A clinical-statistical study of patients with disabilities’ oral health problems, treated under general anesthesia, at the dental department of «Agios Dimitrios» General Hospital of Thessaloniki, Greece, from 01/01/2008 to 31/12/2009
Varvara PERPERIDOU, Ioannis TILAVERIDIS, Grigorios VENETIS, Lambros ZOULOUMIS, Stefanos STEFANIDIS
Dental Department of «Agios Dimitrios» General Hospital of Thessaloniki, Greece (Head: Dr Stefanos Stefanidis)
Hellenic Archives of Oral & Maxillofacial Surgery (2021) 2, 87-100
DOI https://dx.doi.org/10.54936/haoms22287100
SUMMARY: : General anesthesia has proved to be an ef- fective mean for treating patients in need of restorative and surgical treatment, when other methods have failed. Aim: The aim of this retrospective clinical-statistical study was to assess the characteristics, oral health management of special needs patients attending for DGA treatment at Agios Dimitrios General Hospital of Thessaloniki,.
Patients and method: Medical files retrieved from 169 male and 129 female patients, from 5 to 63 years of age and 36,2% of them were children and adoles- cence.257 patients during a twelve year old period, from 01/01/2008 to 31/12/2019. Demographic, quantitative and qualitative data were obtained from patients’ files (e.g place of residence, gender, age, type of disability, comorbidity, amount and type of treatments provided and were analyzed by means of descriptive and comparative statistics.Results: 298 DGA treatments were performed to 169 males and 129 female patients, from 5 to 63 years of age and 63,8% of them were over 18 years old. 68,5% of the patients were mentally retarded, 17,8% were au- tistic, 7% had cerebral palsy, 3,5% suffered from vari- ous syndromes and 3,2% were patients with systemic diseases and other health issues. A total of 2787 treat- ments were provided, with higher prevalence of 49,8% for restorative treatments.
Conclusions: In many patients with severe disability, DGA is the only treatment option. The number and the geographic distribution of dental departments of Greek NHS that provide DGA, does not guarantee the equal and unimpeded access of special needs patients. Therefore, implementation of organized oral preventive programs is necessary, along with investment on the appropriate infrastructure, that would allow the creation of additional dental departments providing DGA treatments within the NHS.
KEY WORDS: Patients with disabilities, oral health, dental general anesthesia (DGA).
REFERENCES
Al-Eheideb Ali A., Neil G. Herman. Outcomes of dental procedures performed on children under general anesthesia. The Journal of Clinical Pediatric Dentistry 2003; 27(2): 181-184
Ali S, Sims C, Foy S, McIndoe A, Yates R, Brooke T. A review of day- case GA services for Special Care patients at University Hospital, Bristol. Community Dent Health 2016; 33: 6–8
American Academy of Pediatric Dentistry, AAPD. Management of dental patients with special health care needs. PediatrDent.Latest revision 2016.
