Dental treatment under general anesthesia for patients with severe disabilities

Patients with disabilities have difficulties tolerating in-office dental treatment due to limitations relating to cooperation and/or physical problems. Therefore, they often require general anesthesia or sedation to facilitate safe treatment. When deciding on dental treatment under general anesthesia, the plan should be carefully determined because compared to general patients, patients with disabilities are more likely to experience anesthetic complications because of their underlying medical conditions and potential drug interactions. Clinicians prefer simpler and more aggressive dental treatment procedures, such as extraction, since patients with impairment have difficulty maintaining oral hygiene, resulting in a high incidence of recurrent caries or restorative failures. This study aimed to review the available literature and discuss what dentists and anesthesiologists should consider when providing dental treatment to patients with severe disability under general anesthesia.

[1]  A. Wiegand,et al.  Survival of direct composite restorations placed under general anesthesia in adult patients with intellectual and/or physical disabilities , 2021, Clinical Oral Investigations.

[2]  W. Hopfenmüller,et al.  Outpatient, dental care of adult vulnerable patients under general anaesthesia—a retrospective evaluation of need for treatment and dental follow-up care , 2020, Clinical oral investigations.

[3]  I. Nitschke,et al.  Outpatient dental care for people with disabilities under general anaesthesia in Switzerland , 2020, BMC oral health.

[4]  D. Ziebolz,et al.  Preoperative Dental Examination Might Prevent Unnecessary Tooth Extractions During Dental Treatment of Patients with Disabilities Under General Anaesthesia - Results of a Retrospective Cross-Sectional Study. , 2020, Oral health & preventive dentistry.

[5]  H. Akpinar Evaluation of general anesthesia and sedation during dental treatment in patients with special needs: A retrospective study , 2019, Journal of dental anesthesia and pain medicine.

[6]  J. Limeres,et al.  The effect of dentist experience on the treatment of individuals with disability under general anesthesia. , 2019, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[7]  H. Dumfahrt,et al.  Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12 years , 2019, Clinical Oral Investigations.

[8]  Hae-Young Kim,et al.  Periapical Healing in Single‐visit Endodontics under General Anesthesia in Special Needs Patients , 2019, Journal of endodontics.

[9]  Juhea Chang,et al.  Analysis of the effect of oral midazolam and triazolam premedication before general anesthesia in patients with disabilities with difficulty in cooperation , 2018, Journal of dental anesthesia and pain medicine.

[10]  T. Miyawaki,et al.  Intellectual disability is a risk factor for delayed emergence from total intravenous anaesthesia , 2018, Journal of intellectual disability research : JIDR.

[11]  Tony Charman,et al.  Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology , 2018, Journal of psychopharmacology.

[12]  Yong-Suk Choi,et al.  Prognosis following dental implant treatment under general anesthesia in patients with special needs , 2017, Journal of dental anesthesia and pain medicine.

[13]  Hyun Jeong Kim,et al.  Prognosis after treatment with multiple dental implants under general anesthesia and sedation in a cerebral palsy patient with mental retardation: A case report , 2017, Journal of dental anesthesia and pain medicine.

[14]  M. S. Moreira,et al.  Endodontic Treatment in Single and Multiple Visits: An Overview of Systematic Reviews , 2017, Journal of endodontics.

[15]  G. Borromeo,et al.  The use of general anesthesia to facilitate dental treatment in adult patients with special needs , 2017, Journal of dental anesthesia and pain medicine.

[16]  G. De-Deus,et al.  Strength of recommendation for single‐visit root canal treatment: grading the body of the evidence using a patient‐centred approach , 2017, International endodontic journal.

[17]  J. Chang,et al.  Prognostic factors of single‐visit endodontic and restorative treatment under general anaesthesia for special needs patients , 2017, Journal of oral rehabilitation.

[18]  S. Sacoor Anaesthesia and Sedation for the Autistic Patient. , 2017, SAAD digest.

[19]  S. Mallineni,et al.  Dental treatment under general anesthesia for special-needs patients: analysis of the literature. , 2016, Journal of investigative and clinical dentistry.

[20]  Lisa V Buda Ensuring Maintenance of Oral Hygiene in Persons with Special Needs. , 2016, Dental clinics of North America.

