Marie Therese Hosey

Why are children still having preventable extractions under general anaesthetic? A service evaluation of the views of parents of a high caries risk group of children

Introduction Despite overall improvements in oral health, the number of children admitted to hospital for extraction of teeth due to caries under general anaesthesia (GA) has been reported as increasing dramatically in England. The new UK government plans to transform NHS dentistry by improving oral health.Aim To evaluate the dental care received by children who required caries-related extractions under GA and obtain the views of their parents or guardians on their experiences of oral health services and the support they would like to improve their childs oral health, to inform future planning.Method An interview questionnaire was designed and piloted to collect data from a consecutive sample of 100 parents or guardians during their childs pre-operative assessment appointment. This took place at one London dental hospital between November 2009 and February 2010.Results Most children were either white (43%) or black British (41%); the average age was seven years (range 2-15, SD 3.1, SE 0.31) and the female:male ratio was 6:5. Most (84%) had experienced dental pain and 66% were referred by a general dental practitioner (GDP). A large proportion of parents or guardians (47%) reported previous dental treatment under GA in their children or childs sibling/s. Challenges discussed by parents in supporting their childs oral health included parenting skills, child behaviour, peer pressure, insufficient time, the dental system and no plans for continuing care for their child. Three out of four parents (74%) reported that they would like support for their childs oral health. Sixty percent of all parents supported school/nursery programmes and 55% supported an oral health programme during their pre-assessment clinic.Discussion These findings suggest that the oral health support received by high caries risk children is low. Health promotion programmes tailored to this cohort are necessary and our findings suggest that they would be welcomed by parents.

An oral health education video game for high caries risk children: study protocol for a randomized controlled trial

BackgroundTooth decay is the most common chronic disease of childhood in the world. Many children develop caries early in their lives, and go on to develop further caries and sepsis as they grow up, indicating failure in prevention. As a result, many end up requiring general anaesthesia to undergo treatment for a disease that is completely preventable. Previous studies have suggested that the families of these children need better oral health education as well as better support in implementing healthy practices at home, as they feel impeded by broader life challenges. Parents of these children have suggested utilizing modern technologies, such as the internet, DVDs and video games as methods of delivery of education that might fit in with their busy lifestyles. The aim of this investigation is to assess the acceptability and efficiency of an oral health education video game directed at these children and their families.Methods/DesignA two-armed phase-II randomized controlled trial will assess a children’s oral health education video game in comparison with verbal oral health education in terms of: family satisfaction, effect on oral health knowledge, and effect on dietary and oral hygiene habits. Up to 110 four- to ten-year-old children, referred for tooth extraction under general anaesthesia due to caries, will be recruited. A sample of 45 participants in each group will be needed to provide 80 % statistical power. The primary outcome measures for this study are: (1) parent and child satisfaction with the intervention, as indicated using a visual analogue scale; (2) improvement in the child’s dietary knowledge measured by a pictorial dietary quiz; and (3) changes in the child’s diet and oral hygiene habits, measured using a children’s dietary questionnaire completed by the parent, and snacking and toothbrushing diaries completed by the child. Measures will be taken at baseline, directly after the intervention, and three months later.DiscussionThis study is a phase-II randomized controlled trial of an oral health education video game for high caries risk children and their families. Few protocols such as this are available in this much-needed research area.Trial registrationISRCTN94617251.

