Brief Report: Analysis of Dental Treatment Provided Under General Anaesthesia for Children and Young Adults with Autistic Spectrum Disorder and Identification of Challenges for Dental Services

Parry, Jennifer; Brosnan, S.; Newton, Tim; Linehan, Conor; Ryan, Christian

doi:10.1007/s10803-021-04898-w

Cited by 8 publications

(15 citation statements)

References 16 publications

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“…Overall, only 17% of patients required a second session of dental treatment under GA. A recent study showed that 47% of patients diagnosed with autism experienced at least one procedure of GA prior to a subsequent course of treatment, occurring within two years in 24% of cases [ 12 ]. In our study group, considering treatment needs, 25% of the participants from the private sector group could be allocated and referred for dental care in public-funded dental centers.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment under GA applied for dental procedures can be clinically justified as the first treatment option for PSN who are not compliant and uncooperative due to severe systemic diseases, where there is a need for urgent care due to pain and/or in a complex dental treatment course. Hence, definite diagnosis and strict radical treatment planning are essential elements [ 11 , 12 , 13 , 14 ]. The family members or persons with legal responsibility/power of attorney must understand GA advantages, risks involved, and consequently be able to provide informed valid consent for dental treatment under GA in the best interest of patients [ 2 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hence, definite diagnosis and strict radical treatment planning are essential elements [ 11 , 12 , 13 , 14 ]. The family members or persons with legal responsibility/power of attorney must understand GA advantages, risks involved, and consequently be able to provide informed valid consent for dental treatment under GA in the best interest of patients [ 2 , 11 , 12 , 13 , 14 ]. The GA benefits include comfort and convenience for the patient as well as the operator and predictable and efficient patient management, as well as safety factors due to strictly controlled protocol, including a secure hospital environment with direct access to critical care facilities considering medical emergency episodes [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…It has to be emphasized that, despite its benefits, GA is regarded as an economical and financial burden for care providers because it requires a specific hospital infrastructure, compatible with the complexity of planned procedures, specialist support of anesthesiologists, and interdisciplinary team to provide safe and efficient care [ 15 , 16 ]. Detailed information related to the treatment of PSN under GA is scarce, despite the well-recognized benefits [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. The general characteristics and health profile of patients subjected to dental procedures under GA are essential when planning a session under GA and indicating this intervention, as well as composing an integral element of public health reporting data to facilitate appropriate strategic planning for improving a healthcare provision.…”

Section: Introductionmentioning

confidence: 99%

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Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services—A Retrospective, Comparative Study

et al. 2022

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In special care dentistry, general anesthesia (GA) is considered as an alternative option to facilitate treatment for uncooperative patients with special needs (PSN) who require invasive dental interventions. Objective: to evaluate the profile of dental treatment procedures performed and the characteristics of PSN who underwent dental treatment under GA, provided by private and public healthcare providers. Methods: A retrospective, observational study involving a sample of 100 PSN treated in hospital and specialist secondary care settings. Demographic data and clinical information were collected. The analysis of data was performed using descriptive analysis and frequency statistical tests. Results: out of 100 participants, 63% of the PSN who received care in the private sector and the remaining 37% of PSN registered with public-funded care providers, aged 6 to 80 years old, were treated under GA. Autistic spectrum disorder was the most common medical diagnosis recorded (33%). More than half (52%) of the PSN treated by private care providers sought specialist care in an outpatient setting prior to GA vs. 5% of the PSN treated by public-funded providers. The utilization of sedation prior to GA was more common in the private sector. A vast majority (86%) of all subjects underwent multiple dental extractions (86%) and restorations (62%). Conclusions: comprehensive dental care under GA, which composes an integral part of special care dentistry, can be safely provided in a hospital setting, in both private and public sectors. While early intervention using sedation and behavioral management partially mitigates the need for dental care under GA, the vast majority of PSN may require dental treatment under GA in future to facilitate complex dental care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services—A Retrospective, Comparative Study

et al. 2022

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“…Oral care for children with ASD can be challenging at home and the dental office. Next to the common problems such as communication and interaction problems, other autism-related factors are associated with non-cooperative behavior during the oral care process [ 4 ]. Therefore, children experience significant difficulties and barriers regarding oral care [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Malocclusion complexity and orthodontic treatment need in children with autism spectrum disorder

