Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE (Open Access)

Cross-sectional analysis of dental treatment under general anaesthesia in hospitalised Western Australian children in 2018–19

Yosef Faraj Amer Alshehri A B F , Wendy Nicholls C , Nhu Quynh Mai A , Joon Soo Park https://orcid.org/0000-0002-2052-558X D E and Estie Kruger D
+ Author Affiliations
- Author Affiliations

A School of Human Sciences, The University of Western Australia, Nedlands, WA 6009, Australia. Email: quynhmai0808@gmail.com

B Ministry of Health, Riyadh, Kingdom of Saudi Arabia.

C Department of Dental Medicine, Perth Children’s Hospital, Nedlands, WA 6009, Australia. Email: wendy.nicholls@health.wa.gov.au

D International Research Collaborative, Oral Health and Equity, School of Human Sciences, The University of Western Australia, Crawley, WA 6009, Australia. Email: estie.kruger@uwa.edu.au

E UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia. Email: alex.park@uwa.edu.au

F Corresponding author. Email: yfa.030@gmail.com

Australian Health Review 45(5) 584-590 https://doi.org/10.1071/AH20318
Submitted: 5 November 2020  Accepted: 9 March 2021   Published: 23 June 2021

Journal Compilation © AHHA 2021 Open Access CC BY-NC-ND

Abstract

Objective To date, there has been little research that has comprehensively analysed dental treatment under general anaesthesia (DGA) at Perth Children’s Hospital (PCH) for dental emergencies (dental pain and sepsis). This cross-sectional descriptive analysis of the PCH dental department analysed the demographic of children admitted and the type of treatment used, and assessed the cost.

Methods This was a retrospective descriptive study analysing the dental records of patients ranging from 2 to 16 years of age at PCH in Western Australia. Of the 310 cases randomly selected from the 2018–19 study period, 202 were admitted for DGA. Two outcome measures were derived: cumulative count of treatment mix and cost analysis.

Results The mean (±s.d.) age at the time of admission was 6.2 ± 2.6 years and the mean (±s.d.) decayed (d/D), missing, (m/M) and filled (f/F) teeth (dmft/DMFT) was 2.1 ± 0.8. Of the 429 teeth affected, 282 were molars. Treatments were grouped therapeutically; of the 856 treatments performed, 465 were extractions (54%). The total cost, consisting of direct and indirect costs, was A$313 823, and equated to an approximate mean (±s.d.) of A$1554 ± 109 per case.

Conclusion Untreated dental caries was the most common cause for hospital admission. Most cases presenting at the emergency department were young children (<7 years old) who underwent extractions under DGA.

What is known about the topic? The Child Dental Benefits Schedule (CDBS) was introduced to improve access and affordability to oral health care for children without private dental insurance. However, a significant number of children are still being admitted to hospital for emergency dental treatment.

What does this paper add? Despite the availability of the CDBS, untreated dental caries remains one of the most common reasons for dental emergency in the PCH.

What are the implications for practitioners? Not only are direct costs a burden on the health budget, but indirect and intangible costs also affect children and their families.

Keywords: cost, dental emergency, general anaesthesia, utilisation, Western Australia.


References

[1]  Australia Bureau of Statistics (ABS). Regional population by age and sex; 2019. Available at: https://www.abs.gov.au/statistics/people/population/regional-population-age-and-sex/latest-release [Verified 22 September 2020]

[2]  Tennant M, Kruger E. Turning Australia into a ‘flat-land’: what are the implications for workforce supply of addressing the disparity in rural-city dentist distribution? Int Dent J 2014; 64 29–33.
Turning Australia into a ‘flat-land’: what are the implications for workforce supply of addressing the disparity in rural-city dentist distribution?Crossref | GoogleScholarGoogle Scholar | 24460591PubMed |

[3]  Australian Institute of Health and Welfare (AIHW). Oral health and dental care in Australia: key facts and figures 2015. 2016.

[4]  Australian Government - Department of Health. Guide to the Child Dental Benefits Schedule. 2018.

[5]  WA Department of Health. State Oral Health Plan 2016–2020. Perth: Office of the Chief Dental Officer, Clinical Services and Research, Department of Health; 2016.

