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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.

Highlights

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

Preventing Relapse

  • 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

 

 

 

7 comments

  1. Nice Article! Thank you. I treat a fair number of cases of ECC under general anesthesia at the hospital operating room. The cases can be frustrating because of the relapse. However, we have found that most of the cases have not relapsed. We have found that many if not most of the cases involve someone other than the parents raising the child. We have also found that under these circumstances, an early visit to the dentist is not even on the radar. The families are in crisis. However, by focusing on the prevention of pain when talking to the care giver and not expressing judgement of any kind, there is interest in doing a much better job of home care and it translates to a way better outcome. Having said that, some people (adults) believe it is “normal” for kids to have ECC and there is little we seem to be able to do to reduce the recurrent decay in these cases.

    • Hello Dr. Christensen,

      Thank you for taking the time to leave your comment on Oasis Discussions. Your comment is quite interesting and it actually spurred a few questions:

      • Do you have data that we could share regarding the first point you make: “most cases have not relapsed.” Are there factors/determinants for the non-relapse?
      • You also mention that “most cases involve someone other than the parents raising the child”: can you give us more details about that? Do these kids live in foster care or with a caregiver in their parents’ home?
      • You refer to a very important point: “no judgment.” This is an important detail when communicating with parents or caregivers. Are there other communication tips that you can share with our audience?
      • One item you mention, which really surprised me, “some people (adults) believe it is “normal” for kids to have ECC”: how come? Is it because they think that once children lose their baby teeth the caries will disappear? But isn’t that caries are more than just a disease? It’s a nutritional lifestyle, sometimes it’s a whole way of life for the child, cultural beliefs, social beliefs, bad feeding habits, etc.… can you please comment on that? And how can we counter those beliefs?

      Like I said, you opened up quite a few interesting topics, and I hope we can keep the conversation going.

      Best regards,
      Chiraz Guessaier, CDA Oasis Manager

  2. Chiraz Guessaier, CDA Oasis Manager

    Excellent topic and presentation! Thank you, Dr. Nouri!

    I would like to “re-publish” this presentation for my local dental society’s digital newsletter. I would like to publish the first paragraph and then provide a link to Oasis website for those interested in the rest of the information and video.

    May I have permission to do so and how would you prefer the credits to be presented for Dr. Nouri and for Oasis?

    Dan Jenkins DDS, CDE-AADEJ
    Editor, Tri-County Dental Society, California, USA

    • Hello Dr. Jenkins,

      Thank you very much for taking the time to leave your comment on Oasis and of course for the nice words, we love it when it’s positive feedback 🙂
      On our end, there is no problem, you have our permission since you intend to give credit, which is what we usually request. I will certainly consult with Dr. Nouri and get back to you. I expect it will be ok, but as a courtesy, I will ask him and get back to you.

      Best regards,
      Chiraz Guessaier, CDA Oasis Manager

  3. Can you clarify what “relapse” means? Is it failure of the restorations placed or new caries? Certainly, one would expect more caries if there is no education/preventive measures undertaken concurrent with the treatment under GA.

    Like Dr. Christensen, I also treat children under GA bi-weekly and I can say that ECC is very much a disease that concentrates on the lower economic strata – I would say that well over 90% of the children I treat are covered by some kind of government funded program.

    David Rose
    Owen Sound, Ontario

    • thank you for your interest, David.
      “relapse” in this study referred to recurrence of disease (i.e. Caries).
      As discussed in the presentation, the lower socioeconomic classes tend to suffer from ECC and its relapse more frequently.
      best wishes,
      Reza Nouri

  4. Dr.Steven Fremeth

    Having provided dental treatment using a general anesthetic provided by a pediatric anesthesiologist for 40 years , I feel more than qualified to relate my experience. On average I’ve treated about 400 young and very young children per year. Success depends on the type of approach I ‘ve taken in treating these primary teeth. Over the years, I’ve come to use more and more stainless steel crowns. The success is 100%. For ssc’s . I also take the approach that if the success in treating a particular is questionable, I extract it…again 100% success. I always assume that the parents won’t take better care of the child’s teeth than before. Given the number of cases I do per year, I am not swamped with failures. In fact, I cannot remember having to deal with a post-op failure. The failures I see are caries in teeth which had not yet erupted,such as the first permenant molars. The failures I see from other practionners treating patients in the OR, are those who do not follow my aggressive approach. I don’t want to be cynical but they may be trying to meet the parents’ idea of a treatment plan or worse, trying to maximize financial return. My 2 cents…I could write a lot more but enough for now.

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