Date of Completion

8-27-2019

Embargo Period

12-5-2022

Advisors

Aadarsh Gopalakrishna, Robert Aseltine, Kamran Safavi

Field of Study

Dental Science

Degree

Master of Dental Science

Open Access

Campus Access

Abstract

Intro: Dental procedures often need to be performed in the operating room setting due to patients’ young age, behavioral conditions, or medical complexity. The majority of procedures completed in the operating room setting are direct restorative procedures and extractions. Endodontic procedures comprise the fewest number of procedures completed in the operating room setting. Since many patients who require dental treatment in the operating room are young patients, it is especially important to preserve as many permanent teeth as possible during development.

Materials and methods: The electronic health records for patients treated at the Pediatric operating room at the University of Connecticut Health Center (UCHC), Connecticut Children’s Medical Center (CCMC) operating room, and general dentistry operating room at UCHC were retrospectively reviewed. Five evaluators who are senior residents in various residencies evaluated the pre-operative radiographs and radiographically diagnosed and categorized caries and identified the presence or absence of periapical radiolucency for each tooth treated in the operating room. The evaluators then treatment planned each tooth for the outpatient clinic and then the operating room clinic selecting either no treatment, restoration, non-surgical root canal therapy, extraction or other. The treatment plans were compared to the treatments previously completed. The changes in treatment planning for the outpatient and operating room setting were compared, as well as the treatment plans to the actual procedures completed. Patient factors including age, medical history, caries risk, oral hygiene practices, insurance type, number of times receiving dental treatment in the operating room and English as a second language were also evaluated.

Aim: The first aim of this study is to compare dental treatment plans in the outpatient setting to treatment plans in the operating room setting. The second aim is to compare treatment plans for the operating room setting to procedures actually completed in the operating room.

Results: 21 cases were identified, yielding a total number of 151 treatment codes completed. Of these, 96 were restorations, 55 were extractions, and 10 were non-surgical root canal therapy. 10 of the restorations were performed on teeth that also had non-surgical root canal therapy, and therefore were not included in the analysis, leaving 86 restorative codes completed. Of the 55 extractions performed, 39, or 70.9%, were planned by the majority of the evaluators to not be extracted in the OR. In 32/55 teeth (58.18%) the evaluators unanimously planned not to extract in the OR. The intra-rater reliability was high at 92.8%. Inter-rater reliability was moderate with a Kappa value of 0.4

Conclusions: Treatment plans became more invasive in the operating room compared to the outpatient setting. The majority of teeth planned to be salvaged or preserved were extracted in the operating room.

Goals: To evaluate how treatment plans change based on treatment setting, analyze treatments completed compared to a treatment plan generated by a multi-specialty team of evaluators, improve access to endodontic care, encourage endodontic consultation and procedures in operating room cases, and prevent unnecessary tooth loss in the future.

Major Advisor

Aadarsh Gopalakrishna

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