Traumatic dental injuries in high school athletes in the United States of America from 2005 to 2020.

BACKGROUND/AIM: Participation in sports activities is a source of dental injury. Despite recommendations for the use of mouthguards, athletes underutilize them. The aim of this study was to provide estimates of dental injuries, the mechanism of injuries and the utilization of mouthguards in high school sports. MATERIALS AND METHODS: This study was a secondary analysis of an existing dataset of a convenience sample of the National High School Sports-Related Injury Surveillance Study. Data of athletic exposures, dental injuries, mouthguard usage, and mechanism of injury from the 2005/2006 to the 2019/2020 academic years were analyzed. RESULTS: During the study period, there were 459 dental injuries in 49,987,927 athletic exposures resulting in a dental injury rate of 0.9 per 100,000 athletic exposures (AE). Slightly more than half of the traumatic dental injuries were sustained during competition (n = 256; 55.8%) and the rest (n = 200; 43.6%) were sustained during practice. The rate of dental injury in competition was 3.6 times higher than the rate in practice (RR: 3.6, 95% CI: 3.0-4.4). Dental injuries comprised 0.4% of the total 108,574 injuries sustained by athletes. Among girls' sports, field hockey had the highest rate (3.5 per 100,000 AE) and among boys' sports, basketball (2.4 per 100,000 AE) had the highest rate of dental injury. The most common mechanism of injury was contact with another player (276; 60.4%) followed by contact with apparatus (146; 31.9%). In the majority of dental injuries (308; 75.1%), the athlete was not wearing a mouthguard when the dental injury was sustained. CONCLUSIONS: Dental injuries were a small proportion of all injuries sustained by high school athletes. The majority of dental injuries were sustained when the athlete was not wearing a mouthguard.

Characteristics, treatment outcomes and direct costs of tooth avulsion in children treated at a major hospital.

BACKGROUND/AIMS: Avulsion of a permanent tooth is one of the most severe traumatic dental injuries, comprising an estimated 0.5%-16% of all dental injuries. The aim of this study was to estimate the direct financial costs of tooth avulsion in children based on stage of root maturity and the occurrence of ankylosis and to report patients' characteristics and outcomes of treatment. MATERIALS AND METHODS: A retrospective review of the dental records of children ages 6-18 who sustained a permanent tooth avulsion from 2010 to 2020 was completed. Relative Value Units (RVUs) were used to calculate the estimated cost of dental trauma care over the 2-year post-injury period for five different scenarios of avulsed teeth based on the stage of root maturity, the occurrence of ankylosis and whether the tooth was replanted. RESULTS: There were 452 avulsed permanent teeth in 348 patients. Of those, 157 teeth were included in the cost analysis. Overall, the average direct dental cost of avulsion was 46.4 RVUs equal to $1619 USD based on the 2021 conversion rate ($34.89 per RVU). Direct costs ranged between 40 RVUs ($1396) and 52.8 RVUs ($1842) depending on the root maturation and ankylosis status or whether the tooth was replanted; however, ANOVA test did not show any statistically significant differences between the mean RVUs of different groups (p = .85). Patients returned 9.5 times on average over the 2-year study period for dental trauma care after avulsion. CONCLUSION: The average direct cost of tooth avulsion within the limits of this study was $1619 USD. On average, patients returned for 9.5 follow-up visits after the avulsion. The stage of root maturity, the occurrence of ankylosis and whether the tooth was replanted or not were not significantly associated with the direct cost of dental care.

Acceptability of medical immobilization: Results from a pilot international survey.

BACKGROUND: Controversy exists on the acceptability of medical immobilization (MI). AIM: To identify regulations, professional conventions, and opinions on the acceptability of MI and to identify practice patterns through a pilot study of members of the International Association of Paediatric Dentistry (IAPD) and their colleagues. DESIGN: A 22-item questionnaire was developed and electronically distributed to 1191 members of the IAPD. RESULTS: Responses were received from 182 dentists in 45 countries. The majority (74.9%) of respondents use MI, and 29.1% use an immobilization device. MI with an immobilization device was reported as professionally acceptable (58.1%) and permitted by medicolegal regulations (70.8%) in their countries of practice. Dentists rated acceptability of MI higher than they perceived parents would overall and perceived MI to be more acceptable by parents for emergency situations and for children with special healthcare needs but 19.8% of respondents found it totally unacceptable in all scenarios. Use and opinions of acceptability varied by geographical location with respondents from North America being more accepting of MI. Most dentists felt that the use of an immobilization device could lead to lasting psychological trauma (72.3%) and violation of the rights of the child (55.4%) but that it improves access to care (58.5%). CONCLUSION: The acceptability of MI remains an area of controversy for paediatric dentists internationally.

