Goodwin Michaela, Sanders Caroline, Pretty Iain A
The Dental Health Unit School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK.
Centre for Primary Care The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
BMC Oral Health. 2015 Apr 18;15:50. doi: 10.1186/s12903-015-0028-4.
Extensive caries in children can result in a referral for tooth extraction under General Anaesthesia (GA). While there are guidelines for the use of GA within paediatric dentistry this process is ultimately dependent upon the decision making of the treating dentist. This decision can be influenced locally by the availability of services and their waiting list. GA services for paediatric extractions (DGA) have developed from different historical positions, including community dental services, maxillofacial services and paediatric led specialist services.
This article explores the differences between DGA services provided by 6 randomly selected hospitals across the North West of England. 456 patients who attended a routine DGA appointment in each hospital over a period of two months from 2012 to 2013 gave consent to allow access to their clinical notes and completed a questionnaire (93% consent rate). Data were entered onto SPSS and appropriate statistical tests undertaken.
Differences between hospitals included the clinic structure, patient characteristics and the treatment provided. There was a significant difference in the number of previous child DGAs experienced within the family, ranging from 33% to 59% across hospitals. Hospital 1 attendees differed in a number of ways to other areas but notably in the stability of life time residency with 20% of patients having previously lived in another area and with just 58% of parents stating their child regularly attended the dentist (compared to an average of 9% and 81% respectively across other hospitals).
Findings suggest services throughout the region face different obstacles in providing support and treatment for young children referred for DGA. There are, however common practices such as preventative treatment, which could impact on caries experience and subsequent DGA referral, a particular issue given the high DGA repeat rate observed. For many children a DGA may be their first dental experience. It is therefore vital to engage with both child and family at this stage, attempt to initiate a pattern of dental attendance and to ensure this experience does not create an on-going cycle of poor dental behaviour and health.
儿童广泛龋齿可能导致在全身麻醉（GA）下转诊拔牙。虽然在儿童牙科领域有关于使用GA的指南，但这一过程最终取决于主治牙医的决策。该决策可能会受到当地服务可用性及其等候名单的影响。儿童拔牙全身麻醉服务（DGA）源自不同的历史背景，包括社区牙科服务、颌面外科服务以及以儿童为主导的专科服务。
本文探讨了英格兰西北部随机选取的6家医院所提供的DGA服务之间的差异。在2012年至2013年的两个月期间，每家医院456名接受常规DGA预约的患者同意提供其临床记录并完成一份问卷（同意率为93%）。数据录入SPSS并进行了适当的统计测试。
医院之间的差异包括诊所结构、患者特征和所提供的治疗。家庭中之前有儿童接受DGA治疗的数量存在显著差异，各医院之间从33%到59%不等。医院1的就诊者在许多方面与其他地区不同，但尤其在终身居住稳定性方面，20%的患者之前居住在另一个地区，只有58%的家长表示他们的孩子定期看牙医（相比之下，其他医院的平均比例分别为9%和81%）。
研究结果表明，该地区的服务在为转诊接受DGA治疗的幼儿提供支持和治疗方面面临不同障碍。然而，存在一些常见做法，如预防性治疗，这可能会影响龋齿经历及随后的DGA转诊，鉴于观察到的高DGA重复率，这是一个特别的问题。对许多儿童来说，DGA可能是他们的首次牙科经历。因此，在这个阶段与儿童及其家庭建立联系、尝试建立看牙模式并确保这种经历不会导致持续的不良口腔行为和健康循环至关重要。
