Savanheimo Nora, Vehkalahti Miira M
Institute of Dentistry, University of Helsinki, Helsinki, Finland.
Int J Paediatr Dent. 2008 Mar;18(2):117-23. doi: 10.1111/j.1365-263X.2007.00858.x.
In Helsinki Public Dental Service (PDS) the Special Oral Health Care Unit (SOHCU) provides comprehensive dental treatments under general anaesthesia (GA). For the present study, all dental treatment given under GA for generally healthy children (n = 102) below 16 years of age (range 2.3-15.8) during a 1-year period and dental treatment and visits of these children in the preceding 2 years in Helsinki PDS was recorded in detail. These children were referred to the SOHCU because of serious difficulties in dental care due to large treatment needs or failures in psychological and chemical management, including sedation.
To describe treatments given to generally healthy children under GA and to evaluate preventive aspects of their dental care in the preceding 2 years.
The study was cross-sectional and retrospective. Data came from the patients' individual records.
Treatments under GA included an average of 6.0 restorations (SD = 2.7, range 0-12) and 1.7 extractions (SD = 2.1, range 0-10). In the 2 preceding years, these children had visited dentist an average of 5.1 times (SD = 2.7, range 1-14) with an average of 2.4 restorations (SD = 1.9, range 0-12) and 0.5 extractions (SD = 1.4, range 0-10). Of the restorations made, 36% were temporary. Of all visits, those with an operative approach accounted for 35%, preventive for 37%, operative and preventive for 5%, and visits with total uncooperation for 23%. Of the children, 90% had at least one preventive visit. Children treated under conscious sedation in the preceding 2 years received less prevention (P = 0.02). Remaining without preventive measures was most likely for those children exhibiting visits with total uncooperation (odds ratio = 4.6; P = 0.004) and for those receiving numerous temporary fillings (odds ratio = 4.1; P = 0.0005).
The uncooperative high-caries children pose a demanding challenge to PDS. The early identification of high-caries risk and efforts of intensive preventive care are in key position to reduce the number of children receiving treatment under GA due to high levels of dentinal decay.
在赫尔辛基公共牙科服务中心（PDS），特殊口腔保健科室（SOHCU）在全身麻醉（GA）下提供全面的牙科治疗。在本研究中，详细记录了在1年期间内在全身麻醉下接受治疗的16岁以下（年龄范围2.3 - 15.8岁）的一般健康儿童（n = 102）的所有牙科治疗情况，以及这些儿童在赫尔辛基PDS之前两年的牙科治疗和就诊情况。这些儿童因治疗需求大或心理及化学管理（包括镇静）失败导致牙科护理严重困难而被转诊至SOHCU。
描述在全身麻醉下给予一般健康儿童的治疗，并评估他们在前两年牙科护理的预防方面。
本研究为横断面回顾性研究。数据来自患者的个人记录。
全身麻醉下的治疗平均包括6.0次修复（标准差 = 2.7，范围0 - 12）和1.7次拔牙（标准差 = 2.1，范围0 - 10）。在前两年，这些儿童平均看牙医5.1次（标准差 = 2.7，范围1 - 14），平均有2.4次修复（标准差 = 1.9，范围0 - 12）和0.5次拔牙（标准差 = 1.4，范围0 - 10）。所做的修复中，36%是临时修复。在所有就诊中，采用手术方法的占35%，预防性就诊占37%，手术和预防性就诊占5%，完全不合作的就诊占23%。这些儿童中，90%至少有一次预防性就诊。在前两年接受清醒镇静治疗的儿童预防措施较少（P = 0.02）。完全不合作就诊的儿童（优势比 = 4.6；P = 0.004）以及接受大量临时补牙的儿童（优势比 = 4.1；P = 0.0005）最有可能没有采取预防措施。
不合作的高龋儿童给PDS带来了严峻挑战。早期识别高龋风险并加强预防护理工作对于减少因牙本质龋坏严重而在全身麻醉下接受治疗的儿童数量至关重要。
