With about a third of UK 5-yr olds and around 50% of 8 yr. olds have experienced dental caries there is a significant demand for treatment. There is also a well-documented impact on children and their families and their quality of life. Oral health-related quality of life (OHRQoL) is one such measure, which aims to evaluate the impact of oral health on daily life. When the dental treatment required is extensive or behavioural and other techniques fail a general anaesthetic (GA) may be required. Within the UK GA for dental treatment is one of the commonest reasons for a child being admitted to hospital.
The aim of this review was to assess change in OHRQoL in children following treatment under GA for the management of dental caries.
Searches were conducted in the Medline, Scopus and Web of Science databases. Two reviewers independently selected studies and abstracted data with study quality being assessed using the QATSDD (Quality Assessment Tool for Studies of Diverse Design) Sirriyeh et al 2012, which assesses 16 items.
Studies involving dental treatment under general anaesthetic for children aged 16 or under measuring change in OHRQoL were considered. A narrative summary was presented.
- 20 studies described in 22 papers were included.
- Studies were conducted in 14 different countries.
- Sample sizes ranged from 28-353 (median; 88)
- Participant age ranged from 2.3-15.1yrs (mean 4.6yrs)
- 18 studies were prospective longitudinal studies, 1 RCT and one secondary analysis study.
- Most were single-group pre-test–post-test study designs.
- A majority of the studies used self-completed questionnaires.
- There were marked differences in the timing of the questionnaire completion.
- 14 studies reported loss to follow up, this ranged from 0% – 47.8%
- A range of OHRQoL instruments was used
- 9 studies used Early Childhood Oral Health Impact Scale (ECOHIS).
- 1 study used the Child Perceptions Questionnaire (CPQ),
- All the other studies used parent/caregiver reported outcomes, with ECOHIS or the Parental-Caregiver Perceptions of child oral health- related quality-of-life (P-CPQ) questionnaire.
- A majority of studies found a significant change in both overall and subscale OHRQoL scores.
- Some studies found an increase (worse OHRQoL) in some subscale scores.
The authors concluded:-
Heterogeneity of included papers limited the conclusions which could be drawn. Treatment under GA appears to result in overall improvements in proxy-reported OHRQoL; however, there is a need for further high-quality studies employing validated, child-reported measures of OHRQoL.
This review has used a broad search strategy so is likely to have identified a majority of the published literature on this topic. The quality assessment of the studies identified a number of areas of concern including the lack of an explicit theoretical framework underpinning the studies and issues around sample sizes. A majority of the studies also used convenience samples and only one used a control group. As the authors’ note a consecutive sample would be more representative. The authors also point out that only one study used a child-reported measure of OHRQoL noting that it has been shown that parents/ caregivers generally have a low to moderate overall agreement with their child’s ratings. Owing to heterogeneity in the studies a meta-analysis could not be carried out and reviews conclusions are therefore limited.
Knapp R, Gilchrist F, Rodd HD, Marshman Z. Change in children’s oral health-related quality of life following dental treatment under general anaesthesia for the management of dental caries: a systematic review. Int J Paediatr Dent. 2016 Aug 17. doi: 10.1111/ipd.12259. Review. PubMed PMID:27531644.
Dental Elf 23rd Nov 2011
Sirriyeh R, Lawton R, Gardner P, Armitage G. Reviewing studies with diverse designs: the development and evaluation of a new tool. J Eval Clin Pract. 2012 Aug;18(4):746-52. doi: 10.1111/j.1365-2753.2011.01662.x. Epub 2011 Mar 16. PubMed PMID: 21410846.