OBJECTIVE: To compare the parental acceptance of dental treatment under general anesthesia and deep sedation in children and assess the changes in postoperative oral health-related quality of life and treatment efficacy. METHODS: The parents of 131 children undergoing dental treatment in the Department of Stomatology of Sichuan Provincial People's Hospital from January, 2022 to June, 2022 were surveyed using a questionnaire of children's advanced oral behavior management, and 83 children receiving general anesthesia or deep sedation for dental treatment between January, 2018 and December, 2021 were also investigated for changes in quality of life after the treatment using a questionnaire. The treatment efficacy was assessed at the 1-year follow-up visit in 149 children who received dental treatment under general anesthesia or deep sedation during the same period. RESULTS: The survey of perantal acceptance showed that 62.6% of the parents preferred deep sedation, 29.01% preferred general anesthesia, and 8.4% preferred compulsory treatment. Dental treatments under general anesthesia and deep sedation both significantly improved oral health-related quality of life of the children. While dental surgeries under general anesthesia resulted in the most significant improvement of pain symptoms, deep sedation was associated with both obvious relief of the children's pain symptoms and reduction of the parents' pressure level. No significant difference was found in the efficacy of treatments under general anesthesia and deep sedation at the 1-year follow-up. CONCLUSION Dental treatment in children under deep sedation has the highest parental acceptance, followed by treatment under general anesthesia, and the acceptance of compulsory treatment is the lowest. The treatments under general anesthesia and deep sedation significantly improve the quality of life of the children and their parents and both have good treatment efficacy.
Humans ; Child ; Quality of Life ; Deep Sedation ; Child Behavior ; Treatment Outcome ; Anesthesia, General ; Parents ; Pain ; Dental Care ; Dental Caries

The use of nitrous oxide-oxygen inhalation sedation to relieve anxiety and pain in dental outpatient treatment has been a very mature and safe technique in the world. This technology has been introduced into China for nearly 20 years, and many clinical cases have proved its safety, practicability and effectiveness, which can meet the clinical needs of patients. To further standardize and popularize this technique, the Society of Sedation and Analgesia, Chinese Stomatological Association formed the recommended application guidelines after many discussions and revisions on the basis of widely soliciting opinions and referring to relevant literatures. It covers indications, contraindications, standardized operation procedures, occupational protection, identification and treatment of adverse reactions, training and other aspects. This guideline can be used as a reference for the use of nitrous oxide-oxygen inhalation sedation techniques in the outpatient setting of dentistry.
Anesthesia, Dental ; Anesthetics, Inhalation/adverse effects* ; Conscious Sedation/methods* ; Dental Anxiety/prevention & control* ; Humans ; Nitrous Oxide/adverse effects* ; Outpatients ; Oxygen

ABSTRACT This retrospective study aimed to evaluate patterns of comprehensive dental treatment under general anaesthesia (GA) for healthy children in Universiti Teknologi MARA, Malaysia. The treatment records of healthy paediatric patients who received dental treatment under GA from February 2017 to January 2021 were reviewed. The patients were divided into two groups: (1) less than 6 years old and (2) 6 to 16 years old. Patients’ characteristics were summarised using descriptive statistics while an independent t-test was applied to investigate the influence of “age group” on treatment duration, number of procedures and use of various restorative materials. A total of 125 paediatric patients (67 boys and 58 girls) were included. The patients’ mean age at the time they underwent GA was 5.77 ± 1.94 years old and the average duration of dental treatment was 62.58 minutes. There was a significant difference in the duration of treatment between the two age groups (p < 0.05). Tooth extraction was the most dental procedure performed (63.31%). The 6 to 16 years old group had a significantly shorter treatment duration (p < 0.05). However, no significant differences were found in all procedures (extraction, restoration, preventive and pulp therapy) and the utilisation of composite, glass ionomer cement (GIC) and compomer in both groups. The use of stainless steel crown (SSC) restorations was significantly higher in the less than six years old group (p < 0.05). Most of the dental procedures performed under GA on healthy children were extraction procedures. Children less than six years of old had a longer treatment duration under GA. Composite restorations and SSC were more frequently used in primary dentition.
Pediatric Dentistry ; Dental Care for Children ; Anesthesia, Dental

In recent years, dental treatments of the outpatient children under general anesthesia has gradually developed as a relatively mature behavior management model. Due to the limited operating time and the large patient flow of children in outpatient clinics, higher requirements of management are proposed both in anesthesia and dental treatment phases. The Society of Sedation and Analgesia of the Chinese Stomatological Association organized experts to formulate a guideline of dental treatments of children under general anesthesia in outpatient clinic. The guideline would provide operable implementing criteria for the entire process including general anesthesia in the dental clinics, basic clinical conditions, types of oral diagnosis and treatment, evaluation and preparation before diagnosis and treatment, anesthesia implementation and monitoring, management during the recovery period, common complications and key points of treatments. This guideline will play an important role in the rapid development of the safe and comfort dental treatments of children under general anesthesia in China.
Anesthesia, Dental ; Anesthesia, General ; Child ; China ; Conscious Sedation ; Humans ; Pediatric Dentistry

