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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 4  |  Page : 197-200

Parental satisfaction after children's dental rehabilitation under general anesthesia


Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt

Date of Submission29-Jun-2019
Date of Acceptance01-Sep-2019
Date of Web Publication28-Feb-2020

Correspondence Address:
Nada M. Wassef
Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tdj.tdj_25_19

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  Abstract 

Aim
Dental treatment under general anesthesia is needed in case of patients with special needs, uncooperative or young children. The aim of this study is to assess the parental satisfaction and oral hygiene compliance after dental rehabilitation for their children under general anesthesia.
Materials and methods
Records of all patients with full dental rehabilitation under general anesthesia by the same operator at Pediatric Dentistry and Dental Public Health Department for 1 year were retrieved from archive. Patients were called for follow-up and to participate in the study. Different treatment modalities for primary and permanent teeth were recorded as pulp therapy (pulpotomy or pulpectomy), stainless steel crowns, preveneered stainless steel crowns, zirconium crowns, composite restorations, amalgam restorations, pits and fissure sealants, extractions, and space maintainers. Questionnaire was completed by parents recording their satisfaction regarding full dental rehabilitation under general anesthesia and their compliance with oral hygiene measures. Statistical analysis was performed. Number and percentages for different treatment modalities were calculated. Percentage of parental satisfaction and oral hygiene compliance was assessed.
Results
A number of 150 children records were retrieved from archive. Most of the parents were satisfied with the full dental rehabilitation under general anesthesia and stated that children were able to eat and smile with no pain. Thus, it affected their general health. Oral hygiene compliance was not satisfactory.
Conclusion
Dental rehabilitation under general anesthesia for children affects their quality of life. Oral hygiene instructions should be provided both orally and written for better compliance after general anesthesia and in follow-up visits.

Keywords: full dental rehabilitation, general anesthesia, oral hygiene, parental satisfaction


How to cite this article:
Abdelgawad FK, Wassef NM. Parental satisfaction after children's dental rehabilitation under general anesthesia. Tanta Dent J 2019;16:197-200

How to cite this URL:
Abdelgawad FK, Wassef NM. Parental satisfaction after children's dental rehabilitation under general anesthesia. Tanta Dent J [serial online] 2019 [cited 2020 Mar 28];16:197-200. Available from: http://www.tmj.eg.net/text.asp?2019/16/4/197/279727


  Introduction Top


Dental caries is considered a major problem affecting children and adults of all age groups. The pain and discomfort that results from carious teeth can have severe effects on children, including effects on eating, sleeping, general growth as well as absence from school and effects on quality of life[1]. Therefore, management of dental caries in children is necessary to avoid all the unwanted consequences of dental caries.

The use of behavior management techniques can lead to favorable results when it comes to treating pediatric dental patients. However, some patients cannot be treated under local anesthesia and general anesthesia becomes mandatory. Patients with special healthcare needs, very young children, uncooperative children that need extensive treatments are among the groups of children where general anesthesia is mandatory[2].

The use of general anesthesia in treatment of children results in benefits for the child and parent including the completion of the full dental rehabilitation in one visit with reduction in travel costs[3]. Several studies were done to evaluate the impact of general anesthesia on the children's quality of life as well as parental satisfaction [4–6].

Acs et al.[4], studied the parental satisfaction and outcomes of dental general anesthesia on their children's quality of life using a questionnaire. The results showed improvement in children's quality of life and parental expectations were met[4].

White et al.[6], used a questionnaire to measure the parental satisfaction after general anesthesia as well as social and physical quality of life. The results showed high parental acceptance of the treatment and increased impact on quality of life[6]. So, the aim of this study is to assess the parental satisfaction and oral hygiene compliance after dental rehabilitation for their children under general anesthesia.


  Materials and Methods Top


The records of children treated under general anesthesia by the same operator during the period of 1 year were retrieved from the archives of the General Anesthetic Unit, Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry. All the records were selected randomly. A written informed consent was provided to the parents explaining the aim of the study and the procedures in accordance with the ethical requirements of the faculty.

