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Dental profiles and general features of referred and under GA treated children in Germany

  • Background: Referral to specialized pediatric treatment seems to rise in Germany, especially for children under 5 years of age and mostly due to behaviour management problems, rampant caries and the need for comprehensive dental treatments. There are indications that more dental treatments under general anesthesia were needed in last decade, but there are very few studies on this topic in Germany. Aim: The objectives of this research were to investigate the characteristics and dental features of referred children to Greifswald university dental clinic in 2008 and 2011 as well as to assess dental treatment and characteristics of the children who underwent general anesthesia in 2011 at Greifswald University Clinic in comparison with three specialized pediatric private practices in Germany. Materials and methods: This retrospective analytical comparative study examined the records of all children younger than 18 years of age, whose were referred to the university dental clinic in Greifswald between 2008 and 2011. In addition, all cases that underwent general anesthesia at the university dental clinic and three other private practices in 2011 were analyzed anonymously. All data including age, gender, dental status and caries levels (dmft/DMFT), as well as diagnosis, referral/GA reasons and the dental treatments were collected and then analyzed using the Statistical Package for the Social Sciences program (SPSS, Ver. 16 for Windows). Descriptive analysis was performed, along with univariate analysis of variance (ANOVA) and Chi square tests. Differences between groups were tested through Mann-Whitney U test and Student’s t-test as appropriate. Results: The final study sample for children and adolescents referred to the university consisted of 389 under 18 years old (205 males and 184 females) with a mean age of 8.75 years in 2008 and 7.38 years in 2011. In addition, 297 children (160 males and 137 females) with a mean age of 4.77 years had been treated under general anesthesia in the three specialized private practices (n= 219, age: 4.81±2.06 years) and in the university (n=78, age: 4.65±2.59 years). More patients of age group 1 (5 yrs or younger), as well as, patients residing within a distance of 31-40 km away from the clinic were referred in 2011 (47.2% and 35.9% resp.) in comparison with 2008 (37.1% and 22.7% resp.) Panoramic and intraoral dental x-rays (46.7%, 11.8% resp.) have been widely carried out in 2011 compared to 2008 (29.9%, 6.5% resp. P = 0.002). Statistical analyses have shown that, younger children with higher values of dental caries indices (dmft, DMFT) were referred in 2011 (5.4 and 2.15 resp.) than in 2008 (5.16 and 1.57 resp.) with increasing demand for comprehensive dental treatment under GA. Whereas, more patients were diagnosed to have rampant caries (42.1%) in 2011 followed by orthodontic/oral surgery problems (16.9%) in comparison with 2008 (29.3%, 10.1% resp. P < 0.001). Non-invasive treatment was much more delivered (63%) in first dental visit for referred patients in 2011 followed by dental consultation (23.6%) compared to 2008 (53.6% and 21.3% resp.). While, on the other hand, considerably more fillings were supplied in 2008 (11.5%) compared to 2011 (2.6%). Further dental treatment pattern revealed more treatment under GA (27%) and a slightly more extractions (16.1%) were done in 2011 compared to 2008 (20.9%, 15.5% resp.). On the contrary, less fillings and preventive procedures were performed in 2011 (26.3% and 4.4% resp.) in comparison with 2008. Sixty-one percent of children were referred back to their family dentists in 2011 which was more than it in 2008. Indeed, about a half of children aged 5 years or younger preferred to stay at the University Clinics in 2011, while, the vast majority of children older than 12 years continued their dental care outside the University Clinics. About eighty percent and seventy percent of children underwent GA at both the university clinics and private practices respectively were under five years old. In total 7.1% mental disabilities and 2.4% preterm birth were detected in children treated under GA, as well as, dental caries were mostly diagnosed (37%) among them followed by irreversible pulpitis (21.5%) and Early Childhood Caries (ECC) (18.5%), where only 4.38% of all examined children had no carious lesions. More panoramic radiographs (41%) and less dental films (26.9%) were conducted at the university clinics as in the private practices (15.1% and 52.1% respectively) with a significant reduction in using x-rays at the university (69.2%) compared to private practices (94.1%). Dental extractions were often performed at university clinic (40.2%, 3.14±2.4) followed by fillings (33.9%, 2.65±2.7), while, more restorations and less extractions were supplied at private practices (47.8%, 5.47±3.1 and 16.3%, 1.86±2 resp.). Both of long (106-120 Min) and short (0-15 Min) treatment’s durations were needed in the university clinics to carried out the adequate dental therapy under GA, while, most of the GAs at private practices have lasted between 45 and 90 minutes. Conclusion: There is a growing definite need for specialized pediatric dentistry in Germany, especially for children under 5 years of age being referred with rampant caries and behaviour management problems to specialized pediatric dentistry. This results in a high number of extensive treatment performed under GA. In contrast to other countries, this seems to be a singular event for most children in Germany indicating a solid treatment under GA and possibly also improvements in the caries activity of the affected children afterwards. The range of dental treatment and its outcome at Greifswald University and in the examined three specialized private practices is very similar reflecting in both the profile of the children a valid indication for GA and the subsequent treatment up to date approaches in pediatric dentistry. Thus, the very professional treatment and effective secondary preventive strategies achieve better oral health and reestablished quality of life for these children, but a primary preventive approach would be preferable decreasing the number of children in need of dental treatment under general anaesthesia.
