Children Oral Health Following Treatment under General Anesthesia: A Retrospective Study

2021 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Oral Health ◽  
General Anesthesia ◽  
Behavior Management ◽  
Dental Treatment ◽  
Caries Experience ◽  
P Value ◽  
Behavior Changes ◽  
Carious Lesions ◽  
Number Of Patients ◽  
Significant Difference

Introduction: Dental treatment for children can be provided and completed in dental chair using one or more behavior management methods applied in dentistry. When these methods did not work, special behavior management technique such as treatment under general anesthesia (GA) may be provided for optimal dental treatment. The purpose of this study was to evaluate long term oral health status such as oral hygiene (OH), recall rate, behavior changes and development of new or recurrent carious lesions in children who received dental treatment under GA. Methods: Data were collected retrospectively from dental records of 433 children who received dental treatment under GA between 2006 and 2010. Collected data looked at 1) Age, 2) Gender, 3) OH before treatment and at the recall visits, 4) Behavior changes, 5) New or recurrent caries experience, and 6) Treatment of these lesions. Results: Age of patients ranged between 2 and 13 yrs. Boys to girls were 223 (51%) to 210 (48%) respectively. OH post operatively was significantly improved in comparison to that before treatment (p-Value < 0.0001). However, OH was almost the same among patients who attended recall visits (p-Value = 0.79). Number of patients who attended recall visits reduced significantly by time (p-Value < 0.0001). There was significant improvement in patient cooperation post operatively in comparison to that pre-operatively (p-Value < 0.0001). There was no significant difference in the incidence of new or recurrent carious lesions through recall visits (p-Value = 0.73). Conclusion: Dental treatment under GA did not seem to be effective in the improvement of OH or in reducing caries experience. However, children behavior showed some improvement in the follow up visits due to no active treatment required or simple dental procedures may be implemented.

Retrospective Review of Oral Probiotic Therapy

2019 ◽  
Vol 43 (6) ◽  
pp. 367-371
Author(s):  
Mark L Cannon ◽  
Ashlee Vorachek ◽  
Catherine Le ◽  
Kevin White
Keyword(s):  
Statistical Analysis ◽  
Oral Health Status ◽  
Dental Restoration ◽  
Probiotic Bacteria ◽  
Caries Experience ◽  
P Value ◽  
Carious Lesions ◽  
Significant Difference ◽  
Active Patients

Purpose: There have been many in vitro studies reporting on the efficacy of probiotic bacteria in inhibiting pathogens, and there have been published studies reporting on the inhibitor effects of probiotic bacteria on the salivary levels of bacterial pathogens. However, there have not been but a few studies on the clinical benefits of oral probiotic therapy. Study design: Dental records of 60 patients that were enrolled in an Institutional Review Board approved study were reviewed as to current caries activity status with measurement of the Decayed Missing Filled Teeth index and by Caries Management By Risk Assessment (CAMBRA) determination. The current oral health status was compared to the prior-to-study enrollment status and then analyzed in respect to published national norms. The data (without any identifiers) had a statistical analysis by a blinded biostatistician. The data was subjected to statistical analysis (Statsgraphic) before and after the probiotic therapy. Results: Of the 53 subjects available for follow up, only 4 had remained caries active with a grand total of 27 carious lesions being detected and subsequently restored in this group. Of the original total of 60 patients with 292 initial carious lesions, after probiotic therapy and dental restoration, 78 total restorations were placed in the subject group over the following three years. Approximately half of these restorations were required in teeth that had initially presented with smaller lesions and had been placed in a “watch” category. Two of the patients that developed further carious lesions had been randomly assigned to the probiotic PerioBalance, while the other two caries active patients were assigned EvoraKids probiotic. Of the original group of caries active patients, 24 did not present with any further carious involvement. Another 25 could be categorized as caries static, as the restorations required were substantially less than before probiotic therapy had been begun. The F-ratio, which in this case equals 51.3313, is a ratio of the between-group estimate to the within-group estimate. Since the P-value of the F-test is less than 0.05, there is a statistically significant difference between the means of the 4 variables at the 95.0% confidence level. Conclusion: The tested probiotic supplements had a statistically significant effect on the caries experience of the enrolled subjects.

Oral Health Status of Autistic Children in India

2011 ◽  
Vol 36 (1) ◽  
pp. 43-48 ◽  
Author(s):  
P Subramaniam ◽  
M Gupta
Keyword(s):  
Health Status ◽  
Oral Health ◽  
Oral Hygiene ◽  
Dental Treatment ◽  
Children With Autism ◽  
Oral Health Status ◽  
Repetitive Behaviors ◽  
Caries Experience ◽  
Autistic Children ◽  
Behavior Rating Scale

Autism is one of the most severe childhood neuropsychiatric disorders. Autistic individuals are characterized by impairment in social interaction with a restricted range of interests and often, stereotyped repetitive behaviors. Studies on oral health conditions in children with autism are sparse. The complicated disability itself makes clinical research difficult. Aim: The need for baseline information regarding the oral health status of children with autism is essential. Method: The present study assessed the oral health status of 106 autistic children aged 4 to 15 years in Bangalore city, India. The dental caries was recorded according to the WHO criteria; oral hygiene was assessed using the Oral Hygiene Index-Simplified (OHI-S) and its modification for deciduous dentition. The behavior of children towards dental treatment was also assessed using the Frankel's behavior rating scale. Data obtained was subjected to statistical analysis. Results showed that caries experience among autistic children was lower; however they were found to have more debris and calculus deposits. Conclusions: Negative behavior towards dental treatment was seen in autistic children.

Utility of Bispectral Index Monitoring during Deep Sedation in Pediatric Dental Patients

2014 ◽  
Vol 39 (1) ◽  
pp. 291-296 ◽  
Author(s):  
C Dag ◽  
T Bezgin ◽  
N Özalp ◽  
G Gölcüklü Aydın
Keyword(s):  
Dental Treatment ◽  
Deep Sedation ◽  
Pediatric Dentistry ◽  
P Value ◽  
Chi Square ◽  
Mean Values ◽  
Dental Patients ◽  
Physiological Variables ◽  
Paired Samples ◽  
Significant Difference

Objective: The aim of this study was to compare the total medicament doses and recovery profiles of patients for whom Bispectral Analysis (BIS) monitor was used to monitor sedation. Study design: Thirty-four uncooperative paediatric patients aged 3-6 years who attended to the Department of Pediatric Dentistry for dental treatment were enrolled in the study. Patients were randomly divided into 2 groups of 17 patients each. Physiological variables including oxygen saturation, blood pressure and heart rate were recorded. In one group (BIS-monitored group), drugs were administered to maintain patients’ BIS values between 60-70, while the other group (Non-BIS-monitored Group) was not monitored using BIS. Data was evaluated by Chi-square, Mann Whitney U, Independent Samples t, Paired Samples t and Wilcoxon signed tests, with a p-value of &lt;0.05 considered to be statistically significant. Results: There was no significant difference in total anesthetic doses, incidence of adverse events or recovery profiles of patients between non- BIS-monitored and BIS-monitored groups (p≯0.05). However, distinct correlation was determined among mean values of UMSS and BIS values (p&lt;0.05). Conclusion: BIS represents no advantage over the current commonly accepted methods for monitoring sedation depth in children.

scholarly journals A Comprehensive Approach Limiting Extractions under General Anesthesia Could Improve Oral Health

2020 ◽  
Vol 17 (19) ◽  
pp. 7336
Author(s):  
Nicolas Decerle ◽  
Pierre-Yves Cousson ◽  
Emmanuel Nicolas ◽  
Martine Hennequin
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
General Anesthesia ◽  
Dental Treatment ◽  
Preoperative Evaluation ◽  
Health Related Quality ◽  
Dental Surgery ◽  
Related Quality ◽  
Health Related

Access to dental treatment could be difficult for some patients due to dental phobia or anxiety, cognitive or sensorial disabilities, systemic disorders, or social difficulties. General anesthesia (GA) was often indicated for dental surgery, and there is almost no available data on adapted procedures and materials that can be applied during GA for maintaining functional teeth on the arches and limiting oral dysfunctions. This study evaluates changes in oral health-related quality of life and mastication in a cohort of uncooperative patients treated under GA according to a comprehensive and conservative dental treatment approach. Dental status, oral health-related quality of life, chewed bolus granulometry, kinematic parameters of mastication, and food refusals were evaluated one month preoperatively (T0), and then one month (T1) and six months post-operatively (T2). One hundred and two adult patients (mean age ± SD: 32.2 ± 9.9 years; range: 18–57.7) participated in the preoperative evaluation, 87 were treated under GA of which 36 participated in the evaluation at T1 and 15 were evaluated at T2. Preoperative and postoperative data comparisons demonstrated that oral rehabilitation under GA helped increase chewing activity and oral health-related quality of life. The conditions for providing dental treatment under GA could be arranged to limit dental extractions in uncooperative patients.

