Dental Damage Under Anaesthesia

Question 1

What anaesthetic factors could predispose to perioperative dental damage

Answer 1

LMA use
Laryngoscopy
Tracheal Intubation,
Use of a double lumen tube
Forceful removal of an airway
Biting during emergence
Vigorous Oropharyngeal suctioning
Difficult intubation
Limited mouth opening

Question 2

What dental factors can predispose to perioperative dental damage

Answer 2

Having primary teeth (aka baby teeth / milk teeth)

Poor dental hygiene

Crowns, fillings and bridges

Patient age over 50 years

Prominent upper incisors

Isolated teeth

Previously traumatised teeth

Question 3

Having intubated a 22-year-old man, you notice a missing front tooth immediately post-intubation. What is your initial management plan for this situation?

Answer 3

Assess for the possibility of airway compromise as a result of the lost tooth;

(alert team, call for senior assistance, assess airway and ventilation, look for tooth in airway, check O2 saturations, auscultate chest, and ensure airway pressures and volumes are appropriate)

Locate the missing tooth;

(Look for the tooth in the mouth using a laryngoscope, assess with CXR if not located, discuss with ENT if the tooth is found in the lungs on CXR)

Reimplant the tooth;

IF intact AND the patient isn’t immunocompromised, insert the tooth into the gum taking care to avoid touching the root and hold in place for several minutes.

Decide whether to continue with surgery;

This depends on the urgency of the surgery and the possibility of further trauma to the mouth and teeth.

If the tooth can not be reimplanted intraoperatively;

Store it in saline or milk until an urgent discussion and/or assessment can be made with a dentist.

Question 4

After management of the acute situation, what actions should be taken following dental damage under anaesthesia

Answer 4

Written referral to a dentist (or the on-site dental service if available), including details of damage and management at the time of the incident.

Incident Form

Discuss the dental damage with the patient and a follow up letter in line with the Dut of Candour Statutory duty

Ensure adequate analgesia for the management of the dental damage as required

Question 5

What strategies are there to avoid dental damage in a patient deemed at high risk for dental damage under general anaesthesia

Answer 5

Avoid general anaesthesia if there is an appropriate alternative

Referral for preoperative dental treatment if poor dentition is assessed as a likely issue perioperatively

Stabilisation of a loose tooth preoperatively (with a suture or tie)

Avoidance of laryngoscopy or airway instrumentation

Nasal fibreoptic intubation

Dental Guards

Soft bite blocks during emergence, specifically, bite block on solid back teeth