The association between traumatic dental and brain injuries in American children.

BACKGROUND/AIM: It is crucial that dentists who treat traumatic dental injuries rule out concomitant brain injuries. Despite anatomic proximity, controversy exists regarding association between facial trauma and head injury. The aim of this study was to examine the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBI) using a national dataset of emergency department (ED) visits. MATERIAL AND METHODS: Nationwide Emergency Department Sample (NEDS) data, one of the Healthcare Cost and Utilization Project (HCUP) datasets, were analyzed. Encounters of patients age 0-18 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with DAT and TBI in the 2010-2014 NEDS were identified. Data were analyzed using descriptive statistics, chi-square test, and logistic regression models to investigate the association between DAT and TBI and factors associated with TBI in DAT-positive patients. RESULTS: During the study period, 6 281 658 ED visits were associated with traumatic injuries. DAT was recorded in 93 408 (1.5%) and TBI was recorded in 996 334 (15.9%) of these traumatic injury visits. Within the group of DAT-positive encounters, 7035 (7.5%) had codes associated with TBI. Of trauma encounters where a DAT was not involved (6 188 250 encounters), 989 299 (16%) had an associated TBI code. Patients with DAT had 0.20 odds of having TBI (95% CI, 0.19-0.20, P < .0001) compared with patients who did not have DAT when all other confounding variables were kept constant. Having multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT. CONCLUSIONS: There was an inverse association between DAT and TBI in this study population.

Absorbable Hemostatic Pack Effect After Primary Incisor Extraction: A Pilot Study and Introduction of a Novel Scale to Assess Post-Operative Bleeding.

OBJECTIVES: This pilot study compared hemostatic pack (HP) application with no intervention following extraction of maxillary primary incisors in healthy children for effect on bleeding time and influence of patient or tooth variables utilizing a novel scale for assessment of bleeding following extraction. STUDY DESIGN: A novel scale was created to assess bleeding after extraction. This scale was utilized in a randomized, split mouth study of healthy children ages 2-7 years old requiring extraction of at least 2 primary maxillary incisors under general anesthesia. One extraction site was randomly assigned to receive HP and the other had no hemostatic measures. Post-operative bleeding was rated at 2, 10, and 15 minutes post-extraction. Other variables recorded included age, sex, periapical radiolucency, presence of fistula, swelling, discoloration, intraoral stabilization device used, and vital signs at two time intervals. Pre-operative radiographs were reviewed for root resorption and periapical radiolucency. RESULTS AND CONCLUSIONS: Twenty-five patients provided 50 teeth. Hemostatic pack had a significant effect on reducing bleeding at each time point and that effect did not change over time. Age, sex, tooth pain, post-extraction heart rate, blood pressure, discoloration, amount of resorption, and presence of a periapical radiolucency had no significant effect on bleeding. The proposed bleeding scale had good intra-rater reliability and could be useful in future studies, once validated.

Gender Differences in Pediatric Dentistry Chairs in the United States and Canada.

OBJECTIVE: To analyze gender differences in personal and professional demographics, job perceptions and work satisfaction between male and female pediatric dentistry academic leaders in the United States and Canada. STUDY DESIGN: A 40-question survey was sent electronically to department chairs requesting information about demographics, current circumstances of the position, professional history, and opinions about the position. Data was analyzed by the sex of the respondent. RESULTS: Eighty-eight surveys were distributed electronically and 55 chairs responded (response rate: 62.5%). Women comprised 29.5% of the sample, were younger and had less leadership training than men. Men had served longer in the position (t(41)=2.02, p=0.05) and had higher ranking academic titles. Women spent more time managing personnel (p=0.026), creating courses and programs (p=0.029), and teaching (p=0.006) than men. Female chairs perceived to have a difficult relationship with the faculty (p=0.027), felt they received less faculty support (p=0.002), and were significantly more dissatisfied in the job (p=0.037). Men were more stressed about a heavy workload than women (p=0.001). CONCLUSION: Gender was significantly related to the demographics, experience, perceptions of the skills and abilities required for job performance, time management and job satisfaction for pediatric dentistry department chairs in American and Canadian institutions.