Andreasen J. O.: Traumatic injuries of the teeth, 2nd edition. Munks- gaard Copenhagen 1981, pp. 28-31
Badre B, Serhier Z, El Arabi S. Waiting times before dental care under general anesthesia in children with special needs in the children’s hospital in Casablanca. Pan Afr Med J 2014; 17:298
Baker S, Yagiela JA. Obesity: a complicating factor for sedation in chil- dren. Pediatr Dent 2006; 28: 487-493
Balasouli C, Fotiou A, Kotsanos Ν. Dental care of institutionalized special needs patients in yhe prefecture of Thessaloniki. Στομα 2008; 36: 157-163
Becker DE. Preoperative medical evaluation. Part 1: general prin- ciples and cardiovascular considerations. Anesth Prog. 2009; 56:92–103
Boynes SG, Moore PA, Lewis CL, Zovko J, Close JM. Complications associated with anesthesia administration for dental treatment in a special needs clinic. Spec Care Dentist. 2010; 30:3–7
Chalmouki G. General anesthesia or sedation for dental procedures to non-cooperative special needs patients. Hellenic Hospital Dentistry 2015; 8: 20-21
Chang J, Kim HY. Prognostic factors of single-visit endodontic and restorative treatment under general anaesthesia for special needs patients. J Oral Rehabil 2017; 44: 96–104
Chaollai A. Ni, Robertson S, Dyer T.A, Balmer R.C, Fayle S.A. An evaluation of paediatric dental general anaesthesia in Yorkshire and the Humber. British Dental Journal 2010; 209:1-6
Chung SS, Casas MJ, Kenny DJ, Barrett EJ. Clinical relevance of access targets for elective dental treatment under general anesthesia in pediatrics. J Can Dent Assoc 2010; 76: a116
Cortinas Sanchez M., Llanos Martinez Gomez, Manuel Roncero Goig, Ursula Saez Cuesta, Marisa Ibarra Martin. Results of a major am- bulatory oral surgery program using general inhalation anesthesia on disabled patients. Med Oral Patol Oral Cil Bucal.2009 Nov 1; 14(11): e60511
Dimitriadis Dimitrios, Konstantinidis Rigas, Zervou-Valvi Flora. The practice of hospital dentistry in the National Health System: find- ings and reflections. Hellenic Hospital Dentistry 2009; 2: 9-14
Εθνική Συνομοσπονδία Ατόμων με Αναπηρία, Ε.Σ.Α.με.Α. Μελέτη: Επιχειρηματικότητα και άτομα με αναπηρία, Αθήνα 2005. www. esamea.gr
Escribano Hernandez A, Hernandez Coral T, Ruiz Martin E, Porteros Sanchez JA. Results of a dental care protocol for mentally handi- capped patients set in a primary health care area in Spain. Med Oral Patol Oral Cil Bucal.2007; 12: E492-5
Ferreira MCD, Renata Oliveira Guare, Igor Prokopowitsch, Maria Teresa Botti Rodrigues Santos: Prevalence of dental trauma in individuals with special needs. Dental Traumatology 2011; 27: 113-116
Franklin DL, Luther F, Curzon MEJ: The prevalence of malocclusion in children with cerebral palsy. Eur J Orthod 1996; 18: 637-643
Garcia-Miguel F, Serrano-Aguilar P, Lopez-Bastida J. Preoperative as- sessment. Lancet. 2003; 362:1749–1757
Giannopoulou Angeliki, Zervou-Valvi Flora. Dental treatment under general anesthesia for people with disabilities. Hellenic Hospital Dentistry 2020; 13: 35-53
Gordon MS, Dionne AR, Snyder J: Dental fear and anxiety as a barrier to accessing oral health among patients with special health care needs. Special Care Dent 1998; 18:88-92
Hennequin M, Moysan V, Jourdan D, Dorin M, Nicolas E: Inequalities in oral health for children with disabilities:A French national sur- vey in special schools. Plos One 2008; 3: 1-10
Ide M, Aoyagi Y, Hoshi M, Moriyasu K, Takano F, Asada Y. A survey of the actual status of the dental treatment under general anes- thesia at pediatric dentistry clinic of university dental hospital. Jpn J Ped Dent 2003; 41: 694-699
Jamieson LM, Roberts-Thomson KF. Dental general anaesthetic trends among Australian children. BMC Oral Health. 2006. pp. 6–16 Jamieson LM, Roberts-Thomson KF. Dental general anaesthetic re-
ceipt among Australians aged 15+ years, 1998–1999 to 2004–
2005. BMC Oral Health. 2008. pp. 8–10
Jamjoom M.M. M.I. Al Malik, R.D. Holt, A. El Nassry. Dental treatment under general anaesthesia at a hospital in Jeddah, Saudi Arabia. International Journal of Paediatric Dentistry 2001; 11: 110-116
Kakali A, Tsichti H, Smith P. The dental health of mentally handicapped children. The need and the difficulties in the establishment of dental services. Παιδοδοντία 1991; 5(2): 71-76.
