Retrospective analysis of dental treatment under general anesthesia among children with early childhood caries in Malaysia

Many children are affected by early childhood caries (ECC) with some requiring dental treatment under general anesthesia (GA). In pediatric dentistry, GA is one of the established methods of behavior management. GA data is useful for understanding the caries burden among young children. This study aimed to determine the trends, patient characteristics, and types of treatments conducted under GA among young children in a Malaysian dental hospital over a 7-year period. A retrospective study using pediatric patient records from 2013 to 2019 was conducted on children aged 2–6 years (24–71 months) having ECC. Relevant data were collected and analyzed. In total, 381 children with a mean age of 49.8 months were identified. Some of the ECC cases were associated with abscesses (32.5%) and multiple retained roots (36.7%). Over a 7-year period, there was an upward trend of preschool children receiving GA. Of the 4713 carious teeth treated, 55.1% were extracted, 29.9% were restored, 14.3% had preventive procedures, and 0.4% were pulp treated. Mean extractions were significantly higher among preschoolers compared to toddlers (p = 0.001), while preventive treatment was markedly higher among toddlers. In terms of the type of restorative materials, almost similar distribution was observed between the two age groups with 86.5% treated using composite restorations. Dental treatment under GA was more frequently used among preschoolers than in toddlers, with extractions and restoration with composite resin being the common treatment options. The findings can help decision-makers or relevant parties address the burden of ECC and enhance oral health promotion activities.

Behavior management; Early childhood caries; Children; General anesthesia; Pediatric dentistry

[1] American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. The Reference Manual of Pediatric Dentistry (pp 79–81). Edition. American Academy of Pediatric Dentistry: Chicago, Ill. 2020. Available at: https://www.aapd.org/media/policies_guidelines/p_eccclassifications.pdf (Accessed: 02 February 2023)

[2] Li MY, Zhi QH, Zhou Y, Qiu RM, Lin HC. Impact of early childhood caries on oral health-related quality of life of preschool children. European Journal of Paediatric Dentistry. 2015; 16: 65–72.

[3] Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. Journal of Natural Science, Biology and Medicine. 2013; 4: 29–38.

[4] Che Salleh N, Yaw SL, Abd Muttalib Khairiyah, Ab Rahman J. National oral health survey of preschool children 2015 (NOHPS 2015), Vol. I: oral health status and caries treatment needs of 5-year-old children. 2017. Available at: https://ohd.moh.gov.my/images/pdf/compendium/NOHPS-2015-CARIES.pdf (Accessed: 10 March 2023).

[5] Strøm K, Rønneberg A, Skaare AB, Espelid I, Willumsen T. Dentists’ use of behavioural management techniques and their attitudes towards treating paediatric patients with dental anxiety. European Archives of Paediatric Dentistry. 2015; 16: 349–355.

[6] Knapp R, Gilchrist F, Rodd HD, Marshman Z. Change in children’s oral health-related quality of life following dental treatment under general anaesthesia for the management of dental caries: a systematic review. International Journal of Paediatric Dentistry. 2017; 27: 302–312.

[7] Takriti M, Alhakim D, Splieth C. Dental characteristics and according to treatments of children under GA in Germany. European Archives of Paediatric Dentistry. 2019; 20: 617–622.

[8] Nadeem S, Mohd Noor SNF, Shahabuddin S, Ghaffar ZA, Soon Eu C. Characteristics and dental treatments of children under general anaesthesia. Archives of Orofacial Science. 2020; 15: 35–44.

[9] Chen Y, Hsieh C, Hsu W, Wu F, Shih W. A 10-year trend of dental treatments under general anesthesia of children in Taipei Veterans General Hospital. Journal of the Chinese Medical Association. 2017; 80: 262–268.

[10] Jankauskienė B, Virtanen JI, Kubilius R, Narbutaitė J. Treatment under dental general anesthesia among children younger than 6 years in Lithuania. Medicina. 2013; 49: 403–408.

[11] Schroth RJ, Quiñonez C, Shwart L, Wagar B. Treating early childhood caries under general anesthesia: a national review of Canadian data. Journal of the Canadian Dental Association. 2016; 82: g20.

[12] Ministry of Health Malaysia. Guidelines early childhood oral healthcare. 2008. Available at: https://ohd.moh.gov.my/images/pdf/xtvtnsop/Guidelines-Early-Childhood-Oral-Healthcare-2008.pdf (Accessed: 05 December 2022).

[13] Anil S, Anand PS. Early childhood caries: prevalence, risk factors, and prevention. Frontiers in Pediatrics. 2017; 5: 157.

[14] Broomhead T, Rodd HD, Baker SR, Jones K, Davies G, White S, et al. A rapid review of variation in the use of dental general anaesthetics in children. British Dental Journal. 2020; 229: 31–39.

[15] Tickotsky N, Petel R, Araki R, Moskovitz M. Caries progression rate in primary teeth: a retrospective study. Journal of Clinical Pediatric Dentistry. 2017; 41: 358–361.

[16] Arrow P. Incidence and progression of approximal carious lesions among school children in Western Australia. Australian Dental Journal. 2007; 52: 216–226.

[17] Xiao J, Alkhers N, Kopycka-Kedzierawski DT, Billings RJ, Wu TT, Castillo DA, et al. Prenatal oral health care and early childhood caries prevention: a systematic review and meta-analysis. Caries Research. 2019; 53: 411–421.

[18] Jamani NA. Prevention of oral health disease: knowledge and practices among pregnant women in Kuantan, Malaysia. International Journal of Allied Health Sciences. 2019; 3: 923–932.

[19] Adeniyi A, Donnelly L, Janssen P, Jevitt C, Kardeh B, von Bergmann H, et al. Pregnant women’s perspectives on integrating preventive oral health in prenatal care. BMC Pregnancy and Childbirth. 2021; 21: 271.

[20] Tahmassebi JF, Achol LT, Fayle SA. Analysis of dental care of children receiving comprehensive care under general anaesthesia at a teaching hospital in England. European Archives of Paediatric Dentistry. 2014; 15: 353–360.

[21] Azadani EN, Peng J, Kumar A, Casamassimo PS, Griffen A, Amini H, et al. A survival analysis of primary second molars in children treated under general anesthesia. The Journal of the American Dental Association. 2020; 151: 568–575.

[22] Bayram M, Akgöl BB, Üstün N. Longevity of posterior composite restorations in children suffering from early childhood caries—results from a retrospective study. Clinical Oral Investigations. 2021; 25: 2867–2876.

[23] Chisini LA, Collares K, Cademartori MG, de Oliveira LJC, Conde MCM, Demarco FF, et al. Restorations in primary teeth: a systematic review on survival and reasons for failures. International Journal of Paediatric Dentistry. 2018; 28: 123–139.

[24] Mejàre I, Axelsson S, Dahlén G, Espelid I, Norlund A, Tranæus S, et al. Caries risk assessment: a systematic review. Acta Odontologica Scandinavica. 2014; 72: 81–91.

[25] Adil AH, Eusufzai SZ, Kamruddin A, Wan Ahmad WMA, Jamayet NB, Karobari MI, et al. Assessment of parents’ oral health literacy and its association with caries experience of their preschool children. Children. 2020; 7: 101.

[26] Centres for Disease Control and Prevention. Positive parenting tips. 2023. Available at: https://www.cdc.gov/ncbddd/childdevelopment (Accessed: 02 February 2023).