[6]  Putri DE, Kruger E, Tennant M. Retrospective analysis of utilisation of the Australian Child Dental Benefit Scheme. Aust Health Rev 2020; 44 304–9.
Retrospective analysis of utilisation of the Australian Child Dental Benefit Scheme.Crossref | GoogleScholarGoogle Scholar | 31648675PubMed |

[7]  Arrow P. Oral health of schoolchildren in Western Australia. Aust Dent J 2016; 61 333–41.
Oral health of schoolchildren in Western Australia.Crossref | GoogleScholarGoogle Scholar | 26296432PubMed |

[8]  Hallett KB, O’Rourke PK. Social and behavioural determinants of early childhood caries. Aust Dent J 2003; 48 27–33.
Social and behavioural determinants of early childhood caries.Crossref | GoogleScholarGoogle Scholar | 14640154PubMed |

[9]  Government of Western Australia. School Dental Service; Available at: https://www.dental.wa.gov.au/dental-services/school-dental-service [Verified 22 September 2020]

[10]  Ha DH, Roberts-Thomson KF, Arrow P, Peres KG, Do LG. Children’s oral health status in Australia, 2012–14. Adelaide: University of Adelaide Press; 2016.

[11]  Alsharif AT, Kruger E, Tennant M. A population-based cost description study of oral treatment of hospitalized Western Australian children aged younger than 15 years. J Public Health Dent 2015; 75 202–9.
A population-based cost description study of oral treatment of hospitalized Western Australian children aged younger than 15 years.Crossref | GoogleScholarGoogle Scholar | 25740273PubMed |

[12]  Alsharif AT, Kruger E, Tennant M. Dental hospitalization trends in Western Australian children under the age of 15 years: a decade of population-based study. Int J Paediatr Dent 2015; 25 35–42.
Dental hospitalization trends in Western Australian children under the age of 15 years: a decade of population-based study.Crossref | GoogleScholarGoogle Scholar | 24460665PubMed |

[13]  Aminian P, Kruger E, Winters J, Nicholls W, Tennant M. Dental emergency attendance at an Australia tertiary children’s hospital. Asia Pac J Health Manag 2018; 13 i35
Dental emergency attendance at an Australia tertiary children’s hospital.Crossref | GoogleScholarGoogle Scholar |

[14]  Yawary R, Anthonappa RP, Ekambaram M, McGrath C, King NM. Changes in the oral health-related quality of life in children following comprehensive oral rehabilitation under general anaesthesia. Int J Paediatr Dent 2016; 26 322–9.
Changes in the oral health-related quality of life in children following comprehensive oral rehabilitation under general anaesthesia.Crossref | GoogleScholarGoogle Scholar | 26370769PubMed |

[15]  Jamjoom MM, al-Malik MI, Holt RD, el-Nassry A. Dental treatment under general anaesthesia at a hospital in Jeddah, Saudi Arabia. Int J Paediatr Dent 2001; 11 110–6.
Dental treatment under general anaesthesia at a hospital in Jeddah, Saudi Arabia.Crossref | GoogleScholarGoogle Scholar | 11310133PubMed |

[16]  Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bonecker M, Raggio DP. Impact of oral diseases and disorders on oral health-related quality of life of preschool children. Community Dent Oral Epidemiol 2011; 39 105–14.
Impact of oral diseases and disorders on oral health-related quality of life of preschool children.Crossref | GoogleScholarGoogle Scholar | 21029148PubMed |

[17]  Kassebaum NJ, Bernabe E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of untreated caries: a systematic review and metaregression. J Dent Res 2015; 94 650–8.
Global burden of untreated caries: a systematic review and metaregression.Crossref | GoogleScholarGoogle Scholar | 25740856PubMed |

[18]  Kruger E, Dyson K, Tennant M. Pre-school child oral health in rural Western Australia. Aust Dent J 2005; 50 258–62.
Pre-school child oral health in rural Western Australia.Crossref | GoogleScholarGoogle Scholar | 17016892PubMed |

[19]  Smith K, Kruger E, Dyson K, Tennant M. Oral health in rural and remote Western Australian indigenous communities: a two-year retrospective analysis of 999 people. Int Dent J 2007; 57 93–9.
Oral health in rural and remote Western Australian indigenous communities: a two-year retrospective analysis of 999 people.Crossref | GoogleScholarGoogle Scholar | 17506468PubMed |

[20]  Dogar F, Kruger E, Dyson K, Tennant M. Oral health of pre-school children in rural and remote Western Australia. Rural Remote Health 2011; 11 1869
| 22166148PubMed |

