Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia

Objective To report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress. Design A prospective national study. Setting Twenty-five Scottish DGA centres in 2001. Subjects and method Four hundred and seven children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, the Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24 hours and one week post-operatively. Anaesthetic induction distress was scored immediately before CDGA induction using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Results The mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r = 0.43, p < 0.001, Pearson Product Moment Correlation Coefficient). Morbidity at 24 hours and seven days was 63% and 24% respectively; this related to MCDAS scores (r = 0.15, p = 0.029 and r = 0.17, p = 0.009, Pearson Product Moment Correlation Coefficient) and to induction distress (chi(2) = 7.14, p = 0.007 and chi(2) = 11.70, p = 0.001). Conclusion The majority of children suffered next day morbidity and many still had symptoms a week later. Most children were dentally anxious; this related to induction distress and postoperative morbidity.