Comprehensive dental care for children with rampant caries under general anaesthesia.

OBJECTIVE: Critical reflection on treatment strategy for dental rehabilitation of young children with rampant caries using day-stay general anaesthesia at a university dental clinic. DESIGN: Cross-sectional analysis of 98 cases. SETTING: The study was undertaken at the university paediatric dental clinic of Leuven, Belgium. SAMPLE AND METHODS: The sample consisted of 98 healthy patients referred for dental treatment under general anaesthesia with a mean age of 4.8 (+/- 1.1) years and mean dmft-score of 9.3 (+/- 3.0). Data were obtained by history taking, clinical examination, questionnaires (filled in by parents) and standardized data records (filled in by dentists and nurses in the recovery area and day-stay clinic). RESULTS: Most patients were referred by their private dentist (74.5%) because of a need for extensive dental treatment in an uncooperative child. Induction of anaesthesia was upsetting in a significant number of cases (68% of children). The mean duration of the whole procedure was 80.9 (+/- 24.7) minutes. A mean number of 7.2 (+/- 2.9) primary teeth were filled and 1.8 (+/- 2.0) extracted per patient. Post-operative problems (nausea/vomiting, temperature rise) were seen in only 8.2% of the patients. CONCLUSIONS: The technique used at this centre allows for extensive dental treatment of young children with a high level of acceptability and minimal morbidity, using day-stay general anaesthesia. Based on this review, it became clear that less upsetting methods for the induction of anaesthesia need to be explored. Criteria for the administration of antibiotics need to be defined more clearly and the use of stainless steel crowns should be envisaged for restorations on primary molars. The global outcome of this treatment provision in children at high caries risk should be evaluated over a longer period, including an evaluation of oral health status, restorative treatment (conservation vs. extraction) and behavioural aspects.

[What is the cause of failure of local anesthesia?]. / Que faire en cas d'échec de l'anesthésie locale?

Local anesthesia fails in 10% of cases of inferior alveolar nerve block and 7% of all cases of local anesthesia in general practice. Possible causes of failure are infection, wrong selection of local anesthetic solution, technical mistakes, anatomical variations with accessory innervation and anxiety of the patient. In this publication we discuss reasons for frequent failure in case of infection and in inferior alveolar nerve block. Understanding the mechanism of failure in local anesthesia, makes it possible to formulate guidelines to guarantee success. These measures are discussed in detail.

[Local anesthesia in children]. / Anesthésie locale chez l'enfant.

Local analgesia in children necessitates a correct approach. Sufficient explanation about the procedure and preparation of the child are important. Because of differences in anatomy, the technique of anesthesia needs adaptation. The different techniques are reviewed and discussed. The children are at greater risk of overdose when local anesthetics are administered. Calculation of the maximum permitted dose is necessary and with good precautions accidents can be prevented.