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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 46-49

A comparative assessment of the changes in quality of life of children with severe early-childhood caries following comprehensive oral rehabilitation treated with or without General Anesthesia


1 Dental Centre, INHS Sanjivani, Naval Base, Kochi, Kerala, India
2 Army Dental Centre (Research and Referral), New Delhi, India

Date of Web Publication29-Aug-2019

Correspondence Address:
Surg Cdr (Dr) Akshai Kannan
INHS Sanjivani, Naval Base, Kochi 682004, Kerala.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_24_19

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  Abstract 

Background: The negative impact of early-childhood caries (ECC) on Oral-Health-related quality of life (OHRQoL) is already known. When total oral rehabilitation is impossible with nonpharmacological management techniques, dental treatment under conscious sedation/general anesthesia (GA) is considered. Objectives: The aim of this study was to compare the changes in quality of life of children with severe ECC after treatment with or without GA. Materials and Methods: Study group included 22 children with severe ECC who were treated by pedodontic team of our institute with or without GA. A questionnaire consisting of 11 questions on OHRQoL were administered to the parents based on a three point Likert scale. Results: Statistical analysis using the chi-squared (χ2) test showed significant association with relation to diet with children in the non-GA group. There was also a significant association in relation to chewing with children in the non-GA group. Conclusion: Dental rehabilitation under GA should be the modality to treat children not manageable with nonpharmacologic methods. The non-GA management of children could be an effective method to provide treatment and reduce costs and anxiety to the parents.

Keywords: ECC, GA, Likert scale, OHRQoL, restorative dentistry oral rehabilitation


How to cite this article:
Chengappa D, Kannan A, Jain P, Ghavri T. A comparative assessment of the changes in quality of life of children with severe early-childhood caries following comprehensive oral rehabilitation treated with or without General Anesthesia. Int J Oral Care Res 2019;7:46-9

How to cite this URL:
Chengappa D, Kannan A, Jain P, Ghavri T. A comparative assessment of the changes in quality of life of children with severe early-childhood caries following comprehensive oral rehabilitation treated with or without General Anesthesia. Int J Oral Care Res [serial online] 2019 [cited 2019 Sep 21];7:46-9. Available from: http://www.ijocr.org/text.asp?2019/7/2/46/265815




  Introduction Top


Oral diseases are the most widespread of the chronic diseases and are a cause of major public health problems worldwide because of their prevalence, impact on individuals, society, and the expenditure on treatment. In children, dental caries represents the most common chronic disease. Early-childhood caries (ECC) is a term used to describe dental caries affecting several deciduous teeth, especially the maxillary incisors in the preschool child. The negative impact of ECC is the detrimental effect on the quality of life of afflicted children.[1] In recent years, the focus of dental research has shifted from the cause of dental diseases to how these diseases affect the general health of children. Oral-health-related quality of life (OHRQoL) is an important aspect of general health, which covers various domains such as functional limitations, diet, and pain, and the impact this has on social and emotional well-being and growth of the child.[2] A majority of children suffering from severe ECC can be treated using routine restorative procedures in conjunction with behavior management techniques. However, this may not be possible in children with severe behavioral problems and they may require management under general anesthesia (GA).[3],[4] This study was conducted to compare the changes in quality of life in children who required extensive oral rehabilitation subsequent to treatment in the clinic without GA with those who required similar treatment under GA.


  Materials and Methods Top


Source of data

A study of children with severe ECC who underwent dental rehabilitation at our institute in the past 1 year comprising a group of 11 children who were treated under GA and 11 children who were treated without GA.

Materials

A questionnaire for assessment of improvement of quality of life subsequent to comprehensive dental rehabilitation with or without GA was administered to the parents [Figure 1]. The questionnaire had 11 questions organized into the following domains:
Figure 1: OHRQoL questionnaire administered to the parents

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  1. Duration of the problem (n = 1)
  2. Disturbance in chewing (n = 1)
  3. Changes in sleep pattern (n = 1)
  4. Pain (n = 1)
  5. Diet (n = 3)
  6. Weight changes (n = 2)
  7. Appearance and overall health (n = 2)
Pretesting of the questionnaire was performed for readability, comprehension, and ease of administration in a study. This was conducted by administering the questionnaire to parents coming to the Dental Centre, INHS Sanjivani, for routine treatment of their children. A single interviewer administered the questionnaire and conducted a qualitative interview of the parent to ascertain the ease of understanding of the questions and their response and to validate the questionnaire.