Klein Ulrich, Arthur J Nowak. Characteristics of patients with Autistic Disorder presenting for dental treatment: a survey and chart re- view. Special Care in Dentistry 1999; 19(5): 200-207
Kourti E, Lefkelidou A, Kotsanos N. The child with autism: Aggra- vating factors of oral health and provision of dental services. Παιδοδοντία 2012; 26(2): 65-71
Limeres Posse J, Vasquez Garcia E, Medina Henriquez J, Tomas Car- mona I, Fernandez Feijoo J, Diz Dios P. Pre assessment of se- verely handicapped patients suitable of dental treatment under general anesthesia. Med Oral 2003; 8(5): 353-360
Maestre C. The use of general anaesthesia for tooth extraction in young handicapped adults in France. Br Dent J 1996; 180: 297- 302
Manfredi M, Figni L, Gagliani M, Lodi G (2016) Single versus mul- tiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev 12:CD005296. https://doi. org/10.1002/14651858.CD005296.pub3
Manley MCG, Skelly AM, Hamilton AG. Dental treatment for people with challenging behavior: general anaesthesia or sedation? Br Dent J 2000; 188: 358–360
Messieha Z. Risks of general anesthesia for the special needs dental patient. Spec Care Dentist 2009; 29: 21–25.
Moles DR, Ashley P. Hospital admissions for dental care in children: England 1997–2006. Br Dent J. 2009. pp. 206–E14
Nunn JH. The dental health of mentally and physically handicapped children: a review of the literature. Community Dent Health 1987; 4: 157-168.
Ohtawa Yumi, Keiichiro Tsujino, Shuhei Kubo, Masakazu Ikeda. Dental treatment for patients with physical or mental disability under general anesthesia at Tokyo Dental College Suidobashi Hospital. Bull Tokyo Dent Coll 2012; 53(4): 181-187
Oreland A, Heijbel J, Lagell S: Malocclusion in physically and/ or men- tally handicapped children. Swed Dent J 1987; 11: 103-119
Peretz B, Spierer A, Spierer S, Rakocz M. Dental treatment of patients with systemic diseases compared to patients with developmental disabilities under general anesthesia. Spec Care Dentist. 2012; 32(1): 21–25.
Savanheimo Nora, Sari A Sundberg, Jorma I Virtanen, Mira M Veh- kalahti. Dental care and treatments provided under general an- aesthesia in the Helsinki Public Dental Service. BMC Oral Health 2010; 12: 45
Shaw L, MacLaurin ET, Foster TD: Dental study of handicapped chil- dren attending special schools in Birmingham, UK. Community Dent Oral Epidemiol 1986; 14: 24-27
Schnabl Dagmar, Anna chiara Guarda, Maria Guarda, Lia Marie Irmtraut von Spreckelsen, Maria Riedmann, Rene Steiner, Herbert Dum- fahrt. Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12 years. Clinical Oral Investigations, published online 04 march 2019
Spyropoulou M. Local or functional etiology of occlusal problems. In: Basic Principles in Orthodontics. 2nd ed, p. 326. Athens: Beta medical Arts, 2000
Tesini DA. An annotated review of the literature of dental caries and periodontal disease in mentally retarded individuals. Special Care Dent 1981; 1:75-87
Vignehsa H, Soh G, Lo LG, Chellapah NK: Dental health of disabled children in Singapore. Aust Dent J 1991; 36(2): 151-156.
Wogelius P, Poulsen S, H toft Sorensen. Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children. Acta Odontologica Scandinavica. 2003; 61(3): 178-183
Woof F, Greening S, Barnard D: Clinical Guidelines and integrated care pathways for the oral health care of people with learning disabilities. British Society for Disabilities and oral health. The Royal College of Surgeons of England 2001
Yasuda J, Iwata K, Ohyama Y, Tanabe S, Nishitouge K, Harada J, Iwaya- ma Y. Clinical study of dental treatments under general anesthe- sia for disabled- statistical survey in our hospital during the past 10 years-. J Jpn Soc Disability Oral Health 2001;22: 1-7
Zambouri A. Preoperative evaluation and preparation for anesthesia and surgery. Hippokratia 2007; 11(1): 13-21
Zervou-Valvi F, Antoniadou A, Thanoulis P, Zouridaki Th, Karageorgos
H. Dental treatment of special needs patients at the Greek Na- tional Health System. Hellenic Hospital Dentistry 1: 19-28, 2008.
