What is the Recurrence of Caries after Treatment under General Anesthesia?
|Dr. Reza Nouri, Certified Specialist in Pediatric Dentistry in the greater Vancouver area, comes back to present the following topic: the recurrence of early childhood caries after treatment under general anesthesia.|
Early childhood caries (ECC) is the most common chronic childhood disease which involves high expenditures from our healthcare system. Advanced cases of ECC are often treated under general anesthesia (GA) due to the young age of the patient(s). Medical management of these severe cases can cost up to $1400 per patient and this does not address the underlying dental issues.
The CIH reports that approximately one third of day surgeries are related to dental caries and this number only reflects public institutions. If private institutions are included the number of day surgeries associated with ECC increases. Rural communities, families with low socioeconomic status and aboriginal populations have more unmet needs with respect to ECC.
Literature reviews reveal that there is a high relapse rate of caries after comprehensive treatment has been done under GA. The relapse can occur as early as 6 months after treatment was rendered. A retrospective study carried out in Vancouver revealed a much lower relapse rate. It was found that a few factors are significant in determining the long-term success of treatment under GA.
- Health status of patient (ASA I or II)
- Number of teeth present at time of GA (A-D vs. A-E)
- Presence of space maintainer at time of GA or posterior extractions
- Number of recalls
- Emphasize dietary influence on caries. A sip of water after all meals, drinks and snacks can reduce the exposure of teeth to acid.
- More comprehensive consultation with the family to understand their unique situation(s)
- 1st dental examination before the age of 1
- Assess-Treat-Prevent each patient according to the findings
- Educate and collaborate with medical colleagues to assess oral cavity and make appropriate referrals
Management of ECC
- Multidisciplinary approach is key
- Fluoride varnish, SDF to arrest carious lesions
- Management of lesions and hypoplastic teeth with glass ionomer cement restorations
- Stainless steel crowns in more extensive carious lesions
- Extractions with space maintainers, when the caries is extensive and non-restorable