[21]  Suchita A. Joshi,et al.  Delayed recovery from anesthesia: A postgraduate educational review , 2016, Anesthesia, essays and researches.

[22]  H. Niwa,et al.  Premedication with midazolam in intellectually disabled dental patients: Intramuscular or oral administration? A retrospective study , 2016, Medicina oral, patologia oral y cirugia bucal.

[23]  T. H. Ferreira-Vieira,et al.  Alzheimer's Disease: Targeting the Cholinergic System , 2016, Current neuropharmacology.

[24]  M. Durmus,et al.  Retrospective Evaluation of Dental Treatment under General Anaesthesia. , 2015, Turkish journal of anaesthesiology and reanimation.

[25]  K. Seo,et al.  Immediate implant placement for schizophrenic patient with outpatient general anesthesia , 2015, Journal of dental anesthesia and pain medicine.

[26]  T. Miyawaki,et al.  Independent predictors of delay in emergence from general anesthesia. , 2015, Anesthesia progress.

[27]  T. Miyawaki,et al.  Independent Factors Affecting Recovery Time After Sedation in Patients with Intellectual Disabilities , 2015, The open dentistry journal.

[28]  Kentaro Ouchi,et al.  Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study , 2015, BMC Anesthesiology.

[29]  A. Loundou,et al.  Effect of sedative premedication on patient experience after general anesthesia: a randomized clinical trial. , 2015, JAMA.

[30]  Hae-Young Kim,et al.  Does caries risk assessment predict the incidence of caries for special needs patients requiring general anesthesia? , 2014, Acta odontologica Scandinavica.

[31]  E. Frost,et al.  Differential diagnosis of delayed awakening from general anesthesia: a review. , 2014, Middle East journal of anaesthesiology.

[32]  T. Tsumoto,et al.  Curtailing Effect of Awakening on Visual Responses of Cortical Neurons by Cholinergic Activation of Inhibitory Circuits , 2014, The Journal of Neuroscience.

[33]  Hae-Young Kim,et al.  Caries risk profile of Korean dental patients with severe intellectual disabilities. , 2014, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[34]  F. Silvestre,et al.  Hospital dental practice in special patients , 2013, Medicina oral, patologia oral y cirugia bucal.

[35]  G. Carlsson,et al.  Treatment with implant-supported fixed dental prostheses in patients with congenital and acquired neurologic disabilities: a prospective study. , 2013, The International journal of prosthodontics.

[36]  C. Eyigor,et al.  Tracheal intubation in intellectually disabled patients: Clinical usefulness of remifentanil and sevoflurane without a muscle relaxant , 2013, The Journal of international medical research.

[37]  R. Rada Treatment needs and adverse events related to dental treatment under general anesthesia for individuals with autism. , 2013, Intellectual and developmental disabilities.

[38]  A. Čelebić,et al.  Changes of the dental service delivered to patients with intellectual disability under general anaesthesia in Dental Polyclinic Split, Croatia, during the years 1985-2009. , 2012, Collegium antropologicum.

[39]  Chi-Hsiang Huang,et al.  Dental anesthesia for patients with special needs. , 2012, Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists.

[40]  Francisco Javier Jiménez Enriquez,et al.  Success rate of single- versus two-visit root canal treatment of teeth with apical periodontitis: a randomized controlled trial. , 2012, Journal of endodontics.

[41]  G. Capone,et al.  A case‐control comparison of lingual tonsillar size in children with and without down syndrome , 2012, The Laryngoscope.

[42]  T. Ichinohe,et al.  Risk factors for nausea and vomiting after day care general anesthesia in mentally challenged patients undergoing dental treatment. , 2011, The Bulletin of Tokyo Dental College.

[43]  A. Buček,et al.  Patients with special needs within treatment under general anesthesia - meta-analysis. , 2011, Prague medical report.

[44]  R. Guaré,et al.  Caries prevalence in patients with cerebral palsy and the burden of caring for them. , 2010, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[45]  J. Close,et al.  Complications associated with anesthesia administered for dental treatment. , 2010, General dentistry.

