/administração & dosagem , Estudos Retrospectivos , Segurança , Resultado do TratamentoRESUMO
The aim of this retrospective study was to examine the correspondence sent to a dental helpline. A general dental practice telephone helpline was established under the auspices of the British Dental Health Foundation (BDHF). The name and contact telephone number were provided via the BDHF or through various media and patient organisations such as the Phobic Society. All the telephone enquirers were encouraged to follow up their telephone call with a written letter. The contents of the 105 letters which were received over a four-year period were collated and categorised. Correspondents fell into two categories: those seeking information about various dental issues and those who described themselves as dental phobics. There were 64 requests for information; of these, 20 were straightforward requests for information booklets, 16 were complaints about denture problems and 10 wanted advice on finding a 'sympathetic' dentist. 'Dental phobics' was how 41 correspondents described themselves. Seven of these 'dental phobics' wrote that they perceived their dental state to have become so poor that they were too embarrassed to attend a dentist. In conclusion, this pilot study highlights the potential value of a helpline in a general dental practice setting and describes the scope of enquiries received. The findings will help general dental practitioners who may wish to use a dental helpline to improve patient access to primary dental care.
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Ansiedade ao Tratamento Odontológico/prevenção & controle , Serviços de Saúde Bucal/estatística & dados numéricos , Odontologia Geral , Linhas Diretas , Correspondência como Assunto , Ansiedade ao Tratamento Odontológico/epidemiologia , Relações Dentista-Paciente , Inglaterra/epidemiologia , Estudos de Avaliação como Assunto , Linhas Diretas/estatística & dados numéricos , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Projetos Piloto , Estudos RetrospectivosRESUMO
Treating anxious children is a challenge that many dentists face. Not only do anxious children find it difficult to cope with dental treatment but dentists also find it difficult to cope with anxious children. This article is intended to simplify the management of anxious children in general dental practice. Behavioural management, the coordination of the whole dental team, treatment planning and the use of inhalation sedation will be discussed.
Assuntos
Ansiedade ao Tratamento Odontológico/terapia , Assistência Odontológica para Crianças/métodos , Terapia Comportamental/métodos , Criança , Pré-Escolar , Sedação Consciente , Recursos Humanos em Odontologia , Relações Dentista-Paciente , Humanos , Óxido NitrosoRESUMO
OBJECTIVE: To investigate, by postal questionnaire, aspects of the selection and use of direct restorative materials, endodontic techniques and approaches to bleaching by general dental practitioners in the UK, and to compare and contrast the findings with those of a related study reported in 2004. METHODS: A questionnaire comprising 18 questions, each of a number of elements, was sent to 1,000 general dental practitioners in the UK, selected at random from the Dentists Register. Non-responders were sent a second copy of the questionnaire after a period of four weeks had elapsed. RESULTS: A total of 662 useable responses were returned, giving a response rate of 66%. Key findings included: dental amalgam was found to be the most commonly used material in the restoration of occlusoproximal cavities in premolar (59% of respondents) and molar teeth (75% of respondents); glass-ionomer cements and related materials were applied extensively in the restoration of deciduous molars (81% of respondents) and for the luting of indirect restorations (67% of respondents); the use of rubber dam was limited, in particular as an adjunct to procedures in operative dentistry (18% of respondents); relatively few respondents used preformed stainless steel crowns, and among the users only occasionally in the restoration of deciduous molars (23%); and bleaching, predominantly home-based (nightguard) vital bleaching (81% of respondents) was widely practised. CONCLUSION: It is concluded that, for the practitioners surveyed, factors other than best available evidence influenced various aspects of the use of direct restorative materials and the clinical practice of endodontics. As a consequence, many of the features of general dental practice revealed in the process of the investigation were at variance with teaching in dental schools. Bleaching, in particular home-based (nightguard), vital bleaching, was provided by >80% of respondents, indicating widespread interest among patients in enhanced dental attractiveness.