The frequent use of antiepileptic and antipsychotic medications highlights the importance of understanding potential drug interactions during anesthetic management in special needs dentistry.
Abstract
Introduction Patients with intellectual disabilities, autism spectrum disorder, and related conditions often require sedation or general anesthesia to receive dental treatment. Many of these patients routinely take multiple medications, including antiepileptic and antipsychotic drugs, which may influence anesthetic management through drug interactions. However, medication use among patients receiving dental anesthesia in special needs dentistry has not been well investigated. This study aimed to clarify patterns of oral medication use in this population. Methods This retrospective descriptive study included patients who underwent dental treatment under general anesthesia or intravenous sedation at Okayama University Hospital, Japan, between April 2022 and March 2025. Demographic characteristics, anesthesia-related variables, and regularly prescribed oral medications were collected from electronic medical records. Medications were categorized by pharmacological class, and descriptive statistical analyses were performed. Results A total of 424 patients were analyzed. The mean age was 27.6 ± 15.3 years, and 67.4% were male. General anesthesia was used in 70.5% of patients. Overall, 71.0% regularly used oral medications, and polypharmacy, defined as the use of five or more medications, was observed in 23.5%. Antiepileptic drugs (36.8%) and antipsychotics (35.4%) were the most frequently prescribed medication classes. Risperidone and sodium valproate were the most commonly prescribed medications. Conclusion Despite the relatively young age of the study population, medication use and polypharmacy were highly prevalent. The frequent use of antiepileptic and antipsychotic medications highlights the importance of understanding potential drug interactions during anesthetic management in special needs dentistry.
AbstractAim: The high prevalence of oral health problems and barriers to dental healthcare access constitute an important health inequity for individuals with disabilities. This inequity becomes more pronounced in patients who cannot be treated in standard clinical settings and require general anesthesia (GA) for comprehensive dental care. This study aimed to evaluate the sociodemographic and clinical profiles, treatment needs, and service process indicators of children and adults with disabilities who received dental health services under GA at a faculty of dentistry.Methods: This retrospective study analyzed Hospital Information Management System (HIMS) records of 262 patients with disabilities who received dental health services under GA between March 2017 and March 2020. Evaluated variables included GA sessions, waiting times, operation durations, medical consultation requirements, referral status, out-of-pocket payment status, and dental treatment needs. Descriptive statistics, Chi-square, and Mann–Whitney U tests were performed. Results: Of the patients, 38.2% were children and 61.8% were adults. Their main diagnosis were neurodevelopmental disorders, diseases of the nervous system, and developmental anomalies. The presence of out-of-pocket payments (Children [C]: 11.0%; Adults [A]: 38.9%; p=0.000) and the rate of receiving multiple GA sessions (C: 1.0%; A: 22.2%; p=0.000) were higher in adults. Additionally, the duration of the first GA session was significantly longer in adults (C: 170 min; A: 195 min; p=0.039). The most common dental treatment needs under GA were restorative (91.0%) and surgical (88.0%) treatments in children, and periodontal (90.1%), restorative (87.2%), and surgical (66.0%) treatments in adults.Conclusion: Dental treatment needs under GA varied by age group, with a more comprehensive and complex treatment burden emerging among adults. Therefore, improvement of preventive applications and easily accessible dental care are the main domains for developing oral health policies for patients with disabilities.Keywords: Dental care for persons with disabilities, General anesthesia, Treatment needs, Health services accessibility, Hospital information management systems
Tuğba Emine Beyhan, Gülcan Berkel, Ş. C. Akmansoy et al.· International Journal of Hea...· 0 citations
Children and young adults with severe pre-existing conditions frequently require dental treatment under general anesthesia (GA) and are commonly scheduled for postoperative inpatient surveillance due to presumed elevated anesthetic or surgical risks. Although this approach prioritizes safety, it may contribute to prolonged or unnecessary hospitalization, increased healthcare costs, and potential psychological burden, particularly in patients with neurodevelopmental or congenital disorders. In light of the reportedly low incidence of severe complications following dental treatment under GA, this study aims to evaluate the necessity of routine inpatient admission in pediatric patients (< 18 years of age) with comorbidities and to assess the frequency and severity of perioperative complications. All pediatric patients with pre-existing conditions who underwent planned inpatient surgical dental treatment under GA at the Department of Oral and Maxillofacial Surgery at Hannover Medical School between 2014 and 2025 were included. The indications for inpatient treatment, anesthesiological parameters such as the American Society of Anesthesiologists (ASA) classification, and severe perioperative complications (corresponding to grade ≥ 2 of the Clavien-Dindo classification) were analyzed. It was assessed whether the ASA classification or the type of pre-existing condition significantly influenced the occurrence of perioperative complications. A total of 199 patients were analyzed. Patients who underwent surgery were mainly categorized as ASA II (n = 80, 40.2%) and III (n = 102, 51.3%), and mostly presented with cardiovascular (n = 68, 34.2%) or hematological/oncological preconditions (n = 47, 23.6%). Perioperative complications occurred in 8 cases (4.2%); of those, 6 were intraoperative (3.1%), and 2 were postoperative (1.0%). The probability of perioperative complications did not correlate with ASA classification or pre-existing conditions (p [Fisher] = 0.166, and p [Fisher] = 0.571, respectively). Age significantly influenced the probability of complications (U = 451.00, p = 0.050), indicating that older patients were more likely to experience complications than younger patients. As postoperative complications occur very rarely, even in patients with pre-existing conditions, inpatient surveillance should warrant thoughtful consideration to liberate hospital capacities. Interdisciplinary pre-, intra-, and postoperative assessment of the need for inpatient surveillance should ensure patient safety and provide further insights into risk factors for peri- and especially postoperative complications. The authors recommend validating risk scores and algorithms for decision-making regarding inpatient surveillance.
