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Paediatrics > Treatment planning for dental care under GA > Flashcards

Treatment planning for dental care under GA Flashcards

1
Q

How many paediatric DGA’s are performed each year in england each year?

A

55,000

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2
Q

How many children are admitted for scheduled DGA in the children’s hospital each year?

A

2000

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3
Q

What age group are people mainly getting DGA’s

A

5-6 years

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4
Q

What is the % of ethnic minority groups in sheffield and what is the % of ethnic minority groups that make up the DGA group?

A

Minority in sheffield = 10% but these make up 28% of DGA group

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5
Q

The majority of children are from families with high levels of deprivation, what does this include?

A

Homes with unempolyed males, overcrowded houses, homes without cars, lack of education

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6
Q

What is the difference in caries experience in patients requiring DGA?

A

Approx 3 times higher

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7
Q

What is the DGA patient profile?

A

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

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8
Q

What is important when treatment planning?

A

Individualised - according to social, medical and OH needs
Holistic
Flexible
Forward planning
Evidence based
Non-authoritarian - patient/guardian ownership woth shared decsion making

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9
Q

Why is treatment planning for a DGA so important?

A

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

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10
Q

What are the different justifications for a DGA

A

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

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11
Q

WWhat are the stages of treatment planning?

A 
history
examination
Special investigations
Diagnosis 
-> further diagnosis 
Treatment plan 
Informed consent, risks, pre-op instructions 
Dental GA
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12
Q

Why take a pre GA assessment?

A

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

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13
Q

What is improtant in the hisory before having the GA?

A

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

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14
Q

What do you look for extra-oral examination?

A

Pyrexia
Swelling
Trismus

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15
Q

What do you look for in the intra-oral examination?

A 
Caries
Restorations
Erosion*
Trauma*
Orthodontic status 
Soft tissue pathology 
Tongue ties 
Mobile teeth
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16
Q

Why may you want to extract A and B?

A

Check for trauma and erosion

If discoloured may want to extract to prevent future problems

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17
Q

What are the different special investigations?

A

Radiograph
Height/weight - BMI
Haematological investigation

18
Q

Why take radiographs for interproximal caries?

A

8x more interproximal carious lesions are detectable by x-rays than by clinical examination alone

19
Q

Why is knowing the BMI important?

A

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

20
Q

Why is haematological investigation important

A

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

21
Q

When may there be alternatives to DGA?

A

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

22
Q

What 3 questions need to be asked before doing the DGA?

A

Is the treatment necessary
Can the treatment be provided without DGA
Is the risk of DGA justified

23
Q

What is the type of GA dictated by?

A 
Facilities available
Waiting lists 
Urgency of need
Medical status
Treatment required
24
Q

What is a short GA?

Who is it for?

A

Non-intubated - have laryngeal mask, dont have throat packed, things can go down the airway
For fit and healthy children - quick extractions

25
Q

What is a long DGA?

A

Intubated

More treatment can involve using the high speed and throat is closed

26
Q

What is a shared GA?

A

Shared with other specialities

If already having a GA can just join with other procedures

27
Q

whare are the failure rates of different procedures under GA?

A 
3% for PMC
2% for vital pulpotomies
13% for fissure sealants 
16% amalgams 
29% tooth coloured restorations 
9% required repeat DGA
28
Q

Why is there caution with pulp therapies in primary teeth?

A

High caries risk children who are irregular attenders with an uncertain prognosis

29
Q

What decisions need to made in treatment planning for children undergoing DGA?

A

Balancing extractions: D and C

D may be balanced in a crowded arch

30
Q

What do you need to think about when extracting second primary molars

A

Dont need to balance but may need to think about space maintenance in suitable patients

31
Q

What is the most important consideration when treatment planning at the 1st DGA?

A

Seeking to minimise the risk of a repeat DGA

32
Q

What are the risk fators for repeat extractions?

What treatment is required for these patients?

A 
Early childhood caries 
Poor attendance 
Dysfunctional chaotic family situation 
Poor compliance with OH and diet 
Radical/aggressive treatment - full coverage restorations and extractions
33
Q

When should the written consent for a DGA be given out?

A

After the parents/legal guardians have had time to reflect on the proposed treatment, should be repeated if time relapse between first signing - invalid after 3 months

34
Q

What should be included in the consent?

A

Itemise specific items of treatment and whether primary or permanent teeth are involved
Definitive plan may depend on EUA and radiographic finding for patient
Parents should understand risk and benefit

35
Q

What is the risk of a serious event in a DGA?

A

1:100,000

36
Q

What is it the duty of the referring dentist to discuss?

A

Risks, benefits and alternatives

37
Q

Ho should the pre-op instructions be given?

A

Written and verbal with help of professional interpreter if necessary
Prevention should be incorporated into the discussion

38
Q

On the day, what should the operator ensure?

A 
DGA is appropriate 
Treatment plan clear and correct 
Informed valid consent obtained 
All records available 
Details of medical status known and anesthetist informed 
Fasting times observed 
Escort requirements are known and observed 
Child fit and well
39
Q

What must the operator have?

A

Child friendly facilities, separate from adult patients, accredited paediatric nurse present

40
Q

What are the patient-reported outcomes following DGA?

A

Parents generally pleased with outcomes and process of care associated with DGA for their child
High level of parental reporting of improvement in child’s quality of life following DGA - more smiling eating and sleeping, improved school preformance

Paediatrics (6 decks)

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