For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Gates Foundation and Bloomberg Philanthropies.
Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.
Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. In 2023, 60·1 million (95% UI 59·0-61·1) deaths occurred globally, of which 4·67 million (4·59-4·75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35·2% (32·2-38·4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66·6% (65·8-67·3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67·7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53·9% and 40·1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61·2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51·2 (50·6-51·7) years for females and 47·9 (47·4-48·4) years for males in 1950 to 76·3 (76·2-76·4) years for females and 71·4 (71·3-71·5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6-74·8) years for females and 69·3 (69·2-69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0-76·6] years for females and 71·5 [71·2-71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. Gates Foundation.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
The COVID-19 pandemic disrupted healthcare delivery worldwide, including dental services. In Japan, the burden and age-specific patterns of dental anesthesia use have not been quantified. We aimed to describe national trends in dental sedation and general anesthesia (GA) in Japan from fiscal year (FY) 2019 (pre-pandemic baseline) through FY 2023 using aggregated claim-level data from the National Database Open Data Japan and interpret these trends in the context of COVID-19-related healthcare constraints. We compared the age distributions of patients who underwent GA in dentistry and medicine. This analysis used aggregated claim counts from the National Database Open Data (FY 2019-FY 2023). Sedation and GA categories were defined using reimbursement codes: inhalation sedation (K002), intravenous sedation interpreted as conscious or moderate sedation (K003), intravenous anesthesia interpreted as deep sedation (L001-2), and GA (L008). Outcomes were annual claim counts, relative indices standardized to FY 2019 (=100), and age-stratified distributions in 5-year groups (0-4 years to ≥90 years). Age distributions for GA were visualized as mirrored pyramids in dentistry and medicine. No inferential tests were performed. Inhalation sedation increased by approximately 7% in FY 2023. Intravenous sedation increased substantially by 68%. Intravenous anesthesia declined sharply in FY 2020, the first pandemic year, and then plateaued. Dental GA decreased in FY 2020, recovered, and expanded to 110,000 claims by FY 2023 (relative index: 122.3). Dental GA showed a bimodal age distribution (peaking at 5-9 years and 15-29 years), whereas medical GA were concentrated at 70-85 years, indicating distinct modality- and sector-specific demand structures. Using claims tabulations spanning the pre-pandemic, pandemic, and "with-COVID" phases, we found heterogeneous trajectories in dental sedation and GA in Japan, characterized by robust growth in conscious or moderate sedation and recovery and expansion of dental GA after an initial 2020 decline. The divergent GA age distributions between dentistry and medicine underscore fundamentally different demand profiles. Interpreted within the context of COVID-19, these modality- and age-specific patterns highlight the adaptive and resilient responses of Japan's dental anesthesia services under pandemic-related constraints and provide a foundation for future policy and workforce planning.
Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.
Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050. Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer. In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3). Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment. Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.
Local anesthesia is essential for pain control and behavioral management in pediatric dentistry. Conventional anesthetic solutions often have low pH, causing injection discomfort and delayed onset. Buffering local anesthetics, typically with sodium bicarbonate, may enhance efficacy by increasing the pH, reducing injection pain, and accelerating onset. This study aimed to evaluate the clinical efficacy of buffered and unbuffered local anesthetic agents in pediatric dental patients, with an emphasis on the onset of anesthesia, patient-reported pain perception (subjective pain), and clinician-assessed pain responses (objective pain) during injection. A systematic literature search was conducted using PubMed, ScienceDirect, the Cochrane Library, LILACS, and Google Scholar for studies published between January 2000 and March 2025. Only randomized controlled trials (RCTs) specifically focused on pediatric patients aged 4-12 years comparing buffered and unbuffered local anesthetics were included. The risk of bias of the included studies was assessed using the Cochrane Risk of Bias 2.0 (ROB 2) tool. Meta-analyses using a random-effects model with standardized mean differences (SMD) accounted for variability across studies. The review protocol was prospectively registered with PROSPERO (CRD420251051999). Of the 138 records initially identified through the literature search, five RCTs met the eligibility criteria and were included. When compared with unbuffered solutions, buffered local anesthetics demonstrated a promising trend toward faster onset and reduced subjective pain. Meta-analysis revealed a significant reduction in subjective pain scores with buffered agents (SMD = -0.59, 95% CI: -1 to -0.17, P < 0.05, I2 = 66%), whereas pooled effects on anesthesia onset (SMD = -1.55, 95% CI: -3.67 to 0.57, I2 = 97%) and objective pain (SMD = -0.53, 95% CI: -1.2 to 0.15, I2 = 82%) were not statistically significant. Risk of bias assessment indicated three low-risk studies, one with some concerns, and one high-risk study suggesting a cautious interpretation of the findings. Buffered local anesthetics reduced injection pain, accelerated the onset of pediatric dental procedures, and enhanced patient comfort. Objective pain outcomes are less consistent, but buffering is a promising and cost-effective adjunct to improve clinical experience. Nevertheless, additional high-quality RCTs with standardized protocols are recommended for additional evidence.
