Comparing sedation versus general anaesthesia for children who need to have dental treatment

Review question

This updated Cochrane systematic review aimed to look at evidence comparing use of sedation versus general anaesthesia to help children (up to 18 years of age) undergoing dental treatment. We wanted to see which (if any) approach allowed dental treatment to be carried out safely and effectively. We were also interested in the relative financial cost of each approach.

Background

At present, children unable to cope with dental care under local anaesthetic may be given general anaesthesia or sedation to help them. This choice is dependent on factors such as patient or dentist preference, the cost of the procedure or local regulations. Some people believe that sedation is better for this, as patients prefer it and it may be cheaper.

Methods

For our original review, we searched the databases until October 2008. For this updated review, we searched the following databases to July 2015: CENTRAL, MEDLINE, EMBASE, LILACS and ISI Web of Science.

Key results

Unfortunately, we could not identify any randomized controlled trials on this topic. These trials are required for comparison of dental general anaesthesia versus sedation, to quantify differences such as morbidity and cost.

Authors' conclusions: 

Randomized controlled studies comparing use of dental general anaesthesia versus sedation are needed to quantify differences such as morbidity and cost.

Read the full abstract...
Background: 

A significant proportion of children have caries requiring restorations or extractions, and some of these children will not accept this treatment under local anaesthetic. Historically this has been managed by the use of a general anaesthetic in children; however, use of sedation may lead to reduced morbidity and cost. The aim of this review was to compare the efficiency of sedation versus general anaesthesia (GA) for provision of dental treatment to children and adolescents younger than 18 years. This review was originally published in 2009 and was updated in 2012 and again in 2015.

Objectives: 

We will evaluate morbidity and effectiveness of sedation versus GA for provision of dental treatment to patients younger than 18 years. If data become available, we will analyse the cost-effectiveness of different interventions. If data are not available, we will obtain crude estimates of cost.

Morbidity can be defined as 'an undesired result or complication'. For the purposes of this review, 'postoperative morbidity' refers to undesired results or complications such as nausea following a procedure, once the patient had been restored to consciousness and could breathe unaided. 'Intraoperative morbidity' refers to any complications that occur during the procedure that may necessitate action by the anaesthetist or the sedationist, such as respiratory arrest.

Search strategy: 

In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 7); MEDLINE Ovid SP (1950 to July 2015); EMBASE Ovid SP (1974 to July 2015); System for Information on Grey Literature in Europe (SIGLE) (1980 to October July 2012); Latin American & Caribbean Health Sciences Literature (LILACS) (1982 to July 2015); and Institute for Scientific Information (ISI) Web of Science (1945 to July 2015).

We also carried out handsearching of relevant journals to July 2015. We imposed no language restriction.

Selection criteria: 

We planned to include randomized controlled clinical trials that compared sedative agents versus general anaesthesia in children and adolescents up to 18 years of age undergoing dental treatment. We excluded complex surgical procedures and pseudo-randomized trials.

Data collection and analysis: 

Two review authors assessed titles and abstracts for inclusion in the review. We recorded information relevant to objectives and outcome measures by using a specially designed 'data extraction form'. We will employ the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach to interpret findings.

Main results: 

In our original review, we identified 16 studies for potential inclusion after searching available databases and screening titles and abstracts. After retrieving full-text studies, we found none to be eligible. We identified no additional studies in the updated search of July 2012. We identified two studies for possible inclusion in the updated search of July 2015; again we found these to be ineligible.

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