Clinical Pathways in Managing High-Caries Children with Adverse Dental Histories

Background and Objectives: Dental treatments of children with previous negative dental experiences are challenging and frequently require sedation or general anesthesia. Therefore, this study aimed to identify treatment pathways and factors associated with dental treatment under general anesthesia, nitrous oxide sedation, and chairside management among pediatric dental patients with adverse dental experiences. Materials and Methods: A retrospective cohort analysis was conducted on all new children aged 2-12 years with negative dental experience and treatment need visiting the Pediatric Department of the Dental Clinic, University of Greifswald, between 1 January and 31 December 2021. Results: Of the 640 newly presenting patients, 78 cases met inclusion criteria and were analyzed (mean age 6.7 ± 2.19 years, baseline dmft 4.5 ± 3.0 and DMFT 0.6 ± 1.2), with 88.5% having caries as chief complaint and 61.5% having a referral from other dentists. Eventually, only 25.6% received general anesthesia (mean age 5.1 ± 1.9 years, mean dt 5.6 ± 2.6), while 56.4% were managed with nitrous oxide sedation (mean age 7.3 ± 1.7 years, mean dt 3.3 ± 2.4), and 18% with chairside treatment (mean age 6.9 ± 2.8 years, mean dt 1.9 ± 2.4). Children of younger age, with higher dmft/dt scores and lower behavior ratings, were more frequently treated under general anesthesia. However, none of these variables could be identified as independent predictors for treatment under general anesthesia. Conclusions: Minimally invasive caries management, combined with appropriate behavior guidance and conscious sedation when indicated, can drastically reduce the need for general anesthesia in children, even among those with dental anxiety or previous negative dental experience.