The counts of different treatments were recorded. The counts of teeth treated by pulpotomy, pulpectomy, stainless steel crowns, anterior crowns in form of preveneered crowns or zirconium crowns, cavity preparation and restorations either composite or amalgam, extractions, pits and fissure sealants, space maintainers and fluoride varnish applications were recorded.

The parents were telephoned to complete the survey and to come for recall follow-up visit. The questionnaire used was that used by Acs et al.[4]. Questions included improvement of pain, eating, sleeping, overall health, overall positive experience and expectations met. Also, the oral hygiene compliance was assessed by intraoral examination of the child and inquiring the parents about the oral hygiene measures used including timing of brushing, use of dental floss, who brushes for the child and the frequency of brushing per day. Number and percentages were calculated for different treatment modalities as well as parental satisfaction and oral hygiene compliance.


  Results Top


A number of 150 children records were retrieved from archive for the same operator with a median age 4.45 years and range (1.5–13 years). There were 19 children with special healthcare needs (12.7% from the total number of records). Sex distribution was 84 (56%) males and 66 (44%) females.

The overall oral hygiene compliance for children was not satisfactory after intraoral examination as 75 (50%) of the children including children with special healthcare needs had visible dental plaque on their teeth. Also, there was three children with dental caries in their teeth that were not erupted at the time of the oral rehabilitation. No one reported the use of dental floss for their children. Most of the parents reported brushing once at the end of the day or the beginning of the day before breakfast and the child brushes by his own sometimes with no supervision (60%).

The different treatment modalities performed were 42 amalgam restorations, 110 composite restorations, 188 pulpotomy and 34 pulpectomy in primary molars, 17 pulpectomy in primary anterior teeth, 189 anterior crowns, 636 stainless steel crowns, 471 extractions and 109 others involving pits and fissure sealants, space maintainers and fluoride varnish applications as shown in [Table 1].
Table 1: Showing the different treatment modalities performed

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The percentage of parents reached after 1 year over the phone were 63%, while 24% did not answer the phone and 13% the phones were out of service as shown in [Figure 1].
Figure 1: A pie chart showing the percentages of parents reached after 1 year from full mouth rehabilitation.

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Regarding the parental satisfaction, in 100% of the children that were reached after 1 year, the parents stated that their expectations were met and that there was an overall positive experience. Also, in 100% of the children, the parents stated that the overall health and sleeping of their children were improved. Eating was improved in 96.8% of the children and the pain was improved in 98.9% of the children as shown in [Figure 2].
Figure 2: A bar chart showing the percentages of parental satisfaction after full mouth rehabilitation.

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  Discussion Top


Full mouth rehabilitation under general anesthesia is considered one of the management techniques performed by pediatric dentists. It is usually needed in special healthcare needs, very young and uncooperative children[2]. The outcomes of treatment have significant effects on the children's overall medical and dental health according to Karim et al.[7].

The records of the same operator were retrieved to standardize the decision made for dental management of children under general anesthesia and the same instructions delivered postoperatively to the parents. So, this removed the variability that is present between different operators and children nearly received the same care from the operator.



The overall oral hygiene compliance was not satisfactory, this may be attributed to the lack of parental oral hygiene awareness to their children. Although instructions were given immediately after the general anesthesia, once the child is pain-free, the parents neglect the oral hygiene measures. Regarding the timing and frequency of brushing per day, lack of parental supervision and dental floss use, Marshman et al.[8], stressed on providing oral hygiene measures and need for parental supervision in follow-up visits[8]. Dental caries encountered in few children was in their teeth that were not erupted at the time of the dental rehabilitation under general anesthesia.



Most of the parents of special healthcare needs children had a problem with the use of the toothbrush as they reported that their children did not open their mouth for brushing. Therefore, written instructions and follow-up visits to ensure proper preventive measures are needed especially in case of special healthcare needs children and this is in agreement with the results of In Chi et al.[9].

Different treatment modalities found in the records were those used for any child with dental diseases. Several teeth were treated using stainless steel crowns due to the high caries risk of these children and multiple surface decay in their molars as recommended by the guidelines of the American Academy of Pediatric Dentistry[10].

