Medical and Dental Consultants’ Association of Nigeria
Home - About us - Editorial board - Search - Ahead of print - Current issue - Archives - Submit article - Instructions - Subscribe - Advertise - Contacts - Login 
  Users Online: 1203   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size

  Table of Contents 
Year : 2014  |  Volume : 17  |  Issue : 3  |  Page : 361-365

A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities

Department of Pediatric Dentistry, Ondokuz Mayis University Faculty of Dentistry, Samsun, Turkey

Date of Acceptance19-Oct-2013
Date of Web Publication9-Apr-2014

Correspondence Address:
M E Sari
Department of Pediatric Dentistry, Faculty of Dentistry, Ondokuz Mayis University, Samsun
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1119-3077.130243

Rights and Permissions

Purpose: The purpose of this study is to determine the properties of the dental procedures performed on children with dental problems under general anesthesia and compared between the patterns of dental treatment provided for intellectual disability and non-cooperate healthy child.
Materials and Methods: In this retrospective study, the records of patients between the ages of 4 and 18 who were treated under general anesthesia were evaluated. Patients were divided into two groups: Those with intellectual disability and healthy patients who had difficulty cooperating. A statistical analysis of the mean standard deviation was conducted with a focus on two factors: Age and dental treatment methods.
Results: In this study, it was observed that restorative treatment and tooth extraction was generally higher in intellectual disability children than in their healthy children. When evaluating the health status of teeth, the value of decayed missing and filled teeth (dmf-t) was observed to be close in healthy and intellectual disability individuals in the 4-6 age groups; it was higher in individuals with intellectual disability in the 7-12 age groups. There was no significant difference in terms of periodontal treatment and fissure sealants in the 12-18 age groups.
Conclusions: By comparing the different patient groups who received dental treatment under general anesthesia, both the number of teeth extracted and DMF-T indices were higher in the disabled group. Therefore, especially more efforts should be made at encouraging these patients to visit the dentist earlier and receive primary preventive care.

Keywords: Dental treatment, general anesthesia, intellectual disability, oral health

How to cite this article:
Sari M E, Ozmen B, Koyuturk A E, Tokay U. A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities. Niger J Clin Pract 2014;17:361-5

How to cite this URL:
Sari M E, Ozmen B, Koyuturk A E, Tokay U. A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities. Niger J Clin Pract [serial online] 2014 [cited 2021 Mar 7];17:361-5. Available from:

   Introduction Top

Pediatric dentists provide oral care and solve dental problems for infants, children, adolescents and young persons with special care needs. The majority of children can be adequately treated with non-pharmacologic behavior modification techniques such as the tell-show-do technique. However, some children who have extensive dental problems cannot cooperate due to a lack of psychological or emotional maturity and/or mental, physical or medical disabilities. Their dental treatment needs to be completed by pharmacological behavior management, such as nitrous oxide/oxygen sedation or general anesthesia. [1],[2],[3] The discipline of special care dentistry provides complex care to individuals with a wide range of disabling conditions. Oral hygiene and the health status (incidence of tooth decay and loss, as well as periodontal problems) of intellectual disability were reported to be worse than that of their healthy peers. [4],[5] In particular, the relationship between disability status and oral hygiene has been established. Studies show that the greater the disability, the worse is the child's oral health, due to the difficulty of removing plaque. [6],[7]

The Samsun Oral Health Care Center provides comprehensive dental treatment for children younger than 18 years and young adults with special needs. A certain percentage of very young individuals, or those suffering extreme anxiety, medical impairment, and mental or physical disabilities, can only be treated under general anesthesia. Ultimately, the purpose of general anesthesia in dental treatment is to allow total oral rehabilitation, which consists of amalgam/composite restoration, pulpal treatment, extraction and scaling and fissure sealant in a single session.

The aim of this retrospective study was to evaluate the characteristics and treatment methods under general anesthesia in pediatric dental patients in this hospital between 2007 and 2011, and to compare the different treatment methods between healthy children and children with special health care needs according to the age groups.

   Materials and Methods Top

The research protocol was approved by the Ondokuz Mayis University Medical Research Ethics Commission (2011/468) and Samsun Oral Health Care Center. In this study, the retrospective records of patients 4-18 years of age who were routinely treated under general anesthesia at Samsun Oral Health Care Center between the years 2007 and 2011 were evaluated. The patients were divided into two groups: Those with intellectual disability who required special care and healthy patients who had difficulty cooperating. Tooth extraction, tooth scaling, restorative treatments, tooth surface cleaning and fissure sealants were the procedures observed in the patient treatment records.

