Is dental general anaesthesia in children an outdated concept? A retrospective analysis.

AIM: The aim of this retrospective study was to determine the prevalence of caries and treatment needs in the collective of patients ?16 years of age, who underwent scheduled dental general anaesthesia (DGA) at the University Clinic of Innsbruck from January 2015 to June 2019, with respect to demographic factors. MATERIALS AND METHODS: A retrospective analysis of children's diagnoses, demographics, and dental treatment under general anaesthesia in Innsbruck, Austria, from 2015 to 2019 was performed. Anonymised demographic data (age; gender; the presence or absence of general disease or disablement; parents' first language (German- (GS) or non-German-speaking (non-GS), reflecting ethnicity; and the number of teeth restored and extracted under DGA were collected from patients' files. Data was analysed by means of descriptive and comparative statistics. RESULTS: The main group consisted of 545 subjects at a median age of 5.3 (IQR 4.4-6.6) years, who had exclusively primary teeth and or first molars that received restorations or were extracted. Of the subjects, 84.4% were classified with uncooperativeness due to dental anxiety and 15.6% with systemic diseases or intellectual and or physical disablement. In this group, 47.9% were GS and 52.1% were non-GS or had GS or non- GS parents. In the total sample, 5 (IQR 3-7) primary teeth were restored and 4 (IQR 4-7) extracted. Subgroup analysis revealed statistically significant differences in the number of extracted primary teeth between children with and without systemic diseases or disablement - 3 (IQR 1-5) versus 4 (IQR 2-7) - and between children of GS and non-GS parents - 4 (IQR 2-6) versus 5 (IQR 3-7.8). Zero (IQR 0-0) first molars were filled and extracted. CONCLUSION: Within the study collective of children in poor oral health, the offspring of non-GS families were overrepresented (compared to their prevalence in the total population) and displayed a higher prevalence of deep caries than those of GS parents. By intensifying and special gearing of prophylactic measures to the non-GS population and promoting the parents' insight into the importance of oral hygiene and regular dental attendance, the demand for scheduled DGA might be greatly reduced. In the small share of children who suffer from severe diseases or disablement and are thus unable to cooperate with home care or dental treatment, DGA will remain the treatment of choice.

Prevalence and distribution of deep caries and abscess formation in children who required emergency dental general anaesthesia. A retrospective analysis.

AIM: The aim of this study was the assessment of prevalence, distribution, and treatment of deep caries and odontogenic abscess formation in children who received emergency dental general anaesthesia (DGA) at the University Hospital of Cranio-Maxillofacial and Oral Surgery of Innsbruck, Austria. MATERIALS AND METHODS: The study population was composed of 1,184 consecutive cases of emergency DGA from January 2008 to June 2014, in patients ?16 years who had presented with odontogenic pain and/or swelling. Under DGA, the tooth causative for the acute pain, and all teeth with deep caries had been routinely removed. From patient files, demographic data, abscess location and therapy, and the number of teeth extracted under DGA were recorded and analysed by means of descriptive statistics. RESULTS: In 549 cases (46.4%) (mean age 5.29±2.39 years), an abscess formation was recorded; 90.5% of all abscesses were submucous, and 9.5% affected fascial spaces. Decayed primary molars and maxillary primary incisors and canines were most often causative for abscess formation. Drainage was in most cases performed by tooth extraction with/without an intraoral incision under antibiotic therapy. Per case, a mean of 5.91±4.04 primary teeth were extracted. In 77 individuals (mean age 9.83± 2.59), a mean of 1.92±1.02 permanent first molars were extracted. CONCLUSION: In the study population, prevalence of deep caries and abscess formation was alarmingly high. In consideration of the medical risks and high efforts immanent in DGA, educational measures should address parents in order to raise awareness of their responsibility for their children´s health.

Prosthetic rehabilitation of patients with hypohidrotic ectodermal dysplasia: A systematic review.

Hypohidrotic ectodermal dysplasia (HED) comprises a large group of inherited disorders of ectodermal structures, characterised by hypo- or anhidrosis, hypotrichosis and hypo- or oligo- or anodontia. We aimed to systematically assess the spectrum of prosthodontic approaches with regard to the patients' age and to provide clinical implications for practicing dentists. An electronic and manual search was conducted in four databases (Medline, LIVIVO, Cochrane Library, Web of Science Core Collection). Publications of multiple study designs written in English or German without data restrictions, reporting on prosthodontic treatment of patients diagnosed with HED and afflicted with oligo- or anodontia, were included. In total, 75 articles on 146 patients were analysed according to the patients' age. In children aged 2-17 years, removable full or partial (over)dentures represented standard treatment. In the mandible, implant-supported removable dentures on two interforaminal implants presented an alternative, already in young childhood. In cases with more than six teeth per jaw, also fixed (resin) bridges were used, frequently after orthodontic treatment. In adults, fixed or removable reconstructions with the help of up to eight implants per jaw, usually placed after bone augmentation procedures, were standard. Ten case reports/series with long-term follow-up illustrated the need for consistent maintenance including denture renewals. Prosthodontic rehabilitation should start in early childhood and needs to be revised in accordance with the patients' growth. Treatment should be carried out by a multidisciplinary team addressing variable demands in different age groups.

Study of parotid and mixed saliva in the diagnosis of chronic pancreatitis.

A study on the diagnostic value of the parotid and mixed saliva assay after stimulation with 1% pilocarpine hydrochloride was carried out in 36 controls and 26 patients affected with chronic pancreatitis. No statistical difference between the two groups was found as far as saliva volume, bicarbonate and amylase (concentration and output) are concerned. No correlation was found between the results of the saliva test and those of the secretin-pancreozymin test or endoscopic retrograde pancreatography. These data excluded any diagnostic role of the saliva test in chronic pancreatitis.