Not all children were reached after 1 year as some of the parents' phones were out of service as these parents might have changed their numbers or left the country. Sometimes, we may have parents coming only to our unit for full mouth rehabilitation under general anesthesia and then they leave the country after the operation. Also, there were several parents who did not answer the phone at all, and this might be contributed to the fact that they will not answer unknown numbers. Most of the parents that answered the phone were very happy about the call received and the appointment that was scheduled for them. They appreciated the follow-up appointment.

The questionnaire used in this study for parental satisfaction was according to Acs et al.[4]. The survey comprised six questions that covered the main items to determine the parental satisfaction and child's health improvement. It was shown that the overall expectations were met with a positive experience. Also, the overall health and sleeping were satisfactory as the children were able to sleep due to subsiding of pain which are similar to the results of Acs et al.[4], White et al.[6], and El Batawi et al.[5].

Some parents stated that eating was not improved after the treatment because their children had several extracted teeth. Thus, they faced difficulty in eating as reported by El Batawi et al.[5]. Also, parents for children with special healthcare needs were not able to determine the eating ability as their children were not providing them with feedback. Pain did not improve after treatment in some children, this may be attributed to the eruption of a new molar especially the first permanent molar at the age of 6 years or the eruption of the second primary molar around the age of 2 years. There was no abscess related to any of the treated teeth.


  Conclusion Top


Full mouth rehabilitation under general anesthesia for children affects their quality of life and overall health. Oral hygiene instructions and dietary recommendations should be provided both orally and written for better compliance after general anesthesia and in follow-up visits.

Acknowledgements

The authors would like to thank all children and their parents who contributed in this study.

The research was self-funded by the researchers. The research was done in the Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gilchrist F, Marshman Z, Deery C, Rodd H. The impact of dental caries on children and young people: what they have to say? Int J Paediatr Dent 2015; 25:327–338.  Back to cited text no. 1
    
2.
American Academy of Pediatric Dentistry (Guidelines). Use of Anesthesia Providers in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patient. Am Acad Pediatr Dent Ref Man 2018; 40:317–320.  Back to cited text no. 2
    
3.
Kolisa Y, Ayo-Yusuf O, Makobe D. Paedodontic general anaesthesia and compliance with follow-up visits at a tertiary oral and dental hospital, South Africa. SADJ 2013; 68:206–212.  Back to cited text no. 3
    
4.
Acs G, Pretzer S, Foley M, Ng MW. Perceived outcomes and parental satisfaction following dental rehabilitation under general anesthesia. Pediatr Dent 2001; 23:419–423.  Back to cited text no. 4
    
5.
El Batawi H, Panigrahi P, Awad M. Perceived outcomes and satisfaction of Saudi parents and their children following dental rehabilitation under general anesthesia: a 2-year follow-up. J Int Soc Prev Community Dent 2014; 4:153–160.  Back to cited text no. 5
    
6.
White H, Lee JY, Vann WF. Parental evaluation of quality of life measures following pediatric dental treatment using general anesthesia. Anesth Prog 2003; 50:105–110.  Back to cited text no. 6
    
7.
Karim ZA, Musa N, Noor SNFM. Utilization of dental general anaesthesia for children. Malays J Med Sci 2008; 15:31–39.  Back to cited text no. 7
    
8.
Marshman Z, Ahern SM, McEachan RRC, Rogers HJ, Gray-Burrows KA, Day PF. Parents' experiences of toothbrushing with children: a qualitative study. JDR Clin Trans Res 2016; 1:122–130.  Back to cited text no. 8
    
9.
In Chi S, Eon Lee S, Seo KS, Choi YJ, Kim HJ, Kim HJ, et al. Telephone follow-up care for disabled patients discharged after receiving dental treatment under outpatient general anesthesia. J Dent Anesth Pain Med 2015; 15:5–10.  Back to cited text no. 9
    
10.
American Academy of Pediatric Dentistry (Guidelines). Policy on early childhood caries (ECC): unique challenges and treatment options. Am Acad Pediatr Dent Ref Man 2018; 40:63–64.  Back to cited text no. 10
    


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Abstract
Introduction
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