Comparing sedation with general anaesthesia to manage child patients who need to have dental treatment

Ashley PF, Williams CECS, Moles DR, Parry J

Published Online:

January 21, 2009

This systematic review aimed to look at any evidence comparing sedation with general anaesthesia for the delivery of dental care for children. At present children who are unable to cope with dental care under local anaesthetic may be given general anaesthesia or sedation, dependent on factors such as preference, economic constraints or the local regulatory framework. There is a suggestion that undertaking this work under sedation might make the experience more comfortable for the patient and could even be cheaper for the funding body. Unfortunately the search could not identify any randomized controlled trials on this topic. Therefore we recommend that these trials be carried out.

Abstract (click to read)

Background:

A significant proportion of children have caries requiring restorations or extractions, and some of these children will not accept this treatment under local anaesthetic. Historically this has been managed in children by use of a general anaesthetic; however use of sedation may lead to reduced morbidity and cost. The aim of this review is to compare the efficiency of sedation versus general anaesthesia for the provision of dental treatment for children and adolescents under 18 years.

Objectives:

We evaluated the intra- and post-operative morbidity, effectiveness and cost effectiveness of sedation versus general anaesthesia for the provision of dental treatment for under 18 year olds.

Search strategy:

We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library; Issue 4, 2008); MEDLINE (OVID) (1950 to October Week 2, 2008); EMBASE (OVID) (1974 to Week 42, 2008); System for information on Grey Literature in Europe (SIGLE) (1980 to October 2008), Latin American & Caribbean Health Sciences Literature (LILACS) (1982 to October 2008), ISI Web of Science (1945 to October 2008).

We also carried out handsearching of relevant journals. There was no language restriction.

Selection criteria:

We included randomized controlled clinical trials of sedative agents compared to general anaesthesia in children and adolescents aged up to 18 years having dental treatment. We excluded complex surgical procedures and pseudo-randomized trials.

Data collection and analysis:

Two authors assessed titles and abstracts for inclusion in the review. We recorded information relevant to the objectives and outcome measures into a specially designed 'data extraction form'.

Main results:

We identified 15 studies for potential inclusion after searching the available databases and screening the titles and abstracts. We identified a further study through personal contacts. Following full text retrieval of the studies, we found none to be eligible

Authors' conclusions:

Randomized controlled studies comparing the use of dental general anaesthesia with sedation to quantify differences such as morbidity and cost are required.

This record should be cited as:

Ashley PF, Williams CECS , Moles DR, Parry J. Sedation versus general anaesthesia for provision of dental treatment in under 18 year olds. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006334. DOI: 10.1002/14651858.CD006334.pub2

Assessed as up to date:

October 21, 2008

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Primary Review Group:

Anaesthesia Group

Health topics:

Anaesthesia & pain control > Anaesthesia & medical diseases > Peri-operative events

Anaesthesia & pain control > Peri-anaesthetic/peri-operative care > Peri-operative management of the anaesthetic patient

Anaesthesia & pain control > Regional anaesthesia > Oral

Dentistry & oral health > Anaesthesia

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Comparing sedation with general anaesthesia to manage child patients who need to have dental treatment

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