Method

The data from the records were scrutinized and the parents and children were called for administration of the questionnaires. The parents were informed about the study and informed consent was taken. Questionnaires [Figure 1] were administered to the parents of children with severe ECC who underwent dental rehabilitation with or without GA. The same examiner introduced the questionnaire to all the participant parents. The participants were asked to rate the importance and frequency of 11 questions on a three point Likert scale. The questions dealt with changes in quality of life of the child after treatment ranging from issues such as duration of the problem, disturbance in chewing, changes in sleep pattern, pain, diet, weight changes, appearance, and overall health. The weight of the children was taken and weight gain was recorded in relation to pretreatment records. The score was calculated for each item on the questionnaire and the score of the two groups, i.e. children with severe ECC treated under GA and those treated without GA in the clinic were compared using the chi-squared (χ2) test. The null hypothesis was considered when there was no significant association between the two groups and the alternate hypothesis was considered when there was significant association between the two groups. The level of significance was kept at α = 0.05.


  Results Top


The parents or caregivers of 22 children participated in the study. The GA group consisted of 11 children with the mean age group of 6.22 years. The non-GA group consisted of 11 children with the mean age group of 5.90 years. A questionnaire consisting of 11 questions was administered to each participant over the telephone. The questions dealt with the changes in quality of life of the child before and after treatment. Complaints of pain, problems with eating and chewing, and weight showed significant improvements in both groups. The before and after weights within each group was compared using the Paired t-test and the weight gain in both the groups was found to be statistically significant[19] [Figure 2]. The statistical analysis using the chi-squared (χ2) test showed significant association with relation to diet with more number of children in the non-GA group showing significant improvement [Figure 3]. The analysis also showed that there was a significant association with relation to chewing with more number of children in the non-GA group [Figure 4]. About 45.45% parents were concerned with the cost of treatment and were anxious about subjecting their child to treatment under GA. Although in the non-GA group, 36.36% of parents expressed anguish over multiple visits for treatment and difficulty in managing the child on the chair and about 27.27% of parents did not go for treatment of the child under GA due to the cost.
Figure 2: Mean weight (kilograms) before and after treatment

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,
Figure 3: Change in diet pattern after treatment

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,
Figure 4: Improvement in chewing pattern after treatment with or without GA

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  Discussion Top


The quality of life of children can be seriously affected by severe ECC because of pain, disfigurement, eating and sleep disruptions, and acute and chronic infections that carry a risk of hospitalization with high treatment costs leading to loss of school days and diminished ability to learn.[1],[2] Most children with this condition can be managed in the clinic with behavior management techniques to carry out the treatment. However, this may not be possible in some, and dental treatment under GA has to be considered. Before GA can be justified, however, all other behavior management options must be considered and ruled out. The reasons for choosing GA include the need for extensive treatment or behavioral management problems (e.g., due to very young age, or because the child is medically and/or developmentally compromised).[3] An assessment of quality of life subsequent to the completion of treatment of a child is important for health care providers as a measure to assess the quality of their clinical practice.[5],[6] The main aim of this study was to compare improvement in quality of life of children suffering from severe ECC after treatment under either GA in a single visit or in the clinic with multiple visits using behavior management techniques.[7],[9] The study also aimed to identify parental perceptions and concerns toward treatment of their children.[10],[11] The results of this study showed no statistically significant association between the two groups as far as pain, types of food items eaten, changes in sleep pattern, and changes in appearance were concerned.[12],[13] Some parents expressed reservations with respect to treatment under GA due to cost and anxiety related to the treatment modality. All participants expressed an overall improvement in quality of life of the child after treatment in either group with improvement in parameters such as pain reduction, chewing, diet, weight gain, appearance, and mingling with other children.[14] The pretreatment and posttreatment parameters, especially weight gain, was found to be statistically significant.[15] The improvement in the chewing pattern especially in the non-GA group[16] could be attributed to the settling of the occlusion that took place between appointments. Both GA and non-GA treatment modalities were accepted by the parents with few expressing reservations with regard to cost and anxiety in the GA group and few expressing reservations with respect to multiple visits and difficulty in managing the child on the chair in the Non GA group.


