Impact of Dental Rehabilitation Under General Anesthesia on Oral Health-Related Quality-of-Life and Dental Anxiety in Turkish Children

Duruk, Gülsüm; Kuru, Raziye; Özkan, Ahmet Selim

doi:10.1590/pboci.2021.006

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ORIGINAL ARTICLE • Pesqui. Bras. Odontopediatria Clín. Integr. 21 • 2021 • https://doi.org/10.1590/pboci.2021.006 copy

Impact of Dental Rehabilitation Under General Anesthesia on Oral Health-Related Quality-of-Life and Dental Anxiety in Turkish Children

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze children's and parents' oral health-related quality of life (OHRQoL) and children's dental fears before and after the dental rehabilitation under general anesthesia (DRGA).

Material and Methods:

104 parents and their 3 to 13-year-old children (5.90 ± 2.42) who received DRGA were surveyed before and after DRGA. The children were divided into two groups: Group 1 - healthy children (n=43) and Group 2 - children with medical problems (n=61). After recording their socio-demographic information, parents completed a self-administered questionnaire named Early Childhood Oral Health Impact Scale (ECOHIS), which includes two main parts - Child Impact Section (CIS) and Family Impact Section (FIS). On the other hand, the children received a dentist-administered questionnaire named Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and Frankle Behavior Scale (FBS). For statistical analyses, Wilcoxon Signed-Rank, Mann Whitney-U, Kruskal-Wallis, and Spearman's Correlation tests were used.

Results:

A statistically significant decrease in all CIS, FIS, ECOHIS and CFSS-DS scores was observed after DRGA (p<0.01). This decline was greater in healthy children than in children with systemic problems (p<0.01).

Conclusion:

Children's and parents' OHRQoL showed better results after DRGA. The decreases in dental anxiety in children were observed after DRGA.

Keywords:
Oral Health; Child; Quality of Life; Dental Anxiety; General Anesthesia.

Variables		N (%)
Age (Mean and SD)	5.90 ± 2.42
Sex
Girl		41 (39.4)
Boy		63 (60.6)
Medical Condition
Healthy		43 (41.3)
CSHCN		61 (58.7)
Number of Siblings
1		12 (11.5)
2		41 (39.4)
3		30 (28.8)
4≥		21 (20.2)
Order of Birth
1st		50 (48.1)
2nd or Other		54 (51.9)
Paternal Age (Mean and SD)	39.13 ± 5.52
Maternal Age (Mean and SD)	34.48 ± 6.48
Age of the Parent Completing the Questionnaire (Mean and SD)		36.58 ± 6.47
Paternal Education
Illiterate		2 (1.9)
Primary School		25 (24.0)
Secondary School		7 (6.7)
High School		35 (33.7)
University		35 (33.7)
Maternal Education
Illiterate		10 (9.6)
Primary School		55 (52.9)
Secondary School		9 (8.7)
High School		0 (0.0)
University		30 (28.8)
Education Level of the Parent Completing the Questionnaire
Illiterate		6 (5.8)
Primary School		38 (36.5)
Secondary School		7 (6.7)
High School		12 (11.5)
University		41 (39.4)
Place of Residence
City Center		91 (87.5)
Suburb		13 (12.5)
Patients' Location
In the Same City as the General Anesthesia Center		57 (54.8)
In a Different City from the General Anesthesia Center		47 (45.2)
Income Level
Low (<2000 TRY)		46 (44.2)
Medium (2000-5000 TRY)		53 (51.0)
High (>5000 TRY)		5 (4.8)
DMFT/dmft score (Mean and SD)		11.19 ± 3.65