Hyponatremia With Intravenous Sulfamethoxazole/Trimethoprim in Children

2019 ◽  
Vol 54 (4) ◽  
pp. 351-358 ◽  
Author(s):  
Katy Stephens ◽  
Jamie L. Miller ◽  
Teresa V. Lewis ◽  
Stephen Neely ◽  
Peter N. Johnson
Keyword(s):  
Cumulative Dose ◽  
Serum Sodium ◽  
A Priori ◽  
Sodium Concentration ◽  
Primary Objective ◽  
P Value ◽  
Number Of Children ◽  
Number Of Patients ◽  
Significant Difference ◽  
Dose Number

Background: Intravenous (IV) sulfamethoxazole/trimethoprim (SMX/TMP) has been associated with hyponatremia in adults. Objective: The primary objective was to identify the number of patients with a serum sodium <135 mEq/L. Secondary objectives between the hyponatremic versus nonhyponatremic groups included demographic comparisons, median serum sodium concentrations, SMX/TMP cumulative dose, number of diuretics, and other medications causing hyponatremia. Methods: This was a retrospective study of children <18 years receiving IV SMP/TMX. Comparisons were conducted via Mann-Whitney-Wilcoxon and Mantel-Haenszel χ2 tests with an a priori P value <0.05. Results: Sixty-one patients received 66 total courses; 20 courses (30.3%) were associated with hyponatremia with a decrease in the median nadir serum sodium concentration of 133 and 138 mEq/L in the hyponatremic and nonhyponatremic groups, respectively ( P<0.001). The median age (interquartile range) was lower in the hyponatremic versus nonhyponatremic group, but this was not statistically significant: 0.6 (0.1-5.5) versus 3.9 (0.3-11.0) years; P=0.077. There was no significant difference in the median cumulative dose (mg/kg) between groups; P=0.104. In addition, there was a significant difference in the number of children in the hyponatremic versus nonhyponatremic groups receiving diuretics (16 [80.0%] vs 23 [50.0%], P=0.023) and other medications that cause hyponatremia (7 [35.0%] vs 5 [10.9%], P=0.034), respectively. Furosemide was noted to be the medication most associated with hyponatremia. Conclusion and Relevance: Approximately one-third administered IV SMX/TMP developed hyponatremia. Concomitant furosemide administration was one of the most common risk factors. Clinicians should be aware of this potential adverse event when initiating IV SMX/TMP in children.

scholarly journals The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia

2019 ◽  
Vol 5 (2) ◽  
pp. 146-155 ◽  
Author(s):  
B.D. Meyer ◽  
R. Wang ◽  
M.J. Steiner ◽  
J.S. Preisser
Keyword(s):  
Health Care ◽  
Early Childhood ◽  
Oral Health ◽  
Health Services ◽  
General Anesthesia ◽  
Early Childhood Caries ◽  
Dental Treatment ◽  
Oral Health Care ◽  
Oral Health Services ◽  
The Impact

Background: Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. Methods: We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina ( N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. Results: Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87–0.99; P = 0.029) and expenditures ($114; CI,−$152.61 to −$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. Conclusions: POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome—treatment under general anesthesia. Knowledge Transfer Statement: The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.

scholarly journals The Use of Tranexamic Acid in Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Laura Luick ◽  
Vytas Ringus ◽  
Garrett Steinmetz ◽  
Spencer Falcon ◽  
Shaun Tkach ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
P Value ◽  
Ankle Arthroplasty ◽  
Estimated Blood Loss ◽  
Number Of Patients ◽  
Significant Difference

Category: Ankle Arthritis Introduction/Purpose: The number of total ankle arthroplasties (TAA) is on the rise. Complications associated with TAA include need for blood transfusion, deep vein thrombosis, hematoma, infection, and wound complications. Tranexamic acid (TXA) use in the total knee and total hip population has been found to decrease the rate of blood transfusion. The rate of infections and blood transfusions in TAA was reported to be 3.2% and 1.3%, respectively. In calcaneal fractures TXA was found to decrease wound complications. Our goal was to evaluate the use of TXA in the TAA population to see if its use decreases blood loss or wound complications. Methods: This is a retrospective review of two patient cohorts operated on by a single surgeon from 2010 to 2016. We compared a group of TAA patients that did not receive TXA versus a subsequent group that received TXA. Patients received 1 g IV TXA before tourniquet was inflated and another 1 g following the release of the tourniquet. Pre-operative hemoglobin and hematocrit levels were compared to postoperative levels. Post-operative complications were compared between the two groups. Results: 87 patients were included in the study. 35 patients (40%) received TXA. In patients that received TXA, 18 had postoperative hemoglobin levels available. These patients were compared to a control cohort of 52 patients that did not receive TXA. No significant difference existed between the two groups in gender or age (p=0.9; p=0.7 respectively). Mean estimated blood loss was the same between the two groups. Overall postoperative complications, including wound complications, were higher in the TXA group at 26% vs 12% but this was not statistically significant (p-value = 0.086). The preoperative to postoperative change in hemoglobin/hematocrit levels was not statistically significant between groups (p-value = 0.78). There was one transfusion required in the non-TXA group and no transfusions required in the TXA group (p=0.9). Conclusion: The use of TXA was not found to provide a beneficial effect in total ankle arthroplasty in either decreasing wound complications or blood loss. Given these results, TXA use might not be cost effective in total ankle arthroplasty as opposed to other total joint arthroplasties. Further higher levels studies with increased number of patients are required to further evaluate TXA effectiveness in TAA.

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