Abstract
Introduction Children find dental extractions under general anaesthesia (GA) painful despite national analgesic guidelines.
Aims To report on children's post-operative pain, morbidity, families' satisfaction and analgesic regime during GA dental extractions.
Design A prospective service evaluation.
Setting King's College Hospital, London.
Methods Children (n = 143) self-reported pain using the Faces Pain Scale-Revised (FPS-R) pre- and post-operatively and one week later by telephone as reported by the child's parent/carer. Morbidity was assessed using the Morbidity Checklist & Post Hospital Behaviour Questionnaire and each family's satisfaction using the Treatment Evaluation Inventory.
Results Children were a mean age of six years and had seven primary teeth extracted. When given intravenous (IV) fentanyl (n = 69), either alone (n = 11) or in combination with paracetamol (n = 58) the children had 0.17 times odds of not having post-op pain compared to patients who received only paracetamol (logistic regression, p = 0.006). After one week 99% of families were satisfied with the service but 11% reported that their child still had post-operative morbidity.
Conclusion Three quarters of children reported pain following extractions of primary teeth under GA. Use of IV paracetamol and fentanyl reduced the immediate post-operative self-reported pain. After a week most families (99%) were satisfied with the treatment their child had received and morbidity was reported by 11% of families.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Oral health survey of threeyearold children: A report on the prevalence and severity of dental decay, 2014.
Hosey M T, Macpherson L M, Adair P, Tochel C, Burnside G, Pine C. Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia. Br Dent J 2006; 200: 39-43.
Sury M R, Palmer J H, Cook T M, Pandit J J. The State of UK Dental Anaesthesia: Results From The NAP5 Activity Survey. A national survey by the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. SAAD Dig 2016; 32: 34-36.
Adewale L, Morton N, Blayney M. Guidelines for the management of children referred for dental extractions under general anaesthesia. London: Association of PaediatricAnaesthetists of Great Britain and Ireland, 2011.
Needleman H L, Harpavat S, Wu S, Allred E N, Berde C. Postoperative pain and other sequelae of dental rehabilitations performed on children under general anaesthesia. Paediatr Dent 2008; 30: 111-121.
Bridgman C M, Ashby D, Holloway P J. An investigation of the effects on children of tooth extraction under general anaesthesia in general dental practice. Br Dent J 1999; 186: 245-247.
Kharouba, J, Hawash N, Peretz B, Blumer S, Srour Y, Nassar M, Sabbah M, Safadi A, Khorev A, Somri M. Effect of intravenous paracetamol as pre-emptive compared to preventive analgesia in a paediatric dental setting: a prospective randomized study. Int J Paediatr Dent 2018; 28: 83-91.
Parekh S, Gardener C, Ashley P F, Walsh T. Intraoperative local anaesthesia for reduction of postoperative pain following general anaesthesia for dental treatment in children and adolescents. Cochrane Database Syst Rev 2012; CD009742.
Pike D. A conscious decision. A review of the use of general anaesthesia and conscious sedation in primary dental care. SAAD Dig 2000; 17: 13-14.
Hosey M T, Bryce J, Harris P, McHugh S, Campbell C. The behaviour, social status and number of teeth extracted in children under general anaesthesia: a referral centre revisited. Br Dent J 2006; 200: 331-334, discussion 327
Hosey M T, Asbury A J, Bowman A W et al. The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction. Br Dent J 2009; 207: E2; discussion 32-33.
Harrison M, Nutting L. Repeat general anaesthesia for paediatric dentistry. Br Dent J 2000; 189: 37-39.
Olley R C, Hosey M T, Renton T, Gallagher J. Why are children still having preventable extractions under general anaesthetic? A service evaluation of the views of parents of a high caries risk group of children. Br Dent J 2011; 210: E13.
Goodwin M, Sanders C, Davies G, Walsh T, Pretty I A. Issues arising following a referral and subsequent wait for extraction under general anaesthetic: impact on children. BMC Oral Health 2015; 15: 3.
Deery C, Owen J, Welbury R, Chadwick B. Dental caries in children and the level of repeat general anaesthetics for dental extractions. A national disgrace. Dent Update 2015; 42: 305-306.
Tochel C, Hosey M T, Macpherson L, Pine C. Assessment of children before dental extractions under general anaesthesia in Scotland. Br Dent J 2004; 196: 629-633.
Macpherson L M, Pine C M, Tochel C, Burnside G, Hosey M T, Adair P. Factors influencing referral of children for dental extractions under general and local anaesthesia. Community Dent Health 2005; 22: 282-288.
Tomlinson D, von Baeyer C L, Stinson J N, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Paediatrics 2010; 126: E1168E1198.
Vernon D T, Schulman J L, Foley J M. Changes in children's behaviour after hospitalization: some dimensions of response and their correlates. Am J Dis Child 1966; 111: 581-593.
Newton J T, Sturmey P. Development of a short form of the Treatment Evaluation Inventory for the acceptability of psychological interventions. Psychol Rep 2004; 94: 475-481.
NICE British National Formulary. Fentanyl. Available online at https://bnf.nice.org.uk/drug/fentanyl.html (accessed 16 September 2019).
Acs G, Pretzer S, Foley M, Ng M W. Perceived outcomes and parental satisfaction following dental rehabilitation under general anaesthesia. Paediatr Dent 2001; 23: 419-423.
Fung D E, Cooper D J, Barnard K M, Smith P B. Pain reported by children after dental extractions under general anaesthesia: a pilot study. Int J Paediatr Dent 1993; 3: 23-28.
Gazal G, Mackie I C. Distress related to dental extraction for children under general anaesthesia and their parents. Eur J Paediatr Dent 2007; 8: 7-12.
Atan S, Ashley P, Gilthorpe M S, Scheer B, Mason C, Roberts G. Morbidity following dental treatment of children under intubation general anaesthesia in a day-stay unit. Int J Paediatr Dent 2004; 14: 9-16.
Rodd H, Hall M, Deery C, Gibson B J, Marshman Z. "I felt weird and wobbly." Child-reported impacts associated with a dental general anaesthetic. Br Dent J. 2014; 216: 1-5.
Anderson H K, Drummond B K, Thomson W M. Changes in aspects of children's oral-health-related quality of life following dental treatment under general anaesthesia. Int J Paediatr Dent 2004; 14: 317-325.
Jankauskiene B, Narbutaite J. Changes in oral health-related quality of life among children following dental treatment under general anaesthesia. A systematic review. Stomatologija 2010; 12: 60-64.
Huntington C, Newton J T, Donaldson N et al. Lessons learned on recruitment and retention in hardtoreach families in a phase III randomised controlled trial of preparatory information for children undergoing general anaesthesia. BMC Oral Health 2017; 17: 122.
Acknowledgement
We would like to extend our thanks to all families and children who participated in this service evaluation and we wish to acknowledge Mr Manoharan Andiappan for statistical advice and Dr Rubya Adamji for her contribution in data collection.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alohali, A., Al-Rubaian, N., Tatsi, C. et al. Post-operative pain and morbidity in children who have tooth extractions under general anaesthesia: a service evaluation. Br Dent J 227, 713–718 (2019). https://doi.org/10.1038/s41415-019-0807-4
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41415-019-0807-4
This article is cited by
-
Pain assessment, cognitive and cortical changes with full mouth rehabilitation in a group of children
BMC Oral Health (2024)
-
Minimally invasive judgement calls: managing compromised first permanent molars in children
British Dental Journal (2020)
