Assessment of the oxidative status of the brain in children under the age of 3 years on an outpatient basis dental appointment

  • O. I. Koval O. Bohomolets National Medical University, Kyiv
Keywords: cerebral oximetry, dental manipulations, general anesthesia

Abstract

Summary. The health of the nation as a whole depends on the health, in particular of the younger generation. Unfortunately, the social, economic and environmental conditions that have developed in the country in recent years do not contribute to stability, and hence the psychological balance of the adult population, which, in turn, negatively affects the psychoemotional state of the child population.

The aim of the study to learn the dynamics of cerebral oximetry in children during dental interventions under general anesthesia on an outpatient basis and on an outpatient basis; establish a safe time interval for dental manipulations of different nature at the dental outpatient reception and the time of rehabilitation of the oral cavity under general anesthesia in children aged 0 to 3 years.

Materials and Methods. The oral cavity was rehabilitated in children under 3 years of age on an outpatient basis (72 children) under general anesthesia (38 children) at the Dental Medical Center of O. Bohomolets National Medical University.

Assessment of oxygen saturation of the brain was performed using a non-invasive neuromonitoring method – cerebral oximetry.

Results and Discussion. When carrying out in children under 3 years of preventive measures the reduction of rSO2 at the dental outpatient reception is linear without sharp fluctuations and at 7 minute makes (62.8±0.67) % which is 18.33 % from the initial value of rSO2 (76.9 ±1.18) %. Significant difference of these indicators in the presence of "elementary" (rSO2=(63±0.01) %  (7’) ‒ ↓19.74 %) and "cryptogenic" (rSO2 = (62.7±0.94) %  (7') ‒ ↓ 17.39 %) of phobias were not detected.

When performing the procedure of "caries treatment" at the dental outpatient reception in children aged 0–3 years, a decrease in the rSO2 indicator to a critical level ‒ ↓ 21.67 % for 8 minutes (rSO2 = (60±2.09) % from the initial value of (76.6±2.6) %. Decrease in rSO2 in dental caries related to dental caries is an average of 1.5 % per minute. Therefore, for 7 minutes. manipulation of the caries treatment rSO2 reaches a critical level of 20.17 %.

Significant difference of these indicators during the procedure of "caries treatment" in the presence of "elementary" (rSO2 = (60±2.13) %  (8 ') ‒ ↓ 24.05 %) and "cryptogenic" (rSO2 = (60±2.31) % (8 ') ‒ ↓ 19.46 %) of phobias were not detected.

During the procedure of "treatment of complicated caries" at the dental outpatient reception in children aged 0–3 years, a decrease in rSO2 to a critical level - ↓ 20 % at 6 minute (rSO2 = (60±2.04) % from the initial value of (75±2.96) %.

Significant difference of these indicators during the procedure of "treatment of complicated caries" in the presence of "elementary" (rSO2 = (61±1.21) %  (6 ') ‒ ↓ 21.39 %) and "cryptogenic" (rSO2 = (58.9±2.29) % (6 ') -‒↓ 18.65 %) of phobias were also not detected.

According to the results of the study, the optimal time of various dental manipulations at the outpatient dental reception in children from 0 to 3 years was established: "preventive" = 7-8 minutes; "caries treatment" = 8 minutes; "treatment of complicated caries" = 6 min.

Analysis of the results of cerebral oximetry in the rehabilitation of the oral cavity in conditions of general anesthesia in children aged 0 to 3 years showed: a linear decrease in rSO2 begins from 30 min. The lowest rSO2 value = (62.5±6.36) % is at 41 min, with a possible min rSO2 = 61.45 %. On average, 1 min. rSO2↓ is 1.2. When predicted, the minimum permissible value of rSO2 will reach at 42 minute. Therefore, a safe time interval for dental rehabilitation under general anesthesia in an outpatient setting in children aged 0 to 3 years is (30±10) minutes.

Conclusions. Therefore, in order to prevent the occurrence of cognitive impairment against the background of brain hypoxia, the dentist is obliged to objectively assess the risks of psychological trauma against the background of the dental status and make a well-informed decision on the conditions of dental care. The choice of dental treatment based on the stage of their development depends on the amount of dental intervention.

References

Akselrod, B.A. (2012). Monitoring oksigenatsii tkaney: novaya volna v palitre anesteziologa [Monitoring tissue oxygenation: a new wave in the palette of the anesthetist]. Otdeleniye intensivnoy terapii – Intensive Care Unit, 1, 8-14 [in Russian].

Bezrukikh, M.M., Sonkin, V.D., & Farber, D.A. (2003). Vozrastnaya fiziologiya (Fiziologiya razvitiya rebenka): ucheb. posobiye dlya stud. vyssh. ped. ucheb. zavedeniy [Age physiology (Physiology of child development): textbook]. Moscow: Izdatelskiy tsentr “Akademiya” [in Russian].

