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Neto, J.M.; Teles, A.R.; Barbosa, J.; Santos, O. Teeth Damage during General Anesthesia. Encyclopedia. Available online: https://encyclopedia.pub/entry/48682 (accessed on 18 May 2024).
Neto JM, Teles AR, Barbosa J, Santos O. Teeth Damage during General Anesthesia. Encyclopedia. Available at: https://encyclopedia.pub/entry/48682. Accessed May 18, 2024.
Neto, João M., Ana Rita Teles, Joselina Barbosa, Orquídea Santos. "Teeth Damage during General Anesthesia" Encyclopedia, https://encyclopedia.pub/entry/48682 (accessed May 18, 2024).
Neto, J.M., Teles, A.R., Barbosa, J., & Santos, O. (2023, August 31). Teeth Damage during General Anesthesia. In Encyclopedia. https://encyclopedia.pub/entry/48682
Neto, João M., et al. "Teeth Damage during General Anesthesia." Encyclopedia. Web. 31 August, 2023.
Teeth Damage during General Anesthesia
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This entry is adapted from the peer-reviewed paper 10.3390/jcm12165343

Dental injuries during anesthesia, especially when advanced airway management is required, represent a legal problem. Factors such as poor dental condition and excessive pressure during intubation contribute to dental damage. The maxillary central incisors are commonly affected.

oral damage dental injury laryngoscopy anesthesia

1. Introduction

Perioperative dental injury is the most common complaint among all medico-legal complaints related to anesthesia and is the cause of one-third of the lawsuits regarding medico-legal anesthesia [1].
Dental trauma or, as a matter of fact, any intra-oral trauma caused as a result of anesthetic practice is a relevant issue which, apart from playing a contributing role to the overall morbidity of a patient, can also lead to litigation issues [2].
It is important to point out that these injuries occur during surgical procedures unrelated to pre-existing dental trauma. It can be detrimental to the patient’s well-being, especially when the patient should not expect complications such as pain, aesthetic, and functional problems resulting from dental trauma which significantly disrupt normal function and quality of life [3]. In addition, the cost of replacing damaged or lost teeth can be significant [4][5]. In a few extreme cases, even near-fatal complications, such as esophageal perforation and mediastinitis following aspiration of a dental prosthesis or a tooth, have been described.
In the peri-operative period, the majority of dental injuries (50–75%) occur during tracheal intubation [1]. The overall incidence of dental injury is estimated to be between 0.06% and 12%, but these values may be underestimated [6].
The incidence of dental damage during orotracheal intubation depends on several factors such as poor dental conditions, significant pressure on the dental arch, and misuse of the protective device supplied by the hospital is often a contributing factor [7]. Also, when a satisfactory view of the glottis is difficult to obtain during laryngoscopy, the patient’s maxillary anterior teeth are sometimes used as a fulcrum by the laryngoscope blade [8]. The majority of these occurrences are caused by the application of pressure from the hard metallic blade of the laryngoscope [6][9][10]. There are three major groups of causative factors: unfavorable patient anatomy, the experience and skill of the anesthesiologist who handles the airway, and the design of the laryngoscope blade [8]. In the study of Diakonoff et al., that review 21 years of law decisions, he found poor dentition in 15 of 19 cases, 78.9% preoperatively document, pre-existing periodontal disease in 16 cases (66.7%), and dental restorations or prostheses in seven cases (30.4%) [11]. Dental injury occurred in 21 cases (87.5%) where intubation was performed [11].
In cases of emergent airway management, the incidence of oral trauma increases to 7% [8]. The most common dental injuries in these cases include enamel fractures, loosened, subluxated teeth, tooth avulsion, crown or root fractures, luxation, and missing teeth [2][6][8][9][10].
The anterior sextant of the maxillary region, more specifically the central maxillary incisors, are the most affected [9]. In fact, the left central incisor is reported to be the tooth with the highest risk of dental injury, due to its direct contact with the laryngoscope blade as well as its use as a fulcrum to position the laryngoscope [9]. However, there are few publications on registration strategies that support the implementation of effective preoperative measures to prevent damage, namely through the laryngoscopy procedures [9]. Nor is this damage a commonly discussed problem in the literature, although it is a subject which the Medical Protection Society warns its members about in a special publication [12].
Protective devices, such as mouthguards, are recommended to prevent dental injuries caused by poor dentition [13]. Although the use of mouthguards has been documented to reduce the force inflicted upon the anterior dentition during laryngoscopy, the effectiveness of a mouthguard as a preventive tool against dental injuries remains controversial, and even when indicated it is rarely used [11][13].
Considering the magnitude of the problem and its physical, economic, and legal consequences, it is important to determine the risk factors, frequency, and outcomes of dental injuries related to anesthesia [1]. Furthermore, raising awareness among anesthesiologists about the significance of this problem is crucial [6]. They should be educated about tooth anatomy, supporting structures, common dental pathologies, and the techniques used in dental rehabilitation to effectively address and prevent dental injuries related to anesthesia [9][10].