Variables	Pre-Treatment	Post-Treatment	p-value^* * Wilcoxon; Effect size (-∞ …. + ∞); 0.2>: Small; 0.2-0.7: Moderate; 0.7<: Large;	Change in Score (SD)	Effect Size
	Mean (SD)	Mean (SD)		Change in Score (SD)	Effect Size
Healthy Children (n=43)
CIS	15.49 (6.71)a	2.00 (3.61)	<0.001	-13.49 (6.79)	+2
Child Symptoms	3.44 (0.96)	0.16 (0.43)	<0.001	-3.28 (1.08)	+3.4
Child Function	6.67 (3.16)	1.16 (2.01)	<0.001	-5.51 (3.53)	+1.7
Child Psychology	4.44 (2.73)	0.12 (0.50)	<0.001	-4.33 (2.82)	+1.6
Child Self-image and Social Interaction	0.93 (2.28)a	0.56 (1.82)	0.320	-0.37 (2.32)	+0.16
FIS	8.07 (3.39)a	0.49 (1.28)	<0.001	-7.58 (2.89)	+2.2
Parental Distress	5.23 (2.20)a	0.28 (0.91)	<0.001	-4.95 (2.10)	+2.3
Family Function	2.84 (2.52)	0.21 (0.64)	<0.001	-2.63 (2.38)	+1
ECOHIS	23.56 (8.71)a	2.49 (3.86)	<0.001	-21.07 (8.53)	+2.4
CSHCN (n=61)
CIS	12.77 (5.70)b	1.54 (3.16)	<0.001	-11.23 (6.30)	+2
Child Symptoms	3.16 (1.10)	0.34 (0.81)	<0.001	-2.82 (1.23)	+2.6
Child Function	5.74 (3.21)	0.75 (1.54)	<0.001	-4.98 (3.51)	+1.6
Child Psychology	3.72 (2.37)	0.31 (0.89)	<0.001	-3.41 (2.49)	+1.4
Child Self-image and Social Interaction	0.15 (0.68)b	0.13 (0.81)	0.786	-0.02 (1.07)	+0.03
FIS	6.16 (3.46)b	0.71 (1.82)	<0.001	-5.46 (3.22)	+1.6
Parental Distress	3.95 (2.49)b	0.41 (1.22)	<0.001	-3.54 (2.43)	+1.4
Family Function	2.21 (2.15)	0.30 (0.78)	<0.001	-1.92 (2.01)	+0.9
ECOHIS	18.93 (7.72)b	2.25 (4.61)	<0.001	-16.69 (8.28)	+2.2
Total (n=104)
CIS	13.89 (6.25)	1.73 (3.34)	<0.001	-12.16 (6.57)	+2
Child Symptoms	3.28 (1.05)	0.27 (0.69)	<0.001	-3.01 (1.19)	+2.9
Child Function	6.13 (3.21)	0.92 (1.75)	<0.001	-5.20 (3.51)	+1.6
Child Psychology	4.02 (2.55)	0.23 (0.75)	<0.001	-3.79 (2.65)	+1.5
Child Self-image and Social Interaction	0.47 (1.60)	0.31 (1.33)	0.359	-0.16 (1.70)	+0.1
FIS	6.95 (3.54)	0.62 (1.61)	<0.001	-6.34 (3.25)	+1.8
Parental Distress	4.48 (2.45)	0.36 (1.10)	<0.001	-4.13 (2.40)	+1.7
Family Function	2.47 (2.32)	0.26 (0.72)	<0.001	-2.21 (2.19)	+1
T-ECOHIS	20.85 (8.42)	2.35 (4.30)	<0.001	-18.50 (8.62)	+2.2

Model	B	Std. Error	β	t	p-value
(Constant)	40.828	8.574		4.762	0.000
Gender	-1.065	1.766	-0.061	-0.603	0.548
Medical Status (Healthy/ CSHCN)	-7.194	4.097	-0.413	-1.756	0.082
ASA Classification	1.451	2.485	0.143	0.584	0.561
Number of Siblings	1.196	1.317	0.131	0.908	0.366
Order of Birth	-3.230	2.229	-0.188	-1.449	0.151
Parent (Mother or Father) Completing the Questionnaire	-3.779	2.599	-0.216	-1.454	0.149
Education Level of the Parent Completing the Questionnaire	1.381	1.632	0.234	0.846	0.400
Paternal Education	-0.345	1.315	-0.049	-0.263	0.793
Maternal Education	-1.846	1.299	-0.308	-1.422	0.159
Place of Residence	-2.003	2.835	-0.077	-0.706	0.482
Patients' Location in the Same/Diferent City as/from the General Anesthesia Center	0.320	1.797	0.019	0.178	0.859
Income	-1.253	2.047	-0.085	-0.612	0.542
Model Summary	R	R²	Adjusted R²	SEE
	0.377^a a Dependent Variable: The change in ECOHIS score; *Multiple linear regression analysis.	0.142	0.029	8.48998

