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DENTAL TREATMENT UNDER GENERAL ANESTHESIA: AN OVERVIEW OF CLINICAL CHARACTERISTICS OF SPECIAL NEEDS PATIENTS

전신 마취 하 장애인 치과치료에 대한 임상적 고찰

  • Chang, Juhea (Clinic for Persons with Disabilities, Seoul National University Dental Hospital)
  • 장주혜 (서울대학교 치과병원 장애인구강진료실)
  • Received : 2014.10.31
  • Accepted : 2014.12.09
  • Published : 2014.12.31

Abstract

The aim of this study was to analyze the clinical characteristics of patients with cognitive and behavioral impairments receiving dental treatment under general anesthesia (GA-dental treatment). From August 2007 to April 2014, information was collected from 475 patients who received GA-dental treatment at the Clinic for Persons with Disabilities, Seoul National University Dental Hospital. The demographic factors (gender, age, disability, medication, GA history, residency type, caregiver, meal type, oral hygiene maintenance, and cooperation level) and dental status (operating duration, DMFT, malocclusion, periodontal disease, tooth defect, and treatment protocol) of the patients were evaluated. DMFT and malocclusion levels were compared among the patients with ANOVA and Sheffe's post-hoc test, and chi-square test, respectively. The correlation between the demographic characteristics and dental status of the patients were analyzed with the Pearson's correction test. The mean age of the patients was 27.1 (7 - 83) years and they had intellectual disabilities (55.4%), developmental disorders (17.9%), brain disorders (16.6%), neurocognitive disorders (4.6%), or others (5.5%). The mean DMFT (DT) was 8.6 (5.2) with a significant difference among the disability types (p<0.05). The incidence of malocclusion was higher in patients with intellectual disabilities and brain disorders than in the other types (p<0.05). The operation time ($191.4{\pm}91.2min$) was correlated with decayed or endodontically-treated teeth (p<0.05). Special needs patients requiring GA-dental treatment showed unfavorable oral conditions. Dental practitioners experience time restrictions and additional costs under a GA setting. Treatment planning and decision-making can be efficiently facilitated by evaluating the clinical characteristics of the patients.

Keywords

References

  1. Davies R, Bedi R, Scully C : ABC of oral health. Oral health care for patients with special needs. BMJ, 321 : 495-498, 2000. https://doi.org/10.1136/bmj.321.7259.495
  2. Glassman P, Subar P : Planning dental treatment for people with special needs. Dent Clin North Am, 53 : 195-205, 2009. https://doi.org/10.1016/j.cden.2008.12.010
  3. 국가법령정보센터 : 장애인복지법시행규칙.
  4. Salvador-Carulla L, Reed GM, Vaez-Azizi LM, et al. : Intellectual developmental disorders : towards a new name, definition and framework for "mental retardation/intellectual disability" in ICD-11. World Psychiatry, 10 : 175-180, 2011. https://doi.org/10.1002/j.2051-5545.2011.tb00045.x
  5. Ratledge DK, Kidd EA, Beighton D : A clinical and microbiological study of approximal carious lesions. Part 1 : the relationship between cavitation, radiographic lesion depth, the site-specific gingival index and the level of infection of the dentine. Caries Res, 35 : 3-7, 2001. https://doi.org/10.1159/000047423
  6. Ainamo J, Barmes D, Beagrie G, et al. : Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). Int Dent J, 32 : 281-291, 1982.
  7. Jenny J, Cons NC : Comparing and contrasting two orthodontic indices, the Index of Orthodontic Treatment need and the Dental Aesthetic Index. Am J Orthod Dentofacial Orthop, 110 : 410-416, 1996. https://doi.org/10.1016/S0889-5406(96)70044-6
  8. Chang J, Lee JH, Son HH, et al. : Caries risk profile of Korean dental patients with severe intellectual disabilities. Spec Care Dentist, 34 : 201-207, 2014. https://doi.org/10.1111/scd.12047
  9. Chang J, Kim HY : Does caries risk assessment predict the incidence of caries for special needs patients requiring general anesthesia? Acta Odontol Scand, 72 : 721-728, 2014. https://doi.org/10.3109/00016357.2014.898788
  10. Chang J, Patton LL, Kim HY : Impact of dental treatment under general anesthesia on the oral health-related quality of life of adolescents and adults with special needs. Eur J Oral Sci, 122 : 363-371, 2014. https://doi.org/10.1111/eos.12150
  11. Morgan JP, Minihan PM, Stark PC, et al. : The oral health status of 4,732 adults with intellectual and developmental disabilities. J Am Dent Assoc, 143 : 838-846, 2012. https://doi.org/10.14219/jada.archive.2012.0288
  12. Loo CY, Graham RM, Hughes CV. : The caries experience and behavior of dental patients with autism spectrum disorder. J Am Dent Assoc, 139 : 1518-1524, 2008. https://doi.org/10.14219/jada.archive.2008.0078
  13. Gurbuz O, Alatas G, Kurt E, et al. : Oral health and treatment needs of institutionalized chronic psychiatric patients in Istanbul, Turkey. Community Dent Health, 27 : 151-157, 2010.
  14. Anders PL, Davis EL : Oral health of patients with intellectual disabilities : a systematic review. Spec Care Dentist, 30 : 110-117, 2010. https://doi.org/10.1111/j.1754-4505.2010.00136.x
  15. Winter K, Baccaglini L, Tomar S : A review of malocclusion among individuals with mental and physical disabilities. Spec Care Dentist, 28 : 19-26, 2008. https://doi.org/10.1111/j.1754-4505.2008.00005.x
  16. Rada RE : Treatment needs and adverse events related to dental treatment under general anesthesia for individuals with autism. Intellect Dev Disabil, 51 : 246-252, 2013. https://doi.org/10.1352/1934-9556-51.4.246