Inclusion criteria for a study of the absence of organ dysfunction, patients who doesn't have any problem to get general anesthesia, intellectual disability, extreme non-cooperation, 4-18 years of age, patients who do not treated dental treatment previously. An exclusion criterion for this study organ dysfunction, patients of orthopedic, visual, auditory disabilities etc., and patients previously treated dental treatment. Dental assessments, medical histories, clinical examinations, hematological tests, and dental radiographs of all patients were taken prior to general anesthesia. The treatment plan for each patient was developed, and the parents were notified about general anesthesia and dental treatment. Anesthesia specialists assessed the patient's general condition and the patient was recommended before general anesthesia. Before the operation, the treatment plan was revised, and the final decision was made. The dental treatment was performed under general anesthesia by means of nasotracheal intubation.

Patients were divided into three age groups according to patient records: 4-6, 7-12, and 13-18 years. The decayed missing and filled teeth (dmft) and the DMFT scores for primary and permanent teeth were recorded before dental treatment under general anesthesia.

Periodontal disease assessment was carried out according to community periodontal index (CPI) and using CPI probe. According to these criteria, periodontal disease and dental caries were determined, and it was identified whether or not the patients were in need of treatment. When considered dmf-t and DMF-T values, decayed and filled teeth were included in the index. As the 7-12 age group is the period of mixed dentition, primary teeth were not considered missing if they had fallen out less than 2 years prior. In the 12 and above age group, all missing and filled teeth were included in the index. Restorative treatments (composite, amalgam and glass ionomer restorations), extractions, dental scaling and fissure sealants applications to primary and permanent teeth were recorded under general anesthesia. It was decided to extract the teeth that were not provided canal treatment indication in a single appointment under general anesthesia. The two groups of patients were recorded separately: The intellectual disability group was recorded as M, and the healthy group was recorded as H. Chi-square (χ2 ) analysis was applied to analyze whether or the dmf-t and DMF-T scores were statistically dependent on whether the children were healthy or disabled. If it was dependent, the contingency coefficients (%) for each contingency table were calculated to determine the degree of association between the dmf-t/DMF-T scores and healthy/intellectual disability. A z-test was then utilized to determine any further differences between the dmf-t and DMF-T scores in healthy and intellectual disability. In addition, an independent sample t-test was applied to determinate the difference between the groups, using the Statistical Package for Social Sciences (SPSS IBM Seattle) package program (SPSS 16.0 V, IBM Corporation, USA). The level of significance was determined at P < 0.05.

   Results Top

In this study, a total of 234 children with age ranged from 4 to 18 years were evaluated; 170 were intellectual disability (group M) and 64 were healthy (group H). The distribution of patients treated under general anesthesia varies according to age group and disease. As patient age increases, the necessity for treatment under general anesthesia in healthy individuals is eliminated; on the other hand, in intellectual disability patients, the number of patients treated under general anesthesia increases with age [Table 1]. [Table 2] shows the distribution of dmft-DMFT indices by age group. While for the 4-6 age group there were no significant differences dmf-t indices, 7-12 age group were there were significant difference in dmf-t scores. The group M had the dmf-t indices (6.02) aged, group H (4.51) aged group 7-12. There was significant difference in dmf-t indices (P < 0.01). When analyzed by age group as well as disability type, group M had DMF-T indices values (4.32), group H (2.47) among participants aged 7-12. Group M DMF-T indices values (7.42) group H (4.02) among participants aged 13-18.
Table 1: Classification of healthy and intellectual disability according to age groups

Click here to view
Table 2: Comparison of dmf-t and DMF-T indices of healthy and intellectual disability