M. L. Linderkamp, E. Papazacharias, Madlen Sophie Eich et al.· Oral and Maxillofacial Surge...· 0 citations
Background: Dental anxiety and uncooperative behavior are common challenges in pediatric dentistry and can
negatively affect treatment outcomes and future dental attendance. Sedation techniques are frequently employed
to reduce anxiety, improve cooperation, and enhance children's overall dental experience. However, evidence
comparing the impact of different sedation techniques on children's experience and compliance remains limited.
Objective: To compare the effects of inhalation sedation and oral sedation on children's experience and
compliance during dental procedures.
Methods: This prospective comparative observational study included 100 children aged 4–10 years requiring
dental treatment under sedation. Participants were divided into two groups: Group A (n = 50) received inhalation
sedation with nitrous oxide–oxygen, and Group B (n = 50) received oral sedation. Children's experience was
assessed post-procedure using a facial image scale, while compliance during treatment was evaluated using the
Frankl Behavior Rating Scale. Demographic and clinical variables were recorded. Data were analyzed using
descriptive statistics, chi-square tests, and logistic and ordinal regression analyses using STATA, with p < 0.05
considered statistically significant.
Results: Children in the inhalation sedation group demonstrated significantly higher rates of positive experience
and cooperative behavior compared to the oral sedation group. Logistic regression analysis showed that inhalation
sedation significantly increased the odds of cooperative behavior. Ordinal regression analysis also indicated a
significant association between inhalation sedation and improved experience scores, independent of age and
gender.
Conclusion: Inhalation sedation was more effective than oral sedation in improving children's dental experience
and compliance during procedures. These findings support the preferential use of inhalation sedation as a behavior
management strategy in pediatric dentistry
Isha Tewary, P. Samir, Esta F Thattil et al.· International Journal of Dru...· 0 citations
Highlights What are the main findings? ASD was the leading systemic condition in both the outpatient clinic and the subgroup treated under general anaesthesia (outpatient: 25.0%; GA subgroup: 42.9%), a significantly higher prevalence compared with a non-overlapping outpatient-only comparator (p = 0.003); 81.0% of GA patients required two or more procedure types per session (mean 2.5 ± 1.0). Dental caries (61.0%) and root remnants (32.1%) far exceeded general Spanish population rates, indicating a critical preventive deficit in CSHCN. What are the implications of the main findings? Referrals originated from 27 hospitals across the Valencian Community, highlighting the regional referral role of the centre. Caregiver-targeted preventive programmes and expanded hospital dental capacity may reduce reliance on resource-intensive surgical intervention in this population. Abstract Background/Objectives: Children with special healthcare needs (CSHCN) face significant barriers to conventional dental care and frequently require general anaesthesia (GA). Data characterising the clinical and therapeutic profile of this population in the Spanish public health system remain scarce. This study aimed to describe the systemic conditions, oral pathology, and dental procedures performed in CSHCN attending a tertiary-care paediatric oral and maxillofacial surgery service, and to characterise the subgroup of patients requiring treatment under GA relative to the wider clinic population. Methods: A retrospective, descriptive, observational study was conducted at the Hospital Universitario y Politécnico La Fe (Valencia, Spain) from November 2022 to February 2026. Data were extracted from electronic health records for 160 outpatient clinic patients aged 0–14 years (70.6% male), of whom 42—a subgroup, not an independent sample—subsequently underwent dental treatment under GA (76.2% male). Sex, age, and autism spectrum disorder (ASD) status were compared between the GA subgroup and a non-overlapping outpatient-only comparator (n = 118) using Fisher’s exact test and Welch’s t-test. Results: ASD was the most prevalent systemic condition in both the outpatient clinic (25.0%) and the GA subgroup (42.9%); a statistically significant association with ASD status was observed against the non-overlapping outpatient-only comparator (18.6% ASD; p = 0.003), while sex (p = 0.432) and age (p = 1.00) did not differ. Dental caries was the most common finding at outpatient assessment (61.0%), followed by root remnants (32.1%). Among GA patients, tooth extraction was performed in 78.6%, composite restoration in 71.4%, and professional dental cleaning in 50.0%. The mean number of procedure types per GA patient was 2.5 ± 1.0 (range 1–5); 81.0% received two or more procedure types in a single session. Conclusions: CSHCN attending this service present advanced oral disease, and those referred for GA had a significantly higher prevalence of ASD than the remaining clinic population, requiring complex, multi-procedure interventions in a single session. The wide geographic pattern of referrals suggests that further evaluation of the distribution of hospital dental services within the public health network may be warranted, and caregiver-targeted preventive programmes may represent a promising strategy to reduce the oral disease burden in this population.