Group	Pre-Treatment		Post-Treatment		p-value^* a Dependent Variable: The change in ECOHIS score; *Multiple linear regression analysis.	Change in Score (SD)	Effect Size
	Mean (SD)	Anxiety Level	Mean (SD)	Anxiety Level
	CFSS-DS
Healthy	38.93 (14.03)	High	25.67(15.81)	Low	<0.001	13.26 (14.95)	+1
CSHCN	37.11 (16.93)	Medium	32.03(16.47)	Medium	<0.001	5.08 (11.06)	+0.3
Total	37.87 (15.75)	Medium	29.40 (16.42)	Low	<0.001	8.46 (13.37)	+0.5
FBS
Healthy	1.33 (0.78)		2.51 (1.24)		<0.001	-1.19 (1.32)	-1.5
CSHCN	1.61 (1.01)		2.18 (1.13)		<0.001	-0.57 (0.94)	-0.6
Total	1.49 (0.92)		2.32 (1.19)		<0.001	-0.83 (1.14)	-0.9

		N	%	Pre-Treatment		Post-Treatment		Change in Score (SD)	p-value^* * Wilcoxon;	p-value^ Mann-Whitney U /Kruskal-Wallis; SD: Standard Deviation;
Variables	Categories			Mean (SD)	Anxiety Level	Mean (SD)	Anxiety Level	Change in Score (SD)
CFSS-DS
Anesthesia Type	General Anesthesia	104	100.0	37.87 (15.75)	Medium	29.40 (16.42)	Low	8.46 (13.37)	<0.001	-
History of General Anesthesia	Yes	48	46.2	35.71 (16.38)	Medium	29.13 (16.31)	Low	6.58 (13.30)	<0.001	0.466
	No	56	53.8	39.71(15.10)	High	29.64 (16.67)	Low	10.07 (13.33)	<0.001
Premedication Drug	Midazolam	104	100.0	37.87 (15.75)	Medium	29.40 (16.42)	Low	8.46 (13.37)	<0.001	-
Premedication Route	Nasal	79	76	37.97 (15.87)	Medium	28.11 (16.2)	Low	9.86 (12.80)a	<0.001	0.012
	Oral	15	14.4	32.73 (17.19)	Medium	32.93 (16.2)	Medium	-0.20 (13.10)b	0.814
	Intravenous	10	9.6	44.70 (10.01)	High	34.30 (17.9)	Medium	10.40 (14.54)^ab a,bDifferent letters indicate statistically significant differences; Anxiety Level = 15–31: Low; 32-38: Medium; 39 or More: High.	0.024
Post-Operative Analgesia	Paracetamol	83	79.8	38.73 (15.95)	High	29.22 (16.62)	Low	9.51 (13.28)	<0.001	0.092
	Tramadol	21	20.2	34.43 (14.82)	Medium	30.14 (16.01)	Low	4.29 (13.21)	0.050
FBS
Anesthesia Type	General Anesthesia	104	100.0	1.49 (0.92)		2.32 (1.19)		-0.83 (1.14)	<0.001	-
History of General Anesthesia	Yes	48	46.2	1.63 (1.04)		2.31 (1.22)		-0.69 (1.17)	0.001	0.428
	No	56	53.8	1.38 (0.80)		2.32 (1.16)		-0.95 (1.12)	<0.001
Premedication Drug	Midazolam	104	100.0	1.49 (0.92)		2.32 (1.19)		-0.83 (1.14)	<0.001	-
Premedication Route	Nasal	79	76	1.49 (0.92)		2.47 (1.14)		-0.98 (1.07)a	<0.001	0.016
	Oral	15	14.4	1.73 (1.16)		1.80 (1.21)		-0.07 (1.28)b	0.854
	Intravenous	10	9.6	1.10 (0.32)		1.90 (1.29)		-0.80 (1.14)^ab a,bDifferent letters indicate statistically significant differences; Anxiety Level = 15–31: Low; 32-38: Medium; 39 or More: High.	0.066
Post-Operative Analgesia	Paracetamol	83	79.8	1.49 (0.93)		2.40 (1.16)		-0.90 (1.14)	<0.001	0.144
	Tramadol	21	20.2	1.48 (0.93)		2.00 (1.27)		-0.52 (1.12)	0.062

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[1] Correspondence: Gulsum Duruk, DDS, Ph.D., Department of Pediatric Dentistry, Faculty of Dentistry, Inonu University, Malatya, Turkey. E-mail: durukgulsum@yahoo.com