Click here to view

According to the [Table 3], restorative treatments (composite, amalgam and glass ionomer restorations except pulp therapies) and tooth extraction for the 4-6 age groups were performed more often on intellectual disability individuals than in healthy individuals. Periodontal treatment (scaling, not prophylaxis) was applied to the intellectual disability more often; there was no significant difference in fissure sealants [Table 3]. [Table 4] shows the mean number of teeth treated with various modalities between patients from 7 to 12 year group. Restorative treatments were performed more often in intellectual disability individuals than in healthy individuals. Groups both H and M, more total teeth extracted more than restorative treatment. There were significant differences for the other treatment modalities, fissure sealants, total number of restored teeth and treated teeth, between these two groups. There was no significant difference in terms of periodontal treatment and fissure sealants. [Table 5] shows, the difference in restorative treatments between the individuals with intellectual disability and the healthy individuals were found to be statistically significant in the 13-18 age groups (P < 0.01). The difference between healthy and intellectual disability individuals in terms of restorative treatment was only due to the permanent teeth. Differences in tooth extraction between the healthy individuals and the individuals with intellectual disability were found to be statistically significant (P < 0.01). Periodontal treatment was applied more often to individuals with intellectual disability; there were no significant differences in fissure sealant rates.
Table 3: Comparison of dental treatment provided on healthy and intellectual disability 4-6 years of age

Click here to view
Table 4: Comparison of dental treatment provided on healthy and intellectual disability 7-12 years of age

Click here to view
Table 5: Comparison of dental treatment provided on healthy and intellectual disability 13-18 years of age

Click here to view

   Discussion Top

In our country, as in the whole world, there are many patients in need of dental treatment under general anesthesia (GA). Individuals with intellectual disability and pediatric patients who are not cooperative compose the majority of these patients. [8],[9] The rate of disabled persons (orthopedic disabled, language-and speech-impaired, visually impaired, hearing impaired, intellectual disability) to the population in our country is only 4.8%. [10] The way to convince young children and intellectual disability individuals to undergo dental treatment is quite difficult. This group of patients cannot be treated under local anesthesia in one session; many dental treatments may be performed under general anesthesia as soon as possible. [11],[12] General anesthesia is beneficial to the patient, the parents, and the doctor. [9],[10],[11],[12],[13],[14] In this study at Samsun Oral Health Care Center, we aimed to investigate which tooth treatment methods were applied under general anesthesia to children with and without intellectual disability retrospectively.

Pediatric dentists are concerned with the oral care of infants, children and young adults with disabilities who require special care. The biggest cause of inadequate medical treatment of children is due to difficulties caused by previous bad experiences or cooperation problems with the child. This is why some young children and intellectual disability patients need GA. [9],[10],[11],[12],[13],[14],[15] Dental treatment performed under general anesthesia in a hospital environment provides great efficacy and safety for particular groups of patients, such as very young or intellectual disability. In our study, 64 young healthy children and 170 children with intellectual disability (mean age 7.2 years) received treatment. Savanheimo et al., were to determine extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive. Preventive measures formed only a minor part of the dental care given under general anesthesia. [16]

In this study, no consideration were taken regarding the level of dental disease, using the dmf-t and DMF-T indices when compared to other study [17] where the authors had recorded these index before the treatment begun. This index may help in determining the most appropriate dental treatment for the patient. For example, in intellectual disability patient who had undergone general anesthesia, the indices will help dentist to justify between extraction and restoration since dmf-t and DMF-T indices might suggested high caries risk. [18]

When evaluating the health status of teeth, the value of dmf-t teeth was observed to be close in healthy and intellectual disability individuals in the 4-6 age groups; it was higher in individuals with intellectual disability in the 7-12 age groups. On the DMF-T evaluation, however, high values were found in individuals with intellectual disability in both the 7-12 and 13-18 age groups. Harrison and Roberts encountered similar findings in their work. Vignehsa et al., and Desai et al., declared that intellectual disability have more incidences of oral disease, but they reported that those patients received less dental care. Furthermore those children requiring teeth brushing assistance had poorer oral hygiene. [19],[20] Stankovα et al., were evaluated results obtained from the documentation of patients with special needs, who have undergone treatment under general anesthesia at the Pediatric Dentistry Department. DMFT was used for comparison. The significant difference between the DMFT of disabled patient and special patient population. [21]

To improve the bad oral health status of children with intellectual disability, there is a requirement for better education of all medical doctors, dentist and parents about the possibilities of better cooperation to help improve the quality of life of the children. When considering tooth extractions and restorative treatments, statistically, dental therapies are applied to individuals with intellectual disability more often than to healthy individuals for all age groups. The same findings were also reported by some researchers. [22],[23],[24] Providing oral hygiene for these individuals is usually the duty of the parents or attendants. [25],[26],[27] As a result, we found more complicated dental problems in intellectual disability. Oral hygiene of patients with intellectual disability can be only done with the assistance of their caregivers.

