Comparison of Dental Treatment Performed under General Anesthesia between Healthy Children and Children with Special Needs at a Teaching Hospital in Egypt

BACKGROUND: The evaluation of dental treatment under general anesthesia (GA) in healthy children and children with special health care needs (SHCN) should take into consideration; firstly, the different dental treatment needs according to the disability condition (scope of disability) and secondly, the limitation of the treatment.
Aim of the study: This retrospective study aims at comparing the different dental treatment modalities performed under general anesthesia for healthy children, on one side, and those with special health needs, on the other. The Study was carried out at Unit for Dental Treatment of Healthy Children and Children with Special Needs, Faculty of Dentistry’ Teaching Hospital, Cairo University, in 2017 and 2018.
Method: This retrospective study was approved by the Research Ethics Committee, Faculty of Dentistry, Cairo University. Data was retrieved from the files of the pediatric patients, aged from 1 to 18 years old, who received dental treatment under GA, between January 2017 to December 2018, at this Unit. Patients with special needs, with either mental or physical disability, were assigned as Group A, while the healthy patients were assigned as Group B. The two Groups were compared for: the treatment modalities of operative restorations, pulp therapy, anterior and posterior crowns, fissure sealants, dental prophylaxis, and extractions of teeth. The number of repeated admissions for dental treatment under GA was also included in the Study.
Results: The total number of children who had dental treatment under GA in the years 2017 and 2018 was 2276. Number of children with SHCN was 553 (24.3%), while the number of healthy children was 1723 (75.7%). Group A showed significantly higher mean age (7.04) than Group B (4.27), (P-value <0.001). Group A showed a higher percentage of previous admissions for dental treatment under GA (13.4%), than group B (0.6%) (P-value <0.001). The most frequent disability was cerebral palsy (41.2%), followed by autism (17.7%), then mental retardation (15.2%). For primary dentition, Group A showed significantly higher prevalence of extractions for molars and incisors than Group B (P-value <0.001, effect size = 0.159 and P-value <0.001, effect size = 0.150, respectively), and higher prevalence of glass ionomer (GI) fillings for molars than Group B. Group A showed significantly lower prevalence of: composite fillings, GI fillings for incisors, pulpotomies, pulpectomies, and crowns. There was no statistically significant difference in amalgam filling treatments and fissure sealant applications between the two Groups. For permanent dentition, Group A showed significantly higher prevalence of amalgam fillings, composite fillings and crowns for molars than Group B. In addition, Group A showed significantly higher prevalence of dental prophylaxis than Group B.
Conclusions: The use of radical treatment as extraction of extensive decayed teeth in children with SHCN is observed in this Study. The use of crowns to protect the teeth even without pulp therapy is demonstrable in the treatment pattern revealed in this Study. A special attention should be directed toward preventive procedures such as dental prophylaxis, fissure sealants and topical fluoride application. Education of parents/caregivers is needed to implement and supervise the proper oral hygiene measures for the children with SHCN.