Increased Paediatric Dental Procedures Under General Anaesthesia Following Introduction of Free Dental Care Agreement

Nearly 5,700 dental procedures under general anaesthesia were performed on children between 2004 and 2017. Most of these cases involved children aged 0–6, while the fewest were in the 12–18 age group. The number of procedures rose following the introduction of a contract between Iceland Health (Sjúkratryggingar Íslands) and the Icelandic Dental Association (Tannlæknafélag Íslands), providing free dental care for children under the age of 18. These findings come from a study by Margrét Huld Hallsdóttir, a dentist and orthodontic specialist, who completed her master’s degree in dentistry at the University of Iceland in February.

“The purpose of the study was to describe the frequency of cases, types of treatments, age distribution, and composition of the group of children in Iceland requiring general anaesthesia due to dental or oral issues. Additionally, I examined the impact of the 2008 economic collapse and the introduction of the agreement with Icelandic Health for approximately free dental care for children on the frequency of dental procedures under general anaesthesia,” Margrét Huld says.

Study inspired by a British TV programme

Margrét Huld’s primary interest lies in orthodontics. Between starting her master’s degree in Iceland and completing it, she moved to Denmark to specialize in orthodontics. Her research can be categorized as dental public health. When asked about the inspiration for her study, Margrét Huld explained that she saw a British TV programme discussing the use of general anaesthesia for children, including for dental treatments. “This made me wonder how such matters were handled in Iceland. As a dentist, I had received inquiries about paediatric dental procedures under general anaesthesia in Iceland but found it frustrating that such information was not readily accessible."

Comparing bills from dentists and anaesthesiologists

The study is a quantitative, descriptive analysis based on secondary data. The data was sourced electronically from Iceland Health. “The data collection was done with the help of IT professionals who normally process data for Iceland Health. I created a template to extract exactly the information needed. The data consisted of all dental bills for children aged 0–18 who underwent dental treatments under general anaesthesia between 2004 and 2017,” Margrét Huld explains.

Key variables analysed included age, gender, year of procedure, number of dentists and anaesthesiologists involved, children’s health status (e.g., special needs), types of dental procedures, and costs covered by Icelandic Health. Patients were divided into three age groups: 0–6, 6–12, and 12–18 years. For each child undergoing a dental procedure under general anaesthesia, two separate invoices were recorded in Iceland Health’s data: one from the dentist and one from the anaesthesiologist. It was not possible to determine from the dentist’s bill whether the procedure involved anaesthesia, nor to ascertain the type of dental procedure from the anaesthesiologist’s bill. “Thus, it was necessary to merge these two databases, the dental bills and the anesthesiologist bills. The comparison group consisted of all dental bills for children that included the same procedure codes as those recorded in the anaesthesia group,"“ Margrét explains.

The study was conducted under the guidance of advisors Eva Guðrún Sveinsdóttir, a paediatric dentistry specialist and lecturer at the University of Iceland’s Faculty of Dentistry, Sigríður Rósa Víðisdóttir, a dentist and lecturer at the same faculty, and Sigurður Rúnar Sæmundsson, a paediatric dentistry specialist.
 

Average of five fillings per child under anaesthesia

The findings were published in Margrét Huld’s master's thesis earlier this year. A total of 5,678 general anaesthesia procedures for dental treatments were performed on children between 2004 and 2017. The average age of children undergoing anaesthesia during this period ranged from 5.92 to 7.49 years. Most cases were in the 0–6 age group, with the fewest in the 12–18 group. Boys generally made up a higher proportion of cases in the younger age groups, while girls were more common in the 12–18 group.

On average, children had 1.52 teeth extracted or other surgical procedures performed in the mouth under general anaesthesia, and 5.17 fillings. The number of extractions was highest in the 12–18 age group and lowest in the 0–6 group, while the number of fillings was highest in the youngest group and lowest in the oldest.

The frequency of anaesthesia procedures increased after the implementation of Icelandic Health’s agreement with the Icelandic Dental Association, which began in 2013 and initially covered 15–17-year-olds. Additional age groups were included over time until full implementation on January 1, 2018. “Trends in the data show when a specific age group was included in the agreement, often peaking after some time. However, based on the data it is not possible to infer the effect of the 2008 financial crisis on the frequency of procedures,” Margrét Huld clarifies.

Access to dental health data should be improved

Asked about the societal and scientific value of the findings, Margrét Huld said public health studies like this can help assess treatment needs and guide appropriate measures. Until now, information about the number of paediatric dental procedures under general anaesthesia in Iceland has been available through Icelandic Health, but no comprehensive analysis of the procedures or patient group composition had been conducted.

“These findings allow us to monitor the impact of approximately free dental care on dental visit frequency and dental surgeries in general, as well as if patient demographics change over time. I hope that access to such data, whether fully processed or not, will improve in the future. Many public institutions already have databases with accessible statistical information, but there is room for improvement regarding dental health data in Iceland,” Margrét Huld concludes.