Factors Associated with Prolonged Exposure to General Anesthesia During Dental Rehabilitation Under General Anesthesia In Patients Under Age Three Years.

Purpose: The purpose of this study was to determine the risk of prolonged general anesthesia (GA) for pediatric dental patients and understand factors that contribute to prolonged GA in patients under age three years in an academic hospital. Methods: A retrospective chart review for pediatric dental patients treated using GA collected data for patient age, treatment provided, other services involved in patient management, and case GA length. Further chart analysis was completed by a multidisciplinary team for cases of prolonged general anesthesia. Results: A total of 114 cases were evaluated. The incidence of prolonged GA exposure was 21.9 percent (N equals 25). Cohort data of cases younger than three years show that cases of prolonged GA exposure were more likely to be closer to age three, require longer non-throat pack time, require more restorative procedures, require longer procedure times, and utilize additional surgical services more often (P<0.05). Four common themes for prolonged exposure were identified (significant restorative needs, provider-level training, anesthesia complications, and utilization of other services), with most cases (88 percent) experiencing multiple themes as contributing factors. Few adverse effects were noted, and none had long-lasting effects. Conclusions: Dental rehabilitation cases in very young patients are at risk for prolonged exposure to GA. Providers should be aware of total anesthesia time while completing dental rehabilitation using GA and proactively attempt to reduce the risk of prolonged exposure.

Influence of Ethnicity on Parental Preference for Pediatric Dental Behavioral Management Techniques.

Purpose: The purpose of this study was to determine how ethnicity influences parental acceptability of behavior management techniques (BMTs) used during dental treatment of children. This is the first known study to compare ethnic differences in acceptance levels of the BMTs. Methods: Parental acceptance of 10 BMTs (tell-show-do, voice control, non-verbal communication, positive reinforcement, distraction, parental presence/absence, nitrous oxide, protective stabilization, sedation, and general anesthesia) was rated using a visual analogue scale (VAS) after watching vignettes of each technique. Parental preferences were stratified by ethnicity and analyzed. Results: Among the 104 parents (21 Caucasians, 29 Hispanics, 30 Asians, and 24 African Americans) who qualified and completed the study, we observed that, overall, non-invasive techniques (positive reinforcement and tell-show-do) were most accepted by parents, while invasive techniques (voice control and protective stabilization) were least accepted (P<0.001). Within each ethnicity, there were significant differences between the BMTs (P<0.001). Additionally, conscious sedation was the only BMT to show a significant difference between the ethnic groups (P=0.047), with Asian parents having a lower mean score than Caucasian and Hispanic parents. Conclusions: Our results suggest that considering the ethnic/cultural differences of patients and their parents is an instrumental component for pediatric dentists to provide quality care to children patients.

Dental Caries Experience in Texan Children with Cleft Lip and Palate.

PURPOSE: The purpose of this study was to assess the caries experience in the primary dentition of children born with cleft lip and palate (CLP). METHODS: A retrospective chart review was conducted on subjects between two and six years old recruited from a university-based pediatric dentistry residency clinic. The number of dental visits and professional fluoride applications, the plaque index and treatment modality, and the presence/location of caries, white spot lesions, and enamel hypoplastic lesions were compared between CLP patients and healthy age- and gender-matched controls. Descriptive statistics, Student's t test, Mann-Whitney U test, and regression analysis were completed. RESULTS: A total of 183 charts were reviewed. Compared to healthy children, CLP children had increases in number of dental visits (P<0.001), decayed-missing-filled surfaces (dmfs; P<0.001), decayed-missing-filled teeth (dmft; P<0.001), enamel hypoplastic lesions (P=0.003), treatment completed under general anesthesia (P<0.001), plaque score (P<0.001), and caries increment between baseline and most recent oral examination (P=0.003). Regression analysis revealed a positive association between age and dmft scores within the CLP group (P=0.018). The caries experience of unilateral and bilateral CLP cases was the same (P>0.05). CONCLUSIONS: Children with cleft lip and palate are at a greater risk of enamel hypoplasia and dental caries. No significant caries experience difference was found between unilateral or bilateral CLP cases.