[21]  Sims C, Stanley B, Milnes E. The frequency of and indications for general anaesthesia in children in Western Australia 2002–2003. Anaesth Intensive Care 2005; 33 623–8.
The frequency of and indications for general anaesthesia in children in Western Australia 2002–2003.Crossref | GoogleScholarGoogle Scholar | 16235481PubMed |

[22]  Australian Institute of Health and Welfare (AIHW). Oral health and dental care in Australia; 2019. Available at: https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia]

[23]  Ernst R. Indirect costs and cost-effectiveness analysis. Value Health 2006; 9 253–61.
Indirect costs and cost-effectiveness analysis.Crossref | GoogleScholarGoogle Scholar | 16903995PubMed |

[24]  Carlisle K, Larkins S, Croker F. Disparities in dental health of rural Australians: hospitalisation rates and utilisation of public dental services in three communities in North Queensland. Rural Remote Health 2017; 17 3807
Disparities in dental health of rural Australians: hospitalisation rates and utilisation of public dental services in three communities in North Queensland.Crossref | GoogleScholarGoogle Scholar | 28092967PubMed |

[25]  Australian Dental Association (ADA). The Australian Schedule of Dental Services and Glossary 12th Edition. 2017.

[26]  Armfield JM. High caries children in Australia: a ‘tail’ of caries distribution. Aust Dent J 2005; 50 204–6.
High caries children in Australia: a ‘tail’ of caries distribution.Crossref | GoogleScholarGoogle Scholar | 16238220PubMed |

[27]  Bratthall D. Introducing the Significant Caries Index together with a proposal for a new global oral health goal for 12-year-olds. Int Dent J 2000; 50 378–84.
Introducing the Significant Caries Index together with a proposal for a new global oral health goal for 12-year-olds.Crossref | GoogleScholarGoogle Scholar | 11197197PubMed |

[28]  Australia Bureau of Statistics (ABS). SEIFA by State Suburb Code (SSC). 2016.

[29]  Australian Government - The Department of Health. The Child Dental Benefits Schedule; 2018. Available at: https://www1.health.gov.au/internet/main/publishing.nsf/Content/childdental [Verified 22 August 2019]

[30]  Anjrini AA, Kruger E, Tennant M. Cost effectiveness modelling of a ‘watchful monitoring strategy’ for impacted third molars vs prophylactic removal under GA: an Australian perspective. Br Dent J 2015; 219 19–23.
Cost effectiveness modelling of a ‘watchful monitoring strategy’ for impacted third molars vs prophylactic removal under GA: an Australian perspective.Crossref | GoogleScholarGoogle Scholar | 26159980PubMed |

[31]  Australia Bureau of Statistics (ABS). Average Weekly Earnings, Australia, May 2019. 2019.

[32]  Australia Bureau of Statistics (ABS). Labour Force, Australia, Sep 2019. 2019.

[33]  Schober P, Boer C, Schwarte LA. Correlation coefficients: Appropriate use and interpretation. Anesth Analg 2018; 126 1763–8.
Correlation coefficients: Appropriate use and interpretation.Crossref | GoogleScholarGoogle Scholar | 29481436PubMed |

[34]  Perth Children’s Hospital. Dental department; 2019. Available at: https://pch.health.wa.gov.au/Our-services/Dental [Verified 1 August 2019.]

[35]  Slack-Smith L, Colvin L, Leonard H, Kilpatrick N, Read A, Messer LB. Dental admissions in children under two years–a total-population investigation. Child Care Health Dev 2013; 39 253–9.
Dental admissions in children under two years–a total-population investigation.Crossref | GoogleScholarGoogle Scholar | 22329557PubMed |

[36]  Slack-Smith L, Colvin L, Leonard H, Kilpatrick N, Bower C, Brearley Messer L. Factors associated with dental admissions for children aged under 5 years in Western Australia. Arch Dis Child 2009; 94 517–23.
Factors associated with dental admissions for children aged under 5 years in Western Australia.Crossref | GoogleScholarGoogle Scholar | 19060007PubMed |

[37]  Tennant M, Namjoshi D, Silva D, Codde J. Oral health and hospitalization in Western Australian children. Aust Dent J 2000; 45 204–7.
Oral health and hospitalization in Western Australian children.Crossref | GoogleScholarGoogle Scholar | 11062939PubMed |

[38]  Kruger E, Dyson K, Tennant M. Hospitalization of Western Australian children for oral health related conditions: a 5–8 year follow-up. Aust Dent J 2006; 51 231–6.
Hospitalization of Western Australian children for oral health related conditions: a 5–8 year follow-up.Crossref | GoogleScholarGoogle Scholar | 17037889PubMed |

