The development of referral guidelines for dentists referring children for extractions under general anaesthesia

Objective: To develop a set of guidelines for referral of children for simple extractions under general anaesthesia and to determine if services providing general anaesthetic extractions comply with the guidelines. Design: The guidelines were developed with reference to published literature and experts in the field. Patient's records were used to determine the compliance with the guidelines. Setting: Community dental services in the North West of England in 2000. Subjects: One hundred and ninety six sets of patient records of children attending to have teeth extracted under general anaesthesia were studied. Results: The mean age of the 196 children was 6.8 years (SD = 2.5 years) and ranged from 2.7 to 15.8 years. Caries was the prime reason for extractions (182; 93%). Of the 196 children who received a general anaesthetic, 103 (53%) dentists had complied with the general anaesthetic referral guidelines whilst 93 (47%) had not. There was wide variation in compliance across 11 trusts in the North West of England. The lowest compliance was 25% and the highest 93%. Conclusion This study has demonstrated that there can be considerable agreement amongst a group of experts on what constitutes clear justification for extracting teeth under general anaesthesia. However there can be marked variation in compliance with these guidelines.