Tratamiento odontológico bajo sedación profunda en una población infantilestudio de cohortes retrospectivo

Abstract

Introduction. Caries is one of the most prevalent non-communicable chronic diseases in child population, that affects directly the quality of life of those whom suffer from it. The treatment of caries lesions, as well as the prevention of the disease, is one of the priorities of our National Health System. These actions are usually carried out in the dental chair but when there are collaboration problems, such as in young children or in patients with special needs, or with anxiety problems, it is necessary to appeal to other types of approaches such as deep sedation. Objective: The general objective of the study was to evaluate the success of dental treatments performed under deep sedation in child population, both healthy and with special needs, as well as the impact of a prevention program on the patient's evolution. Material and methods: A retrospective observational study of treatments performed under deep sedation was carried out for 13 years in a private clinic in Cartagena (Murcia). The sample consisted of 230 children from 2 to 18 years old, both healthy and with special needs. 85 patients conducted a questionnaire on the day of the intervention and one month follow-up to study the impact of oral status on the children's lives. All data was collected in an Excel spreadsheet and statistically analyzed with R version 3.6.0. The influence of the factors age, health status, prevention follow-up, motivation and collaboration were analysed. Results: The main reason for using this type of approach was lack of collaboration in 99.5% of the cases. The group of healthy children presented a greater number of teeth affected by caries than the children with special needs (7.49 ± 4.68 vs. 6.13 ± 4.54) as well as a higher level of pulp involvement (78.90% vs. 57.85%). The 23.91% of the patients required further surgery under deep sedation. Neither the child's initial oral pathology nor the type of treatment performed on the first occasion were predictors of the need for a second sedation. Patients who remained non-cooperative required significantly more second sedations than those who became cooperative (60.9% vs 12.1%). Children with parents motivated in the oral care of their children suffered significantly (p=0.006) fewer second sedations than children with unmotivated parents. 80% of healthy children who undergo prevention follow-up are able to receive surgical treatments while awake, compared to 40.6% of those who do not. Conclusions: Healthy children present more pathology and more severe than children with special needs. The main reason for a second sedation is not the failure of the treatments but the child's persistent inability to collaborate and the appearance of new lesions due to the maintenance of inadequate hygiene and feeding behaviors at home. Prevention follow-up is the key for an early diagnosis of the pathology and, in the case of healthy children, for an adaptation of behavior in the dental chair that allows future treatments with a normal approach. In the case of patients with special needs, attending prevention follow-up does not enable them to receive awake pathology treatments any more than those who do not attend. Patient motivation and the ability to collaborate are two key factors in avoiding reinterventions under deep sedation. Quarterly prevention appointments with motivational interviewing are the best way to achieve the cooperation of parents/guardians and patients.