Huzieieva, T.S. (2004). Suchasni tendentsii psykhichnoho zdorovia naselennia ta zakhody shchodo yoho vdoskonalennia [Current trends in mental health of the population and measures to improve]. Psykhichne zdorovia – Mental Health, 2 (3), 4-8 [in Ukrainian].

Degarle, P. (2001). Preservation of psychic health in the world: challenges and priorities in developing countries.

Davydova, N.S. (2004). Mozhlyvi kryterii prohnozuvannia porushennia mozkovoho krovoobihu pid chas narkozu [Possible criteria for predicting cerebrovascular accidents during anesthesia]. Otdeleniye intensivnoy terapii – Intensive Care Unit, 5, 232-234 [in Russian].

Zakon Ukrainy “Osnovy zakonodavstva Ukrainy pro okhoronu zdorovia” Redaktsiinyi vyd 31.12.2017 zhidno Zakonu Ukrainy vid 14.11.2017 № 2206. Zakon Ukrainy vid 19.11.1992 № 2801-XII. [Law of Ukraine “Basics of the legislation of Ukraine on health care” Editorial view 31.12.2017 according to the Law of Ukraine from 14.11.2017 No. 2206. Law of Ukraine of 19.11.1992 № 2801-XII.] [in Ukrainian].

Kiseleva, O.G. (2006). Profilaktika stomatologicheskogo strakha. Chast I. [Dental fear prevention. Part I.] Detskaya stomatologiya i profilaktika –Pediatric Dentistry and Prevention, 1-2, 54-61 [in Russian].

Kuznetsov, V.M., Prohno, O.I., Koval, P.B., & Kosenko, O.M. (2015). Spivpratsia “dytyna-stomatoloh-batky” – harantiia uspishnoho likuvannia [Cooperation “child-dentist-parents” ‒ guarantee successful treatment]. Neonatolohichna khirurhiia ta perynatalna medytsyna – Neonatology Surgery and Perinatal Medicine, 4 (18), 19-26 [in Ukrainian].

Mikadze, U.V. (2008). Neyropsikhologiya detskogo vozrasta [Childhood neuropsychology]. Saint-Petersburg: Piter [in Russian].

Мaksimenko, S.D. (2004). Zahalna psykholohiia: navch. posib. Vyd. 2, pererob. ta dop. [General Psychology: Tutorial. 2 ed. rev. and compl.] Kyiv: Tsentr navchalnoi literatury [in Ukrainian].

Poriadin, G.V. (Ed.). (2009). Stress i patologiya: metodicheskaya razrabotka dlya samostoyatelnoy raboty studentov lechebnogo i pediatricheskogo fakultetov [Stress and pathology: methodological development for independent work of students of medical and pediatric faculties]. Moscow: RGMU [in Russian].

Burkhart, C.S., & Steiner, L.A. (2012). Can postoperative cognitive dysfunction be avosded? Hosp. Pract, 40 (1), 214-223.

Lobov, M., Knyazev, A., & Ovezov, A. (2010). Perioperatsionnaya profilaktika ranney kognitivnoy disfunktsii u detey [Perioperative prevention of early cognitive dysfunction in children]. Meditsina intensivnoy terapii – Intensive Care Medicine, 36 (2), 276 [in Russian].

Meixensberger, J., Dings, J., & Hamelbeck, B. (1995). Monitoring of cerebral oxygenation by near infrared spectroscopy vs brain tissue PO2 and cerebral perfusion pressure following severe head injury. Proceedings of the Int. Cereb. Hemodyn. Symp., of North America.

Mchedlishvili, G.I. (1998). Arterial behavior and blood circulation in the brain. NY.

Prokhno, O.I. (2014). Clinical and psychological basis of indications for oral cavity sanation in children of different ages under general anesthesia. Proceedings of the International conference Materials Methods and Technologies, Bulgaria.

Reynolds, E.O.R., Wyatt, J.S., Azzopardi, D., Delpy, D.T., Cady, B., Cope, M., & Wray, S. (1988). New noninvasive methods for assessing brain oxygenation and haemodynamics. Brit. Med. Bull.,1052-1075.

Verhagen, E.A., Van Braeckel, K.N., van der Veere, C.N., Croen, H., Dijk, P.H., Hulzebos, C.V. & Bos, A.F. (2015). Cerebral oxygenation is associated with neurodevelopmental outcome of preterm children at age 2-3 years. Dev. Med. Child Neurol., 57 (5), 449-455.

Yakhno, N.N., & Zakharov, V.V. (2010). Kognitivnyye narusheniya. Nevrologiya: natsionalnoye rukovodstvo [Cognitive impairment. Neurology: national leadership]. 10, 532-547 [in Russian].

Published
2019-11-08
How to Cite
Koval , O. I. (2019). Assessment of the oxidative status of the brain in children under the age of 3 years on an outpatient basis dental appointment. Clinical Dentistry, (3), 46-55. https://doi.org/10.11603/2311-9624.2019.3.10465
Section
Children’s stomatology