Pain associated with anesthetic injections is a significant concern in pediatric dentistry and is often linked to dental fear and anxiety. Photobiomodulation (PBMT) may reduce pain symptoms in children during local anesthesia administration. This systematic review aimed to evaluate the current scientific evidence on the effectiveness of PBMT in reducing pain during local anesthesia administration in children. Data search was conducted in PubMed, Web of Science, Scopus, Cochrane CENTRAL, Embase, and BVS-MedLine/LILACS up to January 2025, without restrictions on language or year of publication. Two independent reviewers performed the data extraction and assessed the risk of bias (ROB-2 tool). A meta-analysis was performed, and the mean difference (MD), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated. The strength of the evidence was also assessed. The electronic search identified 9,852 records, of which 10 studies met the eligibility criteria and were included in the qualitative synthesis. The analyzed studies employed different PBMT parameters, varying in wavelengths and energy densities. The meta-analysis included studies with placebo or topical anesthetic gel as control groups, and measured pain outcomes using the WBFPRS and FLACC scales. All included studies measured pain at the moment of needle insertion. Three studies comparing PBMT with a placebo, which contributed 14 comparisons. These studies demonstrated a moderate reduction in pain in favor of PBMT (SMD = -0.44; 95% CI: -0.59 to -0.29; I2 = 0%), indicating a moderate effect favoring the intervention with consistent results across all scales. A sensitivity analysis confirmed the stability of the findings. A second meta-analysis of two split-mouth studies comparing PBMT with topical anesthetic gel demonstrated a large and significant reduction in pain with PBMT (MD = -3.30; 95% CI: -3.98 to -2.62, I2 = 0%). PBMT may be beneficial in reducing pain during local anesthesia in children, although the current evidence remains limited. Further well-designed trials with standardized protocols are needed to strengthen the evidence and better inform its clinical applications. The review protocol was registered in PROSPERO under CRD42024539486.
