Key Points
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Demonstrates a one-year incidence rate for dental general anaesthetic of 7/1,000 among children in three local authorities in England. The highest prevalence was among 5–9-year-olds (12/1,000 children).
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Suggests that rates of DGA were around three times higher in the most deprived than in the least deprived neighbourhoods, but the problem was widely dispersed with children admitted from 104/106 neighbourhoods.
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Shows that reported rates of preventive actions by NHS dental professionals (applications of fluoride varnish and fissure sealant), were low for all ages and groups of children.
Abstract
Introduction Extraction of decayed teeth is the most common reason for UK children aged 5-9 years to receive a general anaesthetic. Inequalities in oral health are well recognised, but is under-explored in dental general anaesthesia (DGA).
Methods Secondary analysis of routinely collected data from three local authorities in South West England was used to assess: 1) dental activities recorded for children <18 years attending NHS general dental practitioners (GDP); 2) the incidence rate of DGA and disease severity among <16-year-olds; and 3) individual and neighbourhood factors associated with higher rates of child DGA, and greater severity of disease.
Results Among 208,533 GDP appointments, rates of preventive action were low where 1/7 included fluoride varnish but 1/5 included permanent fillings. The incidence rate of DGA was 6.6 admissions for every 1,000 children, rising to 12.4/1,000 among 5–9-year-olds. A total of 86 (7.6%) children had previously received a DGA at the same hospital. Area deprivation was strongly associated with higher rates of DGA, but rates of DGA remained high in less deprived areas. No associations were observed between number of teeth removed and socio-economic status.
Conclusion Too many children are receiving DGA, and too few preventive actions are recorded by GDPs. Area-based inequalities in DGA were apparent, but wealthy areas also experienced substantial childhood dental decay.
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Acknowledgements
The study was funded by a grant from the Elizabeth Blackwell Institute for Health Research, University of Bristol, and the Wellcome Trust Institutional Strategic Support Fund. (Grant code 097,822/Z/11/ZR) and by Bristol Health Partners' support to the BoNEE HIT (Bristol Network for Equality in Early Years Health and Wellbeing, Health Integration Team). Dr Lucas' time was further supported by the University of Bristol School of Oral and Dental Science. We would like to thank members of the BoNEE team who contributed to the planning and analysis of this study. Our thanks to Sarah Bain for assistance accessing the theatre records, Kwok Lee and Linda Wadey for data matching with University Hospital Bristol records, and Rob Wise for preparing NHSBSA data sets. We would also like to thank Hannah Lepper for preparation of the choropleth maps.
As the study used routinely collected data for audit and service improvement, formal scrutiny by an NHS research ethics committee was not required. The study was reviewed by the University of Bristol School for Policy Studies Ethics Committee, and granted approval on 13 January 2015. In addition, we were granted NHS permission (CH/2014/4,756, 3/12/2014) and permission from the Caldicott Guardian for access to fully anonymised University Hospital records (granted 15/12/2014). Anonymity of patient data was protected by the UHBristol information analyst, who extracted the required data and provided it to the research team with all identifiers removed (date of birth and home postcode) and patient unique, non-identifiable identification numbers inserted. NHS BSA data was supplied by information analysts in NHS England, and the research team was provided with aggregated data to protect anonymity.
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PJL, KW, JS, JW and PH conceived of the study. PJL, KW & JS secured funding. PJL, DP, KW and PH designed the study, with contributions from all authors. DP collected the data with assistance from KW and prepared the database. PJL and DP conducted the analyses. All authors had access to all of the data, including statistical reports and tables and can take responsibility for the integrity of the data and the accuracy of the data analysis. PJL drafted the manuscript, all authors reviewed and contributed to the final version.
Patricia J Lucas is the guarantor for the study and affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Data sharing: ward level data and SPSS syntax are available from the corresponding author on request. Patient consent for data sharing was not obtained but the potential benefits of sharing these data outweigh the potential harms because data are fully anonymised and available at aggregate level only.
The reporting of this study conforms to the The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement.
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Lucas, P., Patsios, D., Walls, K. et al. Neighbourhood incidence rate of paediatric dental extractions under general anaesthetic in South West England. Br Dent J 224, 169–176 (2018). https://doi.org/10.1038/sj.bdj.2018.77
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DOI: https://doi.org/10.1038/sj.bdj.2018.77
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