How to provide the evidence base for techniques and interventions that ensure equal treatment outcomes for people with disability?

Faulks, Denise; Molina, Gustavo Fabían

doi:10.1111/scd.12285

Cited by 7 publications

(5 citation statements)

References 9 publications

(9 reference statements)

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“…The ethical principle of justice [28], which in this context demands that all people, with and without disabilities are treated equally with the same methods and treatment options, makes the use of GA essential for many cases. People with disabilities should receive the same quality and outcomes in treatments under GA [29,30] as people without disabilities with chairside treatment.…”

Section: Introductionmentioning

confidence: 99%

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland

2020

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Background: Life expectancy of people with permanent disabilities has increased. The dental care of these vulnerable patients is one of the greatest challenges for the dentist and the dental team due to limited or non-existent cooperation and the associated lack of health competence. In order to be able to provide safe and acceptable, quality dental treatment without psychological and physical stress for these patients, it is therefore necessary to resort to sedation or general anaesthesia (GA) under medical supervision. The aim of the analysis is to highlight the need for dental treatment performed under GA for people with disabilities and the associated indications and treatment patterns. Methods: Ten-year retrospective analysis of outpatient dental care under GA for people with disabilities. Results: Of all adult patients (n = 221) who attended the GA pre-assessment, 69.7% (n = 154) received dental treatment under GA based on the clinical findings or in cases of suspected pain. Most patients received one GA. A total of 205 dental treatment sessions were performed under GA mostly for conservative (n = 442, 52%) and surgical (n = 389, 45.8%) procedures. Endodontic treatment (n = 19, 2.2%) was rare. The failure rate related to all teeth in need of treatment (n = 850) was 5.1% (n = 43), in most cases due to secondary caries (n = 40; 93.0%). Patients were enrolled in an annual recall for dental examination and prophylaxis without GA. Non-compliant patients for whom oral hygiene was impossible received a periodic GA. Conclusion: There is a high need of people with disabilities for dental treatment under GA. Main indications for treatment under GA are dental complaints, pain or suspected pain. Dental care can be successful if, for the benefit of patients with special needs, all carers cooperate closely. Caregivers have to be trained in nutrition control as well as in oral hygiene. These factors in conjunction help to prevent dental emergencies.

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Section: Introductionmentioning

confidence: 99%

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland

2020

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“…The extreme importance of conserving functional teeth is increasingly recognized in terms of preventing dysphagia and maintaining masticatory capacity. It is recognized that patients with equal needs should have equal access, equal quality of treatment and equal treatment outcomes, regardless of whether a facilitatory procedure is used to achieve treatment . Thus, there is a need to encourage the provision of restorative and endodontic treatment under general anesthesia, to standardize treatment procedures, and to evaluate the outcomes of such treatment approaches.…”

Section: Introductionmentioning

confidence: 99%

Conservative and endodontic treatment performed under general anesthesia: A discussion of protocols and outcomes

Linas

Faulks

Hennequin

et al. 2019

Special Care in Dentistry

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Aims: This work discusses the procedures and outcomes of restorative and endodontic treatments performed under general anesthesia, with examples from the Unit of Special Care Dentistry at the University Hospital of Clermont-Ferrand. Methods and results:The restorative and endodontic treatment techniques used in the Special Care Unit are described. These techniques are compared to existing reports in the literature of treatment procedures under general anesthesia. Little evidence was found in the literature regarding sealants or restorative protocols. A few studies described root canal treatment and pulpotomy protocols carried out under general anesthesia, and the results of these met academic outcome standards. Conclusion:Patients with equal needs should have equal access, equal quality of treatment and equal treatment outcomes, regardless of whether a facilitatory procedure is used to achieve treatment. The provision of restorative treatment under general anesthesia is essential to avoid an excessive number of extractions in patients unable to receive treatment in the chair. Restorative care provided under general anesthesia should be standardized and evaluated in the same way as treatment performed under local anesthesia. In this way, the provision of conservative dental care under general anesthesia could be promoted and the maintenance of a functional dentition encouraged. K E Y W O R D Sendodontics, general anesthesia, operative dentistry

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“…2 Equity in health implies that people in equal need should have equal access, equal treatment and equal treatment outcomes within the health system, regardless of disability status. 3,4 The question is which dental material is the most appropriate to ensure equal treatment outcomes when operating conditions are difficult?…”

Section: Introductionmentioning

confidence: 99%

High-viscosity glass-ionomer vs. composite resin restorations in persons with disability: Five-year follow-up of clinical trial

et al. 2019

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The aim of this clinical trial was to compare the 5-year cumulative survival of atraumatic restorative treatment restorations using high-viscosity glass-ionomer restorations (ART/HVGIC) and conventional resin composite restorations (CRT) placed in patients with intellectual and/or physical disability. Patients referred for restorative care to a special care service in Córdoba, Argentina, were recruited. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. The treatment protocols were ART (hand instruments/HVGIC) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). Two independent, trained and calibrated examiners evaluated restoration survival using established ART codes after 6, 12, 24, 36 and 60 months. The proportional hazard model with frailty corrections provided survival estimates. Jackknife errors were used to test 5-year results. Sixty-six patients (13.6 ± 7.8 years) with 16 different medical conditions participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was provided for 47 patients (71.2%). A total number of 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). Four patients died between the 3 and 5-year follow up. Percentage survival and jackknife standard error were calculated and were significantly higher for all ART/HVGIC restorations (90.2% ± 2.6) than for all CRT restorations (82.8% ± 5.3), 5 years after placement (p=0.044). These 5-year follow-up results confirm that ART/HVGIC is an effective treatment protocol for patients with disability, equal to that of conventional resin composite restoration. The results of this clinical trial support the use of ART as an evidence-based treatment resource contributing to the reduction of inequalities in access to oral health care among people with disability.

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How to provide the evidence base for techniques and interventions that ensure equal treatment outcomes for people with disability?

Cited by 7 publications

References 9 publications

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland

Outpatient dental care for people with disabilities under general anaesthesia in Switzerland

Conservative and endodontic treatment performed under general anesthesia: A discussion of protocols and outcomes

High-viscosity glass-ionomer vs. composite resin restorations in persons with disability: Five-year follow-up of clinical trial

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