|Year : 2021 | Volume
| Issue : 2 | Page : 158-161
|Parental issues and concerns for their children treated under general anaesthesia for early childhood caries: A qualitative research approach
Rachana Srinivas1, Latha Anandakrishna2
1 Department of Pedodontics and Preventive Dentistry, Subbaiah Institute of Dental Sciences, Shimoga, Karnataka, India
2 Department of Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
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|Date of Submission||03-Jan-2021|
|Date of Decision||29-Mar-2021|
|Date of Acceptance||13-Jul-2021|
|Date of Web Publication||22-Nov-2021|
| Abstract|| |
Context: Most often, young children with early childhood caries (ECC) may need oral rehabilitation under general anaesthesia (GA) as treatment cannot be done chairside. A procedure under GA can be traumatic and stressful for both the parents and the children. Hence, it becomes necessary to understand the parents' opinions and address their concerns to provide better treatment. Aims: This qualitative study was conducted to explore the parental issues and concerns for their children treated under GA for ECC. Qualitative research approach was used so that it would enable us to address these issues better and prepare parents by counselling them in advance. Settings and Design: An in-depth interview was conducted with the parents of children who underwent oral rehabilitation under GA for ECC in the M.S. Ramaiah Memorial Hospital, admitted under the Department of Pedodontics and Preventive Dentistry. Participants and Methods: Data were audio-recorded and transcribed. Statistical Analysis Used: Data collected were analysed using thematic analysis. Results: The themes derived were 'Concerns and Issues of GA Procedures and Improved Oral-health-related Quality of Life'. Conclusions: The parents of children who underwent oral rehabilitation under GA initially had a few concerns and were reluctant about the procedure but were happy with the improvement post-operatively.
Keywords: ECC, OHRQoL, Oral rehabilitation under GA
|How to cite this article:|
Srinivas R, Anandakrishna L. Parental issues and concerns for their children treated under general anaesthesia for early childhood caries: A qualitative research approach. Indian J Dent Res 2021;32:158-61
|How to cite this URL:|
Srinivas R, Anandakrishna L. Parental issues and concerns for their children treated under general anaesthesia for early childhood caries: A qualitative research approach. Indian J Dent Res [serial online] 2021 [cited 2022 Oct 5];32:158-61. Available from: https://www.ijdr.in/text.asp?2021/32/2/158/330854
| Introduction|| |
Caries is the most common oral disease affecting children worldwide, being five times more common than asthma and seven times more common than hay fever. Early childhood caries (ECC) can be defined as 'the presence of one or more decayed (non-cavitated or cavitated), missing (due to caries), or filled tooth surfaces in any primary tooth in a child up to 71 months of age or younger'. It is a serious socio-behavioural and a chronic dental problem that affects infants and toddlers all over the world. These children are at risk for compromised growth due to poor nutrition., Significant morbidity is experienced by these children and their families in terms of pain, missed school days, decreased academic performance and increased medical expenses. They are also more susceptible to caries in the permanent teeth. Hence, early treatment is necessary in these children to improve their oral-health-related quality of life (OHRQoL).
Most often, younger children may need oral rehabilitation under general anaesthesia (GA) as treatment cannot be done chairside in the dental operatory either due to the age of the patient as in the case of an emotionally immature child, due to time constraints, Special Health Care Needs (SHCN) children or if extensive dental treatment is necessary. Even though oral rehabilitation under GA may be the best choice or the only treatment option in certain cases, it can be quite traumatic and stressful for both the parents and the children. Hence, it becomes essential to understand the patients' opinions and address their concerns to provide better care. Although literature is available regarding the improvement of OHRQoL and the recurrence of caries following GA, the data exploring the issues and concerns faced by the parents of these children are sparse.
Qualitative research follows an 'interpretive approach' by allowing one to identify issues from the perspective of study participants and to understand the meanings and interpretations that they give to behaviour, events or objects. Hence, a qualitative research approach was used to acquire a deeper understanding of the concerns and issues faced by the parents of children treated under GA to enable us to address these issues better and prepare the parents by counselling them in advance.
Thus, the aim of the present study was to explore the parental issues and concerns for their children treated under GA for ECC by means of a qualitative research approach.
| Participants and Methods|| |
Ethics clearance for the study was obtained from the Institutional Review Board. Informed consent was obtained from each of the participants. Data were obtained from the parents of children who underwent oral rehabilitation under GA for ECC in M. S. Ramaiah Memorial Hospital between January 2014 and January 2016, admitted under the Department of Pedodontics and Preventive Dentistry. The participants who returned for regular follow-up every 3 months and spoke English fluently were chosen by purposive sampling. The participants were contacted by telephone. A small number of parents refused to participate in the study for various reasons, such as time constraints. The interviews were scheduled for the participants who agreed and were conducted at their convenience. Informed consent was obtained from each of the participants. One-on-one in-depth interviews were conducted by the primary investigator (R.S) with the parents of children with ECC, i.e., those aged 3–6 years at the time when they underwent oral rehabilitation under GA. The sessions were held in a discussion room with a natural setting and were conducted in a relaxed manner. The interviews were fully audio-recorded by means of an audio recorder with the consent of the participants, whose anonymity was maintained, and then transcribed verbatim by the investigator. Immediately after the session, the investigator 'spot-checked' the recording equipment to ensure that it had worked. Each interview lasted for 25–30 minutes, with no breaks during the session, and was conducted in English. The in-depth interviews were conducted according to the pilot-tested interview guide developed based on the literature search.
