Bless you.

AIMS: To investigate patterns of referral, disease and treatment for healthy children who had received two or more dental general anaesthetics (DGA) for exodontia. METHODS: Records from 200 episodes of repeat DGA were studied retrospectively. RESULTS: The mean age of patients at first referral was 5y4m, and the mean interval before repeat was 22 months. Self-referrals rose from 14% at DGA1 to 30% at DGA2. New caries at second referral, where all diagnosed disease had been treated at DGA1, accounted for only 15% of the total. Where a specific request was made in the referral, only 8% of letters matched the charting made in hospital. 30% of all specific requests were honoured, but then required treatment for previously diagnosed caries at DGA2.75% of single-tooth extractions required repeat DGA for caries left at DGA1. CONCLUSIONS: It may be too optimistic to address only the most grossly diseased teeth when a child requires GA exodontia. A more radical treatment-planning approach, combining primary care, secondary care and public health considerations, may be required to avoid the unnecessary use of DGA.

Anesthesia, Dental↗

PubMed2000

An investigation of patient management methods used for orthodontic extractions by general dental practitioners in north west England.

OBJECTIVE: To quantify the patient management methods used by dental practitioners for orthodontic extractions and to determine what factors influence their choice of method. DESIGN: Practitioners working in the General Dental Service in the area of the former North West Regional Health Authority were randomly sampled and sent a postal questionnaire. SETTING: General Dental Service in the North West of England. SUBJECTS: 204 completed questionnaires were returned; a response rate of 71.1%. INTERVENTIONS: Practitioners were asked about the patient management methods that they used for orthodontic extractions and what factors were important in choosing to use a general anaesthetic. OUTCOME MEASURES: The mean percentages of patients treated with local anaesthetic alone, general anaesthesia and inhalation sedation with local anaesthesia were calculated for the sample. Factors influencing the choice of method used were scored by the practitioners on a ten point scale. RESULTS: Local anaesthesia alone was used for two thirds of orthodontic extraction patients and general anaesthesia for one third. Inhalation sedation was rarely used. Poor patient cooperation and a nervous patient were the most important factors in choosing a general anaesthetic. CONCLUSIONS: Local anaesthesia is used for the majority of orthodontic extractions. However there remains an overuse of general anaesthesia and an underuse of inhalation sedation.

Anesthesia, Dental↗