The Use of General Anesthesia in Pediatric Dental Care of Children at Multi-Dental Centers in Saudi Arabia

Objective: High caries reports in young Saudi children strongly suggest the need occasionally for general anesthesia to provide quality dental work. The purpose of this study was to investigate the characteristics of patients, dental procedures and hospital protocols for Pediatric Dental General Anesthesia (PDGA) procedure at multi-dental centers in Jeddah, Saudi Arabia. Study Design: Study sample included 90 children attending PDGA treatment at three governmental hospitals in Jeddah. Collected data included patient's demographics, medical condition, admission type, intra-operative protocols, and dental procedures.Results: Results showed the mean age of treated children was 5±2 years and the majority of them (93%)were treated for the first time under general anesthesia (GA). Long waiting duration for PDGA procedure was reported regardless of the patient age and medical status. Being very young with extensive caries was the major indication for GA (58%). Children mean preoperative fasting times were 10 ± 2 hours. Hospitals were significantly different in some protocols for PDGA procedures. Child behavior during GA induction was significantly related to child's age, premedication use, and hospital admission type. The mean number of treated teeth per child was 14±3.8 and the treatment mostly included restorations. Age was found to significantly affect the type of dental treatment, while gender and medical status did not. Conclusions: PDGA procedure is used mostly for young children with extensive dental caries. Children treated under GA received a comprehensive dental care in Saudi hospitals. Efforts should be directed to improve some of the existing hospitals protocols with PDGA procedure. The long waiting period for PDGA operation indicated the need to improve available facilities in the three hospitals.

General anesthesia, hospital dentistry, dental treatment, children

1. Al-Dosari AM, Wyn AH, Akpata ES and Khan NB. Caries prevalence and its relation to water fluoride levels among schoolchildren in central province of Saudi Arabia. Int Dent J, 54: 424–428, 2004.

2. Al-Malik M, Holt RD and Bedi R. Prevalence and pattern of caries, rampant caries, and oral health in two- to five year old children in Saudi Arabia. J Dent Child, 70: 235–242, 2003.

3. Al-Malik MI and Rehbini YA. Prevalence of Dental Caries, Severity, and Pattern in Age 6 to 7-Year-old Children in a Selected Community in Saudi Arabia. J Contemp Dent Pract, 2: 046–054, 2006.

4. Klingberg G. Dental fear and behavioral management problems in chil-dren. Swed Dent J, 103: 333–335, 1995.

5. Lowry LY, Reid B, Scott P. and Metcalfe K. Treatment of anxious pedi-atric dental patients by a dental therapist. Int J Paediatr Dent, 14: 394, 2004.

6. AAPD. Clinical guideline on behavior guidance for the pediatric dental patient. Pediatr Dent, 28: 97–105, 2007.

7. Abushal M and Joseph OA. The use of behavior management tech-niques by dentists in Saudi Arabia; A survey. SDJ, 12: 129–134, 2000.

8. Alcaino E, Kilpatrick N.M and Kingsford S.E.D. Utilization of day stay general anaesthesia for the provision of dental treatment to children in New South Wales, Australia. Int J Paediatr Dent, 10: 206–212, 2000.

9. Klingberg G, Dahllof G, Erlandsson AL, Grindefjord M, Hallstrom-Stalin U, Koch G, and Lundin SA. A survey of specialist paediatric den-tal services in Sweden: results from 2003, and trends since 1983. Int J Paediatr Dent, 16: 89–94, 2006.

10. Al-Malik MI and Al-Sarheed MA. Comprehensive dental care of pedi-atric patients treated under general anesthesia in a hospital setting in Saudi Arabia. J Contemp Dent Pract, 7: 79–88, 2006.

11. North S, Davidson LE, Blinkhorn AS, and Mackie IC. The effects of a long wait for children’s dental general anaesthesia. Int J Paediatr Dent, 17: 105–109, 2007.

12. Osuji OO, and Assery MK. The dental treatment of children under gen-eral anesthesia at a hospital in Taif, Saudi Arabia. SDJ, 17: 120–125, 2005.

13. Mason C, Holt RD and Rule DC. The changing pattern of day-care treatment for children in a London dental teaching hospital. Br Dent J, 179: 136–140, 1995.

14. Wong FSL, Fearne JM, and Brook AH. Planning future general anes-thetic services in pediatric dentistry on the basis of evidence: an analysis of children treated in the Day Stay Centre at the Royal Hospitals NHS Trust, London, between 19851995. Int Dent J, 47: 285–292, 1997.

15. Haubek D, Fuglsang M, Poulsen S and Rolling I. Dental treatment of children referred to general anesthesia association with country of ori-gin and medical status. Int J Paediatr Dent, 16: 239–246, 2006.

16. Vinckier F, Gizani S, and Declerck D. Comprehensive dental care for children with rampant caries under general anaesthesia. Int J Paediatr Dent, 11: 25–32, 2001.

