Tx Planning for GA

Question 1

What is the most common age for DGA?

Answer 1

Mean 5-6years

50% pre-school age

Question 2

What is the most common ethnicity for DGA?

Answer 2

25% London DGA were Asian

High proportion from ethnic minority groups

Question 3

Is deprivation a factor in DGA?

Answer 3

Yes

Majority are from household w/ high level of deprivation

Question 4

What makes a household likely to have high levels deprivation?

Answer 4

Homes unemployed males, overcrowded houses, homes w/o cars

Question 5

What is the caries experience for children undergoing DGA?

Answer 5

3x greater than the norm

see rvc for dmft

Question 6

What is the dental attendance like of those going for DGA?

Answer 6

22% failed turn up pre-GA
16% failed turn up GA
69% failed 6-month recall (38% of those turned up had new carious lesions)

Question 7

What is aim of good tx planning?

Answer 7

Consider short and long term OH - ensure good quality care is received and they reach adulthood w/ good OH, aesthetics, function and positive attitude

Question 8

What are the general principles behind tx planning?

Answer 8

Individual 
Holistic
Flexible
Forward-planning
Evidence based
Non-authoritarian (shared decision making)

Question 9

When can DGA be justified?

Answer 9

Children management problems (can't use other techniques) e.g very young/learning disabilities
Orofacial trauma
Multiple XLA/ quadrant dentistry
Acute facial swelling - LA ineffective 
Medical hx

Question 10

What are the stages prior to GA being carried out?

Answer 10

Hx –> exam –> special investigation –> diagnosis –> tx plan –> informed consent/risk –> pre-op instruction/assessment –> GA carried out

Question 11

Why is pre-GA assessment needed?

Answer 11

Time for family to reflect - does child need this?
Ensure appropriate pre-op instructions given and risk understood
Opportunity behaviour management
Less risk cancelled pt/ problems

Question 12

What hx is vital to obtain?

Answer 12

1. Who attending w/ child - can provide legal consent, do they understand
2. Hx of PC
3. MH/DH/SH

Question 13

Why is BMI important to obtain?

Answer 13

Increased BMI is risk for GA

Pt need longer post-op monitoring (service capacity implications)

Question 14

Why are bloods important?

Answer 14

NICE guidelines - 10% non-white European groups may have haemaglobinopathy

If born Jessops hospital will be screened - can access results
If not need to be tested

Question 15

What questions must be answered before sending child for GA?

Answer 15

1. Is tx necessary? - asymptomatic, arrested, close exfoliation
2. Can tx be provided w/o GA - CBT, inhalation etc.
3. Is risk DGA justified?

Question 16

What are different GA’s available?

Answer 16

Short GA - non-intubated
Long GA - intubated
Shared GA

Question 17

What is the best way to restore teeth under GA?

Answer 17

PMC > multiple surface intra-coronal restorations (29% failure rate)
Anterior restorations have high failure rate
Pulp therapy - not indicated if high caries risk who are irregular attender

Question 18

Should teeth be balanced?

Answer 18

Need to balance XLA C’s
First primary molars (Ds) balanced in crowded arch
Don’t balance E’s

Question 19

What are risk factors for DGAs/ repeat DGAs?

Answer 19

Early childhood caries
Poor attendance
Chaotic family situation
Poor compliance diet/OH

Question 20

How should pre-op risks/ instructions be communicated?

Answer 20

Need to say ‘risk of serious event 1:100,000’
Duty of referring dentist to discuss risks, benefits and alternatives
Both written and verbal

Informed consent vital - needs signing