Dental Department of «Agios Dimitrios» General Hospital of Thessaloniki, Greece (Head: Dr Stefanos Stefanidis)
Hellenic Archives of Oral & Maxillofacial Surgery (2021) 2, 87-100
DOI https://dx.doi.org/10.54936/haoms22287100
SUMMARY: : General anesthesia has proved to be an ef- fective mean for treating patients in need of restorative and surgical treatment, when other methods have failed. Aim: The aim of this retrospective clinical-statistical study was to assess the characteristics, oral health management of special needs patients attending for DGA treatment at Agios Dimitrios General Hospital of Thessaloniki,.
Patients and method: Medical files retrieved from 169 male and 129 female patients, from 5 to 63 years of age and 36,2% of them were children and adoles- cence.257 patients during a twelve year old period, from 01/01/2008 to 31/12/2019. Demographic, quantitative and qualitative data were obtained from patients’ files (e.g place of residence, gender, age, type of disability, comorbidity, amount and type of treatments provided and were analyzed by means of descriptive and comparative statistics.Results: 298 DGA treatments were performed to 169 males and 129 female patients, from 5 to 63 years of age and 63,8% of them were over 18 years old. 68,5% of the patients were mentally retarded, 17,8% were au- tistic, 7% had cerebral palsy, 3,5% suffered from vari- ous syndromes and 3,2% were patients with systemic diseases and other health issues. A total of 2787 treat- ments were provided, with higher prevalence of 49,8% for restorative treatments.
Conclusions: In many patients with severe disability, DGA is the only treatment option. The number and the geographic distribution of dental departments of Greek NHS that provide DGA, does not guarantee the equal and unimpeded access of special needs patients. Therefore, implementation of organized oral preventive programs is necessary, along with investment on the appropriate infrastructure, that would allow the creation of additional dental departments providing DGA treatments within the NHS.
KEY WORDS: Patients with disabilities, oral health, dental general anesthesia (DGA).
REFERENCES
Al-Eheideb Ali A., Neil G. Herman. Outcomes of dental procedures performed on children under general anesthesia. The Journal of Clinical Pediatric Dentistry 2003; 27(2): 181-184
Ali S, Sims C, Foy S, McIndoe A, Yates R, Brooke T. A review of day- case GA services for Special Care patients at University Hospital, Bristol. Community Dent Health 2016; 33: 6–8
American Academy of Pediatric Dentistry, AAPD. Management of dental patients with special health care needs. PediatrDent.Latest revision 2016.
Andreasen J. O.: Traumatic injuries of the teeth, 2nd edition. Munks- gaard Copenhagen 1981, pp. 28-31
Badre B, Serhier Z, El Arabi S. Waiting times before dental care under general anesthesia in children with special needs in the children’s hospital in Casablanca. Pan Afr Med J 2014; 17:298
Baker S, Yagiela JA. Obesity: a complicating factor for sedation in chil- dren. Pediatr Dent 2006; 28: 487-493
Balasouli C, Fotiou A, Kotsanos Ν. Dental care of institutionalized special needs patients in yhe prefecture of Thessaloniki. Στομα 2008; 36: 157-163
Becker DE. Preoperative medical evaluation. Part 1: general prin- ciples and cardiovascular considerations. Anesth Prog. 2009; 56:92–103
Boynes SG, Moore PA, Lewis CL, Zovko J, Close JM. Complications associated with anesthesia administration for dental treatment in a special needs clinic. Spec Care Dentist. 2010; 30:3–7