Tsai et al., Lee et al., and Harrison and Roberts' results are similar to our study results. [3],[8],[11] A larger number of extractions were seen in children who had intellectual disability than in healthy children. This is due to a higher rate of primary teeth extraction at an early age, and a higher rate of permanent teeth extraction in life than normal. In our study as well, tooth extraction rate was observed to be higher in individuals with intellectual disability than in healthy individuals in the 13-18 group. As a result of the oral hygiene on intellectual disability children in this age group is worse, the number of poor prognosis teeth is much more. For this reason it was decided to extract the teeth having poor prognosis in intellectual disability children, the teeth extractions increased compared with non-cooperative healthy children. It appears reasonable to conclude that pediatric dentists in the present study modified the treatment protocol and adopted a more-aggressive dental treatment strategy, such as extraction of teeth rather than preserving them for intellectual disability children due to their preexisting medical conditions. Osuji and Assery and Karim et al., were to describe the characteristics of the children treated under GA, the indications, and types of dental treatment. The younger children in this study although had relatively more caries experiences, they received more restorations compared with the older children who had more tooth extractions. These results are compatible with our study. [28],[29]

Dentists avoid complex treatments in intellectual disability in order to reduce complications and the need for retreatment. For example, a tooth extraction is preferred, instead of pulp therapy, for teeth with periapical pathologies. [8] Although periodontal treatment in patients of all age groups is performed more often on individuals with intellectual disability than on healthy individuals, there are no obvious differences regarding fissure sealant application. The ideal is not achieved in dental care on healthy or intellectual disability individuals, due to the lack of routine preventive treatments.

With increasing awareness of dental health care for people with disabilities, it will be possible to promote healthy teeth and reduce the number of teeth extracted in the permanent dentition. [13] In the literature, studies have reported that intellectual disability have poorer oral hygiene, advanced periodontal problems. [30],[31],[32] Moreover, they have dental caries, differences in the flow of saliva, [33],[34],[35] muscle and joint problems and chewing difficulties. [28],[29] In this study, it was seen that the rates of restorative treatment and the need for extracting teeth in intellectual disability children are higher than in their healthy peers. This highlights the issue that children with intellectual disability must pay more attention to oral care.

   Conclusion Top

According to the our study results, by comparing the different patient groups who received dental treatment under general anesthesia, both the number of teeth extracted and DMF-T scores were higher in the disabled group. Therefore, especially more efforts should be made at encouraging these patients to visit the dentist earlier and receive primary preventive care. This result shows the necessity of better preventive care of disabled and special patient.

