Participation of paediatric patients in primary dental care before and after a dental general anaesthetic.

PURPOSE: The aim of this retrospective study is to determine children's attendance and experience of preventative interventions and operative treatment (restorations and extractions) with their primary care dentist (PCD) in the 12 months before and after their caries management under dental general anaesthetic (DGA). METHODS: A record of all children who had an elective DGA in 2016 across two hospital sites was retrospectively obtained (n = 1308). A representative sample of 300 was randomly selected encompassing 114 dental practices. An online questionnaire to the children's PCDs collated quantitative and qualitative data regarding participation in the pre- and post-DGA period. RESULTS: Data was collated and analysed for 80 children (mean age: 6 years 10 months [SD = 2.49; range: 2 years 1 month - 14 years 3 months]; equal sex distribution) with 43 responding PCDs. Attendance for examination declined significantly from 85% (n = 68) pre-DGA to 57.5% (n = 46) post-DGA (p ≤ 0.001). Attendance at emergency appointments pre-DGA was high (33.75% [n = 27]); a significant reduction post-DGA was recorded (p ≤ 0.001). Over one third of children (37.5% [n = 30]) did not receive any form of preventative intervention over 24 months. A non-significant reduction in the provision of operative treatment was observed post-DGA (p = 0.06 [fill, primary]; p = 0.78 [fill, permanent]; p = 0.66 [ext, primary]). No statistical difference between age and treatment experience was found. Qualitative analysis revealed challenges in providing care included behavioural difficulties and poor attendance. CONCLUSION: Improvements are required in strategies employed to support high caries risk children pre- and post-DGA to facilitate a higher incidence of attendance and preventative intervention with PCDs.

What children say and clinicians hear: accounts relating to incisor hypomineralisation of cosmetic concern.

AIM: To explore the range of impacts relating to incisor opacities as described by children, their general dental practitioners and paediatric dentists. METHODS: Participants included 50 children, aged 7-16 years, referred to a UK hospital paediatric dentistry service for management of incisor opacities. All children were subsequently diagnosed with molar incisor hypomineralisation. Following ethical approval, data were recorded as follows: patient demographics, distance travelled, waiting times, nature of any impacts relating to incisor opacities documented in referral letters and/or in subsequent paediatric dentistry assessment records. Additionally, children completed the short form Child Oral Health Impact Profile questionnaire (COHIP-SF19) as a self-report measure of their oral health-related quality of life (OHRQoL). RESULTS: Nearly, half (48%, n = 24) of the referral letters mentioned that the child was experiencing one or more negative social and/or functional impacts. Mean COHIP score was significantly lower (indicating poorer OHRQoL) for children whose referring dentist had identified a negative impact (COHIP = 42.9) compared to those with no documented impact (COHIP = 50.5; p = 0.018, independent t test). At the hospital consultation, negative impacts were elicited by a paediatric dentist in 86% (n = 43) of cases. Again, mean COHIP score was significantly lower for children whose assessment records noted a negative impact (COHIP = 44.5) compared to those with no recorded impact (COHIP = 60.2; p = 0.001). Families travelled a mean distance of 57 km (range 3-218 km) to the hospital service, with an average waiting time of 75 days from referral. CONCLUSION: It is encouraging that dental professionals seem to be aware of the negative psychosocial impacts experienced by some children with enamel opacities, and that children feel able to describe them.