Treatment Planning for Paediatric Exodontia under General Anaesthesia: A Re-Audit

Abstract

This re-audit of paediatric exodontia under general anaesthetic assessed seventy one patients’ GA records across three boroughs in the directorate Bury, Oldham and Rochdale between 02/01/2020 to 17/03/2020. It assessed compliance with Pennine Care local guidelines including: • The justification for GA • Attendance at a dedicated POA • Pre-operative radiographs and their justification • Pre-operative restorations • Were patients caries free following GA? • Were guidelines adhered to when extracting FPM’s including orthodontic considerations? • Were first permanent molars balanced/compensated where appropriate? • Were all poor prognosis deciduous teeth extracted under GA? • Was appropriate consideration given to balancing/compensating extractions? • Record keeping standards • Were patients appropriately discharged/reviewed? Results were varied and showed good compliance with some parts of the guidelines such as 70/71 (98.6%) patients having dedicated POA in the re-audit. The percentage of patients with a dedicated oral health appointment rose from 13.9% (11/79) for Cycle 1 to 38.0% (27/71) for Cycle 2 which is a 24.1% improvement. The percentage of patients without documented justification for a lack of radiographs dropped from 26.5% (9/34) for Cycle 1 to 9.1% (3/33) for Cycle 2. This shows a 17.4% improvement. There were improvements in the numbers of patients having appropriate balancing extractions for unilaterally carious deciduous canines: 6/9 (66.7%) for Cycle 1 and 11/13 (84.6%) for Cycle 2. This shows an improvement of 17.9% 24/26 of patients (92.3%) in Cycle 2 who had planned extraction of FPM’s had pre-operative x-rays and there were some improvements in the number of patients with documented orthodontic considerations compared to Cycle 1. For example: The number of patients with documented assessment of crowding rose from 16.7% (4/24) in Cycle 1 to 85.2% (23/27) in Cycle 2. This is a 71.8% improvement. The percentage of patients who were advised of the risk of future mesial tipping or malocclusion of the second permanent molars rose from 8.3% (2/24) in C1 to 57.7% (15/26) in C2. This is a 49.4% improvement. 94.3% (67/71) of patients were caries free following completion of GA in the re-audit whereas the target is 100%. However, some of these findings appear to be record keeping errors. Greater consistency is needed regarding record keeping as well as the post-operative review/discharge process. A greater awareness of the guidelines would be helpful.