Chronic Conditions and Treatment Under General Anesthetic

Chronic conditions are on the rise in the US, and that includes Medicare patients and children. Previous research has demonstrated that Medicare-enrolled children are more likely to have dental caries, have dental needs unmet and thus have more significant dental problems at the time of treatment (often late in the progression of dental problems). The researchers in the study summarized here looked at the relationship between general anesthetic use during dental treatment and chronic conditions for children in Iowa enrolled in Medicare. No particular practice was studied; rather, Medicare billing records from 2003-2008 were the basis for analysis.

These researchers found that 37% of the children studied had chronic conditions–a larger number than reported in other studies. For children aged 6-14, those with a chronic condition were three times as likely to receive general anesthetic during dental treatment. For those children, the more severe the chronic condition, the more likely general anesthetic was to be administered.

This study raises several important concerns for electronic health records and dentistry. Anesthetic can interact with existing medications, and dental care has been linked to overall health. As chronic conditions continue to rise, more and more adults will also be coming to dental care with long, complex health and medication histories. Electronic records can store and transfer that information so that dental and health care providers have access to full patient data. Particularly for the chronic condition population, EHRs will offer dramatic increases in patient safety and possibly compliance with treatment. In addition, having access to historical EHR information can reduce liability and the chance of medication errors.

Lessons Learned:

  • Chronic conditions are increasing throughout the US, and possibly even more in children than in the general population.
  • Children aged 6-14 with a chronic condition (or multiple) are more likely to be treated for dental care under general anesthetic.
  • As these children grow up, adults with complex condition and medication history will need care. EHRs can reduce liability and increase quality of care.

Chi, D. L., Momany, E. T., Neff, J., Jones, M. P., Warren, J. J., Slayton, R. L., Weber-Gasparoni, K., Damiano, P. C. (2010). Impact of chronic condition status and severity on dental treatment under general anesthesia for Medicaid-enrolled children in Iowa state. Paediatric Anaesthesia, 20(9): 856-65.