Factors associated with use of general anaesthesia for dental procedures among British children

Objectives To assess the demographic, socioeconomic, behavioural and clinical factors associated with use of dental general anaesthesia (DGA) among British children.Methods This study used data from 3053 children who participated in the 2013 Childrens Dental Health Survey in England, Wales and Northern Ireland. Data were collected through parental questionnaires and clinical examinations. The crude and adjusted association of demographic (sex, age, ethnicity and country of residence), socioeconomic (socioeconomic classification and area deprivation), behavioural (age toothbrushing started, age when first went to the dentist, usual reason for dental visit and dental anxiety) and clinical factors (numbers of decayed and filled teeth) with DGA was assessed in logistic regression models.Results The lifetime prevalence of DGA use was 9.1%. Older children and those living in Wales, with higher levels of dental anxiety and more dental fillings, who visited the dentist only when in trouble, and who had parents in routine/manual occupations and parents who never worked have greater odds of reporting having ever used DGA.Conclusion This study shows that family socioeconomic background, usual reason for dental visit and country of residence were associated with DGA use among British children, over and above the effect of child age, dental anxiety and dental status.

An in vitro investigation of pre-treatment effects before fissure sealing

BACKGROUND Fissure sealants prevent occlusal caries in permanent molars. Enamel preparation methods are used before fissure sealing. AIMS To investigate effects of bioglass air-abrasion pre-treatment with and without an adhesive, on fissure enamel of permanent teeth, with respect to etchability, microleakage and microtensile bond strength. DESIGN Half of the occlusal surfaces of 50 extracted premolars underwent bioglass air-abrasion. Dye was applied to the entire occlusal surface. Photographs were taken to score etched surface by dye uptake. Adhesive was applied to 25 of the bioglass-treated areas and all teeth were fissure sealed, sectioned, and evaluated using confocal microscopy. Buccal and lingual surfaces of a further eight premolars were acid-etched and randomly received: air-abrasion, adhesive, both, or none before sealant application for microtensile bond strength measurement in half of the samples immediately and half following 6 months of water immersion. RESULTS Linear mixed models and multinomial logistic regression were used (P = 0.05). Bioglass air-abrasion significantly improved enamel etchability and reduced microleakage. The addition of an adhesive made no difference to either microleakage or microtensile bond strength. The combination of bioglass abrasion and adhesive led to more cohesive, rather than adhesive, failure. CONCLUSIONS Bioglass air-abrasion improved enamel etchability and reduced microleakage irrespective of the adhesive use but neither pre-treatment affected the microtensile bond strength.

Sedation of Pediatric Patients for Dental Procedures: The United States, European, and South American Experience

The challenges of sedating a child for dental procedures are multifactorial: The patient’s age, health, temperament and emotional status, parental concerns, clinician philosophy on patient management, extent and quality of clinician training and experiences with sedation, state dental board regulation of sedation, issues of third-party coverage or parental reimbursement, knowledge of and adherence by clinicians to sedation guidelines, facility preparedness, and support staff experiences are but a few of many important considerations. To overcome these challenges, a pediatric dentist has to be at the hub of the preventive, operative and behavioral treatment plan.

On-line preparatory information for children and their families undergoing dental extractions under general anesthesia: A phase III randomized controlled trial

Family‐centered interactive on‐line games are increasingly popular in healthcare, but their effectiveness for preoperative preparation needs further research. www.scottga.org is the new on‐line version of a proven nonweb‐based game for children and parents/caregivers.

Can oral health education be delivered to high-caries-risk children and their parents using a computer game? – A randomised controlled trial

BACKGROUND Families of children undergoing general anaesthesia (GA) for caries management requested that oral health advice is delivered using audio-visual media. OBJECTIVE To compare an oral health education computer game to one-to-one education. DESIGN A blind randomised controlled trial of 4- to 10-year-old children scheduled for GA due to caries. Primary outcome measures were (1) parent and child satisfaction with education method; (2) improvements in childs dietary knowledge; and (3) changes in childs diet and toothbrushing habits. Measures were taken at baseline, post-intervention, and three months later. RESULTS One hundred and nine families took part. Both methods of education were highly satisfactory to children and parents. Children in both groups showed significant improvement in recognition of unhealthy foods immediately post-education (P < 0.001). Fifty-five per cent of all participants completed telephone follow-up after 3 months and reported improvements in diet, including reducing sweetened drinks (P = 0.019) and non-core foods (P = 0.046) intake, with no significant differences between the groups. Children reported twice-daily toothbrushing but no changes in snack selection. Attendance for a 3-month dental review was poor (11%). CONCLUSION Oral health education using a computer game can be as satisfactory and as effective in improving high-risk-childrens knowledge as one-to-one education. The education received can lead to the positive dietary changes in some families.