Cytotoxic effects of silver diamine fluoride.

PURPOSE: To investigate the effect of silver diamine fluoride (SDF) and fluoride varnish (FV) on human gingival fibroblasts (HGF) and bacteria. METHODS: HGF cell viability was assessed after exposure to various dilutions of SDF or FV. Hydroxyapatite (HA) discs treated with SDF, FV, or saline were rinsed in artificial saliva for 84 days. HGF were exposed to treated discs and viability assessed fluorescently. Oral bacteria were exposed to treated discs and survival quantified. RESULTS: At 0.01%, SDF was almost 100% cytotoxic to HGF. SDF and FV treated HA discs, induced near-complete cell death after 24 hours of contact. After rinsing FV discs for 21 days, cell survival exceeded 95%. SDF treated discs were toxic to HGF and bacteria after 9 weeks of rinsing. CLINICAL SIGNIFICANCE: SDF and FV can induce cell death. FV lost its cytotoxicity within 3 weeks, while SDF remained cytotoxic even after 9 weeks of rinsing. This research confirms that SDF has long lasting antimicrobial effects at very low concentrations although it does raise concerns regarding cytotoxicity. However, HGF cells are exposed to other cytotoxic substances in dentistry with little, if any, long-term effects.

Student and faculty perspectives of a faculty-student mentoring programme in a dental school.

PURPOSE/OBJECTIVES: In addition to an established peer mentoring programme, the Louisiana State University Health Sciences Center, School of Dentistry introduced a faculty-student mentoring programme, the first-year dental student (D1)-Faculty Guide Program, in 2013. The intent of the D1-Guide Program was to provide faculty mentorship for D1 students. The purpose of this study was to evaluate the outcomes of the programme and identify areas for improvement. METHODS: Faculty members, D2 and D3 students were surveyed regarding their experiences and perceptions of the D1-Guide Program with a seven question and 12 question survey, respectively, via Survey Monkey® and data were analysed. RESULTS: The response rate for the students and faculty was 61% and 64%, respectively. The majority of faculty (92%) felt comfortable serving as a guide to the D1 students with 79% of those surveyed having served as a guide for 3 or 4 years. The majority of students (81%) felt that the D1-Guide Program provided mentoring that was not redundant to existing peer mentoring and valuable to their acclimation to dental school. CONCLUSIONS: Despite adding additional duties for faculty and students, the D1-Guide Program was considered valuable during the student's first year of dental school with encouragement to continue the programme. The programme helped establish a student-faculty rapport beyond the boundaries of the classroom.

Effect of Light Cure Methods for Intermediate Adhesive Layer on Microleakage of Sealants. An in Vitro Study.

Background: The objective of this study was to determine the effect of an adhesive layer and its photopolymerization on the microleakage of sealants. Study design: 0.5mm-deep standardized fissurectomies were performed on extracted molars (n = 72). Teeth were randomly assigned to 3 different sealant materials (n = 24/group). Teeth were further divided to receive sealants with or without an adhesive layer. Each sealant with adhesive was also divided into two groups: adhesive was light-cured separately or light cured together with the sealant. Following thermocycling, microleakage was assessed using dye penetration and image analysis. Data was analyzed using ANOVA and Tukey's studentized ranged HSD tests. Results: Microleakage was not affected by type of sealant material (p>0.05) but was significantly influenced by application (p<0.05). Overall, placement of sealants without adhesive displayed greater microleakage than sealants with uncured adhesive (p<0.05). Within individual sealant types, this difference was only significant for Ultraseal XT (p<0.05). Sealants bonded with and without prior light curing did not show a significant difference in levels of leakage (Tukey's Studentized Range Test, p>0.05). Conclusion: An adhesive layer should be placed beneath sealants, but whether it should be light cured or left uncured before sealant placement varies by the sealant type.

Analysis of Fluoride Content in Alternative Milk Beverages.