The global burden of sepsis, a life-threatening dysregulated host response to infection leading to organ dysfunction, remains challenging to quantify. We aimed to comprehensively estimate the global, regional, and national burden of sepsis, including the impact of the COVID-19 pandemic and underlying causes of sepsis-related deaths with co-occurring infectious syndromes. We used multiple cause-of-death, hospital, minimally invasive tissue sampling, and linked death certificate and hospital record data representing 149 million deaths, covering 4290 location-years with mortality estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to capture explicit and implicit sepsis cases and deaths. We estimated age-location-sex-specific fractions of sepsis-related deaths from 195 underlying causes of death and 22 infectious syndromes from 1990 to 2021 using binomial logistic regression models, and estimated sepsis-related deaths using GBD cause-specific mortality estimates. Using 250 million hospital admissions and 7·82 million deaths from hospital data, representing 1310 location-years, we modelled case fatality rates by use of binomial logistic regression, applied to sepsis death estimates to estimate sepsis incidence by age, location, and year. In 2021, we estimated 166 million (95% uncertainty interval 135-201) sepsis cases and 21·4 million (20·3-22·5) all-cause sepsis-related deaths globally, representing 31·5% of total global deaths. Sepsis-related deaths decreased between 1990 and 2019, followed by a surge in 2020 and 2021. As of 2021, individuals aged 15 years and older experienced increases across incidence (230%) and mortality (26·3%) since 1990. Those aged 70 years and older had the highest sepsis-related mortality in 2021 (9·28 million [8·74-9·86] deaths). Sepsis-related deaths from infectious underlying causes decreased from 11·8 million (11·1-12·5) in 1990 to 8·34 million (7·72-9·01) in 2019, then increased by 86·4% to 15·5 million (14·7-16·4) in 2021. Sepsis-related mortality due to non-infectious underlying causes of death increased from 4·69 million (4·35-5·05) in 1990 to 5·81 million (5·40-6·25) in 2021; the leading non-infectious underlying causes of death with sepsis were stroke, chronic obstructive pulmonary disease, and cirrhosis. In 2021, bloodstream infections inclusive of HIV and malaria (3·08 million [2·83-3·35]) and lower respiratory infections inclusive of COVID-19 (11·33 million [1·20-1·47]) were the most prominent infectious syndromes complicating sepsis-related deaths from non-infectious underlying causes, representing a consistent trend since 1990. The global burden of sepsis increased in 2020 and 2021, reversing progress from 1990. Sepsis incidence and mortality increased in people aged 15 years and older, especially those aged 70 years and older, and as a complication of non-infectious underlying causes of death such as stroke, primarily through bloodstream infections and lower respiratory infections. The global burden of sepsis is substantial, and sepsis is increasingly a complication of non-infectious causes of death. Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
Postoperative pain commonly follows dental procedures, and appropriate analgesic selection plays a critical role in its management. This systematic review evaluated the efficacy and safety of tenoxicam compared with other pharmacological agents for postoperative dental pain control. Indexed databases, including PubMed, EMBASE, Ovid, Scopus, Web of Science, and the Cochrane Library, were searched through August 2025. Risk of bias was assessed using the Cochrane Risk of Bias tool for interventions. Nine randomized controlled trials met the inclusion criteria and covered a range of dental procedures, including third molar extraction, endodontic treatment, orthodontic adjustment, and implant surgery. Comparators included placebo, ibuprofen, diclofenac, flurbiprofen, meloxicam, methylprednisolone, and rofecoxib. Pain outcomes were measured primarily with the Visual Analogue Scale at multiple postoperative time points. Across studies, tenoxicam showed analgesic efficacy that was generally superior or comparable to other agents, with several trials reporting statistically significant reductions in pain scores at both early and later postoperative intervals. Most studies had low overall risk of bias, although some raised concerns related to allocation concealment and outcome reporting. Tenoxicam appears to be an effective and well-tolerated option for postoperative dental pain management. Study heterogeneity and domain-level bias concerns indicate a need for additional high-quality trials to confirm these findings and support routine clinical use.
