2021 Volume 42 Issue 3 Pages 293-299
We work at a dentistry department in a social welfare facility for people with intellectual disabilities and provide dental treatments for both residents and outpatients. At our department, dental treatments are provided under general anesthesia (GA) for patients who are restless because of intellectual disabilities or other reasons. We provide patients who are difficult to treat at primary care facilities with treatments under intravenous sedation (IVS) and day treatment under GA, and we refer patients who require inpatient treatment under GA to tertiary medical care facilities. To share useful information for smooth collaborative dental treatment for people with disabilities, we conducted a survey on dental treatments provided under GA at our department for over 25 years. Of a total of 112,093 patients treated (70,884 residents and 41,209 outpatients), 368 were treated under GA (80 residents and 288 outpatients), with a mean annual number of 14.7 (6.7) patients. Patients aged 21-30 years accounted for the largest proportion (33.7%), and the majority were men (67.1%). Intellectual disabilities were the most common disabilities observed in these patients, and dental pulp treatment was the most common treatment provided. The mean treatment duration, GA duration, and time to recovery after GA were 94.5 (40.9) minutes, 139.5 (44.0) minutes, and 112.5 (37.5) minutes, respectively. Slow anesthesia induction accounted for 72.3% of all induction methods used. The most commonly used anesthetics for the intraoperative maintenance of GA were nitrous oxide–sevoflurane and propofol (135 cases, 36.7%). After the muscle relaxant was switched from vecuronium bromide to rocuronium bromide, the time needed for GA induction was shortened；the usage of nitrous oxide was ceased, but the time to arousal was unaffected by this change. Perioperative complications were observed in 18 cases (4.9%), but all of them improved without exacerbation.
For better collaborative dental treatment for people with disabilities, we need to choose safe day treatments under GA whenever possible primarily for outpatients referred from primary healthcare institutions. Hence, in the past 25 years we have made efforts to shorten the durations of treatment and anesthesia and ensure the availability of ample recovery time. Moreover, to provide day treatments under GA efficiently with a limited number of staff, it is important to call back patients who had received GA and evaluate their oral health and provide them with training so that they can receive dental treatments under IVS or in the standard setting.
