Concept: Dental Surgeries / Dental Extractions to Treat Severe-Early Childhood Caries (S-ECC) in Preschool Children

Introduction

Severe-early childhood caries (S-ECC), defined as severe dental decay involving primary teeth in children under the age of six (0-5 years old), is common among Canadian children. In fact, caries is the most common chronic disease in North American children and severe forms of early childhood caries (ECC) have an impact on childhood health and well-being. Due to the young ages of children suffering from extensive caries, treatment is often performed in the operating room using general anesthesia (GA). This indicator includes all preschool children under the age of six who underwent rehabilitative surgery under general anesthetic to treat caries.

MCHP Research Definitions

This section identifies definitions for dental extractions/dental surgeries that have been used in published MCHP research.

Dental Extractions

In several MCHP research projects, a common definition of dental extractions was used, identified by the presence of one of the following procedure/intervention codes:

ICD-9-CM procedure codes: (from the hospital abstracts data prior to April 1, 2004)


• 23.01 (extraction of deciduous tooth),
  
• 23.09 (extraction of other tooth),
  
• 23.11 (removal of residual root), or
  
• 23.19 (other surgical extraction of tooth).

Canadian Classification of Health Interventions (CCI) codes: (from the hospital abstracts data after March 31, 2004)


• 1.FE.89 (total excision, includes excision (surgical) tooth, excision tooth (impacted) and enucleation tooth (non erupted)), or
  
• 1.FE.57 (tooth extraction, includes tooth removal, using forceps).

NOTE: This definition was limited to procedures taking place in a hospital setting and was measured for children under the age of six (0-5 years old). Dental extractions performed in a surgery clinic or a private dentist's office cannot be identified because MCHP does not have this type of data in the MCHP Data Repository. In addition, out-of-province procedures are excluded.

Dental Surgeries

In the deliverable Our Children, Our Future: The Health and Well-being of First Nations Children in Manitoba by Chartier et al. (2020), the following definition for dental surgeries was used:


• from the Hospital Abstracts data - Canadian Classification of Health Intervention (CCI) procedure codes: 1.FE.57 or 1.FE.89, OR
  
• from the Medical Services / Medical Claims data - Dental anesthesia: tariff code = '6999'
  
  Note: This applied to children under the age of six (0-5 years of age). In addition, the hospital abstract must indicate that the patient received general anesthesia or a dental anesthesia claim must have been made during the hospital stay or in the five days preceding or in the five days following the hospital stay. This includes both inpatient and day surgeries.

The following exclusions were also applied:

• newborns and infants requiring extraction of natal or neonatal teeth in the first five months of life.
  
• children diagnosed with a cleft-lip or cleft-palate at < 72 months of age using the following ICD-10-CA codes:
  
  • Cleft hard palate: Q35.1
    
  • Cleft soft palate: Q35.3
    
  • Cleft hard palate with cleft soft palate: Q35.5
    
  • Cleft uvula: Q35.7
    
  • Cleft palate, unspecified: Q35.9
    
  • Cleft lip, bilateral: Q36.0
    
  • Cleft hard palate with bilateral cleft lip: Q37.0

New Definition for Prevalence Studies

In our previous research, we used a definition of dental extractions/dental surgeries that is now considered narrow in scope. After the 2020 publication, and following discussion with experts in dentistry, we developed an updated dental surgeries definition that is more in line with current definitions for measuring the prevalence of dental surgeries to treat caries in preschoolers.

This new definition is much broader in scope, including several more procedures/interventions. It also eliminates the condition of general anesthesia (found in the hospital abstracts data) as a co-existing procedure with the expanded list of dental procedures. The reason for eliminating this condition is that, typically, any of these procedures on a preschooler would require general anesthesia. This definition also includes separately any child who has received a dental general anesthesia found in the Medical Services/Medical Claims data, because a growing number of dental surgeries for preschool children are conducted in surgery clinics or private dentist offices. The MCHP Data Repository does not contain procedure/intervention data from surgery clinics or private dental offices, but does contain medical services/claims data.

