title: Use of general anaesthesia in paediatric dentistry: barriers to discriminate between true and false cases.
abstract: OBJECTIVE
  The use of general anaesthesia (GA) has shown significant increase in child dental patients. This study aimed to assess whether behaviour management strategies can be the effective methods for decreasing the need for GA and its over-utilisation in paediatric dentistry.
  
  
  METHODS
  The patients (n = 240) aged 3-6 years old were selected from referrals by paediatric dentists (PD) or general dentists (GD) for dental treatment under GA. Each child's behaviour during first and subsequent appointments was assessed using the Frankl Behaviour Rating Scale. A first visit included clinical examination and fluoride therapy. In all sessions, a hierarchy of anxiety-reducing behaviour guidance strategies was implemented over nine steps in a logical treatment order.
  
  
  RESULTS
  Overall, 47.5% of children referred for dental treatments under GA were retrained to be treated routinely. False referrals were significantly higher in GD compared to PD group. 80.0% of the referred children by PD and 6.7% of those referred by GD were true GA cases and still needed GA. 20.1% of retrained children and 67.4% of true GA cases received conscious sedation. There was no significant change in the frequency of children considered uncooperative as the years of experience increased among GD, while this value was significant for PD.
  
  
  CONCLUSIONS
  The findings may highlight the importance of using behaviour management techniques thoroughly prior to referring an uncooperative child for treatment under GA, and may discourage its over-utilisation. Specifically, these skill sets and their efficient practice should be improved among general dentists.
authors.affiliation: Department of Paediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran.
authors.forename: N A
authors.initials: NA
authors.lastname: Aminabadi
authors.affiliation: Department of Paediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran.
authors.forename: E
authors.initials: E
authors.lastname: Najafpour
authors.affiliation: Department of Paediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Aghaee
authors.affiliation: Dental and Periodental Research Centre, Faculty of Dentistry, Tabriz University of Medical Science, Daneshgah St, Golgasht St, Tabriz, East Azerbaijan, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Sighari Deljavan
authors.affiliation: Department of Oral Science, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, East Azerbaijan, Iran.
authors.forename: Z
authors.initials: Z
authors.lastname: Jamali
authors.affiliation: Dental and Periodental Research Centre, Faculty of Dentistry, Tabriz University of Medical Science, Daneshgah St, Golgasht St, Tabriz, East Azerbaijan, Iran. s.shirazi.tbzmed88@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Shirazi
mesh_terms: D000766:Anesthesia, Dental; D000768:Anesthesia, General; D001007:Anxiety; D001521:Behavior Therapy; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D003815:Dentists; D005260:Female; D006801:Humans; D008297:Male; D010377:Pediatric Dentistry
keywords: Anaesthesia, general; Child behaviour; Child, preschool; Dental anxiety; Paediatric dentistry; Referral and consultation