Treatment planning for dental care under GA Flashcards
(40 cards)
How many paediatric DGA’s are performed each year in england each year?
55,000
How many children are admitted for scheduled DGA in the children’s hospital each year?
2000
What age group are people mainly getting DGA’s
5-6 years
What is the % of ethnic minority groups in sheffield and what is the % of ethnic minority groups that make up the DGA group?
Minority in sheffield = 10% but these make up 28% of DGA group
The majority of children are from families with high levels of deprivation, what does this include?
Homes with unempolyed males, overcrowded houses, homes without cars, lack of education
What is the difference in caries experience in patients requiring DGA?
Approx 3 times higher
What is the DGA patient profile?
Young children
High caries rates
Socially disadvantaged families
Parents have little control or motivation towards child’s oral health and dietary practices
DGA not viewed as a disastrous event
Highly unlikely to attend for routine recall or preventive treatment
What is important when treatment planning?
Individualised - according to social, medical and OH needs
Holistic
Flexible
Forward planning
Evidence based
Non-authoritarian - patient/guardian ownership woth shared decsion making
Why is treatment planning for a DGA so important?
Risk of death
High levels of morbidity - over 50% feel sick, dizzy or have bleeding/ pain post-op
Inconvenience for the family
Psychological upset for the child
Maximise the efficiency and minimise the costs - £18000 tariff for each DGA
What are the different justifications for a DGA
Children with managment problems; not amendable to other behaviour management strategies e.g very young, learning diabilities
Orofacial trauma
Surgery or multiple extractions/quadrant dentistry
Acute facial swelling - trismus, high temp
Mitigating medical history e.g. if have haemophilia
WWhat are the stages of treatment planning?
history examination Special investigations Diagnosis -> further diagnosis Treatment plan Informed consent, risks, pre-op instructions Dental GA
Why take a pre GA assessment?
Sufficient time to obtain a full history and discuss treatment options
Time to request special tests, or undertake any other necessary dental treatment
Opportunity for discussion with child’s paediatrician and your anaesthetist
time for family to refelct
Opportunity for behaviour management pre-GA
Things will run better on the day: less likely to have cancelled patients or problems relating to poor communications or planning
Less risk of serious incident at the admission
Less risk of repeat DGA
Will actually reduce the overall prescription of a DGA
What is improtant in the hisory before having the GA?
Who is accompanying the child and do they fully understand what is proposed?
History of presenting complaint
Past dental history - compliance
MH - CVD, allergies, bleeding problems, previous GA
SH - ease of attendance
What do you look for extra-oral examination?
Pyrexia
Swelling
Trismus
What do you look for in the intra-oral examination?
Caries Restorations Erosion* Trauma* Orthodontic status Soft tissue pathology Tongue ties Mobile teeth
Why may you want to extract A and B?
Check for trauma and erosion
If discoloured may want to extract to prevent future problems
What are the different special investigations?
Radiograph
Height/weight - BMI
Haematological investigation
Why take radiographs for interproximal caries?
8x more interproximal carious lesions are detectable by x-rays than by clinical examination alone
Why is knowing the BMI important?
Increased BMI is increased risk for GA and patients need longer post-op monitoring so there are service capacity implications
Need to know weight for when giving medication
Children overweight at most risk, when come back can get respiratory obstruction
Why is haematological investigation important
10% of non-white european groups have haemaglobinopathy such as sickle cell anaemia or thalasaemia
19% children 6 years presenting for GA were anaemic Hb<11g/dl
Small children undergoing multiple molar extractions may lose 5% of their blood volume
When may there be alternatives to DGA?
Asymptomatic carious lesions, arrested lesions, teeth close to exfoliation
If can be treated with inhalation sedation/simple behaviour management/ CBT
If having them just for ortho extractions, single tooth extraction, serious MH
What 3 questions need to be asked before doing the DGA?
Is the treatment necessary
Can the treatment be provided without DGA
Is the risk of DGA justified
What is the type of GA dictated by?
Facilities available Waiting lists Urgency of need Medical status Treatment required
What is a short GA?
Who is it for?
Non-intubated - have laryngeal mask, dont have throat packed, things can go down the airway
For fit and healthy children - quick extractions