[39]  Foster H, Fitzgerald J. Dental disease in children with chronic illness. Arch Dis Child 2005; 90 703–8.
Dental disease in children with chronic illness.Crossref | GoogleScholarGoogle Scholar | 15970611PubMed |

[40]  Slack-Smith LM, Read AW, Colvin LJ, et al Total population investigation of dental hospitalizations in indigenous children under five years in Western Australia using linked data. Aust Dent J 2011; 56 358–64.
Total population investigation of dental hospitalizations in indigenous children under five years in Western Australia using linked data.Crossref | GoogleScholarGoogle Scholar | 22126344PubMed |

[41]  Arrow P. Prevalence of developmental enamel defects of the first permanent molars among school children in Western Australia. Aust Dent J 2008; 53 250–9.
Prevalence of developmental enamel defects of the first permanent molars among school children in Western Australia.Crossref | GoogleScholarGoogle Scholar | 18782370PubMed |

[42]  Hubbard MJ. Molar hypomineralization: What is the US experience? J Am Dent Assoc 2018; 149 329–30.
Molar hypomineralization: What is the US experience?Crossref | GoogleScholarGoogle Scholar | 29703275PubMed |

[43]  Americano GC, Jacobsen PE, Soviero VM, Haubek D. A systematic review on the association between molar incisor hypomineralization and dental caries. Int J Paediatr Dent 2017; 27 11–21.
A systematic review on the association between molar incisor hypomineralization and dental caries.Crossref | GoogleScholarGoogle Scholar | 27098755PubMed |

[44]  Owen ML, Ghanim A, Elsby D, Manton DJ. Hypomineralized second primary molars: prevalence, defect characteristics and relationship with dental caries in Melbourne preschool children. Aust Dent J 2018; 63 72–80.
Hypomineralized second primary molars: prevalence, defect characteristics and relationship with dental caries in Melbourne preschool children.Crossref | GoogleScholarGoogle Scholar | 28881480PubMed |

[45]  Jamieson LM, Roberts-Thomson KF. Dental general anaesthetic trends among Australian children. BMC Oral Health 2006; 6 16
Dental general anaesthetic trends among Australian children.Crossref | GoogleScholarGoogle Scholar | 17184552PubMed |

[46]  Pedersen J, Stensgaard K, Melsen B. Prevalence of malocclusion in relation to premature loss of primary teeth. Community Dent Oral Epidemiol 1978; 6 204–9.
Prevalence of malocclusion in relation to premature loss of primary teeth.Crossref | GoogleScholarGoogle Scholar | 278705PubMed |

[47]  American Academy Of Pediatric Dentistry (AAPD) Pulp Therapy for Primary and Immature Permanent Teeth. Pediatr Dent 2017; 39 325–33.
| 29179372PubMed |

[48]  Monte-Santo AS, Viana SVC, Moreira KMS, Imparato JCP, Mendes FM, Bonini GAVC. Prevalence of early loss of primary molar and its impact in schoolchildren’s quality of life. Int J Paediatr Dent 2018; 28 595–601.
Prevalence of early loss of primary molar and its impact in schoolchildren’s quality of life.Crossref | GoogleScholarGoogle Scholar | 30105883PubMed |

[49]  Independent Hospital Pricing Authority. National Hospital Cost Data Collection Australian Public Hospitals Cost Report 2012–2013, Round 17. Darlinghurst, NSW: Independent Hospital Pricing Authority: 2015.

[50]  Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 1997.

[51]  Alsharif AT, Kruger E, Tennant M. Disparities in dental insurance coverage among hospitalised Western Australian children. Int Dent J 2014; 64 252–9.
Disparities in dental insurance coverage among hospitalised Western Australian children.Crossref | GoogleScholarGoogle Scholar | 24835791PubMed |

[52]  Kruger E, Tennant M. Potentially preventable hospital separations related to oral health: a 10-year analysis. Aust Dent J 2015; 60 205–11.
Potentially preventable hospital separations related to oral health: a 10-year analysis.Crossref | GoogleScholarGoogle Scholar | 25989466PubMed |

[53]  hit92.9. It’s time: Perth wants those community service ads back on TV! 2017. Available at: https://www.hit.com.au/story/its-time-perth-wants-those-community-service-ads-back-on-tv-15415 [Verified 10 September 2020]