1. Audit: Paediatric Oral surgery 2012
RACH ARI
Mark Burrell
Mhairi Walker
William Anderson

2. OMFS theatre list RACH Oral surgery provision under GA for under 16s
1 Experienced Oral Surgeon + 1 DF2 junior assistant
Consistent personnel
Includes
Predominantly Orthodontic referrals
Primary care referrals
Patients under care of OMFS.
Soft tissue procedures
Extractions
Exposures

3. AIMS OJECTIVES Provide clinical data to support the quality of service
Identify areas of potential improvement
Compare with ‘gold standard’
Extensive pubmed search showed limited data analysis of paediatric GA general services (caries control/deciduous extractions)
but no assessment of specialist oral surgery in Paeds patients

4. Canine Ectopia Maxillary canine second most frequently impacted tooth
1.5% prevalence.
Risks
Root resorption
CBCT suggests 66.7% incisors adjacent to max impacted 3s show resorption.1
Cystic changes
Low frequency
1 L. Walker et al., Am J Orthod Dentofacial Orthop 2005

5. Patient numbers 2012 RACH (OMFS) GA service
Patients booked onto theatre list = 140
Unable to retrieve medical notes = 4
Did not attend = 2
Not done medical grounds = 2
Total assessed in audit = 132

6. Procedures Performed 2012 RACH (OMFS) GA service
Total 132 individuals
Surgical removal teeth 73
Surgical exposure teeth 17
Surgical removal and exposure 24
Soft tissue procedure (cyst/mucocele) 18

7. Retrospective analysis clinical notes
Patients advised to contact department with any post-op problems
Many have follow-up appointments, not all.
Determined from clinical notes whether any further intervention required post-op due to complication....

8. Complications
‘An adverse outcome related to surgical procedure requiring active intervention e.g. medication, dressing, further surgical procedure’.
Re-exposure of failing to erupt canine.
Infection
Pain
Loss vitality adjacent tooth.

9. Complications associated with Paediatric Oral surgery RACH 2012
Post-op infection 1
Surgical removal LRE: ankylosed, bone removal
Px Antibiotics and CHX mouthwash
Post op pain 1
Following open and closed exposure or upper 3s.
Sutures causing discomfort: removed.
2/132 = 1.5%

10. Surgical Exposures
4 patients observed ‘slow’ eruption after surgical exposure (further review).
0 needed further surgery/ re-exposure.
(one procedure performed was a ‘re-exposure’ from 2011 and one patient went on to have a canine exposed and re-exposed in 2013)
In 2012 there were no patients needing further intervention surgically to manage impaction.

11. Extractions
Referrals for impacted, submerged teeth and multiple extractions.
Distribution of specific teeth extracted noted in figure 1.
290 teeth extracted in 2012.
124 primary teeth
149 permanent
17 supernumery teeth.

12. Distribution of teeth extracted
Number teeth
Tooth removed

13. Surgical exposures (all teeth)
Open:
palatal ‘window’ to allow eruption or buccal apically repositioned flap
OR buccal apically repositioned flap:
32 teeth.
Closed:
gold bracket chain bonded to canine/incisor aid eruption: 14 teeth.
-J OMS
-71 participants
-Sheffield

14. Counihan et al Dental update
Nov 2013
Adapted from
Pitt et al
Eur. J Orth
2006

15. Surgical Exposures OMFS RACH 2012
OPEN exposures
Canines: 28
Central incisors 1
Other 3
CLOSED exposures
Canines 8
Central incisors 5
Other 1

16. Management of Canines:(individual teeth)
64 teeth ‘treated’
28 extracted (43.8%)
28 open exposures (43.8%)
8 closed exposures (12.4%)
Decision affected by prognostic factors

17. Soft Tissue procedures
18 patients in 2012
Cyst enucleation/ mucocele excision 9/132
Frenectomy 2/132
Biopsy 4/132
Other 3/132
Neoplastic lesions
Trauma

18. Administration Discharge summary missing 14/132 (EDI from Ward issue)
Transition from dictated discharge to EDI system
Wrong name on discharge summary 1/132
Incorrect charting FDI on referral letter 1/132

19. Future Review figures regularly (possibly annual audit).
New ‘Canine clinic’ to ensure continuity of clinicians and record transfer success: as identified in previous audit.
Surgeon carrying out procedures present at assessment stage.
Publish data in clinical effectiveness bulletin.