The online version of this article (doi:10.1186/s12903-015-0028-4) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
MG, IAP and CS all contributed to the design and write up of the research. MG carried out the research within hospitals and analysed the data. All authors read and approved the final manuscript.
Extensive caries in children can result in a referral for tooth extraction under General Anaesthesia (GA). While there are guidelines for the use of GA within paediatric dentistry this process is ultimately dependent upon the decision making of the treating dentist. This decision can be influenced locally by the availability of services and their waiting list. GA services for paediatric extractions (DGA) have developed from different historical positions, including community dental services, maxillofacial services and paediatric led specialist services.
This article explores the differences between DGA services provided by 6 randomly selected hospitals across the North West of England. 456 patients who attended a routine DGA appointment in each hospital over a period of two months from 2012 to 2013 gave consent to allow access to their clinical notes and completed a questionnaire (93% consent rate). Data were entered onto SPSS and appropriate statistical tests undertaken.
Differences between hospitals included the clinic structure, patient characteristics and the treatment provided. There was a significant difference in the number of previous child DGAs experienced within the family, ranging from 33% to 59% across hospitals. Hospital 1 attendees differed in a number of ways to other areas but notably in the stability of life time residency with 20% of patients having previously lived in another area and with just 58% of parents stating their child regularly attended the dentist (compared to an average of 9% and 81% respectively across other hospitals).
Findings suggest services throughout the region face different obstacles in providing support and treatment for young children referred for DGA. There are, however common practices such as preventative treatment, which could impact on caries experience and subsequent DGA referral, a particular issue given the high DGA repeat rate observed. For many children a DGA may be their first dental experience. It is therefore vital to engage with both child and family at this stage, attempt to initiate a pattern of dental attendance and to ensure this experience does not create an on-going cycle of poor dental behaviour and health.
Additional file 1: Table S1. Hospital Service delivery and organisation breakdown. FT = Foundation Trust, CT2 – Core training 2 previously known as SHO, CDS = Community Dental Service. Staffing issues refer to staff leaving due to retirement, maternity or other personal reasons and a delay in implementing new staff or finding appropriate replacements.12903_2015_28_MOESM1_ESM.xlsx
Additional file 2: Table S2 Descriptive Statistics around population attending for DGA. P = Permanent teeth, D = Deciduous Teeth, P&D Permanent and Deciduous teeth. 25%a/50%b of cells have expected count of less than 5 therefore results should be viewed with caution. *indicates where statistical difference occurs. Medical history % out of those who had accurately reported records.12903_2015_28_MOESM2_ESM.xlsx
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- A study of the provision of hospital based dental general anaesthetic services for children in the northwest of England: part 1 - a comparison of service delivery between six hospitals
Iain A Pretty
- BioMed Central
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