The burden of early childhood caries in the Western Cape Public Service in relation to dental general anaesthesia: implications for prevention.

INTRODUCTION: Multiple extractions under Dental General Anaesthesia (DGA) are frequently performed on pre-school children treated in the public sector in the Western Cape. There s a need to examine current public health strategies in relation to Early Childhood Caries (ECC) in order to provide a framework for both the improvement of treatment and the prevention of ECC in general. METHODS: This retrospective descriptive study reviewed the records on the Department of Health (DoH) database of 16 732 pre-school patients treated under Dental General Anaesthesia over a three year period. RESULTS: Of the 58 255 procedures recorded for these preschool patients in the district health clinics in the Western Cape, 99.94% were for extractions and 0.0001 for restorations. The average rate of DGA per 1000 of the population was 1.06. Only 9% (i.e.: 2/22) of dentists at district clinics reported that pre-DGA prevention was provided. CONCLUSION: The demand for DGA was found in this study to be relatively high and the associated treatment was almost exclusively by means of extractions. The lack of preventive measures could possibly result in a need for retreatment under DGA. Therefore, preventive guidelines are recommended for use in the Public Service.

CPITN: a tool in the planning of dental services.

The need for a systems approach in the planning of dental public services has been emphasised. A random sample of 1,400 farm labourers and their dependants was assessed using the CPITN index. This data was used to estimate manpower and time requirement based on treatment strategies. Results indicate that virtually everybody aged 7 years and older (94 per cent) require oral hygiene education, 79 per cent need a scaling, while 5 per cent need complex treatment. The need for scaling increased from 61 per cent among 7 to 19-year-olds to 98 per cent in the over-20-year-olds. A small proportion (22 per cent) of sextants amongst 7 to 19-year-olds need scaling, compared with 82 per cent in the over-20 group. While no sextants in the 7 to 19-year-olds require complex treatment, a negligible proportion (0.43 per cent) among over-20-year-olds need such treatment. The findings are extrapolated to the sample population and the times for each procedure used to calculate resources for treating the sample population. It is estimated that approximately 7.3 working years would be required to provide the necessary treatment. In terms of manpower it is estimated that seven full-time oral hygienists and one part-time dentist will be needed to fulfil the total treatment needs. The CPITN appears to be an appropriate tool in the planning of dental health services. Planners should, however, relate estimates to available resources and establish priorities accordingly.