Nitrous oxide-oxygen (N2O:O2) inhalation sedation is a safe and effective technique for managing dental anxiety and achieving light conscious sedation. It increases the pain threshold, reduces fatigue, and improves patient cooperation. Two primary induction techniques are used: slow and rapid induction, with the latter preferred for highly anxious or uncooperative patients who require immediate sedation during dental procedures. This study aimed to evaluate the efficacy of different concentrations of N2O:O2 inhalation sedation and to assess changes in physiological and psychomotor parameters, and post-sedation recovery, in pediatric patients. A total of 78 children who met the inclusion criteria were randomly divided into three groups: Group A (conventional slow induction), Group B (rapid induction with 30:70 N2O:O2), and Group C (rapid induction with 50:50 N2O:O2). Demographic and medical data were recorded. Baseline vital signs and the Trieger Dot Test were performed before treatment. Induction was carried out according to group protocol. The Face, Legs, Activity, Cry, Consolability (FLACC) pain score and the Observer's Assessment of Alertness/Sedation (OAA/S) scale were used to assess pain and sedation levels, respectively. Vital signs were monitored during and after treatment. Post-recovery, the Trieger Dot Test was repeated, and a 24-hour follow-up call was made to assess the child's well-being. All groups maintained vital signs within normal limits. Differences in pain perception and psychomotor impairment were statistically non-significant. A statistically significant difference was observed in the sedation levels among the groups (P = 0.033). Light sedation was achieved in 69.23%, 57.69%, and 73.08% of participants in Groups A, B, and C, respectively, while moderate sedation was observed in 19.23% of participants in the 50:50 induction group. A 24-hour telephonic follow-up revealed that all children had resumed normal activities and daily routines. The results provide clinicians with evidence-based guidance on N2O:O2 titration and induction techniques. The preadjusted mixture of 30% N2O and 70% O2 offers a more efficient approach to achieving an adequate depth of sedation in a shorter period while increasing pain tolerance. Therefore, it can serve as an effective alternative to slow induction for administering N2O:O2 inhalation sedation in restless and anxious pediatric patients.
Inferior alveolar nerve block (IANB) is the standard anesthetic approach for mandibular first molars; however, it has well-documented limitations, including variable success rates, delayed onset, higher anesthetic dose requirements, and potential complications. The TuttleNumbNow (TNN) anesthesia protocol introduces intraosseous (IO) injections as the primary anesthetic modality, followed by infiltration and IANB as a last resort. This approach seeks to provide rapid site-specific anesthesia at reduced pharmacological doses. This study evaluated the clinical efficacy of the TNN protocol for mandibular first molar procedures in a private practice setting. This retrospective observational study reviewed patient records from Tuttle Family Dental (Orem, Utah, USA) between January and December 2023. Eligible cases included patients undergoing composite restorations, crown preparations, or crown seating on the mandibular first molars, where anesthesia was administered according to the TNN protocol. Data were extracted from Eaglesoft electronic dental records and categorized as follows: no anesthetic, single-agent TNN (articaine 4% with epinephrine 1:100,000 or mepivacaine 3% without epinephrine), dual-agent TNN, or conversion to IANB. Descriptive statistics summarized the anesthetic regimens, and Fisher's exact test assessed the association between procedure type and IANB conversion. In total, 184 cases (74 composites, 57 crown preparations, and 53 crown seats) were included. One-quarter of the procedures (47; 24.9%) required no local anesthesia. Of the 137 cases requiring anesthesia, 88 (64.2%) were managed with a single agent, 41 (29.9%) with dual agents, and 8 (5.8%) required an IANB. Overall, 129 of the 137 cases (94.2%) were successfully completed without IANB. The need for IANB was significantly associated with procedure type (P = 0.0008), occurring most frequently during crown preparations (7 of 57 cases, 12.3%). The TNN anesthesia protocol achieved profound anesthesia in 94.2% of mandibular first molar cases without requiring IANB, demonstrating its effectiveness as a primary anesthetic strategy. Compared with traditional IANB, the TNN approach offers rapid-onset, site-specific anesthesia while reducing patient anesthetic exposure and postoperative complications. These findings support reframing IO anesthesia from a secondary "rescue" technique to an effective first-line modality. Prospective multicenter studies are warranted to validate its efficacy in broader patient populations.