  Conclusion Top


The treatment of children in a single session under GA brought about significant improvement in quality of life of the children.[17],[18],[19] However, those treated without GA in multiple visits in the clinic also showed improvement in quality of life and were better off than the GA group in some parameters. There was not much difference in most parameters of OHRQoL among the two groups. The majority of parents reported a high degree of satisfaction with the care received in both groups.

Acknowledgement

The authors would like to thank the Department of Anaesthesia, INHS Sanjivani, for their kind cooperation and assistance in the conduct of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Martins-Júnior PA, Vieira-Andrade RG, Corrêa-Faria P, Oliveira-Ferreira F, Marques LS, Ramos-Jorge ML Impact of early childhood caries on the oral health-related quality of life of preschool children and their parents. Caries Res 2013;47:211-8.  Back to cited text no. 1
    
2.
Jankauskiene B, Narbutaite J Changes in oral health-related quality of life among children following dental treatment under general anaesthesia. A systematic review. Stomatologija 2010;12:60-4.  Back to cited text no. 2
    
3.
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4.
Baens-Ferrer C, Roseman MM, Dumas HM, Haley SM Parental perceptions of oral health-related quality of life for children with special needs: impact of oral rehabilitation under general anesthesia. Pediatr Dent 2005;27:137-42.  Back to cited text no. 4
    
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Omar J, Yunus Nahar NN, Thevadoss P Clinical practice guidelines in management of severe early childhood caries. Ministry of Health Malaysia; 2005.  Back to cited text no. 5
    
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Ijbara M An assessment of comprehensive dental treatment provided under general anaesthesia at tygerberg oral health centre. University of the Western Cape; 2006.  Back to cited text no. 6
    
7.
Holly Portwood A, Thikkurrissy S, Casamassimo P Early childhood caries under general anaesthesia: a Burden Analysis. The Ohio State University; 2010.  Back to cited text no. 7
    
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Klaassen MA, Veerkamp JS, Hoogstraten J Dental treatment under general anaesthesia: the short-term change in young children’s oral-health-related quality of life. Eur Arch Paediatr Dent 2008;9:130-7.  Back to cited text no. 8
    
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Jankauskiene B, Narbutaite J Changes in oral health-related quality of life among children following dental treatment under general anaesthesia. A systematic review. Stomatologija 2010;12:60-4.  Back to cited text no. 9
    
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Amin MS, Bedard D, Gamble J Early childhood caries: recurrence after comprehensive dental treatment under general anaesthesia. Eur Arch Paediatr Dent 2010;11:269-73.  Back to cited text no. 10
    
11.
Acs G, Pretzer S, Foley M, Ng MW Perceived outcomes and parental satisfaction following dental rehabilitation under general anesthesia. Pediatr Dent 2001;23:419-23.  Back to cited text no. 11
    
12.
Malden PE, Thomson WM, Jokovic A, Locker D Changes in parent-assessed oral health-related quality of life among young children following dental treatment under general anaesthetic. Community Dent Oral Epidemiol 2008;36:108-17.  Back to cited text no. 12
    
13.
Gaynor WN, Thomson WM Changes in young children’s OHRQoL after dental treatment under general anaesthesia. Int J Paediatr Dent 2012;22:258-64.  Back to cited text no. 13
    
14.
Jankauskiene B, Virtanen JI, Kubilius R, Narbutaite J Oral health-related quality of life after dental general anaesthesia treatment among children: a follow-up study. BMC Oral Health 2014; 14:81.  Back to cited text no. 14
    
15.
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 2017;27:302-12.  Back to cited text no. 15
    
16.
Arrow P, Klobas E Child oral health-related quality of life and early childhood caries: a non-inferiority randomized control trial. Aust Dent J 2016;61:227-35.  Back to cited text no. 16
    
17.
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 2014;122:363-71.  Back to cited text no. 17
    
18.
Jankauskiené B, Virtanen JI, Narbutaité J Follow-up of children’s oral health-related quality of life after dental general anaesthesia treatment. Acta Odontol Scand 2017;75:255-61.  Back to cited text no. 18
    
19.
Sachdev J, Bansal K, Chopra R Effect of comprehensive dental rehabilitation on growth parameters in pediatric patients with severe early childhood caries. Int J Clin Pediatr Dent 2016;9:15-20.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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