OBJECTIVES: To evaluate the efficacy and health economics of the comprehensive therapy for the children with severe early child caries (S-ECC) under dental general anesthesia (DGA) and conventional outpatient treatment to provide references for dentists and parents in the choice of clinical treatment. METHODS: A retrospective cohort study was conducted on S-ECC children aged 36-71 months and who received dental treatment under general anesthesia or routine outpatient situation. The filled tooth survival rate, treatment cost, and cost-filled tooth survival time of the two groups were compared, and the curative effect and health economics was evaluated. RESULTS: The filled tooth survival rate of the DGA group was higher than that of the routine outpatient group ( CONCLUSIONS Compared with the conventional outpatient treatment group, the treatment outcomes of S-ECC under general anesthesia were better, and the costs were higher. However, no significant difference was observed in the total medical cost-filled tooth survival time between these two groups, and the conventional outpatient treatment did not have evident economic advantages.
Anesthesia, Dental ; Anesthesia, General ; Child ; Dental Care ; Dental Caries ; Dental Caries Susceptibility ; Humans ; Outpatients ; Retrospective Studies

OBJECTIVE: This study aimed to evaluate the postoperative complications undergoing dental general anesthesia in children and analyze the prevalence and related factors. METHODS: This prospective study involved 292 systematically healthy children (36 to 71 months old) who received extensive dental treatment under general anesthesia. Data about patients' histories, characteristics, dental and anesthesia procedure were collected. Parents or caregivers were interviewed face to face preoperation and 72 h postoperation. Data were analyzed using logistic regression. RESULTS: Approximately 93.5% of the enrolled children reported one or more complications. The most prevalent complication was postoperative pain, followed by weariness, agitation, problem in eating, drowsiness, oral bleeding, cough, fever, etc. The length of operative time and femininity were the risks of the postoperative pain. Nutrition status was the factor probably in association with fever. CONCLUSIONS The children receive longer operative time and girls show to be more susceptible to the postoperative pain. High nutrition status could be the protective factor of postoperative fever.
Anesthesia, Dental ; Anesthesia, General ; Child ; Child, Preschool ; Dental Care ; Dental Caries ; Female ; Humans ; Postoperative Complications ; Prospective Studies

OBJECTIVE: To analyze the clinical data of patients undergoing intravenous sedation in oral and maxillofacial surgery, to understand the epidemiological characteristics, to evaluate the efficacy and safety of intravenous sedation for oral surgery, and to summarize our experience. METHODS: We retrospectively reviewed the clinical data of patients undergoing intravenous sedation between January 2010 and December 2018 in the Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology. The gender, age, source, disease types, the values of perioperative vital signs, the use of sedatives and analgesics, duration of surgery and sedation, effect of sedation during the operation and the postoperative anterograde amnesia were analyzed. RESULTS: A total of 2 582 patients experienced oral surgery by intravenous sedation. The peak age was 3.5 to 10 years and between 21 to 40 years. Supernumerary teeth (38%, 981/2 582) and impacted third molars (30%, 775/2 582) were the major disease types, and other types of disease accounted for 32 percent (826/2 582). The values of heart rate(HR), mean arterial pressure(MAP), respiration rate(RR) and bispectral index(BIS) showed statistically significant differences at the time of before sedation, local anesthesia injection, surgical incision, 10 min after operation and the end of operation. In the study, 69%(1 781/2 582) cases received midazolam alone, 7%(181/2 582) cases received propofol alone, and 24% (620/2 582) cases received midazolam and propofol combined for intravenous sedation. Fentanyl (33%, 852/2 582)was the most common intravenous analgesic we used, followed by flurbiprofen axetil (23%, 594/2 582) and ketorolac tromethamine (6%, 157/2 582). Besides, 35% (907/2 582) patients didn't use any intravenous analgesic during the surgery. The average operation time was (31.2±20.8) min, and the average sedation time was (38.4±19.2) min. During the surgery procedure, most of the patients scored on a scale of 2 to 4 according to the Ramsay sedation score (RSS). The postoperative anterograde amnesia rates of local anesthesia injection, surgical incision and dental drill during surgery were 94% (2 431/2 582), 92% (2 375/2 582) and 75% (1 452/1 936). CONCLUSION Intravenous sedation on the oral and maxillofacial surgery is effective and safe, can make the patients more comfortable, and should be further promoted and applied.
Anesthesia, Dental ; Anesthetics, Intravenous ; Humans ; Hypnotics and Sedatives ; Midazolam ; Propofol ; Retrospective Studies ; Surgery, Oral