The combination of local anesthesia (LA) and distraction techniques effectively reduces procedural pain and anxiety, enhance cooperation, and promote positive dental experiences in children. This study aimed to evaluate the effectiveness of the Hands-Eyes-Mouth Distraction Technique (HEM-DT) and the Covering Patient's Vision Technique (CPV-T) on pain perception and anxiety during local anesthesia administration in children aged 6-12 years. Fifty-two healthy children aged 6-12 years requiring LA were randomly allocated into two treatment groups: those receiving the HEM-DT, and those receiving the CPV-T. Anxiety was assessed subjectively using the Animated Emoji Scale before and after the intervention, while pulse rate was recorded using a pulse oximeter before, during, and after LA. Pain perception was measured during LA using the Sounds, Eyes, Motor (SEM) scale and after LA using the colored analog scale. Physiological data were analyzed using independent t-tests for intergroup comparisons, and paired t-tests with repeated-measures ANOVA for intragroup analysis. Wilcoxon signed-rank test was used to evaluate intragroup anxiety scores, and Mann-Whitney U test was used for intergroup comparisons of anxiety and pain scores. Intragroup comparisons revealed statistically significant differences in pulse rates before, during, and after LA (P < 0.001). Intergroup comparisons also showed statistically significant differences in pulse rates during and after LA. Anxiety scores decreased significantly in the HEM-DT group (P < 0.001), which also had lower mean SEM and colored analogue scale pain scores than the CPV-T group (P < 0.001). HEM-DT was effective in reducing pain and anxiety during LA administration in children.
Intravenous (IV) sedation is an effective method of alleviating patient anxiety and pain, thereby improving cooperation during dental procedures. In South Korea, most drugs used for IV sedation are classified as psychotropic substances, which require strict management throughout the processes of administration, storage, and disposal. In 2018, all medical institutions in Korea were mandated to report on the manufacture, import, use, administration, and disposal of narcotic and psychotropic drugs to the Narcotics Information Management System (NIMS). Thus, in this study, we aimed to analyze the current status and trends of narcotic and psychotropic drug use in IV sedation performed at domestic dental clinics and hospitals by year, region, sex, and age using the aforementioned big data. Data on narcotic and psychotropic drug use reported nationwide by dental clinics and hospitals between January 2020 and December 2024 were collected. The drugs analyzed included midazolam, propofol, ketamine, and remimazolam (used for intravenous sedation), as well as fentanyl, remifentanil, and pethidine (used as analgesic adjuncts). Annual trends, regional distributions, and usage ratios by age and sex were analyzed for these medications. During the analysis period, the use of intravenous sedatives in domestic dental practice showed a continuous annual increase. As of 2024, midazolam account for the largest share, at approximately 76.5% of the total sedative use, followed by propofol (10.6%), ketamine (9.9%), and remimazolam (2.8%). Notably, ketamine showed the most rapid growth, with its annual usage increasing by approximately 152% in 2023 compared to the previous year. According to the type of medical institution, the volume of sedatives used in dental clinics account for 90.8% of the sedatives in 2024, indicating a higher growth rate in dental clinics than in dental hospitals. The average annual growth rate of sedative use is high among adults. Regionally, usage tends to become increasingly concentrated in the Seoul Metropolitan Area (Seoul and Gyeonggi). The use of IV sedation in Korean dentistry is consistently increasing. Safe IV sedation methods, primarily involving midazolam, are being widely implemented for adults in dental clinic settings.
The inferior alveolar nerve block (IANB) is one of the most painful procedures, especially in children. Effective pain management during IANB is a critical prerequisite for the successful treatment of pediatric patients. This systematic review aimed to evaluate the combined effectiveness of extraoral vibration and cooling (EVC) in reducing pain perception during IANB in children. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for the compilation of this systematic review. PROSPERO registration was performed using registration number CRD42024558538. PubMed, ScienceDirect, Cochrane, Google Scholar, and LILACS were searched for relevant studies published from the inception of the databases until January 1, 2025. Studies that compared the use of EVC with conventional methods for IANB in children were selected. The primary and secondary outcomes were subjective and objective measures of pain, respectively. The initial search of the five electronic databases yielded 483 records. After excluding 113 duplicates and screening 309 irrelevant titles and abstracts, 61 studies were included. Of these, six were selected for full-text analysis, and three studies met the inclusion criteria for the final systematic review. Meta-analysis was feasible for two of these studies because of their comparable methodologies and outcome measures. All included studies involved pediatric patients aged 5-12 years undergoing IANB. The intervention group underwent IANB using a combination of EVC, whereas the control group underwent conventional IANB without adjuncts. Pain and anxiety were assessed using both subjective (Wong-Baker Faces Pain Scale) and objective (Face, Legs, Activity, Cry, Consolability) scoring systems. The results indicated a statistically significant reduction in pain scores in the EVC group than in the control group, suggesting that EVC may be an effective adjunct for improving pain perception during IANB in children. Pain perception during IANB was significantly lower in the combined EVC group than in the control group. However, meta-analysis reports indicated that there was no significant difference in pain perception between the intervention and control groups.