[46]  Li-ping Chen,et al.  Comprehensive dental treatment under general anesthesia in healthy and disabled children. , 2009, Chang Gung medical journal.

[47]  Mary L Voytus Evaluation, scheduling, and management of dental care under general anesthesia for special needs patients. , 2009, Dental clinics of North America.

[48]  Z. Messieha Risks of general anesthesia for the special needs dental patient. , 2009, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[49]  P. Glassman,et al.  Special Care Dentistry Association consensus statement on sedation, anesthesia, and alternative techniques for people with special needs. , 2009, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[50]  A. Caputo Providing deep sedation and general anesthesia for patients with special needs in the dental office-based setting. , 2009, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[51]  N. Dougherty The dental patient with special needs: a review of indications for treatment under general anesthesia. , 2009, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[52]  M. Santos,et al.  Assistive stabilization based on the neurodevelopmental treatment approach for dental care in individuals with cerebral palsy. , 2007, Quintessence international.

[53]  A. Ekfeldt Early experience of implant-supported prostheses in patients with neurologic disabilities , 2005, The International journal of prosthodontics.

[54]  A. Kohjitani,et al.  Intravenous sedation for dental patients with intellectual disability. , 2004, Journal of intellectual disability research : JIDR.

[55]  B. Brandom,et al.  Frequency of anesthesia‐related complications in children with Down syndrome under general anesthesia for noncardiac procedures , 2004, Paediatric anaesthesia.

[56]  Guillermo Machuca Portillo,et al.  Dental treatment under general anesthesia: a useful procedure in the third millennium? (l). , 2003, Medicina oral : organo oficial de la Sociedad Espanola de Medicina Oral y de la Academia Iberoamericana de Patologia y Medicina Bucal.

[57]  J. Limeres Posse,et al.  Pre-assessment of severely handicapped patients suitable of dental treatment under general anesthesia. , 2003, Medicina oral : organo oficial de la Sociedad Espanola de Medicina Oral y de la Academia Iberoamericana de Patologia y Medicina Bucal.

[58]  A. Karidis,et al.  Oral health status in Greek children and teenagers, with disabilities. , 2002, The Journal of clinical pediatric dentistry.

[59]  J. H. Van Der Walt,et al.  An audit of perioperative management of autistic children , 2001, Paediatric anaesthesia.

[60]  S. Hulland,et al.  Hospital-based dental care for persons with disabilities: a study of patient selection criteria. , 2000, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[61]  C. Ayoub,et al.  Attenuation of the Preoperative Stress Response with Midazolam: Effects on Postoperative Outcomes , 2000, Anesthesiology.

[62]  M. Manley,et al.  sedation: Dental treatment for people with challenging behaviour: general anaesthesia or sedation? , 2000, British Dental Journal.

[63]  T. Brown,et al.  Anaesthesia and pain management in cerebral palsy , 2000, Anaesthesia.

[64]  L. Karalliedde,et al.  General anesthesia for disabled patients in dental practice. , 1998, Anesthesia progress.

[65]  R. Billings,et al.  Clinical outcomes for nursing caries treated using general anesthesia. , 1997, ASDC journal of dentistry for children.

[66]  F. Farrington,et al.  Recall intervals: effect on treatment needs of the handicapped patient: a retrospective study. , 1996, The Journal of clinical pediatric dentistry.

[67]  P. Gordon,et al.  A retrospective review of a service to provide comprehensive dental care under general anesthesia. , 1995, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[68]  R. Thisted,et al.  The initial clinical experience of 1819 physicians in maintaining anesthesia with propofol: characteristics associated with prolonged time to awakening. , 1993, Anesthesia and analgesia.

[69]  T. Dodson,et al.  Risk factors associated with dental implants in healthy and medically compromised patients. , 1993, The International journal of oral & maxillofacial implants.

[70]  I. Verma,et al.  Congenital heart disease in Down syndrome: an echocardiographic study. , 1992, Indian pediatrics.

[71]  J. Murray,et al.  Management of the handicapped and the anxious child: a retrospective study of dental treatment carried out under general anaesthesia. , 1985, Journal of paediatric dentistry.

[72]  P. Grimaud [Cerebral palsy]. , 1972, Pediatrie.