Patients with Down's syndrome have several dental complications such as small teeth caused by underdevelopment of dentin and enamel, periodontitis, agenesis of teeth, prolonged retention of primary teeth and malocclusion due to narrow palate. Removable denture with maxillary double crowns would be a good treatment option to solve the problems of the patient with Down's syndrome. Double crowns compensate the insufficient support and retention of denture and easily solve the cross bite problem. Double crowns also allow easy repair of denture in case of abutment teeth extraction. In this case, 26-year-old female patient with Down's syndrome and dental phobia had small number of teeth with enamel hypoplasia, prolonged retention of primary teeth and dental cross bite. Prosthetic treatment was done using removable denture with double crowns in the maxilla. In the mandible, teeth preparation was done on enamel margin without anesthesia. Anterior laminate and posterior complete zirconia crown restorations were performed. As a result, the cross bite was effectively corrected by denture with double crowns. Pronunciation and appearance were also improved without extraction of teeth and dental anesthesia.
Adult ; Anesthesia ; Anesthesia, Dental ; Crowns* ; Dental Anxiety ; Dental Enamel ; Dental Enamel Hypoplasia ; Dentin ; Denture, Partial ; Dentures* ; Down Syndrome* ; Female ; Humans ; Malocclusion* ; Mandible ; Maxilla ; Palate ; Periodontitis ; Tooth ; Tooth, Deciduous

Objective To evaluate the safety and effectiveness of oral midazolam sedation combined nitrous oxide sedation for reducing dental fear in children.Methods Totally 77 children with a Frankl's Behavior Rating Scale score of 1 were included in this study,among whom 41 received a total of 78 person-times of oral midazolam sedation (0.50-0.75 mg·kg ) (midazolam group) and 36 children were treated with the combination of 0.4 mg/kg oral midazolam with 30%-40% nitrous oxide (totally 73 person-times)(combination group). At each visit,heart rate,arterial oxygen saturation,and treatments were recorded. The behaviors of children during the treatment were assessed by Frankl's Behavior Rating Scale,the completion of treatment was assessed by Houpt Scale,and the sedation status was assessed by Ramsay Scale. Telephone follow-up was performed to record the side effects 24 hours after treatment. Results The vital signs were stable among all the 77 subjects,with a Ramsay score of 2 or 3. In the midazolam group, the behaviors were cooperative in 52 person-times (66.7%) and not cooperative in 26 person-times (33.3%);the planned treatments were completed in 62 person-times (79.5%) and partially completed in 16 person-times(20.5%). In the combination group,the behaviors were cooperative in 56 person-times (76.7%) and not cooperative in 17 person-times (23.3%);64 person-times (87.7%) completed the planned treatments and 9 person-times (12.3%) partially completed the treatments. The success rates of sedation (χ =1.87,P= 0.17) and treatment (χ =1.83,P= 0.18) were not significantly different between these two groups. The median Frankl scale score was significantly higher in the combination group [3 (3,4)] than in the midazolam group [3 (2,4)] (Z=2.647,P=0.008]. The median score of Houpt scale in the combination group [5(4,6)] was also significantly higher than in midazolam group [5(3,5)] (Z=2.236,P=0.026]. In midazolam group,there were 7 person-times of dysphoria,3 person-times of diplopia,and 2 person-times of hiccough among 78 person-times;in the combination group,there were 5 person-times of dysphoria,5 person-times of diplopia,1 person-time of hiccough,and 2 person-times of vomit among 73 person-times of treatment. Thus,there was no significant difference in the incidence of side effects (15.4% vs.17.8%,χ =0.160,P=0.689). Logistic regression analysis showed that the success rate of treatment was not associated with sex (OR=1.704,P=0.174),dose (OR=1.289,P=0.516),and treatment types (OR=0.555,P=0.143). Children over 3 years old had a significantly high success rate than those under 3 years old (OR=3.372,P=0.011). Conclusions Oral midazolam is safe and effective for reducing dental fear in children. The combination of oral midazolam with 30%-40% nitrous oxide can improve the behaviors of children during the dental treatment,especially in children over 3 years old.
Administration, Oral ; Anesthesia, Dental ; Child ; Child, Preschool ; Conscious Sedation ; Cross-Over Studies ; Dental Anxiety ; Humans ; Hypnotics and Sedatives ; Midazolam ; therapeutic use ; Nitrous Oxide

Early childhood caries is a global healthcare concern in developing and industrialized countries. If left untreated, it leads to immediate and long-term complications that affect the well-being and quality of life of concerned families. Therefore, many preventive and treatment approaches are available to the healthcare provider to curb this virulent form of caries. After behavioral interventions, general anesthesia is used in specific settings when a young patient presents with extensive teeth damage and exhibits a lack of cooperation that is incompatible with conventional dental office care. However, without proper follow-up, any positive results might be lost over time.
Anesthesia, General ; Child, Preschool ; Delivery of Health Care ; Dental Caries ; Dental Offices ; Developed Countries ; Follow-Up Studies ; Health Personnel ; Humans ; Oral Health ; Quality of Life ; Tooth