A Postsurgical Obturator After Cleft Lip Repair in Patients With Holoprosencephaly.

Several factors affect healing of lip repair in children with complete cleft lip and palate in the immediate postoperative period. However, children with holoprosencephaly present a unique challenge. Because of their wide midline clefts and premaxillary agenesis they have protrusive positioning of their tongue, which can adversely affect the surgical result. In these cases we have found a postsurgical obturator made with hard-setting acrylic to be especially useful. Such an appliance may be used for the initial healing period (1-2 weeks). Two cases are presented here where such a device was used successfully.

Sources of drinking water in a pediatric population.

PURPOSE: The purpose of this study was to determine the primary sources of water used for consumption and cooking by the patients of a university-based pediatric dental practice. METHODS: A simple, prewritten questionnaire-consisting of seven questions and available in English and Spanish-was conducted verbally with the caregivers of 123 pediatric patients during a designated timeframe. Analysis of responses included descriptive statistics and a chi-square test for a single proportion. RESULTS: Nonfiltered tap water accounted for the primary drinking water source in only 10 percent of the respondents. Firty-two percent of the respondents selected bottled water as the primary source of drinking water, and 24 percent selected vended water stations as a primary drinking water source. Nonfiltered tap water was much more likely to be utilized in cooking (58 percent). CONCLUSIONS: The majority of the patients in this study's pediatric dental practice do not consume fluoridated tap water. With the vast majority of the patients primarily consuming bottled or vended water, these patients are likely missing out on the caries-protective effects of water fluoridation.

Medical-dental findings and management of a child with infantile Refsum disease: a case report.

Infantile Refsum disease (IRD) is a peroxisome biogenesis disorder (PBD), and is part of a larger group of diseases called leukodystrophies, which are inherited conditions that damage the white matter of the brain and affect motor movements. Multiple signs and symptoms of IRD begin in infancy and progress through early childhood, including hearing and visual impairment, intellectual and growth impairment, seizures, liver involvement, and orofacial and dental abnormalities. This paper presents a case history of a 12-year-old female patient with IRD who underwent dental rehabilitation in the operating room under general anesthesia and includes a 2-year follow-up. Medical, dental, and management considerations in the care of this child's condition are presented. This paper also discusses the importance of a multidisciplinary approach in the management of children with special needs.

Comprehensive oral rehabilitation with general anesthesia and prosthetic care in the primary dentition: a case report.

This case report describes the oral rehabilitation of a 5-year-old male referred by a general dentist to a pediatric dentist due to acute psychological stress to dental treatment and extensive dental caries. The patient's dental restorations and extractions were completed under general anesthesia. Maxillary and mandibular prostheses were completed in the outpatient clinical setting. The treatment plan for this child provided options to improve appearance, self-image and oral function.

Dental trauma in children and adolescents with mental and physical disabilities.

AIM: to determine the occurrence of dental trauma in children and adolescents with a mental and/or physical disability compared to otherwise healthy children, and to assess factors associated with and mechanism of such trauma. METHODS: Eighty-six subjects consisting of 43 special needs and 43 otherwise healthy children between the ages of 8 and 15 years were chosen from the patient pool at Special Children's Dental Clinic within Children's Hospital, New Orleans. The study utilized a parent interview questionnaire and a clinical exam of the patient. RESULTS: Although healthy children had a higher number of injuries than children with special needs on average, the difference was not statistically significant. Neither healthy children nor children with special needs exhibited a significant correlation between the number of injuries and the size of the overjet (mm) (p=0.722, 0.712). There was not a significant difference in the number of injuries for children with different oral profiles (p=0.949), or adequate versus inadequate lip coverage (p=0.940). CONCLUSION: In this study population, the children with special needs living at home may have had the same amount of trauma as the otherwise healthy children and studies with larger sample sizes may be needed to further explore this possibility. Excessive overjet, type of facial profile, and adequacy of lip coverage did not seem to increase the amount of trauma noted in our study population.