European Archives of Paediatric Dentistry

, Volume 15, Issue 2, pp 105–112 | Cite as

Self-reported causes for referral to dental treatment under general anaesthesia (DGA): a cross-sectional survey

  • H. Taskinen
  • T. Kankaala
  • P. Rajavaara
  • P. Pesonen
  • M.-L. Laitala
  • V. AnttonenEmail author
Original Scientific Article



To determine causes leading to dental care under general anaesthesia (DGA) in public health care reported by the patients or the parents/caregivers.

Study design

All the patients referred to DGA at the Municipal Health Centre, Oulu, Finland, during 10 months were invited to participate in the present cross-sectional survey. They were sent a questionnaire on indications for referral to DGA, dental fear, possible reasons for it as well as prior treatment of dental fear. For measuring overall dental fear, the modified Corah dental anxiety scale (MCDAS) and visual analogue scale (VAS) forms were also included in the questionnaire.


The most common self-reported indication for referral to DGA was dental fear (63.9 %). For children and adolescents (<18 years), need for extensive care was the second most common reported cause. The great majority of the respondents reported having dental fear (90.8 %). Dental fear was more common among females than males, but the difference between the genders was not statistically significant. The most common cause for dental fear was earlier negative experiences in dental care (51.9 %). The mean MCDAS score was 19.0 (SD 5.7; 5–25) indicating severe dental anxiety. An increasing trend towards older age groups could be seen in VAS scores reporting fear of pain, needles, scaling, scolding by the dentist, extractions, as well as endodontic treatment. Dental fear had been taken into consideration in dental treatment preceding DGA.


Dental fear is the most common self-reported indication for referral to DGA and should be taken into consideration.


Dental fear General anaesthesia DGA 



We want to express our thanks to dental assistants Hilkka Säävälä and Anitta Solaranta for their kind help in collecting the questionnaires from the patients. We also want to thank Dr. Leena Niskanen for her valuable comments.

Supplementary material

40368_2013_71_MOESM1_ESM.doc (37 kb)
Supplementary material 1 (DOC 37 kb)


