Kim Jieun, Kim Hyuk, Seo Kwang-Suk, Kim Hyun Jeong
Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
J Dent Anesth Pain Med. 2022 Jun;22(3):205-216. doi: 10.17245/jdapm.2022.22.3.205. Epub 2022 May 27.
People with special needs tend to require diverse behavioral management in dentistry. They may feel anxious or uncomfortable or may not respond to any communication with the dentists. Patients with medical, physical, or psychological disorders may not cooperate and therefore require sedation (SED) or general anesthesia (GA) to receive dental treatment. Using the healthcare big data in Korea, this study aimed to analyze the trends of SED and GA in special needs patients undergoing dental treatment. It is believed that these data can be used as reference material for hospitals and for preparation of guidelines and related policy decisions of associations or governments for special needs patients in dentistry.
The study used selected health information data provided by the Korean National Health Insurance Service. Patients with a record of use of one of the eight selected drugs used in dental SED between January 2007 and September 2019, those with International Classification of Diseases-10 codes for attention deficit hyperactivity disorder (ADHD), phobia, brain disease, cerebral palsy, epilepsy, genetic disease, autism, mental disorder, mental retardation, and dementia were selected. The insurance claims data were analyzed for age, sex, sedative use, GA, year, and institution.
The number of special needs patients who received dental treatment under SED or GA from January 2007 to September 2019 was 116,623. Number of SED cases was 136,018, performed on 69,265 patients, and the number of GA cases was 56,308, implemented on 47,257 patients. In 2007, 3100 special needs patients received dental treatment under SED while in 2018 the number of cases increased 6 times to 18,528 SED cases. In dentistry, ADHD was the most common disability for SED cases while phobia was the most common cause of disability for GA. The male-to-female ratio with respect to SED cases was higher for males (M: F = 64.36% : 35.64%).
The application of the SED method and GA for patients with special needs in dentistry is increasing rapidly; thus, preparing guidelines and reinforcing the education and system are necessary.
有特殊需求的人群在牙科治疗中往往需要多样化的行为管理。他们可能会感到焦虑或不适，或者可能对与牙医的任何沟通都没有反应。患有医学、身体或心理障碍的患者可能不配合，因此需要镇静（SED）或全身麻醉（GA）才能接受牙科治疗。本研究利用韩国的医疗大数据，旨在分析接受牙科治疗的特殊需求患者的镇静和全身麻醉趋势。相信这些数据可作为医院的参考资料，以及协会或政府为牙科特殊需求患者制定指南和相关政策决策的依据。
本研究使用了韩国国民健康保险服务提供的选定健康信息数据。选取了2007年1月至2019年9月期间有使用牙科镇静中八种选定药物之一记录的患者，以及患有注意力缺陷多动障碍（ADHD）、恐惧症、脑部疾病、脑瘫、癫痫、遗传疾病、自闭症、精神障碍、智力迟钝和痴呆的国际疾病分类第10版编码的患者。对保险理赔数据进行年龄、性别、镇静剂使用、全身麻醉、年份和机构分析。
2007年1月至2019年9月期间，在镇静或全身麻醉下接受牙科治疗的特殊需求患者有116,623例。镇静病例数为136,018例，涉及69,265名患者，全身麻醉病例数为56,308例，涉及47,257名患者。2007年，3100名特殊需求患者在镇静下接受牙科治疗，而2018年病例数增加了6倍，达到18,528例镇静病例。在牙科领域，ADHD是镇静病例中最常见的残疾类型，而恐惧症是全身麻醉病例中最常见的残疾原因。镇静病例的男性与女性比例中男性更高（男：女 = 64.36% : 35.64%）。
牙科中对特殊需求患者应用镇静方法和全身麻醉的情况正在迅速增加；因此，制定指南并加强教育和制度是必要的。