17. Jamjoom MM, Al-Malik MI, Holt RD and El-Nassry A. Dental treat-ment under general anesthesia at a hospital in Jeddah, Saudi Arabia. Int J Paediatr Dent, 11: 110–116, 2001.

18. Harte HM, Palmer NAO and Martin MV. Treatment planning extrac-tions for children referred for general anesthesia. Int J Paediatr Dent, 14: 397–398, 2004.

19. AAPD. Clinical Guideline for Monitoring and Management of Pedi-atric Patients During and After Sedation for Diagnostic and Therapeu-tic Procedures. Pediatr Dent, 28: 115–132, 2007.

20. AAPD. Clinical Guideline on Use of Anesthesia care providers in the administeration of in-office deep sedation/general anesthesia to the pediatric dental patient. Pediatr Dent, 28: 133–135, 2007.

21. AAPD. Policy statement on hospitalization and operating room access for dental care of infants, children, adolescents, and persons with spe-cial health care needs. Pediatr Dent, 28: 58–59, 2007.

22. AAPD. Growth Chart. Pediatr Dent, 28: 239–242, 2007.

23. Worthen TB and Mueller W. Implications of parental compliance on decision making in care provided using GA in a low income popula-tion. J Dent Child, 67: 197–199, 2000.

24. AlBadri SS, Jarad FD, Lee GT and Mackie IC. The frequency of repeated general anesthesia for teeth extraction in children. Int J Paedi-atr Dent, 16: 45–48, 2006.

25. Ng MW, Tate AR, Needleman, and Acs G. The influence of medical history on restorative procedure failure rates following dental rehabili-tation. Pediatr Dent, 23: 487–490, 2001.

26. ASA. Guidelines for Preoperative Fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures. A Report of the Amer-ican Society of Anesthesiologists. Available at: www.asahq.org/publi-cationsAndServices/npoguide.html.

27. Soreide E, Eriksson LI, Hirlekar G, Eriksson H, Henneberg SW, Sandin R and Raeder J. Pre-operative fasting guidelines: an update; (Task Force on Scandinavian Pre-operative Fasting Guidelines, Clinical Prac-tice Committee Scandinavian Society of Anaesthesiology and Intensive Care Medicine). Acta Anaesthesiol Scand, 49: 1041–1047, 2005.

28. D’Eramo EM, Bookless SJ and Howard JB (2003). Adverse events with outpatient anesthesia in Massachusetts. J Oral Maxillofac Surg, 61: 793–800, 2003.

29. D’Eramo EM, Bookless SJ and Howard JB. Adverse events with out-patient anesthesia in Massachusetts. J Oral Maxillofac Surg, 61: 793–800, 2003.

30. Ersin NK, Oncag O, Cogulu D, Cicek S, Balcioglu ST, Cokmez B. Post-operative Morbidities Following Dental Care Under Day-Stay General Anesthesia in Intellectually Disabled Children. J Oral Maxillofac Surg, 63: 1731–1736, 2005.

31. Perrott DH, Yuen JP, Andresen RV and Dodson TB. Office based ambu-latory anesthesia: Outcomes of clinical practice of oral and maxillofa-cial surgeons. J Oral Maxillofac Surg, 61: 793–800, 2003.

32. Nunn JH, Davidson G, Gordon PH, and Storrs J. A retrospective review of a service to provide comprehensive dental care under general anes-thesia. Special Care in Dentistry, 15: 97–101, 1995.

33. Anderson HK, Drummond BK and Thomson WM. Changes in aspects of children’s oral-health-related quality of life following dental treat-ment under general anaesthesia. Int J Paediatr Dent, 14: 317–325, 2004.

34. Lewis CW and Nowak AJ. Stretching the safety net too far waiting times for dental treatment. Pediatr Dent, 24: 6–10, 2002.

35. Lalwani K, Kitchin J, Lax P. Office-based dental rehabilitation in chil-dren with special healthcare needs using a pediatric sedation service model. J Oral Maxillofac Surg, 65: 427–433, 2007.

36. Harrison MG, and Roberts GJ. Comprehensive dental treatment of healthy and chronically sick children under intubation general anesthe-sia during a 5-year period. Br Dent J, 184: 503–506, 1998.

37. Solidani F, and Foley J. An assessment of rubber dam usage amongst specialists in pediatric dentistry practictising within the UK. Int J Pae-diatr Dent, 16: 50–56, 2007.

38. Fayle SA, Welbury RR, Roberts JF. British Society of Paediatric Den-tistry: a policy document on management of caries in the primary den-tition. Int J Paediatr Dent, 11: 153–157, 2001.

39. AAPD. Guideline on pulp therapy for primary and young permanent teeth. Pediatr Dent, 28: 144–148, 2007.

40. Tate AR, Ng MW, Needleman HL, and Acs G. Failure rates of restora-tive procedures following dental rehabilitation under general anesthe-sia. Pediatr Dent, 24: 69–71, 2002.

41. Al-Ehaideb AA and Herman NG. Outcomes of dental procedures per-formed on children under general anesthesia. J Clin Pediatr Dent, 27: 181–183, 2003.