Chalmouki G. General anesthesia or sedation for dental procedures to non-cooperative special needs patients. Hellenic Hospital Dentistry 2015; 8: 20-21
Chang J, Kim HY. Prognostic factors of single-visit endodontic and restorative treatment under general anaesthesia for special needs patients. J Oral Rehabil 2017; 44: 96–104
Chaollai A. Ni, Robertson S, Dyer T.A, Balmer R.C, Fayle S.A. An evaluation of paediatric dental general anaesthesia in Yorkshire and the Humber. British Dental Journal 2010; 209:1-6
Chung SS, Casas MJ, Kenny DJ, Barrett EJ. Clinical relevance of access targets for elective dental treatment under general anesthesia in pediatrics. J Can Dent Assoc 2010; 76: a116
Cortinas Sanchez M., Llanos Martinez Gomez, Manuel Roncero Goig, Ursula Saez Cuesta, Marisa Ibarra Martin. Results of a major am- bulatory oral surgery program using general inhalation anesthesia on disabled patients. Med Oral Patol Oral Cil Bucal.2009 Nov 1; 14(11): e60511
Dimitriadis Dimitrios, Konstantinidis Rigas, Zervou-Valvi Flora. The practice of hospital dentistry in the National Health System: find- ings and reflections. Hellenic Hospital Dentistry 2009; 2: 9-14
Εθνική Συνομοσπονδία Ατόμων με Αναπηρία, Ε.Σ.Α.με.Α. Μελέτη: Επιχειρηματικότητα και άτομα με αναπηρία, Αθήνα 2005. www. esamea.gr
Escribano Hernandez A, Hernandez Coral T, Ruiz Martin E, Porteros Sanchez JA. Results of a dental care protocol for mentally handi- capped patients set in a primary health care area in Spain. Med Oral Patol Oral Cil Bucal.2007; 12: E492-5
Ferreira MCD, Renata Oliveira Guare, Igor Prokopowitsch, Maria Teresa Botti Rodrigues Santos: Prevalence of dental trauma in individuals with special needs. Dental Traumatology 2011; 27: 113-116
Franklin DL, Luther F, Curzon MEJ: The prevalence of malocclusion in children with cerebral palsy. Eur J Orthod 1996; 18: 637-643
Garcia-Miguel F, Serrano-Aguilar P, Lopez-Bastida J. Preoperative as- sessment. Lancet. 2003; 362:1749–1757
Giannopoulou Angeliki, Zervou-Valvi Flora. Dental treatment under general anesthesia for people with disabilities. Hellenic Hospital Dentistry 2020; 13: 35-53
Gordon MS, Dionne AR, Snyder J: Dental fear and anxiety as a barrier to accessing oral health among patients with special health care needs. Special Care Dent 1998; 18:88-92
Hennequin M, Moysan V, Jourdan D, Dorin M, Nicolas E: Inequalities in oral health for children with disabilities:A French national sur- vey in special schools. Plos One 2008; 3: 1-10
Ide M, Aoyagi Y, Hoshi M, Moriyasu K, Takano F, Asada Y. A survey of the actual status of the dental treatment under general anes- thesia at pediatric dentistry clinic of university dental hospital. Jpn J Ped Dent 2003; 41: 694-699
Jamieson LM, Roberts-Thomson KF. Dental general anaesthetic trends among Australian children. BMC Oral Health. 2006. pp. 6–16 Jamieson LM, Roberts-Thomson KF. Dental general anaesthetic re-
ceipt among Australians aged 15+ years, 1998–1999 to 2004–
2005. BMC Oral Health. 2008. pp. 8–10
Jamjoom M.M. M.I. Al Malik, R.D. Holt, A. El Nassry. Dental treatment under general anaesthesia at a hospital in Jeddah, Saudi Arabia. International Journal of Paediatric Dentistry 2001; 11: 110-116
Kakali A, Tsichti H, Smith P. The dental health of mentally handicapped children. The need and the difficulties in the establishment of dental services. Παιδοδοντία 1991; 5(2): 71-76.
