To reduce need for anesthesia, increase prevention

By the CDHP team

Though one million children under 4 years old have general anesthesia (GA) for surgery each year, some research has raised questions about its long-term impact on children's development. CDHP recently talked with Courtney Chinn, an associate clinical professor of dentistry at New York University College of Dentistry, for perspective on the use of anesthesia in dental care.

Simply telling a parent or a child that they need to brush more or to stop eating sweets at their dental check up is not enough.

Q: How are anesthesia and sedation used in dental care?
CHINN: Today, a large number of young children are receiving dental procedures under GA or moderate sedation. This approach is often taken when there is a large amount of dental work to be done or when it is not possible to safely perform dental procedures otherwise. GA and moderate sedation allow the dentist to serve families with young children who would otherwise not be treated. However, operating room visits are expensive and carry more risk when compared to traditional treatment performed in a dental office. Placing fillings and/or extracting teeth without addressing the underlying disease process of early childhood caries has a high rate of recurrence. Some studies put this reoccurrence as high as 50-70% within 1-2 years of treatment. 

Q: How is disease prevention addressed during clinical training?
CHINN: Dental professionals have historically been trained to surgically repair teeth. While we have received some training in disease prevention and oral health promotion, the overwhelming majority of our clinical training is spent filling holes in teeth. So there’s a dichotomy there. Dentists need to be able to perform dental procedures in their training, but dental education also needs to include adequate and practical training in disease management. Simply telling a parent or a child that they need to brush more or to stop eating sweets at their dental check up is not enough. As dental professionals, we need to be more expansive, creative, and collaborative in our approach.

Q: Can you explain “disease management” for those that are unfamiliar with the term?
CHINN: Obtaining adequate fluoride, establishing healthy oral health behaviors, and encouraging diet modification are examples of how to manage the disease of Early Childhood Caries (ECC). Many have compared the chronic disease of ECC to having a house that is on fire. Addressing ECC using surgical treatment alone —fillings, root canals, etc.—is like trying to rebuild a house while the fire is still raging. Disease management of ECC is the equivalent of making sure the fire is controlled and extinguished. Once the fire is put out, there may still be the need to rebuild or make esthetic or functional repairs, but the house would be out of immediate threat. Similarly, after ECC is "managed," there may still be remaining white spots or even cavities that may still require surgical repair, even if not progressing or symptomatic.

Q: Dentists aren’t the only people who can help reduce tooth decay so that the need for anesthesia is also reduced. Who else can play supportive roles?
CHINN: You don’t need to be a dentist to promote oral health. This is great news because dentists can work with a lot of other partners, especially those who have expertise in behavioral management, such as community health works, Head Start, social workers, nurses, and physicians. Everyone can play a role in advocating for early dental care visits and treatment. Dentists may find a new role in advising and managing these new partnerships and collaborations.

Dentists will always need to be skilled in filling cavities, but if we can be equally skilled in our non-surgical ability to manage ECC, we may be able to significantly reduce the need for so many visits to the operating room.

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children ages 6-12 suffered a toothache in the previous six months.
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