Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia

Abstract

Objective To report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress. Design A prospective national study. Setting Twenty-five Scottish DGA centres in 2001. Subjects and method Four hundred and seven children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, the Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24 hours and one week post-operatively. Anaesthetic induction distress was scored immediately before CDGA induction using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Results The mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r= 0.43, p<0.001, Pearson Product Moment Correlation Coefficient). Morbidity at 24 hours and seven days was 63% and 24% respectively; this related to MCDAS scores (r= 0.15, p=0.029 and r= 0.17, p= 0.009, Pearson Product Moment Correlation Coefficient) and to induction distress (chi 2 = 7.14, p= 0.007 and chi 2 = 11.70, p= 0.001). Conclusion The majority of children suffered next day morbidity and many still had symptoms a week later. Most children were dentally anxious; this related to induction distress and postoperative morbidity.

Comparison of a new auto-controlled injection system with traditional syringe for mandibular infiltrations in children: A randomized clinical trial

“…[12] Pain in the dental operatory leads to the development of negative attitude toward dentistry, which is projected as dental anxiety and fear in the future visits of a child; hence, pediatric dentists should focus on minimizing the same. [34] Nevertheless, most of the routine dental procedures pose some sort of discomfort or pain and can be alleviated by administering local anesthetic (LA) injections, which itself is a pain-provoking procedure. Thus, there was a need to explore strategies for painless injection techniques during LA administration, and to fulfill this, many forms of topical anesthetics, vibrotactile devices, jet injectors, and new electromagnetic and computer-controlled LA delivery systems were introduced in practice.…”

The use of intranasal midazolam in the treatment of paediatric dental patients*

“…This technique has advantages when compared with oral administration as the bioavailability of intranasally administered midazolam is approximately 55%, compared with 15% when administered orally [11,12]. The rate of onset and recovery are more rapid and the patient is not required to actively swallow or hold the bitter preparation in their mouth [13].…”

Nurse unfairness

“…In paediatric dentistry, the management of carious teeth often involves dental extractions under general anaesthesia resulting in unnecessary morbidity, the risk of anaesthetic exposure, increased dental anxiety 4 and future orthodontic problems. 5 In addition, for an immuno-compromised patient, dental sepsis can be potentially life-threatening and have a catastrophic effect on their planned management such as chemotherapy or bone marrow transplantation.…”