title: Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service.
abstract: BACKGROUND
  Dental general anaesthesia (DGA) is a very efficient treatment modality, but is considered only in the last resort because of the risks posed by general anaesthesia to patients' overall health. Health services and their treatment policies regarding DGA vary from country to country. The aims of this work were to determine the reasons for DGA in the Helsinki Public Dental Service (PDS) and to assess the role of patient characteristics in the variation in reasons and in the treatments given with special focus on preventive care.
  
  
  METHODS
  The data covered all DGA patients treated in the PDS in Helsinki in 2010. The data were collected from patient documents and included personal background: age (<6, 6-12, 13-17, 18-68), gender, immigration, previous conscious sedation and previous DGA; medical background; reasons for DGA and treatments provided. Chi-square tests, Fisher's exact test, and logistic regression modelling were employed in the statistical analyses.
  
  
  RESULTS
  The DGA patients (n=349) were aged 2.3 to 67.2 years. Immigrants predominated in the youngest age group (p<0.001) and medically compromised patients among the adults (p<0.001) relative to the other age groups. The main reason for DGA was extreme non-cooperation (65%) followed by dental fear (37%) and an excessive need for treatment (26%). In total, 3435 treatments were performed under DGA, 57% of which were restorations, 24% tooth extractions, 5% preventive measures, 5% radiography, 4% endodontics and the remaining 5% periodontics, surgical procedures and miscellaneous. The reasons for DGA and the treatments provided varied according to age, immigration, previous sedation and DGA and medical background. The logistic regression model showed that previous sedation (OR 2.3; 95%CI 1.3-4.1; p=0.005) and extreme non-cooperation (OR 1.7; 95%CI 0.9-3.2; p=0.103) were most indicative of preventive measures given.
  
  
  CONCLUSIONS
  Extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive, conservative DGA in the Helsinki PDS. The reasons for the use of DGA and the treatments provided varied according to personal and medical background, and immigration status with no gender-differences. Preventive measures formed only a minor part of the dental care given under DGA.
authors.affiliation: Department of Community Dentistry, Institute of Dentistry, University of Oulu, Oulu, Finland.
authors.forename: Nora
authors.initials: N
authors.lastname: Savanheimo
authors.forename: Sari A
authors.initials: SA
authors.lastname: Sundberg
authors.forename: Jorma I
authors.initials: JI
authors.lastname: Virtanen
authors.forename: Miira M
authors.initials: MM
authors.lastname: Vehkalahti
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003190:Comprehensive Dental Care; D016854:Dental Anxiety; D003729:Dental Care / Q000706:statistics & numerical data*; D003752:Dental Health Services; D003793:Dental Restoration, Permanent; D054242:Emigrants and Immigrants; D005260:Female; D005387:Finland; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011313:Preventive Dentistry; D014081:Tooth Extraction; D055815:Young Adult