  1. Aartman IHA, De Jongh A, Makkes PC, Hoogstraten J. Dental anxiety reduction and dental attendance after treatment in a dental fear clinic: a follow-up study. Commun Dent Oral Epidemiol. 2000;28:435–42.CrossRefGoogle Scholar
  2. Almeida AG, Roseman MM, Sheff M, Huntington N, Hughes CV. Future caries susceptibility in children with Early Childhood Caries following treatment under general anesthesia. Pediatr Dent. 2000;22:302–6.PubMedGoogle Scholar
  3. American Academy of Paediatric Dentistry; American Academy of Paediatric Dentistry Committee on Sedation and Anesthesia. Guideline on the elective use of minimal, moderate, and deep sedation and general anesthesia for pediatric dental patients. Pediatr Dent. 2005–2006;27:110–8.Google Scholar
  4. Åstrøm A, Skaret E, Haugejorden O. Dental anxiety and dental attendance among 25-year-olds in Norway—time trends from 1997 to 2007. BMC Oral Health. 2011;11:10.PubMedCentralPubMedCrossRefGoogle Scholar
  5. Berggren U, Carlsson SG. Psychometric measures of dental fear. Commun Dent Oral Epidemiol. 1984;12:319–24.CrossRefGoogle Scholar
  6. Corah NL. Development of a dental anxiety scale. J Dent Res. 1969;48:596.PubMedCrossRefGoogle Scholar
  7. Hägglin C. Dental anxiety in a Swedish city population of women. A cross-sectional and longitudinal study of prevalence, dental care utilisation and oral and mental health factors. University of Gothenburg, Gothenburg, Sweden. 2000 [doctoral thesis].Google Scholar
  8. Hill KB, Chadwick B, Freeman R, O’Sullivan I, Murray JJ. Adult Dental Health Survey 2009: relationships between dental attendance patterns, oral health behaviour and the current barriers to dental care. Br Dent J. 2013;214:25–32.PubMedCrossRefGoogle Scholar
  9. Humphris G, King K. The prevalence of dental anxiety across previous distressing experiences. J Anxiety Disord. 2011;25:232–6.PubMedCrossRefGoogle Scholar
  10. Kakaounaki E, Tahmassebi JF, Fayle SA. Repeat general anaesthesia, a 6-year follow up. Int J Paediatr Dent. 2011;21:126–31.PubMedCrossRefGoogle Scholar
  11. Karki AJ, Thomas DR, Chestnutt IG. Why has oral health promotion and prevention failed children requiring general anaesthesia for dental extractions? Commun Dent Health. 2011;28:255–8.Google Scholar
  12. Krikken J, van Vijk A, ten Cate J, Veerkamp J. Measuring dental fear using CFSS-DS. Do children and parents agree? Int J Paediatr Dent. 2013;23:94–100.PubMedCrossRefGoogle Scholar
  13. Lee JY, Vann WF, Roberts MW. A cost analysis of treating pediatric dental patients using general anesthesia versus conscious sedation. Pediatr Dent. 2000;22:27–32.PubMedCrossRefGoogle Scholar
  14. Luoto A, Lahti S, Nevanperä T, Tolvanen M, Locker D. Oral-health-related quality of life among children with and without dental fear. Int J Paediatr Dent. 2009;19:115–20.PubMedCrossRefGoogle Scholar
  15. Luoto A, Tolvanen M, Rantavuori K, Pohjola V, Lahti S. Can parents and children evaluate each other’s dental fear? Eur J Oral Sci. 2010;118:254–8.PubMedCrossRefGoogle Scholar
  16. Macpherson LM, Pine CM, Tochel C, Burnside G, Hosey MT, Adair P. Factors influencing referral of children for dental extractions under general and local anaesthesia. Commun Dent Health. 2005;22:282–8.Google Scholar
  17. Milgrom P, Newton JT, Boyle C, Heaton LJ, Donaldson N. The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London. Commun Dent Oral Epidemiol. 2010;38:453–9.CrossRefGoogle Scholar
  18. Oosterink F, de Jongh A, Aartman I. Negative events and their potential risk of precipitating pathological forms of dental anxiety. J Anxiety Disord. 2009;23:451–7.PubMedCrossRefGoogle Scholar
  19. Pohjola V, Lahti S, Vehkalahti MM, Tolvanen M, Hausen H. Association between dental fear and dental attendance among adults in Finland. Acta Odontol Scand. 2007;65:224–30.PubMedCrossRefGoogle Scholar
  20. Rantavuori K, Lahti S, Hausen H, Seppä L, Kärkkäinen S. Dental fear and oral health and family characteristics of Finnish children. Acta Odontol Scand. 2004;62:207–13.PubMedCrossRefGoogle Scholar
  21. Savanheimo N, Sundberg S, Virtanen J, Vehkalahti M. Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service. BMC Oral Health. 2012;12:45.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Sheller B, Williams BJ, Hays K, Mancl L. Reasons for repeat dental treatment under general anesthesia for the healthy child. Pediatr Dent. 2003;25:546–52.PubMedGoogle Scholar
  23. Skaret E, Raadal M, Berg E, Kvale G. Dental anxiety and dental avoidance among 12 to 18 year olds in Norway. Eur J Oral Sci. 1999;107:422–8.PubMedCrossRefGoogle Scholar
  24. Vinckier F, Gizani S, Declerck D. Comprehensive dental care for children with rampant caries under general anaesthesia. Int J Paediatr Dent. 2001;11:25–32.PubMedCrossRefGoogle Scholar
  25. Wannemueller A, Joehren P, Haug S, et al. A practice-based comparison of brief cognitive behavioural treatment, two kinds of hypnosis and general anaesthesia in dental phobia. Psychother Psychosom. 2011;80:159–65.PubMedCrossRefGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2013

Authors and Affiliations

  • H. Taskinen
    • 1
  • T. Kankaala
    • 2
  • P. Rajavaara
    • 2
  • P. Pesonen
    • 4
  • M.-L. Laitala
    • 1
  • V. Anttonen
    • 1
    • 3
    Email author
  1. 1.Department of Cariology, Endodontology and Paedodontics, Institute of DentistryUniversity of OuluOuluFinland
  2. 2.City of Oulu; Oral Health CareDental Teaching UnitOuluFinland
  3. 3.Oulu University HospitalOuluFinland
  4. 4.Institute of DentistryUniversity of OuluOuluFinland

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