Fear of injections and dental anxiety are the major barriers to successful pediatric dental treatment. Visual threats associated with conventional syringes can increase anxiety and pain perception in children, necessitating the use of child-friendly strategies. This study aimed to evaluate and compare the impact of camouflaged and insulin syringes, with and without counter-stimulation, on anxiety levels, pain perception, and behavioral responses during local anesthesia administration in children. A clinical trial involving 120 children aged 8-10 years who required bilateral maxillary local anesthesia was performed. Local anesthesia with camouflaged and insulin syringes was administered to each child once with and without thumb pressure counter-stimulation. Anxiety was measured using pulse rates, pain was measured using the Wong-Baker Faces Pain Rating Scale, and behavior was measured using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Statistical analyses were performed using the independent t-test and chi-square test. Both groups were demographically comparable with no significant differences in age (independent t-test, P = 0.539) or sex distribution (chi-square test, P = 0.854). At first appointment, camouflaged syringes showed significantly lower pain scores (3.58 ± 0.74 vs. 4.17 ± 1.37; P = 0.005), lower pulse rates (89.10 ± 5.84 vs. 99.00 ± 1.80 bpm; P < 0.001), and better behavioral responses (FLACC score: 2.27 ± 0.78 vs. 2.80 ± 0.68; P < 0.001) compared with insulin syringes, as assessed by the independent t-test. These effects were further enhanced by counter-stimulation. At second appointment, although overall scores improved in both groups, post-treatment differences between the syringe types were not statistically significant (P > 0.05). Camouflaged syringes combined with counter stimulation represent an effective, simple, and non-pharmacological method for reducing anxiety and improving cooperation during local anesthesia administration in pediatric dental patients. However, the findings are limited by the use of a homogenous sample of healthy, cooperative children aged 8-10 years and potential bias due to the inability of blind operators or participants. Future studies should evaluate a broader population and incorporate blind assessment protocols.
Pain remains one of the main causes of apprehension during dental procedures. In this context, topical anesthetics play an essential role in reducing discomfort, and new compounds such as amitriptyline and jambu (Acmella oleracea) extract have been investigated as promising alternatives. Drug delivery systems, such as Pentravan®, a nanosomal transdermal base, are also of interest; however, their application on oral mucosa has not yet been clinically evaluated. Therefore, this study aimed to compare the anesthetic efficacy of lidocaine (LDC) and prilocaine (PLC) combined with either amitriptyline or jambu, formulated as ointments or incorporated into Pentravan®, for topical anesthesia of the buccal and palatal mucosa of maxillary premolars, using pulpal response and puncture sensitivity as outcome measures. A randomized, blinded, crossover clinical trial was conducted with 40 healthy volunteers who received six formulations: (1) LDC 2.5% + PLC 2.5% (positive control); (2) LDC 2.5% + PLC 2.5% + amitriptyline 5%; (3) LDC 2.5% + PLC 2.5% + jambu extract 20% (7.5% spilanthol); (4) LDC 2.5% + PLC 2.5% + amitriptyline 5% in Pentravan®; (5) LDC 2.5% + PLC 2.5% + jambu extract 20% in Pentravan®; and (6) base ointment without active ingredients (placebo). Pain upon needle puncture was assessed using the visual analog scale, and pulpal anesthesia was evaluated with an electric pulp tester. Formulations 1 and 2 produced the lowest pain scores in the buccal mucosa, with Formulation 1 showing statistically superior results than Formulations 3, 4, 5, and 6 (P < 0.05). Formulation 6 yielded the highest pain scores, while Formulations 2-5 demonstrated intermediate efficacy without significant differences. Formulations 1 and 2 were also the most effective on the palatal mucosa. None of the formulations achieved significant pulpal anesthesia. Adverse effects were mild and self-limiting, with mucosal desquamation observed only with Formulation 2. Amitriptyline demonstrated relevant clinical potential, whereas jambu extract showed intermediate efficacy. Pentravan®-based formulations did not exhibit clinical superiority. Future studies should focus on optimizing these combined formulations to enhance the efficacy of topical anesthesia in dentistry.