Background: The dentist has a responsibility to provide nutritional counseling and fluoride consumption recommendations. The purpose of this study was to measure and compare the concentrations of fluoride in a large number of alternative milk beverages and bovine milk. Study design: Thirty-three milk alternatives, including 9 diverse types and 11 different brands, were analyzed using a fluoride ion-selective electrode (ISE) and an ISE meter. Fluoride concentrations were then compared among different types and between different brands. Results: Fluoride concentration ranged from 0.01 ppm (Malk® Pure Cashew Milk) to 0.80 ppm (Almond Breeze® Original Unsweetened Almond Milk) with a mean concentration of 0.32 ppm. When compared, bovine whole milk (0.03±0.00 ppm) was found to be significantly lower in fluoride than all samples analyzed except Malk Pure Cashew Milk, Soy Milk Vanilla, Rice Milk, and Pecan Milk. Major differences also existed between the same milk alternative types of different brands. Conclusion: The amount of fluoride varies among different types of milk alternatives and different brands. To ensure that the dental team can provide proper recommendations regarding fluoride use, manufacturers should consider placing fluoride concentrations on nutrition labels.

Analysis of the Cariogenic Potential of Various Almond Milk Beverages using a Streptococcus mutans Biofilm Model in vitro.

To evaluate the cariogenic properties of almond milk beverages, 6 almond milks, along with soy and whole bovine milk, were analyzed for their abilities to support Streptococcus mutans biofilm formation and acid production, and their capacity to buffer changes in pH. Biofilm formation by S. mutans was analyzed using an in vitro 96-well plate model and measured by crystal violet staining. Acid production by S. mutans was evaluated by a colorimetric L-lactate assay and pH measurement of bacterial cultures. Buffering capacity was assessed by a pH titration assay. Soy milk supported the most biofilm growth, while the least was observed with unsweetened almond milk (both p < 0.001). Among almond milks, sucrose-sweetened milk led to the highest level of biofilm formation (p < 0.001), while the least was observed with unsweetened milk (p < 0.05). Sucrose-sweetened almond milk yielded the lowest pH (4.56 ± 0.66), followed by soy milk and bovine milk; the highest pH was with unsweetened almond milk (6.48 ± 0.5). When analyzed by pH titration, the unsweetened almond milk displayed the weakest buffering capacity while bovine milk showed the highest (p < 0.001). These results suggest that the almond milk beverages, except those that are sweetened with sucrose, possess limited cariogenic properties, while soy milk exhibits the most cariogenic potential. As milk alternatives become increasingly popular, dentists must counsel their patients that almond milks, especially sucrose-sweetened varieties, have cariogenic potential. For patients who are lactose-intolerant or suffer from milk allergy, almond milks may be a better alternative than soy-based products.

Behavior guidance: that was then but this is now.

Pediatric dentistry has evolved. Seasoned pediatric dentists believe that patients, parents, and behavior techniques have changed over their practice lifetimes. The purpose of this article is to provide dentists with a framework in which to adapt to the changes in society. Understanding cultural diversity, current societal values, technology and media influences, and contemporary parenting philosophies is essential to fostering communication with patients and their families. Building and honing behavior guidance skills are part of the process by which dentists help turn child patients into fearless adult patients with excellent oral health. This article reviews basic techniques and offers practical examples of implementing these in daily practice. The discussion also addresses changing parental and societal acceptance of various techniques and dentists' responsibility for informed consent regarding the risks and benefits of advanced behavior guidance techniques. Treating a patient from childhood to adulthood is the ultimate opportunity for the dentist to play a vital role in advancing the health and wellness of another human being.

Dental Age Difference in Children with ADHD.

OBJECTIVE: The purpose of this study was to determine if changes in dental development are associated with Attention Deficit Hyperactivity Disorder (ADHD) or ADHD medications. STUDY DESIGN: This retrospective chart review evaluated the dental age of 128 patients between 6 and 16 years of age using the Demirjian method from the following two groups a) children with ADHD b) unaffected children. The ADHD group was further stratified into four groups according to the medication type. The impact of ADHD on dental age difference (the difference between dental age and chronologic age) was analyzed using T-test and the association between medication type and dental age difference was analyzed through one way ANOVA. RESULTS: The mean difference between estimated dental age and chronologic age (dental age difference) for all subjects was 0.80 years. There was no significant dental age difference in subjects with ADHD and the control group (0.78±1.28vs. 0.84 ±1.09 years respectively; P=0.75) and there was no significant difference in dental age difference and type of medication (P=0.84). CONCLUSION: No significant difference was found between children with ADHD and unaffected children with respect to dental age difference. No significant differences were found in dental age difference in the four medication groups.

