1. Paediatric Dentistry
IAPD 25th Congress Pre-Congress Symposium Cleft Care

2. Impact of a Preventive Clinic on General Anaesthetic requirements for Dental Extractions in children with cleft lip/palate. 

3. Introduction
Children with cleft lip and/or palate (CLP) in the West of Scotland (WoS) have a significantly higher caries burden when compared to national data
Many of these carious teeth will require extraction, either electively, or on an emergency basis
It is often necessary to administer general anaesthesia to facilitate this treatment
Age : Mean dmft - Cleft 3.24, NDIP Caries free – Cleft 37.2%, NDIP 57.7%
Scotland 2013/14 – 98 admissions for emergency extractions, 7000 elective

4. Introduction
Administering dental general anaesthesia (DGA) is associated with significant risks, including headache, sore throat, dizziness, sickness, and rarely hypoxic brain injury or death.
DGA also carries material, labour and overhead costs

5. Introduction
A preventive clinic was introduced in 2008 at Glasgow Dental Hospital and School
Children are seen by a paediatric dentist and speech and language therapy, if required
Starts with eruption of first tooth
Topical fluoride varnish is also applied
The aim of the clinic was to reduce the caries burden for children with CLP and to facilitate comprehensive care

6. Aim
The aim of this audit was to assess whether the introduction of the preventive clinic had any impact on the requirements for DGA by the age of 5 in children with CLP in the WoS.

7. Methods
Two cohorts of children (one born in 2002, the other in 2007) in the WoS CLP service were selected from the Cleft Care Scotland Database
A retrospective case note analysis was performed to assess DGA requirements up to and including the age of 5
The postcode of the parents/carers’ home was entered into the 2012 version of the Scottish Index of Multiple Deprivation (SIMD) ‘lookup’ file to allow the degree of deprivation to be analysed
Statistical analysis was performed using the Chi squared test.
Cohort born in 2002 received all their care before the introduction of the preventive clinic.
Cohort born in 2007 received all their care after the introduction of the preventive clinic.

8. Results 2002 Cohort 48 Children 7 not analysed 41 (85.4%) analysed
4 Casenotes not available
2 No dental input
1 Emigrated

9. Results 2002 Cohort 41 Analysed SIMD 1 (most deprived) 7 SIMD 2 128
SIMD 5
(least deprived) 11
No SIMD data
(England postcode) 1

10. 2002 Cohort - DGA requirements by SIMD
Results
2002 Cohort - DGA requirements by SIMD
SIMD 1
SIMD 2
SIMD 3
SIMD 4
SIMD 5
DGA 2 6 1 4
No DGA 5 7
p = 0.164

11. Results 2002 Cohort - DGA requirements by SIMD SIMD 1 SIMD 2 SIMD 3
DGA for exodontia only 2 1
DGA for comprehensive care 4 3
p = 0.497

12. Results 2007 Cohort 55 Children 10 not analysed 45 (81.8%) analysed
3 Casenotes not available
5 No dental input
2 Lost to follow up

13. Results 2007 Cohort 41 Analysed SIMD 1 (most deprived) 10 SIMD 2 143
SIMD 5
(least deprived) 8

14. 2007 Cohort - DGA requirements by SIMD
Results
2007 Cohort - DGA requirements by SIMD
SIMD 1
SIMD 2
SIMD 3
SIMD 4
SIMD 5
DGA 3 4
No DGA 7 10 8
p = 0.123
Not statistically significant, but all DGA administered to SIMD 1 and 2 (2 most deprived quintiles)

15. Results 2007 Cohort - DGA requirements by SIMD SIMD 1 SIMD 2 SIMD 3
DGA for exodontia only
DGA for comprehensive care 3 4
Numbers too few to calculate p value
p value N/A

16. Inter-Cohort - DGA requirements
Results
Inter-Cohort - DGA requirements
2002
2007
DGA 15 7
No DGA 26 38
p = 0.026
Significant difference in the DGA requirements between the 2002 and 2007 cohorts

17. Results Inter-Cohort - DGA requirements 2002 2007
DGA for exodontia only 5
DGA for comprehensive care 10 7
Not statistically significant, but all DGA in 2007 cohort is for comprehensive care
p value 0.082

18. Discussion
First study to demonstrate reduction in DGA requirements after the introduction of a preventive type clinic
Limited to West of Scotland only
Comparatively low numbers affect statistical significance
Does not take into account exodontia under emergency admissions
Childsmile programme started in 2008
Drop in hospital admissions for paediatric dental extractions in Scotland: 9300 in 2006/7, 8000 in 2007/8, 7500 in 2008/9, 2009/10, 2010/11, 2011/12, 7000 in 2012/13, 2013/14. Would expect more of a drop in national figures if Childsmile was responsible.

19. Conclusions
Significant reduction in DGA requirements since the introduction of the preventive clinic
No DGA for exodontia only since the introduction of the preventive clinic
Prospective studies in this area are required

20. References
Britton KFM, Welbury RR. Dental caries prevalence in children with cleft lip/palate aged between 6 months and 6 years in the West of Scotland. European Archives of Paediatric Dentistry 2010; 11(5): Davies C, Harrison M, Roberts G. Guideline for the Use of General Anaesthesia (GA) in Paediatric Dentistry. RCSEng 2008 ISD Scotland. Hospital Care Data Tables. Available at: Care/Publications/data-tables.asp The Scottish Government. Scottish Index of Multiple Deprivation. Available at: