Bridging the gap: An integrative literature review on guidelines for the use of dental general anaesthesia in children

Abstract

Dental general anaesthesia (DGA) in children has become widely accepted in many countries, including New Zealand. This is a risk to patients' health and well-being; as the DGA referral volume increases, so does the length of the theatre waitlist, and subsequently, critical treatments for these patients are delayed. This is alarming as dental caries themselves are a preventable disease. The aim of this research is to review and analyse the literature on DGA referral criteria and care pathways, and with the findings, to recommend guidelines for the use of DGA in children in New Zealand. DGA referral guidelines for New Zealand children were called for in 2008 by a working group commissioned by the New Society of Hospital and Community Dentistry. However, this integrative literature review could find no evidence in the adoption of consistent national guidelines or on subsequent recommendations. International evidence suggests that the DGA referral rates for children could be reduced by up to 50% through a combination of; improving practitioners' skills on behaviour management strategies in clinics, rigorous assessment of the need for DGA referrals in the face of alternative treatment modalities, improved informed decision-making of the parents, and ultimately a clear set of guidelines for DGA referrals in children. This integrative literature review identified 15 articles from four databases and synthesised nine themes. The themes were translated into recommendations which could form the basis of a pilot study for the guidelines of DGA in children. The evidence level of this review is sufficient to support a pilot study, according to the John Hopkins Nursing Evidence-Based Practice model. Enabling practitioners to reduce their DGA referral rates is only a form of disease management, an interim solution to this public health crisis. The real disease solution is, and has always been, to focus on addressing the root cause of dental caries via public health prevention measures.