Introduction

Parents have a significant role in ensuring their children have good oral health. Parents' involvement is crucial and important for children with impairments [1]. Children with disabilities have an increased risk of developing oral diseases such as dental caries and gingivitis/periodontitis because they are less likely to practice good oral hygiene due to intellectual and motor impairments [2]. Consensus exists that addressing children's behavioral needs is crucial when delivering dental treatment [3]. Indeed, it is difficult, if not impossible, to carry out any necessary dental treatment if a child's conduct in the dental surgery/office cannot be handled [4]. Most youngsters perform well enough under a pedodontist's care when they use behavioral methods. However, these treatments are ineffective for treating certain youngsters [5].

In a state of transient numbness and complete unconsciousness, general anesthesia (GA) is comparable to that of a very deep slumber. Inducing it is the job of anesthetics, which may be either specific drugs or other compounds [6]. General anesthesia numbs the patient so they do not feel anything during surgery or other operations [7, 8]. Healthy and medically impaired children may get complete, safe, and high-quality dental treatment under general anesthesia [9, 10]. This research shows that parents of children with special needs are worried about having their children undergo general anesthesia (GA) during pediatric dental treatment.

However, some parents' concerns regarding hospitalization and GA usage continue to impact their treatment decisions for their children [11]. The internet and modern technologies have increased the data accessible to patients regarding their treatment options and any potential risks they may face. There is a risk that not all information is reliable. Because of the paucity of data on Saudi parents' attitudes toward pediatric DGA, educating them on the benefits and drawbacks of pediatric dental care under GA would help them make better future treatment decisions for their children [12].

People with impairments are those who, by today's standards, have different capacities and can do things differently [13]. Visible disabilities affect the body, the senses, and the mind. Common side effects are the inability to move, see, think, hear, learn, talk, communicate, remember, and socialize. Most of the world's disabled population (80%) is located in developing nations, making up 15% of the global population [13].

People with special needs may encounter several obstacles while seeking dental care, which raises the incidence of oral disorders in this group, according to research [14]. The dental health of people with special needs is poor, and they experience oral injustice more often than those without disabilities [15]. Additionally, immunological responses may be altered by developmental problems like Down syndrome, rendering the person more vulnerable to periodontal disease and peri-implantitis. International efforts have been undertaken to prepare dentists to care for patients with special needs. According to estimates, 2.9% of Saudi Arabia's population suffers from a serious kind of impairment. Additionally, research indicates that oral diseases such as dental caries and periodontal disease are more common among Saudis with special needs [16].

Distance, a lack of professionals with the necessary training, the carers' lack of knowledge or education, and the expense of the treatment are some of the obstacles to providing oral health care for people with special needs. Patients with intellectual impairments could undervalue the value of dental treatment and may not know how to take advantage of available dental options [17]. Additionally, providing dental care for those with special needs could take longer and need more employees, as well as sedation or anesthetic techniques [14].

Study rationale

General anesthesia brings several misconceptions and hesitations among the parents of special needs children. Therefore, it is imperative to know the Saudi parents’ attitude towards the use of general anesthesia when treating their special needs children.

Aims, objectives, and significance

This study aims to determine parental attitudes, knowledge, and beliefs toward GA. The objective of this study will be to understand parents’ educational level and co-relating it to acceptance or rejection of GA and understanding parents’ concerns regarding GA.

Materials and Methods

This is a cross-sectional study among parents of children with special needs.

An online questionnaire using Google Forms was distributed to pediatric patients’ parents in Saudi Arabia via social media and messengers to prevent contamination. 500-1000 responses were expected to be collected from special needs patients’ parents who visit private and public dental clinics around Saudi Arabia.

Questionnaire

A 14-point self-constructed survey was used in this study. The first half of the survey included questions related to demographics. The second half of the survey included questions related to various pediatric-related disorders, anxiety toward dental treatment, types of behavioral management, and questions related to general anesthesia.

Instrument validity and reliability

The survey was sent to 20 participants as part of a pilot research, and the results were entered into SPSS version 22 to calculate the reliability using Cronbach's coefficient alpha. The questionnaire's validity was examined by submitting it to seasoned researchers at REU, and improvements were made in response to their suggestions and criticisms.

Sample size calculation

The margin of error: 5%

Confidence level: 95%

Population size: 20000

Response distribution: 50%

Minimum sample size: 377

Patient confidentiality

Data collected from the participants was kept confidential and was not disclosed to anyone or used without the consent of the participant.

Inclusion criteria

• Parents of patients with special needs
• Children aged between 4-12

Exclusion criteria

• Parents of healthy patients
• Children aged more than 12 years or less than 4

Statistical analysis

Using SPSS version 22, both descriptive and inferential statistics will be performed on the collected data. Comparative analyses of groups were conducted while keeping the significance level at 0.05.  A test for normality was performed, and based on the results, a choice of statistical tests was made.

Research question

Is the attitude of Saudi parents of special needs children towards general anesthesia use positive?

Results and Discussion

Figure 1 shows that 52% were boys and 48% girls who participated in this study. Figure 2 shows the age group distribution and Figure 3 disclosed their nationalities. Table 1 presents the frequencies of different types of disabilities among the children of the study participants. Each disability type is listed, along with its corresponding percentage frequency. The first disability listed is mental retardation, which has a frequency of 6.4%. This indicates that 6.4% of the children in the study were identified as having mental retardation. The second disability is a speech disorder, also with a frequency of 6.4%. This suggests that 6.4% of the children in the study had a speech disorder.

