Clinical relevance of access targets for elective dental treatment under general anesthesia in pediatrics.
OBJECTIVE
To evaluate the clinical relevance of access targets for elective dental procedures performed under general anesthesia at The Hospital for Sick Children in Toronto, Ontario, by assessing incremental changes in the burden of dental disease over wait times for such procedures.


METHODS
Children scheduled for elective dental procedures under general anesthesia were assigned a priority according to the dental diagnosis and the medical risk status. Each priority level was defined by a specific diagnostic code and access target (maximum acceptable wait time). The dental records of children who underwent dental procedures with general anesthesia between June 2005 and December 2008 were assessed retrospectively. A novel assessment scale was used to measure the cumulative burden of dental disease during the waiting period.


RESULTS
A total of 378 children (age range 10 months to 17 years) met the inclusion criteria. Statistically significant correlations were identified between disease burden and wait times for priority group IV (access target 90 days) (p=0.004), for the entire sample (p<0.001), for children with advanced dental caries and low medical risk (p=0.005), for patients with comorbidities (p=0.036), for healthy patients (p<0.001), for females (p=0.014) and for males (p=0.008). The mean cumulative burden of disease over time did not differ between matched groups with and without comorbidity (p=0.38).


CONCLUSIONS
A trend suggestive of increasing burden of dental disease for children with longer wait times for elective dental procedures involving general anesthesia was found, but it was not clinically significant. Refinements in the assessment scale and a better understanding of the natural history of dental disease will likely be useful in developing clinically relevant access targets.
Department of Dentistry, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8.
Sonia S
SS
Chung
Michael J
MJ
Casas
David J
DJ
Kenny
Edward J
EJ
Barrett
D000293:Adolescent; D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D019140:Dental Care for Children / Q000458:organization & administration*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D009864:Ontario; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014218:Triage; D018875:Vocabulary, Controlled