Maria Carmona-Santamaría, María Isidora Sarciat Aguayo, L. Marqués-Martínez et al.· Children· 0 citations
Background and Objectives
Anesthetic management for Charcot-Marie-Tooth disease (CMT) is still controversial and source of concerns for both anesthetists and patients. We explored the frequency of self-reported complications following anesthesia in a large cohort of patients with CMT compared with unaffected controls.
Methods
We administered an online ad hoc questionnaire to patients enrolled in the Italian CMT Registry and to unaffected controls. The questionnaire collected self-reported adverse events following any anesthetic procedure undergone during the participants' lifetime. Anesthetic procedures were categorized as general anesthesia (including endotracheal intubation or deep sedation), central neuraxial anesthesia (epidural or spinal anesthesia), and peripheral regional anesthesia (plexus or peripheral nerve blocks).
Results
Overall, the questionnaire was completed by 290 patients with CMT (160 female patients; mean age 47.8 ± 13.1 years) and 94 controls (46 female patients; mean age 47.5 ± 13.2 years), and a total of 508 and 161 procedures, respectively, were analyzed. The rate of self-reported complications following general, central neuraxial, and peripheral regional anesthesia did not differ between patients with CMT and controls. All reported events in the CMT cohort were transient and fully resolved, with a favorable anesthetic outcome in all cases. Demyelinating CMT subtypes were not more likely to report complications than axonal subtypes. Moreover, experienced complications following anesthesia for cesarean delivery occurred with similar frequency in patients with CMT and controls.
Discussion
Anesthesia-related complications are not reported more frequently in patients with CMT compared with controls. However, longitudinal studies incorporating objective clinical assessments and detailed information on anesthetic agents are warranted.
Alessandro Bertini, Marco Gemma, Fiore Manganelli et al.· Neurology: Genetics· 0 citations
Introduction: Dental anxiety is a significant challenge in oral healthcare, affecting patients of all ages and potentially compromising treatment adherence, cooperation during procedures, and overall clinical outcomes. Non-pharmacological interventions have increasingly been used as complementary strategies to reduce anxiety and promote patient comfort during dental care and procedures.
Objectives: To identify and map the existing scientific evidence on non-pharmacological interventions used to reduce anxiety in patients undergoing dental care and procedures.
Methodology: A scoping review will be conducted in accordance with the Joanna Briggs Institute methodological guidance and reported in line with the PRISMA-ScR recommendations. The literature search will be conducted in PubMed, MEDLINE Complete, CINAHL Ultimate, Scopus, Psychology and Behavioral Sciences Collection, RCAAP, and BASE. Search strategies will combine controlled vocabulary, where applicable, with free-text terms structured around three conceptual blocks: anxiety or dental fear, dental/oral healthcare and procedures, and non-pharmacological interventions. Quantitative, qualitative, mixed-methods, observational, experimental, quasi-experimental, descriptive, and case studies meeting the eligibility criteria will be considered for inclusion. Study selection and data extraction will be conducted independently by two reviewers, with disagreements resolved through discussion and, when necessary, consultation with a third reviewer. The study selection process will be documented using a PRISMA-ScR flow diagram. The protocol has been registered and made publicly available through the Open Science Framework 10.17605/OSF.IO/J59PG.
Expected Results: The review is expected to identify and categorise the range and characteristics of non-pharmacological interventions investigated for anxiety management during dental care and procedures, including complementary and holistic approaches, and to map the outcomes assessed and gaps in the existing evidence.
Conclusion: This scoping review is expected to provide a comprehensive mapping of non-pharmacological strategies for anxiety management in dental care, supporting evidence-informed, patient- centred practice and identifying priorities for future research.
M. Moreira, L. Oliveira, Inês Lopes Cardoso et al.· Athena Health & Research...· 0 citations