Hypothyroidism and cardiac disease are both listed with a frequency of 0.8%. This implies that 0.8% of the children had either hypothyroidism or cardiac disease. The next disability listed is emotional and behavioral disorders, which have a frequency of 10.4%. This indicates that 10.4% of the children in the study had emotional and behavioral disorders.

Down syndrome has a frequency of 7.2%, suggesting that 7.2% of the children had Down syndrome. Visual impairment is listed with a frequency of 3.2%, implying that 3.2% of the children had visual impairments.

Autism has the highest frequency at 13.6%. This means that 13.6% of the children in the study were identified as having autism. Hearing loss, neurological disorders, intellectual disability, and cerebral palsy all have a frequency of 0.8%. This indicates that 0.8% of the children had each of these respective disabilities.

PTSD (post-traumatic stress disorder) has a frequency of 2.4%, suggesting that 2.4% of the children had PTSD. Obsessive-compulsive disorder and osteogenesis imperfecta are both listed with a frequency of 0.8%. This implies that 0.8% of the children had either obsessive-compulsive disorder or osteogenesis imperfecta.

The category "Other" has a frequency of 7.2%, indicating that 7.2% of the children had disabilities not specifically listed in the table. Finally, the category "None" has the highest frequency at 32.8%, suggesting that 32.8% of the children did not have any disabilities.

Overall, the table provides an overview of the different types of disabilities present among the children of the study participants and their respective frequencies, allowing for a better understanding of the distribution of disabilities in the sample.

Table 1. Frequencies of disabilities among children of the study participants

Table 2. Responses to the survey questions

Table 2 presents responses to various survey questions related to dental visits and treatment plans.

The first question asks about the timing of the last dental visit. The responses indicate that 39.8% of participants had their last dental visit within the past 3-6 months, 36.6% visited between 6-12 months ago, 13% visited 2 years ago, and 10.6% have never visited a dentist. The next question pertains to the reason for dental visits. The responses show that 48.7% of participants visited for a regular checkup, while 51.3% visited due to provoked pain.

The survey also asks whether the participants' anxiety has affected their child's dental visits. The responses reveal that 48.4% of participants answered "yes," indicating that their anxiety has had an impact, while 51.6% answered "no." Participants were then asked to list the difficulties their child faces while attending dental clinics. The responses indicate that 22.4% reported fear, 40.8% mentioned their child's refusal to follow instructions, 32% stated that their child doesn't stay still, and 4.8% reported no difficulties.

The survey also explores the participants' satisfaction with their child's treatment plan. The responses reveal that 8.1% of participants don't approve of the treatment plan, 20% feel that it could be better, 51.6% are very satisfied, and 11.3% admitted to not understanding the treatment plan. Lastly, the participants were asked whether they were familiar with different behavioral management techniques. The responses show that 33.1% of participants answered "yes," indicating familiarity with such techniques, while 66.9% answered "no." Among those familiar with these techniques, the preferred methods were general anesthesia (34.5%), nitrous oxide (30.9%), and restraint (34.5%).

Overall, the table provides a comprehensive overview of the participant's responses to the survey questions, covering the timing of dental visits, reasons for visits, the impact of parental anxiety, difficulties experienced by children, satisfaction with treatment plans, and knowledge of behavioral management techniques.

Table 3. Comparison of survey responses based on child’s gender

The p-values in the table indicate the statistical significance of the differences observed between the responses of boys and girls in the survey. In statistical analysis, the p-value represents the probability of obtaining results as extreme as the observed data, assuming that there is no true difference or relationship between the variables being compared (Table 3).

For the question "Who attends a dental appointment with the child?", the p-value is 0.282. This suggests that there is no statistically significant difference in the proportions of fathers, mothers, and others accompanying boys and girls to dental appointments. The p-value for the question "When was the last visit?" is 0.126. This indicates that there is no strong evidence of a significant difference in the distribution of time intervals between boys and girls for their last dental visits.

Regarding the reason for dental visits, the p-value is 0.058. This suggests a weak indication of a difference between boys and girls in terms of their reasons for dental visits, with girls slightly more likely to visit for a regular checkup and boys slightly more likely to visit due to provoked pain. However, the result is not statistically significant at conventional significance levels. The question in focus is "Reason for dental visit?" and the percentages represent the distribution of responses between boys and girls. Among boys, 56.4% reported visiting the dentist for a regular checkup, while 43.6% reported visiting due to provoked pain. On the other hand, among girls, 40.3% reported visiting for a regular checkup, while 49.7% reported visiting due to provoked pain.

The p-value for the question related to parental anxiety affecting the child's dental visits is 0.231. This indicates no significant difference between boys and girls in terms of the impact of parental anxiety on their dental visits. For the question about difficulties experienced by children during clinic visits, the p-value is 0.997. This high p-value suggests that there is no significant difference between boys and girls in terms of the reported difficulties they face while attending dental clinics.

In summary, the p-values reflect the statistical significance of the observed variations between boys and girls in their survey responses. A p-value below a predetermined threshold (e.g., 0.05) would indicate a significant difference, while a higher p-value suggests that the observed differences may be due to chance and not necessarily reflective of a true disparity between boys and girls.

Table 4. Comparison of survey responses based on child’s age