   References Top

1.American Academy of Pediatric Dentistry Clinical Affairs Committee-Behavior Management Subcomittee, American Academy of Pediatric Dentistry Council on Clinical Affairs-Committee on Behavior Guidance. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 2005;27:92-100.  Back to cited text no. 1
2.Enger DJ, Mourino AP. A survey of 200 pediatric dental general anesthesia cases. ASDC J Dent Child 1985;52:36-41.  Back to cited text no. 2
3.Roeters J, Burgersdijk R. The need for general anesthesia for the dental treatment of mentally handicapped patients: A follow-up study. ASDC J Dent Child 1985;52:344-6.  Back to cited text no. 3
4.Tesini DA. An annotated review of the literature of dental caries and periodontal disease in mentally retarded individuals. Spec Care Dentist 1981;1:75-87.  Back to cited text no. 4
5.Mitsea AG, Karidis AG, Donta-Bakoyianni C, Spyropoulos ND. Oral health status in Greek children and teenagers, with disabilities. J Clin Pediatr Dent 2001;26:111-8.  Back to cited text no. 5
6.Full CA, Kerber PE, Boender P, Schneberger N. Oral health maintenance of the institutionalized handicapped child. J Am Dent Assoc 1977;94:111-3.  Back to cited text no. 6
7.Bozkurt FY, Fentoglu O, Yetkin Z. The comparison of various oral hygiene strategies in neuromuscularly disabled individuals. J Contemp Dent Pract 2004;5:23-31.  Back to cited text no. 7
8.Lee PY, Chou MY, Chen YL, Chen LP, Wang CJ, Huang WH. Comprehensive dental treatment under general anesthesia in healthy and disabled children. Chang Gung Med J 2009;32:636-42.  Back to cited text no. 8
9.Giovannitti JA Jr. Dental anesthesia and pediatric dentistry. Anesth Prog 1995;42:95-9.  Back to cited text no. 9
10.Turkey Disability Survey. Ankara: State Institute of Statistics Prime Ministry Republic of Turkey and Turkish Prime Ministry Presidency of Administration on Disabled People; 2002. p. 5-6.  Back to cited text no. 10
11.Tsai CL, Tsai YL, Lin YT, Lin YT. A retrospective study of dental treatment under general anesthesia of children with or without a chronic illness and/or a disability. Chang Gung Med J 2006;29:412-8.  Back to cited text no. 11
12.Klaassen MA, Veerkamp JS, Hoogstraten J. Young children's oral health-related quality of life and dental fear after treatment under general anaesthesia: A randomized controlled trial. Eur J Oral Sci 2009;117:273-8.  Back to cited text no. 12
13.Savanheimo N, Vehkalahti MM, Pihakari A, Numminen M. Reasons for and parental satisfaction with children's dental care under general anaesthesia. Int J Paediatr Dent 2005;15:448-54.  Back to cited text no. 13
14.Trapp LD. Techniques for induction of general anesthesia in the pediatric dental patient. Anesth Prog 1992;39:138-41.  Back to cited text no. 14
15.Trapp LD. Special considerations in pedodontic anesthesia. Dent Clin North Am 1987;31:131-8.  Back to cited text no. 15
16.Savanheimo N, Sundberg SA, Virtanen JI, Vehkalahti MM. Dental care and treatments provided under general anaesthesia in the helsinki public dental service. BMC Oral Health 2012;12:45.  Back to cited text no. 16
17.Atan S, Ashley P, Gilthorpe MS, Scheer B, Mason C, Roberts G. Morbidity following dental treatment of children under intubation general anaesthesia in a day-stay unit. Int J Paediatr Dent 2004;14:9-16.  Back to cited text no. 17
18.Kidd EA. Assessment of caries risk. Dent Update 1998;25:385-90.  Back to cited text no. 18
19.Vignehsa H, Soh G, Lo GL, Chellappah NK. Dental health of disabled children in Singapore. Aust Dent J 1991;36:151-6.  Back to cited text no. 19
20.Desai M, Messer LB, Calache H. A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Aust Dent J 2001;46:41-50.  Back to cited text no. 20
21.Stanková M, Buèek A, Dostálová T, Ginzelová K, Pacáková Z, Seydlová M. Patients with special needs within treatment under general anesthesia-Meta-analysis. Prague Med Rep 2011;112:216-25.  Back to cited text no. 21
22.Nunn JH, Gordon PH, Carmichael CL. Dental disease and current treatment needs in a group of physically handicapped children. Community Dent Health 1993;10:389-96.  Back to cited text no. 22
23.Shyama M, Al-Mutawa SA, Morris RE, Sugathan T, Honkala E. Dental caries experience of disabled children and young adults in Kuwait. Community Dent Health 2001;18:181-6.  Back to cited text no. 23
24.Gizani S, Declerck D, Vinckier F, Martens L, Marks L, Goffin G. Oral health condition of 12-year-old handicapped children in Flanders (Belgium). Community Dent Oral Epidemiol 1997;25:352-7.  Back to cited text no. 24
25.Siklos S, Kerns KA. Assessing the diagnostic experiences of a small sample of parents of children with autism spectrum disorders. Res Dev Disabil 2007;28:9-22.  Back to cited text no. 25
26.Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E. Oral health status of disabled individuals attending special schools. Eur J Dent 2010;4:361-6.  Back to cited text no. 26
27.Davies R, Bedi R, Scully C. ABC of oral health. Oral health care for patients with special needs. BMJ 2000;321:495-8.  Back to cited text no. 27
28.Osuji OO, Assery MK. The dental treatment of children under general anaesthesia at a hospital in Taif, Saudi Arabia. Saudi Dent J 2005;17:120-5.  Back to cited text no. 28
29.Karim ZA, Musa N, Noor SN. Utilization of dental general anaesthesia for children. Malays J Med Sci 2008;15:31-9.  Back to cited text no. 29
30.Jain M, Mathur A, Sawla L, Choudhary G, Kabra K, Duraiswamy P, et al., Oral health status of mentally disabled subjects in India. J Oral Sci 2009;51:333-40.  Back to cited text no. 30
31.Nunn JH. The dental health of mentally and physically handicapped children: A review of the literature. Community Dent Health 1987;4:157-68.  Back to cited text no. 31
32.Morinushi T, Lopatin DE, Tanaka H. The relationship between dental caries in the primary dentition and anti S. mutans serum antibodies in children with Down's syndrome. J Clin Pediatr Dent 1995;19:279-84.  Back to cited text no. 32
33.Stefanidis S, Hirakis S, Thanoulis P, Kasmali E, Ginalis A, Hatzivastou-Loukidou CH. Oral condition of non-institutionalized children and adolescents with down syndrome. Stoma 1999;27:39-44.  Back to cited text no. 33
34.Gabre P, Martinsson T, Gahnberg L. Incidence of, and reasons for, tooth mortality among mentally retarded adults during a 10-year period. Acta Odontol Scand 1999;57:55-61.  Back to cited text no. 34
35.Deidre P. Dental care for the handicapped. Br Dent J 1981;20:267-70.  Back to cited text no. 35