Klein Ulrich, Arthur J Nowak. Characteristics of patients with Autistic Disorder presenting for dental treatment: a survey and chart re- view. Special Care in Dentistry 1999; 19(5): 200-207
Kourti E, Lefkelidou A, Kotsanos N. The child with autism: Aggra- vating factors of oral health and provision of dental services. Παιδοδοντία 2012; 26(2): 65-71
Limeres Posse J, Vasquez Garcia E, Medina Henriquez J, Tomas Car- mona I, Fernandez Feijoo J, Diz Dios P. Pre assessment of se- verely handicapped patients suitable of dental treatment under general anesthesia. Med Oral 2003; 8(5): 353-360
Maestre C. The use of general anaesthesia for tooth extraction in young handicapped adults in France. Br Dent J 1996; 180: 297- 302
Manfredi M, Figni L, Gagliani M, Lodi G (2016) Single versus mul- tiple visits for endodontic treatment of permanent teeth. Cochrane Database Syst Rev 12:CD005296. https://doi. org/10.1002/14651858.CD005296.pub3
Manley MCG, Skelly AM, Hamilton AG. Dental treatment for people with challenging behavior: general anaesthesia or sedation? Br Dent J 2000; 188: 358–360
Messieha Z. Risks of general anesthesia for the special needs dental patient. Spec Care Dentist 2009; 29: 21–25.
Moles DR, Ashley P. Hospital admissions for dental care in children: England 1997–2006. Br Dent J. 2009. pp. 206–E14
Nunn JH. The dental health of mentally and physically handicapped children: a review of the literature. Community Dent Health 1987; 4: 157-168.
Ohtawa Yumi, Keiichiro Tsujino, Shuhei Kubo, Masakazu Ikeda. Dental treatment for patients with physical or mental disability under general anesthesia at Tokyo Dental College Suidobashi Hospital. Bull Tokyo Dent Coll 2012; 53(4): 181-187
Oreland A, Heijbel J, Lagell S: Malocclusion in physically and/ or men- tally handicapped children. Swed Dent J 1987; 11: 103-119
Peretz B, Spierer A, Spierer S, Rakocz M. Dental treatment of patients with systemic diseases compared to patients with developmental disabilities under general anesthesia. Spec Care Dentist. 2012; 32(1): 21–25.
Savanheimo Nora, Sari A Sundberg, Jorma I Virtanen, Mira M Veh- kalahti. Dental care and treatments provided under general an- aesthesia in the Helsinki Public Dental Service. BMC Oral Health 2010; 12: 45
Shaw L, MacLaurin ET, Foster TD: Dental study of handicapped chil- dren attending special schools in Birmingham, UK. Community Dent Oral Epidemiol 1986; 14: 24-27
Schnabl Dagmar, Anna chiara Guarda, Maria Guarda, Lia Marie Irmtraut von Spreckelsen, Maria Riedmann, Rene Steiner, Herbert Dum- fahrt. Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12 years. Clinical Oral Investigations, published online 04 march 2019
Spyropoulou M. Local or functional etiology of occlusal problems. In: Basic Principles in Orthodontics. 2nd ed, p. 326. Athens: Beta medical Arts, 2000
Tesini DA. An annotated review of the literature of dental caries and periodontal disease in mentally retarded individuals. Special Care Dent 1981; 1:75-87
Vignehsa H, Soh G, Lo LG, Chellapah NK: Dental health of disabled children in Singapore. Aust Dent J 1991; 36(2): 151-156.
Wogelius P, Poulsen S, H toft Sorensen. Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children. Acta Odontologica Scandinavica. 2003; 61(3): 178-183
Woof F, Greening S, Barnard D: Clinical Guidelines and integrated care pathways for the oral health care of people with learning disabilities. British Society for Disabilities and oral health. The Royal College of Surgeons of England 2001
Yasuda J, Iwata K, Ohyama Y, Tanabe S, Nishitouge K, Harada J, Iwaya- ma Y. Clinical study of dental treatments under general anesthe- sia for disabled- statistical survey in our hospital during the past 10 years-. J Jpn Soc Disability Oral Health 2001;22: 1-7
Zambouri A. Preoperative evaluation and preparation for anesthesia and surgery. Hippokratia 2007; 11(1): 13-21
Zervou-Valvi F, Antoniadou A, Thanoulis P, Zouridaki Th, Karageorgos
H. Dental treatment of special needs patients at the Greek Na- tional Health System. Hellenic Hospital Dentistry 1: 19-28, 2008.
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