The semi-structured interview guide emphasised domains such as
- Opinion and awareness about oral health
- Information given by the surgeon/dentist regarding the procedure
- Issues and concerns of the parents regarding the child undergoing procedures under GA
- Experience in the hospital
- Improvement in the child's QoL after oral rehabilitation
Data collection and transcription were done simultaneously. The grounded theory approach was used. Transcripts were read and re-read to arrive at the codes manually. Codes were re-read and grouped into patterned categories. Then, based on the thematic concept analysis framework, themes were derived from the data. In-depth interviews were continued until data saturation was achieved. All the recorded data were destroyed when the study was completed.
| Results|| |
Six in-depth interviews were conducted with the parents of children with ECC who underwent oral rehabilitation under GA before data saturation was reached. The mean age of the children was 53 months at the time they underwent the oral rehabilitation. Among the parents interviewed, 3 were female and 3 were male, with 4 male and 2 female children who underwent oral rehabilitation.
Five main categories were identified after coding using thematic analysis [Table 1].
Oral hygiene concerns: All the parents understood the importance of oral health and expressed the importance of the absence of oral problems and pain of any dental origin. The study participants were aware of the adverse effects of improper oral hygiene on health in general and particularly on the psychological well-being and confidence of the children. One parent was of the opinion that his child's overall health was affected, enunciating the suffering with the words, 'get fever regularly'. Most of the parents spoke about their previous inadequate knowledge regarding appropriate oral hygiene practices and dietary habits. A mother of one child who was on the autism spectrum expressed her child's inability to voice discomfort or pain due to dental origin and stressed the importance of oral hygiene maintenance and frequent visits to dentists, especially for children with special health care needs. In general, all parents agreed that their children were in a lot of pain or experienced discomfort due to their oral health. Most of the parents mentioned that their children were unable to eat adequately before the oral rehabilitation. One parent revealed that the child was mostly on a liquid diet. Another parent said that he/she was worried about the nutrition required for the growth of the child, stating that 'I think he had lost around 1–2 kilos when he was around 2 years'.
Risks of GA: The parents in the study expressed significant concerns about the risks of GA procedures, especially given the ages of their children. This opinion could be generalised even though one parent found the experience of treatment with the use of the drill too traumatic for the young child. Another parent recalled that the child 'had become very cold during the procedure', which was a cause for worry. Nevertheless, all parents were happy about the decision following the procedure as all the participants agreed that it would be a less traumatic alternative in children in the pre-cooperative age group and also given the reduced number of appointments required for the extensive treatment.
Concerns for the GA procedure: All the parents in the study agreed that even though they were initially anxious and apprehensive about the procedure, they were convinced to go ahead with it once all the concerns were addressed by the doctors. One parent in the study expressed concern about re-treatment and was worried about whether the child would have to undergo GA again. Another mother was worried about whether her son would allow the insertion of the I.V. line, which, according to her, is almost always necessary for the procedure. She agreed to the procedure once she was convinced that establishing an IV line would not be difficult once the child was sedated by inhalation. In general, the parents were apprehensive about the safety of the procedure and were reassured only after knowing that many similar procedures had been conducted not only in the institution but elsewhere as well and that their child was cared for by specialists in their respective fields.
Issues during the procedure: Most of the parents said that all the procedures—from the pre-anaesthetic check, admission, and the stay in the ward to the actual procedure—went smoothly and uneventfully. One parent was concerned about the child and wanted to observe the procedure. The parent was unhappy that he was not allowed to observe and stated that 'it was only dental treatment and attenders are allowed to other procedures such as childbirth'. Another parent was concerned about the GA procedure as his family was against subjecting such a young child to GA. He complained that the media had 'hyped' unfortunate incidents so much that it was a concern for the family.
Post-procedural improvement: All the parents in the study were content with the outcomes of the procedures. The children reported decreased pain and discomfort following the procedure. The parents also recounted immense improvement in their children's dietary habits. One parent expressed his pleasure, saying that the child was 'able to eat whatever he wants'. Another parent revealed a healthy weight gain in his child following the procedure. The parents also agreed that there was improvement in oral hygiene maintenance and increased compliance for review and follow-up visits from them. All the parents were willing to recommend oral rehabilitation under GA to others if the child needed it. One parent stated that 'it is better to undergo dental treatment under general anaesthesia because the child won't feel the pain and there won't be any psychological trauma'.
