Dentists' Prescribing of Analgesics for Children in British Columbia, Canada

OBJECTIVE: Recently, there has been great interest in the use, abuse and over-prescribing of opioid analgesics for children. However, there is a paucity of evidence on patterns of prescribing of both narcotic and non-narcotic analgesics for children by dentists. METHODS: We used a population-wide prescription drug database (PharmaNet) in British Columbia, Canada, to examine prescribing and dispensing of analgesics surrounding dental procedures. We examined all drugs prescribed for children by dentists between 1997 and 2013, as we had access to data on drug doses and days of medication supply. We also examined trends in the use of various narcotic and non-narcotic analgesics and benzodiazepines. RESULTS: In total, 268 691 children were prescribed at least 1 study drug by a dentist. Codeine was the most frequently prescribed: 50% of children received codeine for more than 3 days. Duration of use of codeine was greatest among children ≥12 years, the longest duration of use being 5 days. CONCLUSIONS: Our study reveals that codeine prescription by dentists increased over the 16-year study period. Codeine is prescribed by dentists for 50% of children; prescriptions are for too long a duration to avoid potential morphine accumulation and are not in line with current treatment guidelines.

Factors related to postoperative discomfort in young children following dental rehabilitation under general anesthesia.

PURPOSE: This study, conducted in ambulatory surgical centers, was a response to queries from pediatric dentists who wondered if postoperative discomfort in their patients treated for early childhood caries under general anesthesia was related to specific dental procedures. The purpose of this study was to identify factors related to the occurrence and severity of postoperative discomfort. METHODS: Subjects were children younger than 7 years old. The faces, legs, activity, cry, consolability pain assessment tool measured discomfort immediately postoperatively; the dental discomfort questionnaire (DDQ-8) measured discomfort preoperatively and after treatment. Data was analyzed with bivariate tests and hierarchical linear multiple regression. RESULTS: Of the 160 participants (52.9±15.0 months old), approximately 51% had preoperative dental discomfort (DDQ-8 score=>3). The proportion with discomfort had significantly decreased to 27% by days 2 to 5. Immediate discomfort in recovery was influenced by number of crowns and space maintainers and inversely by the length of postoperative sleep. Dental discomfort in the first week postoperatively was predicted by amount of preoperative discomfort, length of sleep in recovery, and not resuming a regular diet on Day 1. CONCLUSION: In these children, discomfort after treatment was mild, decreased over time, and, other than immediately postoperatively, was not related to specific dental procedures.

Laboratory-made space maintainers: a 7-year retrospective study from private pediatric dental practice.

PURPOSE: The purpose of this study was to report survival times and problems encountered with laboratory made space maintainers placed over 7 years by one pediatric dentist. METHODS: Charts were reviewed for 235 patients with fixed space maintainers placed between January 1, 1997, and December 31, 2003, and followed to December 31, 2005. Problems encountered and appliance lifetimes were recorded and assessed. Failures were recorded as: (1) cement loss; (2) solder breakage; (3) split bands; (4) eruption interference; (5) bent wire; (6) complete loss; or (7) not specified. Appliance outcomes, transferred patients, and those lost to follow-up were recorded. RESULTS: A total of 323 appliances were followed, with: (a) 93 (29%) successes; (b) 110 (34%) still in service; and (c) 104 (32%) known failures. Of the latter, most (62%) were from cement loss (60%) and 13 (12%) were totally lost. No statistically significant differences were noted between types of appliances, gender, and types of failure, except for the fact that bands and loops exhibited more cement loss (P=.045). Mean pooled survival times were between 26 and 27 months.. Of the 104 failures: (a) 34 (33%) were no longer needed (being considered clinically successful); (b) 57 (55%) were recemented; and (c) 13 (12%) were remade. Sixteen appliances were lost to follow-up or transferred. CONCLUSION: A total of 63% of all space maintainers lasted their anticipated lifetimes or were still in use.

Success Rate of Treatments Provided for Early Childhood Caries under General Anesthesia: A Retrospective Cohort Study.

PURPOSE: The purpose of this study was to assess the success rate of various treatments provided under general anesthesia for early childhood caries (ECC) over three-year follow-up period. METHODS: ECC children no older than 72 months at the time of dental surgery, who had completed a three-year follow-up, were included. The success rate of every treatment was evaluated. The longevity of each treatment and significant factors associated with failures were assessed. RESULTS: A total of 818 children (55.8 percent were males with a mean age of 46.2±13.4 months old) were included. Of these, 32.9 percent had restored teeth that required further treatment during the three-year follow-up. Amalgam restorations and stainless steel crowns (SSCs) showed significantly longer survival than composite restorations in all types of restorations (P<.05). The survival rate of both indirect pulp capping and pulpotomies were the same (P=0.234), and they were significantly higher than that for pulpectomies (P=0.001, P=0.039, respectively). The lower lingual holding arch (LLHA) had a significantly lower survival rate than other space maintainers (P<0.05). CONCLUSIONS: SSCs and amalgam restorations were clinically more successful and had better survival times than composite restorations. The survival rate for the LLHA was low compared to other space maintainers.