Abstract
Overview
Dental caries is one of the most prevalent preventable diseases in childhood and dental treatment for children under general anaesthetic (GA) is one of the leading reasons for avoidable hospital admissions each year in New Zealand. A large group of children receiving such care reside in Auckland as it is the largest populated city in New Zealand and accounts for approximately one-third of New Zealand’s population. Reports have indicated that the number of children who receive a dental GA is rising. Children residing in the most deprived areas are over-represented and often have more teeth affected by dental caries than those from least deprived areas; however, little is known if this has changed in recent years, particularly in the Auckland region. Ethnic inequalities exist, and Māori children have been disproportionally represented, but there is little published data about Pacific children who receive such care and the types of treatments they have despite knowing that this group has a high caries experience. Auckland has a multicultural population and a large population of children born overseas, and yet little is known about other ethnic groups who have received a dental GA. Few published studies have reported on repeat GA rates among New Zealand children but there are no recent reports and no published data for the Auckland region.
Aims
The aims for this study were for the Auckland region from 2007 to 2019: (1) to describe any changes observed in the number of dental GA cases carried out annually; (2) to describe the demographic characteristics of children who received dental treatment under GA; (3) to identify and describe any changes in the type and amount of dental treatment provided under GA; (4) to determine the number and characteristics of children who have had multiple dental GAs; (5) to describe any changes observed in the number of overseas-born children who received dental treatment under GA.
Methods
Hospital admission data for children treated at Auckland District Health Board aged 0-17 admitted under Hospital and Specialist Dentistry for dental treatment under GA from 1st January 2007 to 31st December 2019 were obtained from an Auckland District Health Board dataset. Each entry in the dataset corresponded to a single hospital admission and included demographic details, birth country, American Society of Anesthesiologists (ASA) physical status classification system codes, diagnosis, and procedure codes. Data were reported descriptively with population rates calculated using Statistics New Zealand population estimates for the years in question.
Results
During the 13-year period, 22,550 children and adolescents aged 0-17 years were treated. The number of GAs carried out increased by 17.6% from 1,843 in 2007 to 2,167 by 2019. The proportion of children admitted aged 0-4 decreased from 44.9% in 2007 to 33.1% in 2019 while an increase was observed among children aged 5-9 from 45.9% to 55.4%. Close to one in three admissions were for Pacific children while one in five were for Māori. Ethnic disparities were evident in the rate of admissions per 1,000 children among those aged 0-4 and 5-9 with admissions being lowest among European children. Almost half of those treated resided in the most deprived quintile. The proportion of children treated who were born overseas decreased from 16.6% in 2007 to 12.5% in 2015 before increasing again to 17.2% in 2019. Overseas-born children had more teeth extracted per child than New Zealand-born. The rate for children who received stainless steel crowns more than doubled among children aged 0-4 and increased five times among those aged 5-9. An increase was also observed in the average number of stainless steel crowns and extractions per child aged 0-4 and 5-9 among children of all ethnic groups. During the study period, 2,160 children received at least one repeat GA. The rate of repeat GAs within four years of the initial GA decreased markedly from 16.3% where the first procedure was in 2007 to 5.6% in 2016. The relative risk of Pacific children receiving a second or third GA was significantly lower than for European children, while children of Māori, Asian, and MELAA ethnicities were at a significantly lower risk of receiving a third GA. Children with moderate to severe medical comorbidities were 4.6 times more likely than healthy children to receive a second GA and 33.9 times more likely to have three or more GAs.
Conclusions
This study confirms that the number of children who receive dental treatment under GA in Auckland has continued to increase. Ethnic and socioeconomic disparities have persisted and may have widened. The treatment provided under GA has changed with an increase in the number of children receiving stainless steel crowns and an increase in the average number of stainless steel crowns and extractions received per child indicating that the severity of caries may be increasing among those who need treatment under GA. The rate of repeat admissions within four years of initial GA has decreased and this is encouraging from the child and service perspective. Improving the oral health of New Zealand children should be a priority at policy level to reduce the burden on hospital dental services. Upstream interventions and policy changes are needed to make any meaningful difference.