Meuffels

Kuijpers-Jagtman

Tjoa³

et al. 2022

Clin Oral Invest

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Objectives This study aimed to investigate the malocclusion complexity and orthodontic treatment need among children with and without autism spectrum disorder (ASD) referred for orthodontic treatment by quantifying the Discrepancy Index (DI) and Index of Orthodontic Treatment Need (IOTN). Materials and methods Dental records of 48 ASD and 49 non-ASD consecutive patients aged between 9 and 18 years (median age 13.0 years) referred for orthodontic treatment were reviewed and compared. The Discrepancy Index (DI) was quantified to determine the malocclusion complexity, and the Index of Orthodontic Treatment Need (IOTN), including the Dental Health Component (IOTN-DHC) and Aesthetic Component (IOTN-AC), was quantified to determine the orthodontic treatment need. Statistical analysis included descriptive analysis, Pearson chi-square tests, Fisher’s exact test, Mann–Whitney U tests, and several univariate and multivariate regression analyses. The statistical analysis used descriptive analysis, Pearson chi-square test, Fisher’s exact test, and multivariate logistic regression. Results The results show that both malocclusion complexity (DI, p = 0.0010) and orthodontic treatment need (IOTN-DHC, p = 0.0025; IOTN-AC p = 0.0009) were significantly higher in children with ASD. Furthermore, children with ASD had a higher prevalence of increased overjet (p = .0016) and overbite (p = .031). Conclusions Malocclusion complexity and orthodontic treatment need are statistically significantly higher among children with ASD than children without ASD, independent of age and sex. Clinical relevance Children with autism may benefit from visits to a dental specialist (orthodontist) to prevent, to some extent, developing malocclusions from an early age.

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Effect of midazolam in autism spectrum disorder: A retrospective observational analysis

Hanamoto

Hirose²,

Toyama

et al. 2023

Acta Anaesthesiol Scand

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Background: While midazolam is commonly used as premedication for uncooperative patients, its effects are difficult to predict in patients with autism spectrum disorder for whom abnormalities in gamma-aminobutyric acid have been reported. This study aimed to investigate the influence of autism spectrum disorder on the effect of midazolam when used as premedication.Methods: This retrospective observational study was performed between April 2017 and August 2018. Before inducing general anesthesia with sevoflurane for dental treatment, 390 uncooperative patients received premedication with midazolam.Ordinal logistic regression analysis was performed with the Observer's Assessment of Alertness/Sedation score 30 min after premedication as the objective variable.Age, sex, American Society of Anesthesiologists physical status class, premedication route, dose per body weight, presence of specific disorders (autism spectrum disorder, intellectual disability, epilepsy, cerebral palsy, and other psychiatric disorders), and regular benzodiazepine or non-benzodiazepine psychotropic administration were included as explanatory variables. Kendall's rank correlation coefficient was used to assess the correlation between the Observer's Assessment of Alertness/Sedation score and cooperation level (1, obvious negative response; 2, negative response; 3, positive reaction; 4, obvious positive reaction) during admission and inhalation induction. All data were extracted from anesthesia and medical records.Results: Age (odds ratio 1.437 [95% confidence interval (CI) 1.213-1.708], P < .001), autism spectrum disorder (1.318 [1.079-1.612], P = .007), benzodiazepine medication (0.574 [0.396-0.827], P = .002), and intramuscular route (1.478 [1.137-1.924], P = .004) were significantly associated with the Observer's Assessment of Alertness/ Sedation score, while the score was negatively associated with cooperation levels during admission (τ = À0.714, P < .001) and inhalation induction (τ = À0.606, P < .001).Conclusions: Patients with autism spectrum disorder may be susceptible to premedication with midazolam; however, regular benzodiazepine administration may reduce the effect.

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Brief Report: Analysis of Dental Treatment Provided Under General Anaesthesia for Children and Young Adults with Autistic Spectrum Disorder and Identification of Challenges for Dental Services

Cited by 8 publications

References 16 publications

Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services—A Retrospective, Comparative Study

Dental Treatment under General Anesthesia in Patients with Special Needs Provided by Private and Public Healthcare Services—A Retrospective, Comparative Study

Malocclusion complexity and orthodontic treatment need in children with autism spectrum disorder

Effect of midazolam in autism spectrum disorder: A retrospective observational analysis

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