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General Anesthesia and Deep Sedation for Dental Treatments in Children: A Review of Clinical Effectiveness and Guidelines

Last updated: March 7, 2017
Project Number: RC0863-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of dental treatment under deep sedation or general anesthesia compared with moderate sedation or minimal sedation in children?
  2. What are the evidence-based guidelines regarding the appropriate dental treatments that can be performed under general anesthesia or deep sedation in children?
  3. What are the evidence-based guidelines regarding the volume of procedures that can be performed under a single general anesthesia or deep sedation in children?

Key Message

One systematic review investigated the use of general anesthesia (GA) in pediatric patients compared with lower levels of sedation; however, there were no randomized controlled trials (RCTs) that met the inclusion criteria for their review. Similarly, there were no RCTs identified that met the inclusion of CADTH’s review. One large prospective cohort study reported that there was no statistically significant difference in the frequency of complications for deep sedation/GA compared with moderate sedation for patients undergoing third-molar extraction. One small prospective study, reported that conscious sedation (CS) was associated with statistically significantly lower oxygen saturation compared with GA and a statistically significantly shorter duration for the procedure. One small retrospective cohort study reported that patients who were treated for early childhood caries (ECC) under GA were statistically significantly more likely to exhibit positive behavior during follow-up dental examinations at six months compared with those who received CS; however, there were no statistically significant differences at 12 or 18 months. Indigenous populations were a subgroup of interest for this review; however, there were no studies identified that specifically addressed this population. There were no Canadian clinical practice guidelines that addressed the question of what dental treatments are appropriate to be performed under GA or deep sedation. One clinical practice guideline from the United Kingdom recommended the following clinical circumstances as situations where the use of GA may be suitable: severe pulpitis requiring immediate relief; acute soft tissue swelling requiring removal of the infected tooth/teeth; surgical drainage of an acute infected swelling; single or multiple extractions in a young child unsuitable for conscious sedation; symptomatic teeth 1 quadrant; moderately traumatic or complex extractions; teeth requiring surgical removal or exposure; biopsy of a hard or soft tissue lesion; debridement and suturing of orofacial wounds; established allergy to local anesthesia; and post-operative hemorrhage requiring packing and suturing. There were no evidenced-based guidelines identified in the literature search that specifically addressed the volume of dental procedures that could be carried out under a single GA.