J Am Dent Assoc. 2024 Sep;155(9):765-773. doi: 10.1016/j.adaj.2024.06.014. Epub 2024 Aug 3.
The aim of this study was to assess factors associated with higher odds of undergoing repeat general anesthesia (GA2) for dental treatments.
The authors studied children up to age 48 months of age enrolled in Medicaid who underwent dental treatment under first general anesthesia (GA1). The authors used a case-control design to compare children who had a GA2 within 48 months of GA1 (case patients) with those who did not (control patients).
In total, 60 case patients were age and sex matched to 120 control patients. Mean (SD) age at GA1 was 38 (5.2) months for case participants and 40 (4.7) months for control participants (P = .08). Higher caries involvement of maxillary incisors (P = .04), and lower caries involvment of canines (P = .003), first molars (P = .012), and second molars (P < .001) at GA1 was associated with higher odds of occurrence of GA2. There was a significant inverse association between full-coverage restoration on canines (P = .003), first molars (P = .001), and second molars (P = .002) at GA1 and occurrence of GA2. There was a significant direct association between the use of composites or sealants on second molars in GA1 and occurrence of GA2 (P = .02). The number of extractions at GA1 was not associated significantly with the occurrence of GA2.
The use of full-coverage restorations on primary molars and canines under general anesthesia (GA) was associated with lower odds of occurrence of GA2. Resin restorations and sealants on primary second molars were associated with higher odds of occurrence repeat GA. The findings support preferential use of full-coverage restorations for young children undergoing dental GA.
Full-coverage restorations should be considered strongly for young children undergoing GA for dental treatments to reduce the risk of requiring GA2.
本研究旨在评估与多次全身麻醉（GA2）行牙科治疗相关的因素。
作者研究了在医疗补助计划下接受首次全身麻醉（GA1）下牙科治疗的 48 个月以下的儿童。作者采用病例对照设计，比较了 GA1 后 48 个月内行 GA2 的儿童（病例组）与未行 GA2 的儿童（对照组）。
共纳入 60 例病例组患儿，与 120 例对照组患儿进行年龄和性别匹配。病例组 GA1 时的平均（SD）年龄为 38（5.2）个月，对照组为 40（4.7）个月（P＝0.08）。GA1 时上颌切牙龋病累及程度较高（P＝0.04），犬牙（P＝0.003）、第一磨牙（P＝0.012）和第二磨牙（P<0.001）龋病累及程度较低，GA2 的发生概率较高。GA1 时犬牙（P＝0.003）、第一磨牙（P＝0.001）和第二磨牙（P＝0.002）全冠修复以及 GA1 时使用复合树脂或窝沟封闭剂与 GA2 的发生呈显著负相关。GA1 时第二磨牙使用复合树脂或窝沟封闭剂与 GA2 的发生呈显著正相关（P＝0.02）。GA1 时的拔牙数量与 GA2 的发生无显著相关性。
全身麻醉下使用恒牙和乳磨牙全冠修复与 GA2 发生的概率较低相关。在乳磨牙第二磨牙上使用树脂修复和窝沟封闭剂与重复 GA 的发生概率较高相关。研究结果支持对接受牙科 GA 的幼儿优先使用全冠修复。
对于接受全身麻醉治疗牙病的幼儿，应强烈考虑使用全冠修复，以降低需要 GA2 的风险。