The suggested definition for prevalence studies of dental surgeries is:


• any record that identifies one of the following hospital procedure codes:
  
  
  • ICD-9-CM procedure codes:
    
    • 23.01 (extraction of deciduous tooth),
      
    • 23.09 (extraction of other tooth),
      
    • 23.11 (removal of residual root),
      
    • 23.19 (other surgical extraction of tooth),
      
    • 23.2 (restoration of tooth by filling),
      
    • 23.3 (restoration of tooth by inlay),
      
    • 23.41 (application of crown),
      
    • 23.49 (other - other dental restoration),
      
    • 23.70 (root canal, not otherwise specified), or
      
    • 23.72 (root canal therapy with apicoectomy); OR
    
    
  • Canadian Classification of Health Interventions (CCI) codes: (from the hospital abstracts data after March 31, 2004)
    
    
    • 1.FE.57 (extraction, tooth; includes removal, tooth, using forceps),
      
    • 1.FE.89 (excision total, tooth; includes enucleation, tooth (non erupted); excision (surgical), tooth; excision, tooth (impacted)),
      
    • 1.FE.57.JA (extraction, tooth using external approach (e.g. forceps)),
      
    • 1.FF.56 (removal of foreign body, root of tooth),
      
    • 1.FF.89 (excision total, root of tooth),
      
    • 1.FE.29 (tooth restoration),
      
    • 1.FE.53.JA-RV (implantation of internal device, tooth - of retentive device (e.g. pin)),
      
    • 1.FF.59.JA (destruction, root of tooth),
      
    • 1.FD.52 (drainage, gingiva),
      
    • 1.FE.87.JA-H1 (excision partial, tooth - using medicated protective dressing (temporary)),
      
    • 1.FF.53 (implantation of internal device, gingiva),
      
    • 1.FF.80 (repair, root of tooth), or
      
    • 1.FF.87 (excision partial, root of tooth); OR
  
  
• received a dental anesthesia (tariff code = ‘6999’) found in the Medical Services/Medical Claims data.

Alternative Definitions

However, depending on the research goals, this definition can be narrowed. Below are three alternate definitions in which a child may be identified as having a dental surgery. For specific clinical studies, the researcher may find one of these alternate definitions more suitable for use. These three alternate definitions will capture less children and undercount the number of children receiving dental surgeries in prevalence studies. For example, dental surgeries are now done more frequently in private clinics where hospital procedure codes of interest are not available in the MCHP Data Repository, so using alternate definition 1 would exclude those children.

Alternate Definition 1

The child has one of the following hospital abstract procedure codes:


• ICD-9-CM procedure codes: 23.01, 23.09, 23.11, 23.19, 23.2, 23.3, 23.41, 23.49, 23.70, 23.72 OR
  
• CCI procedure codes: 1.FE.57, 1.FE.89, 1.FE.57.JA, 1.FF.56, 1.FF.89, 1.FE.29, 1.FE.53.JA-RV, 1.FF.59.JA, 1.FD.52, 1.FE.87.JA-H1, 1.FF.53, 1.FF.80, 1.FF.87 AND

there is a corresponding dental anesthesia record (tariff = ‘6999’) found in the Medical Services/Medical Claims data during the hospital stay or in the five days preceding or in the five days following their hospital stay (admdt – 5 <= servdt <= sepdt + 5)

Alternate Definition 2

The child has one of the following hospital abstract procedure codes:


• ICD-9-CM procedure codes: 23.01, 23.09, 23.11, 23.19, 23.2, 23.3, 23.41, 23.49, 23.70, 23.72 OR
  
• CCI procedure codes: 1.FE.57, 1.FE.89, 1.FE.57.JA, 1.FF.56, 1.FF.89, 1.FE.29, 1.FE.53.JA-RV, 1.FF.59.JA, 1.FD.52, 1.FE.87.JA-H1, 1.FF.53, 1.FF.80, 1.FF.87

Alternate Definition 3

The child received a dental anesthesia (tariff code = ‘6999’) found in the Medical Services/Medical Claims data.

NOTE: However, the researcher should keep in mind that this would not differentiate what the dental surgery was for. Researchers cannot assume that the tariff alone is only for treatment of dental caries under general anesthesia.

MCHP Research - Findings and Discussion

The following list of MCHP Deliverables (Reports) provide links to the relevant findings and discussion sections on dental surgeries/dental extractions that can be found in each published research project:


• Manitoba Child Health Atlas Update by Brownell et al. (2008). For more information see the section titled Dental Extractions
  
• Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? by Martens et al. (2010). For more information see the section titled Dental Extraction
  
• The 2013 RHA Indicators Atlas by Fransoo et al. (2013). For more information see the section titled Dental Extractions Among Young Children
  
• The 2019 RHA Indicators Atlas by Fransoo et al. (2019). For more information see the section titled Dental Extraction Surgery Among Children
  
• Our Children, Our Future: The Health and Well-being of First Nations Children in Manitoba by Chartier et al. (2020). For more information see the section titled Dental Surgeries