Sedation or general anaesthesia for dental treatment in children

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Although dental disease levels have improved significantly in the industrialised nations, it remains a significant problem in the UK with roughly a third of 5-year-olds, having untreated decay in primary teeth. While some children will accept treatment under local anaesthesia, with anxiety and behaviour management many require sedation and/or general anesthesia to have their treatment carried out. The aim of this Cochrane review was to compare the efficiency of sedation versus general anaesthesia (GA) for provision of dental treatment to children and adolescents younger than 18 years.

Methods

Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL); Medline; Embase; SIGLE; LILACS and Institute for Scientific Information (ISI) Web of Science databases with no language restriction. Randomised controlled trials comparing sedative agents versus general anaesthesia in children and adolescents up to 18 years of age undergoing dental treatment were to be considered with data collection and analysis following standard Cochrane Collaboration methods.

Results

The original review identified 16 studies for potential inclusion after searching available databases and screening titles and abstracts but none were eligible. No new studies were identified for the July 2012 update, and while two studies for possible inclusion were identified for this 2015 update, none were found to be eligible.

Conclusions

The authors concluded:

Randomized controlled studies comparing use of dental general anaesthesia versus sedation are needed to quantify differences such as morbidity and cost.

Comments

There have been substantive reductions in the number of general anaesthetics provided for dental treatment in children in the UK over recent decades but it still remains one of the commonest reasons for children to be admitted to hospital. Over the same period there has also been a substantial increase in the amount of sedation provided for children to undergo dental treatment.

While the move from GA to sedation is to be welcomed, it is perhaps surprising that no high quality studies, compared the outcomes of these two approaches, have been carried out. In their discussion, the authors highlight a range of potential outcome variables to be considered in any further studies including common measures of morbidity, patient satisfaction, quality of life and cost.

Links

Ashley PF, Williams CECS, Moles DR, Parry J. Sedation versus general anaesthesia for provision of dental treatment to patients younger than 18 years. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD006334. DOI:10.1002/14651858.CD006334.pub4.

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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