General anesthesia (GA) is widely used in pediatric dentistry when conventional behavioral management techniques are insufficient, particularly in young children and patients with disabilities. Although the use of GA has increased, comprehensive long-term analyses integrating both dental and anesthetic characteristics in pediatric dental settings remain limited. This retrospective study included all patients aged <14 years who underwent dental treatment under GA between 2014 and 2023 at the Department of Pediatric Dentistry, Dankook University Jukjeon Dental Hospital, which serves as a regional disability oral health center. Data were extracted from the electronic medical and anesthesia records. Patient demographics, disability status, frequency of GA, types of dental procedures, feasibility of preanesthetic evaluation, anesthetic induction methods, airway management, duration of anesthesia, recovery time, and postoperative complications were reviewed. In total, 1,157 GA procedures were performed in 1,003 patients over a 10-year period, with a steady increase in the annual number of cases. Patients with disabilities comprised 40% of the study population. Caries-related treatments, including restorative, pulpal, and prosthodontic procedures, were performed more frequently in patients with disabilities, whereas minor oral surgery was predominant in patients without disabilities. Inhalational induction with sevoflurane and nasotracheal intubation were the predominant anesthetic approaches used in both groups. Most procedures lasted 60-119 min, and all patients were discharged on the same day. Postanesthesia complications were mild and self-limiting, with respiratory symptoms being the most common. This 10-year retrospective review demonstrates the increasing use of GA in pediatric dentistry at a regional disability oral health center. Distinct differences in dental treatment patterns were observed according to disability status, whereas anesthetic management remained standardized and safe, with a low incidence of serious complications.
Individuals with disabilities often face significant barriers to receiving appropriate dental care due to limited cooperation, communication difficulties, and underlying medical conditions. Dental treatment under general anesthesia (GA) is an effective alternative for patients who are unable to tolerate conventional outpatient procedures. This study aimed to analyze cases of dental treatment under GA performed at the Gyeongnam Dental Clinic Center for the Disabled and to compare them with findings from other regional centers in Korea. A retrospective review of 181 cases of dental treatment under GA performed at the Gyeongnam Center between November 8, 2022, and October 30, 2024, was conducted. Patient data, including demographic characteristics, disability type, American Society of Anesthesiologists (ASA) physical status classification, treatment type, number of GA sessions, procedure duration, and regional residence, were collected from anonymized electronic medical records. Statistical comparisons were made with findings from previous studies to assess trends and clinical implications. Among the 181 patients treated under GA, 61.9% were male, with a mean age of 22.4 years. Intellectual disabilities (41.4%) and autism spectrum disorder (28.6%) were the most common indications. Most patients were classified as ASA class II (60.8%) and underwent an average of 14 procedures per session, with restorative treatment being the most frequent (43.5%). Single-session treatments were predominant (90.9%), with an average duration of 147.5 m. Most patients resided in Gyeongsangnam-do (62.4%), reflecting the center's geographic accessibility. This study provides foundational data on dental treatment under GA for individuals with disabilities at a regional center. The findings emphasize the need for specialized facilities, efficient treatment planning, and structured follow-up systems. Improved accessibility and financial support are essential to enhancing oral health outcomes in this population. Future studies should include pediatric cases and account for overlapping disabilities to better reflect clinical complexity.