Purpose: As of 2011, 70% of all states (35/50) have legislation outlining criteria for the use of general anesthesia (GA) to manage early childhood caries (ECC). Criteria are inconsistent, with varying age, health and disease requirements. The purpose of this study was to compare parental and pediatric dentist criteria for treatment of dental disease under GA.
Methods: This case cohort series surveyed caregivers at both a large urban tertiary hospital and also at a suburban private pediatric dental practice. Caregiver responses were compared to results from an electronic survey sent to Board-certified members of the American Academy of Pediatric Dentistry (AAPD).
Results: Data were collected from 195 parents 631 dentists. Parents believe that children (a) from ages 3-4, (b) with 2-4 carious teeth or (c) requiring 2-4 extractions or restorations all immediately qualify for GA; all significantly different (P<.0001) from surveyed dentists, who felt the above did not provide a solely adequate criteria. Thirty-two percent of parents felt that a developmental delay automatically qualified a patient for GA, significantly more than the 12% of dentists (P<.0001). Parents and dentists did agree that a behavior problem at any age qualified a patient for GA (P=<.78). When asked “who was most qualified to determine appropriateness for treatment of dental cavities under GA?” both parents and dentists ranked dentists first, and insurance companies last. However, parents ranked themselves above physicians, while dentists ranked physicians higher. This difference was significant (P<.0001). Pediatric dentists report they consult the AAPD guidelines first when considering a child for general anesthesia, followed by state legislation and insurance company reimbursement last. Fifty-five percent of pediatric dentists report they have delayed urgent/ emergent care waiting for insurance pre-authorization.
Conclusion: Board certified pediatric dentists were less likely to have specific tooth number or disease-criteria for GA than parents. Most pediatric dentists referred to the AAPD guidelines for GA, with less than 10% citing state legislation as their first choice. Twenty-seven percent of parents felt they were most qualified to request GA, while 11% of parents felt physicians were most qualified.