  • Trotz des Kariesrückgangs in letzten Jahren werden steigende Zahlen von Patienten mit ECC beschrieben und auch die Anzahl der Narkosesanierungen bei Kindern nimmt zu. Es liegen zur Struktur der spezialisierten Kinderbehandlung wenig wissenschaftliche Untersuchungen vor. Ziel dieser Studie war es, das Profil der zahnmedizinischen Versorgung und Strukturen der überwiesenen und unter ITN behandelten Kinder zu bestimmen. Es wurden alle Patienten unter 18 Jahren, die in den Jahren 2008 und 2011 von niedergelassenen Zahnärzten überwiesen und 2011 unter Narkose behandelt wurden, aus dem Datensystem des ZZMK/Universität Greifswald retrospektiv ermittelt. Außerdem wurden die Daten der Narkosesanierungen aus 3 Kinderzahnarztpraxen ausgewertet. Die Überweisungen an die Zahnklinik (n = 389) zeigten eine Altersverschiebung von den 12- bis 17-Jährigen (2008) mit erheblicher Anzahl von Begründungen „ausgedehnte Karies“ und „Extraktionen“ (14,8%, 11,6%) hin zu den 1– bis 5-Jährigen (2011) mit Nachfrage zur „ITN“ und KFO/MKG (17,9%, 16,4%). Die Gründe für Narkosesanierungen in der Zahnklinik (n = 78) waren vor allem hoher Kariesbefall (47,4%), irreversible Pulpitiden (19,2%) und ECC (14,1%) und entsprachen den Mustern in den Praxen (n = 219) mit ausgedehnter Karies (33,3%), irreversiblen Pulpitiden (22,4%) und ECC (20,1%). Während die durchschnittlichen Narkosebehandlungen pro Kind in der Zahnklinik 3,14 Extraktionen, 2,65 Füllungen, 0,62 endodontische Behandlungen und 1,08 Stahlkronen umfassten, waren sie in den spezialisierten Praxen 1,86, 5,47, 1,31 und 1,80 jeweils. Schlussfolgerungen: Die Polarisation des Kariesbefalls führt zu einem erkennbaren Bedarf an spezialisierter Kinderzahnheilkunde, wobei die Erkrankungs- und Behandlungsmuster in der Universität Greifswald und 3 spezialisierten Praxen sehr ähnlich waren.

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Author: Moutaz Takriti
Title Additional (German):Zahnstatus und allgemeine Charakteristik der überwiesene und in der Narkose behandelten Kinder in Deutschland
Advisor:Prof. Dr. Anahita Jablonski-Momeni, Prof. Dr. Christian Splieth
Document Type:Doctoral Thesis
Date of Publication (online):2016/11/01
Granting Institution:Ernst-Moritz-Arndt-Universität, Universitätsmedizin (bis 31.05.2018)
Date of final exam:2016/10/05
Release Date:2016/11/01
Tag:Children, Dental profiles, General Anesthesia, Germany, Referred
GND Keyword:Deutschland, Kinder, Narkose, Zahnstatus
Faculties:Universitätsmedizin / Poliklinik für Kieferorthopädie, Präventive Zahnmedizin und Kinderzahnheilkunde
DDC class:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin und Gesundheit