Interdisciplinary approach to education: preparing general dentists to manage dental trauma.

The traditional dental curriculum presents limited opportunities for students to evaluate and treat patients with acute dental trauma. In an effort to increase student experiences, faculty at a dental school initiated and taught an interdisciplinary trauma course from 2014 to 2016. This course was elective, offered in the final year of dental school, and combined student-led and faculty-led case-based discussions of management of traumatic dental injuries with hospital trauma call shadowing. Modifications of the course were made based on student feedback. Preliminary data from student surveys showed a favorable opinion of the course. Attendees were exposed to a higher number of acute traumatic injuries and they expressed greater confidence in their diagnosis and management abilities than their peers.

Use of local anesthesia during dental rehabilitation with general anesthesia: a survey of dentist anesthesiologists.

The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: "stabilization of vital signs/decreased depth of general anesthesia" (92.9%, 26/28) and "improved patient recovery" (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.

Predictors of Empathy Among Dental Hygiene Undergraduate Students.

Purpose Empathetic engagement is considered a vital component in forming respect-based relationships between patients and clinicians, leading to more optimal patient care. The purpose of this study was to explore whether there was a relationship between dental hygiene students' levels of empathy and student demographics including age, gender, year in school, and the degree type of dental hygiene program attending.Methods This was a cross-sectional observation study conducted among dental hygiene undergraduate students attending three dental hygiene programs in the Midwestern United States. Two programs offered associate degrees and one offered a baccalaureate degree. Participants completed the 20-item Jefferson Scale of Empathy©, student edition (JSE-S) along with demographic questions including age, gender, year in dental hygiene program, and degree type of dental hygiene program. Descriptive statistics and comparisons of the empathy scores were conducted using t-test and one-way analysis of variance (ANOVA). Regressions were conducted to determine whether the students' year in dental hygiene program and the type of degree program were predictors of empathy.Results Forty-one participants completed the questionnaire for a 65% response rate. The mean empathy score was 83.05 ± 10.04 among the participants. There were no statistically significant differences between levels of empathy of first- and second-year students or those attending a two-year institution versus a four-year university. Age, year in program, and type of degree were not shown to be predictors of empathy.Conclusion Results from this study did not show relationships or predictors of empathy with dental hygiene students' demographics or type of degree program. Future research should expand beyond a small homogenous convenience sample and include a longitudinal gauge to assess potential fluctuations in empathy as students progress throughout the curriculum and as practicing clinicians.

Estimated Carbon Emissions Associated With Dental Treatment For Early Childhood Caries.

Purpose: The purpose of this study was to evaluate the environmental impact of travel and anesthetic gas emissions associated with treating early childhood caries at a single institution. Methods: Outpatient preventive, treatment, and modeled general anesthesia (GA) cases in children 71 months old and younger were included in this retrospective chart review. The main outcomes were kilograms of carbon dioxide equivalents (kgCO2e) for travel- and anesthetic gas-related emissions. Descriptive statistics and non-parametric tests were used. Results: Most subjects had a caries treatment visit (n equals 3,630 out of 5,767), and nine percent of treatment visits (n equals 353 out of 3,630) received nitrous oxide (N2O), which added 29.4 kgCO2eto the visit emissions. Children without caries treatment had lower travel-related emissions (median equals 7.5 kgCO2e; interquartile range [IQR] equals 7.6) than children with caries treatment (median without N2O equals 8.7 kgCO2e; IQR equals 18.2; median with N2O equals 8.4 kgCO2e; IQR equals 10.3). Modeled GA travel emissions were estimated at 16.4 kgCO2e (IQR equals 21.9) with between 3.8-12.9 kgCO2e in anesthetic gas emissions. Total emissions were greatest for N2O treatment visits (median equals 43.3 kgCO2e; IQR equals 22.8). Conclusions: Travel-related emissions were greatest for children requiring caries treatment. Minimizing patient travel may reduce environmental impact. Nitrous oxide contributes a significant amount to a dental visit???s environmental impact. Community-focused models of care and applying systematic and practical case selection to reduce excess N2O emissions could reduce dental care-related carbon emissions.

Filled Opioid Prescriptions Following Pediatric Dental Procedures Among Medicaid-Insured Children in Ohio.