Thus, the themes derived from the categories were concerns and issues for the GA procedures and improved OHRQoL.
| Discussion|| |
The qualitative method of epidemiology was used in our study to facilitate better understanding of the concerns and issues faced by parents of children who underwent oral rehabilitation under GA. The methodological orientation adopted for the present study was phenomenology because we wanted to understand the 'lived' experiences of the parents of such children. This approach helps us in gaining a deeper understanding of the meaning of the everyday 'lived' experiences of people and how people make sense of or perceive the experiences. It relies on the paradigm of personal knowledge and subjectivity and emphasises the importance of personal perspective and interpretation. Phenomenological studies make detailed comments about individual situations which do not lend themselves to direct generalisation in the same way, which is sometimes claimed in quantitative research.
The in-depth interview method of qualitative research was used in this study as it provided a conducive environment for the participants to voice their opinions and express their 'lived experiences' in their own words without being influenced by other parents. The advantages of the one-on-one interviews included the opportunity to build rapport with participants, the ability to adapt the interviews to participants' responses and probe when necessary, and also the ability to make observations relevant to the study's results during data collection.
The parents in the study understood the importance of oral health and its association with general health. It is especially true in the case of children as ECC is known to hamper the growth of children., The considerable morbidity and suffering the children undergo because of their poor oral health is likely to help the family understand the importance of oral health. Although the parents in the study agreed that they previously had inadequate knowledge regarding oral health and hygiene practices, they were taking care to ensure that the children practised proper oral hygiene after the oral rehabilitation. This may be due to the fear of caries recurrence or to avoid repeated and extensive treatment in the future. This finding agrees with the results of a study conducted looking into the oral hygiene practices following oral rehabilitation under GA.
All parents in the study were initially apprehensive about subjecting their children to GA because of the risks associated with it and concerns they had, probably because they did not consider dental rehabilitation an emergency or life-saving procedure, even though they understood the severity and extent of the treatment required. However, the parents were willing once they were reassured and convinced about the safety of the procedure. Although there were a few setbacks during the procedures, the well-trained and organised team proved to be efficient in handling them. Indeed, selection of an exceptional team is crucial. However, one parent expressed an opinion that 'drilling' might more be traumatic to a child, perhaps from her personal experience, which could have instilled her dental fear in the child.
The participants in the study were very pleased with the outcomes of the procedures. They reported a significant improvement in the OHRQoL, similar to that reported in previous studies.,,,,, The parents also showed improved attention to oral hygiene maintenance and supervision and an overall more positive dental attitude. This can be attributed to the parents' increased awareness towards the prevention of oral diseases or avoidance of repeated dental procedures under GA. However, only parents who brought their children for regular follow-ups were selected for this study. Even though it was beyond the scope of the study, regular follow-up was observed only in certain parents who had developed a positive attitude towards the dental treatment, mainly in the preventive treatment domain. This may explain the low overall follow-up rate seen in patients. One parent had expressed concerns about repeated treatment for her child. Children with ECC certainly are susceptible to future caries, and variable failure rates are seen depending upon the treatment done., Although it was beyond the scope of the study to measure, none of the children in our study needed re-treatment under GA. However, proper recall and follow-up eliminate the need for repeated treatment under GA, as reported in a study.
Certain drawbacks might be present in our study. As our study was a single-centre study, the results may not be replicated elsewhere. Measures were taken to avoid interviewer bias during coding. The codes were re-read and discussed with peers to avoid bias caused by subjectivity. Similar studies might help to advance knowledge on this subject.
| Conclusion|| |
The parents of children who underwent oral rehabilitation under GA initially had a few concerns and were reluctant about the procedure but were happy with the improvement in their child's post-operative OHRQoL, so much that they would recommend it to other parents. A positive attitude was instilled in the parents towards their child's oral health. In general, if the issues and concerns of these parents are satisfactorily addressed, then more parents will readily accept oral rehabilitation under general anaesthesia for their children with ECC.
A study of this kind is important to paediatric dentists
- As it helps us in understanding the parents' concerns during oral rehabilitation of young children and provide superior quality treatment by addressing them beforehand
- Deal with the issues faced by the parents of children and address them appropriately
- In a country like India where oral rehabilitation under GA is not readily accepted due to the credence of inherent risks not just in the parents but among dentists too, this study can motivate more dental health professionals to readily accept it as an alternative when other methods of behaviour management are unsuccessful or if the need arises.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Rachana Srinivas
Department of Pedodontics and Preventive Dentistry, Subbaiah Institute of Dental Sciences, NH-13, Purle - 577 222, Shimoga, Karnataka
Source of Support: None, Conflict of Interest: None
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