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

This article has been cited by
1 A Retrospective Comparison of Dental Treatment under General Anesthesia Provided for Uncooperative Healthy Patients and Patients with Special Health Care Needs
Volkan Ciftci,Iffet Yazicioglu
Journal of Clinical Pediatric Dentistry. 2020; 44(3): 196
[Pubmed] | [DOI]
2 Evaluation of general anesthesia and sedation during dental treatment in patients with special needs: A retrospective study
Hatice Akpinar
Journal of Dental Anesthesia and Pain Medicine. 2019; 19(4): 191
[Pubmed] | [DOI]
3 Çocuklarda Genel Anestezi Altinda Dis Tedavileri Sonrasi Veli Memnuniyeti
Ebru Delikan,Seçil Çaliskan,Sena Kizilaslan
[Pubmed] | [DOI]
4 Specialist hospital treatment and care as reported by children with intellectual disabilities and a cleft lip and/or palate, their parents and healthcare professionals
Amanda Bates,Rachel Forrester-Jones,Michelle McCarthy
Journal of Applied Research in Intellectual Disabilities. 2019;
[Pubmed] | [DOI]
5 The effect of dentist experience on the treatment of individuals with disability under general anesthesia
Javier Fernández-Feijoo,Beatriz Carro,Ana Branco,Lucía García-Caballero,Márcio Diniz,Jacobo Limeres
Special Care in Dentistry. 2019;
[Pubmed] | [DOI]
6 Agiz Dis Çene Cerrahisinde Sedasyon Uygulamalari ve Dis Çekimlerinin Retrospektif Olarak Degerlendirilmesi
Müge Çina Aksoy,Hatice Akpinar
SDÜ Saglik Bilimleri Dergisi. 2018;
[Pubmed] | [DOI]
7 Different Aspects of General Anesthesia in Pediatric Dentistry: A Review
Nahid Ramazani
Iranian Journal of Pediatrics. 2016; In Press(InPress)
[Pubmed] | [DOI]
8 Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN)
Marco Dziwak,Roswitha Heinrich-Weltzien,Kathrin Limberger,Susanne Ifland,Ilka Gottstein,Thomas Lehmann,Ina M. Schüler
Clinical Oral Investigations. 2016;
[Pubmed] | [DOI]
9 The Dental Needs and Treatment of Patients with Down Syndrome
Azizah Bin Mubayrik
Dental Clinics of North America. 2016; 60(3): 613
[Pubmed] | [DOI]
10 Dental treatment need and dental general anesthetics among preschool-age children with cleft lip and palate in northern Finland
Ville Lehtonen,George K. Sándor,Leena P. Ylikontiola,Sari Koskinen,Paula Pesonen,Virpi Harila,Vuokko Anttonen
European Journal of Oral Sciences. 2015; 123(4): 254
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Materials and Me...
    Article Tables

 Article Access Statistics
    PDF Downloaded759    
    Comments [Add]    
    Cited by others 10    

Recommend this journal