What do expectant mothers need to know about oral health? A cohort study from a London maternity unit

Objective:To determine the oral health knowledge of pregnant women and to report their future plans to provide dental care for their expected child.Design and setting:Prospective cohort study; Ultrasound maternity services at St Thomas’ Hospital, London, 2014. Pregnant women attending for a routine ultrasound scan completed a questionnaire.Results:Women did not know that milk, dried fruit or fruit juices can cause caries. Most women knew about the benefit of fluoridated toothpaste, dental floss and sugar-free chewing gum, but only a minority knew about fluoride varnish. Most pregnant women planned to read or seek advice before purchasing their child’s first toothpaste. There was no difference regarding knowledge of prevention tools (diet and fluoride supplements) for dental caries (P>0.05) between first-time mothers and those who had children already. Though the latter knew more about toothpaste dose and timing of starting toothbrushing (P<0.05).Discussion:Oral health knowledge among pregnant women was deficient with respect to the cariogenicity of prolonged night-time milk feeding, dried fruits and fruit juice consumption. There was also limited knowledge of the benefit of fluoride varnish and timing of starting toothbrushing.Conclusions:Oral health knowledge amongst pregnant women is still deficient in many aspects. In this study population the need to improve maternal knowledge was shown.

Comparing the profile of child patients attending dental general anaesthesia and conscious sedation services

Aims To compare the profile of paediatric patients receiving dental treatment under general anaesthesia (GA) or conscious sedation (CS). A second aim was to explore whether there is an overlap between the two patient groups.Design This service evaluation study was based on sociodemographic and clinical data extracted from clinical records of patients attending dental appointments for GA or CS services at Kings College Hospital. Sociodemographic and clinical differences between GA and CS groups were explored using logistic regression models.Results Data from 113 children (58 GA and 55 CS) were analysed. There were differences between groups in terms of age and numbers of quadrants and teeth treated, but not in terms of sex, ethnicity or deprivation scores. In the adjusted model, older children and those having more teeth treated were more likely to be in the GA than in the CS group. An overlap between the GA and CS groups was found, with 50% of children aged four to nine years having two to four teeth treated in both groups.Conclusion Age and number of teeth treated were the main characteristics associated with receiving care under GA or CS. Some overlap between children receiving dental treatment under GA or CS existed despite demographic and clinical differences between both groups.

What reward does a child prefer for behaving well at the dentist

Background:Paediatric dentists often report using positive reinforcement to encourage their young patients to show co-operative behaviour. For effective reinforcement to take place the reward should be salient to the individual. To date, there is little research into what reward a young patient will choose when attending the dentist.Aim:To identify what reward children between the age of 4–8 years will choose when attending the dentist, and to determine the extent of agreement between children and caregivers in reward choice.Method:Observational study. Fifty-two children from different age groups (4–5 years, 6–7 years and 8 years) attending a primary-care dental clinic were asked to choose between a range of different rewards. The caregiver attending with them was also asked to anticipate the child’s preferred choice.Results:There was no clear favourite reward for children from both genders and different age group. However, no child chose the ‘sticker’ reward that is traditionally given out at the dentist. Overall carers agreed with the child’s choice of toy on 18 occasions (34.6%), but there were significant differences across the age groups with carers of older children showing less agreementConclusion:To ensure that rewards are salient, children should be given a choice of rewards when attending the dental clinic. Parents ability to predict their child’s preferred rewards decreases as the child ages.Clinical relevance:A child’s motivation to co-operate during dental treatment can be increased by offering a range of rewards. Asking children to choose their reward from a limited range will increase the saliency of the reward for the child.