Purpose: To investigate opioid prescription fills following pediatric/adolescent dental procedures in central/southeastern Ohio. Methods: This population-based, retrospective cohort study utilized health insurance claims from a pediatric public accountable care organization (???Medicaid???) in central/southeastern Ohio. Patients aged 18 years and younger who had a dental procedure between January 2012 and February 2019 were identified, and claims were searched for opioid prescription fills within 14 days post-procedure. Trends in prescription fill percentages, types of opioid, procedure classification and patient characteristics were examined. Results: A total of 512,922 encounters among 212,813 patients were included. The overall opioid prescription fill was 4.9 percent. Percentages decreased throughout the study period from 6.1 percent (95 percent confidence interval [95% CI]=5.9 to 6.3) in 2012 to 3.4 percent (95% CI=3.1 to 3.8) in early 2019. When limited to extractions and endodontic procedures, the overall prescription fill percentage fell from 15.7 percent (95% CI=15.2 to 16.1) in 2012 to 9.5 percent (95% CI=8.5 to 10.4) in early 2019. The most common opioids were hydrocodone (68.6 percent) and codeine (24.7 percent), with marked annual reductions in codeine prescription fills among children younger than 14 years. From 2017 to 2018, surgical extractions compared to endodontics-only procedures (risk difference [RD]=40.7; 95% CI=38.6 to 42.9) and older patient age (RD for 18-year-olds versus 13-year-olds=21.9; 95% CI=19.8 to 24.0) were strong risk factors for filling an opioid prescription. Conclusion: Post-procedure opioid prescription fill percentages have decreased since 2012 among pediatric/adolescent Medicaid enrollees undergoing dental procedures in central/southeastern Ohio. Substantial differences in the likelihood of filling a prescription remained by procedural and demographic variables. There were marked trends in the types of opioid for which prescriptions were filled, which varied by patient age.

The Value of Clinical Photographs in the Management of Traumatic Dental Injuries.

Purpose: The purpose of this study was to explore the perceived value of clinical photographs for traumatic dental injuries (TDIs). Methods: A survey was sent to members of the American Academy of Pediatric Dentistry (AAPD). The survey collected respondents' responses to case-based questions with and without photographs, and opinions about the value of photography for TDI. Results: A total of 496 respondents (5.8 percent response) completed the survey. Overall, no significant difference in correct answers was observed between cases with and without a photograph (P=0.09). The majority of respondents (82.2 percent) agreed that photographs should be taken for the management of TDIs, with 88.7 percent stating that the photographs aided in the diagnosis of TDIs. The majority of respondents acknowledged the time-saving (80.9 percent) and legal importance (77.0 percent) of photographs. Conclusion: Photographs should be taken in the management of traumatic dental injuries when possible for history and documentation purposes.

Restorative and patient factors associated with repeat general anesthesia for dental treatments in young children: A case-control study.

BACKGROUND: The aim of this study was to assess factors associated with higher odds of undergoing repeat general anesthesia (GA2) for dental treatments. METHODS: The authors studied children up to age 48 months of age enrolled in Medicaid who underwent dental treatment under first general anesthesia (GA1). The authors used a case-control design to compare children who had a GA2 within 48 months of GA1 (case patients) with those who did not (control patients). RESULTS: In total, 60 case patients were age and sex matched to 120 control patients. Mean (SD) age at GA1 was 38 (5.2) months for case participants and 40 (4.7) months for control participants (P = .08). Higher caries involvement of maxillary incisors (P = .04), and lower caries involvment of canines (P = .003), first molars (P = .012), and second molars (P < .001) at GA1 was associated with higher odds of occurrence of GA2. There was a significant inverse association between full-coverage restoration on canines (P = .003), first molars (P = .001), and second molars (P = .002) at GA1 and occurrence of GA2. There was a significant direct association between the use of composites or sealants on second molars in GA1 and occurrence of GA2 (P = .02). The number of extractions at GA1 was not associated significantly with the occurrence of GA2. CONCLUSIONS: The use of full-coverage restorations on primary molars and canines under general anesthesia (GA) was associated with lower odds of occurrence of GA2. Resin restorations and sealants on primary second molars were associated with higher odds of occurrence repeat GA. The findings support preferential use of full-coverage restorations for young children undergoing dental GA. PRACTICAL IMPLICATIONS: Full-coverage restorations should be considered strongly for young children undergoing GA for dental treatments to reduce the risk of requiring GA2.