Dental Treatments under General Anesthesia in Children: A Comprehensive Retrospective Study using Administrative Data
Creators: Yazdanbakhsh, Elnaz
Publisher: name: University of Alberta Library
Year: 2024

<p>Background: Dental caries remains a prevalent chronic disease in children, impacting over half of Canadian children despite preventative efforts. While conventional dental care suffices for many, a significant portion requires general anesthesia (GA) for dental treatments, particularly those with severe dental needs, medical complexities, or very young age. This is especially true for children with special healthcare needs (SHCN), who experience greater barriers to routine dental care and are more susceptible to oral health issues.<br>
Although GA offers a safe and effective method for delivering comprehensive dental care in these cases, it is not without drawbacks. It represents a medically invasive and costly procedure and does not inherently address the underlying causes of dental caries, potentially leading to recurrence and the need for repeat dental general anesthesia (DGA) procedures. This poses significant financial burdens on families and healthcare systems and increases the risk of morbidity and emotional stress for the child. A deeper understanding of current DGA utilization patterns and predictors of multiple DGA procedures is crucial to inform strategies for improved prevention, resource allocation, and ultimately, better oral health outcomes of this population.<br>
Aim: This study aimed to investigate the utilization patterns of DGA among children in Alberta and identify factors associated with multiple DGA procedures. This study paid particular attention to children with SHCN, aiming to characterize this patient population undergoing DGA and their primary medical diagnoses.<br>
Design: This retrospective population-based cohort study utilized administrative health data to investigate DGA utilization patterns among children under 18 years old in Alberta, Canada, between 2010 and 2020. The study included all children who received DGA for oral and dental-related issues in Alberta Health Services-affiliated facilities (hospital and community-based). Using International Statistical Classification of Diseases, 10th Revision, Canada (ICD-10-CA) codes extracted from patient records, we categorized children as having SHCN or healthy (no medical condition). SHCN were further classified into seven disability groups: behavioural/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions. The primary outcome was the occurrence of oral and dental-related DGA events, specifically focusing on multiple DGA events within the study period. Descriptive statistics, binary logistic regression, Cox proportional hazards regression, and Kaplan-Meier survival analysis were employed to analyze the data.<br>
Results: This study analyzed 30,523 pediatric dental general anesthesia events, revealing that the majority of children undergoing DGA were under six years old (62.8%) and from low-income families (54.6%). While most children were medically healthy (91.2%), SHCNs were a significant predictor of multiple DGA events. We identified 3,884 DGA visits involving SHCN children, with a predominance of males aged 6-11 years from low-income families. Mental/intellectual disabilities were the most prevalent SHCN category (31.8%), with autism being the most common specific diagnosis. Dental caries was the primary dental diagnosis across all SHCN groups; however, children with psychiatric/behavioural disorders exhibited a higher prevalence of pulp problems (23.6%), while periodontal issues were more common in those with physical-mental disabilities (13.2%). Overall, 28.7% of SHCN children experienced multiple DGAs, with younger age at first DGA, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments emerging as significant risk factors.<br>
Conclusion: This study highlights the significant association between SHCNs and multiple DGA events in children. Our findings underscore the need for targeted preventative strategies and improved access to dental care for children with SHCNs to reduce the need for DGA and mitigate the potential for caries recurrence and associated complications.</p>