362 - Behavior Management Techniques for Pediatric Patients Following General AnesthesiaTreatment

Purpose:
This study examines the relationship between a history of dental treatment under
general anesthesia and the behavior management techniques required for subsequent dental
visits. This study specifically evaluates patients of record at Stony Brook University School of
Dental Medicine under 7 years and 3 months of age with ASA status I–II who were previously
treated in the operating room under general anesthesia and later required outpatient dental care.
The study identifies behavior management strategies most frequently employed in this
population and provides insights into the long-term dental, behavioral, and sedation needs to
improve post-general anesthesia care strategies and preventive protocols in an educational
setting. This study addresses a gap in knowledge by examining which behavioral management
techniques such as nitrous oxide/oxygen inhalation sedation, oral conscious sedation, protective
stabilization, or repeat general anesthesia are most used following prior treatment under general
anesthesia. Findings will aid clinicians in understanding how general anesthesia influences
anticipatory guidance, treatment planning, and preventive strategies to reduce behavioral and
treatment challenges during future care sessions.

Methods:
A retrospective chart review was conducted using AxiUm electronic dental records
to identify patients treated under general anesthesia and those with subsequent outpatient visits
for restorative, surgical, or emergency care. Charts were reviewed for medical
history, subsequent treatments completed, and behavior management methods employed.
Data analysis utilized included descriptive statistics along with parametric tests of
independence, and nonparametric analyses as appropriate.

Results:
Of 326 GA encounters, 68 patients (20%) required subsequent in-office dental treatment: 28 (41.2%) female and 40 (58.8%) male. Of 103 post-GA treatment appointments, 66% utilized N₂O, 11% non-IV conscious sedation, 9.7% combination protective stabilization/N₂O, 8.7% protective stabilization alone, and 3.9% basic behavior management. Procedures performed in the clinic following GA most commonly included extractions, followed by one-surface restorations, stainless steel crowns, two-surface restorations, and three-surface restorations.

Conclusions:
Nitrous oxide (N₂O) was the most frequently used behavior management technique (66% of visits), consistent with AAPD recommendations for minimally invasive behavior guidance. More advanced techniques (oral conscious sedation and/or protective stabilization) were required in a minority of visits, suggesting persistent behavioral challenges in some patients post-GA. Extractions were the most common procedure (40.7%), indicating ongoing disease burden or limited restorative prognosis. Stainless steel crowns (20.4%) were also commonly placed, supporting AAPD guidance favoring durable, full-coverage restorations in high–caries-risk children. These findings emphasize the importance of risk-based treatment planning and aggressive preventive strategies at the time of GA to reduce future retreatment needs.