2. Types of Tooth Injury

The types of tooth injury were only reported by six articles.
Newland et al., reported eight types of injuries that affected 78 patients described from dental consultation: 25 (32.1%) enamel fractures; 18 (23.1%) loosening/subluxations; 3 (3.8%) luxations; 7 (9%) avulsions; 6 (7.7%) Crown fractures; 1 (1.3%) crown and root fracture; 8 (10.3%) missing tooth/teeth; 17 (21.8%) other minor complications [14]. Tan et al. only reported that in 3 patients out of 51 who suffered injuries there were two cases (66%) of tooth avulsion and 1 case (34%) of crown fracture diagnosis by the dentistry of the hospital [15]. Mourão et al. reported two types of injuries that affected 86 patients: 82 (15%) enamel fractures; 4 (0.7%) avulsions using the modified WHO’s classification [16]. Watanabe demonstrated 1 patient out of 2 affected patients had a subluxation and another had a crown fracture, then treated by the institutional dentistry [17]. Kuo et al. reported seven types of injuries from 76 patients who suffered an injury, identified by anesthetist, patients, or nurses: 8 (20%) loosening/subluxations; 2 (5%) dislocations; 14 (35%) avulsions; 6 (15%) coronary fractures; 1 (2.5%) missing tooth/teeth; 4 (10%) other minor complications; 5 (12.5%) fixed partial denture damage [18]. Gaudio et al. reported five types of injuries that 83 patients suffered: 1% enamel fracture; 3.8% dislocation; 50% Avulsion; 14% coronary fracture; 12% crown and root fracture [19].

3. Types of Airways Management and Teeth Damage

Different forms of airway management were performed, however not all of them affected the teeth. Newland et al. reports that of the 78 dental injuries, 75 were due to Laryngoscopy; 2 due to facial Masks, and 1 due LMA [14]. Warner et al. demonstrate that the 132 dental injuries were caused by laryngoscopy [20]. Martin et al. demonstrate that the six dental injuries were caused by Laryngoscopy [21]. Tan et al. reports that of the 51 dental injuries, 40 dental injuries were due to Laryngoscopy, 7 dental injuries were due to SADs, 3 to double lumen tube, and 1 dental injury due to a mask. Of those with descriptive data, laryngoscopy was the most common cause of dental injury [15]. Mourão et al. demonstrate that the 134 dental injuries were due to Laryngoscopy [16]. Watanabe et al. demonstrate that the two dental injuries were due to Laryngoscopy [17]. Kuo et al. demonstrate that 42.1% of the dental injuries were due to LMA and 28.9% were due to Laryngoscopy [18]. Gaudio et al. demonstrate that the 83 dental injuries were due to Laryngoscopy [19].

4. Teeth Affected

In general, it is possible to verify in almost all articles that the most affected teeth are the upper central incisors.
Newland et al. reports that the upper left and right central incisors were the most affected. From the right lateral incisor to the right first premolar moderately affected. Left lateral incisor to left first premolar moderately affected [14]. Warner et al. reports that the teeth the most affected were the upper central incisors [20]. Tan et al. reports that upper right and left incisors were the most affected, although there were also three injuries to the lower left central incisor, one injury to the right upper canine and right upper premolar, one injury to the lower right central incisor and right lower canine and one injury on the left lower canine and left premolar [15]. Mourão et al. reports 80 injuries to the upper right central incisor, 3 injuries to the upper right lateral incisor, 53 injuries to the upper left central incisor, 11 injuries to the upper left lateral incisor, 4 injuries to the lower left central incisor, 1 injury to the lower left lateral incisor, 8 injuries to the lower right central incisor, 1 injury to the lower right lateral incisor, and 1 injury to the lower right canine [16]. Watanabe et al. reports that the most teeth affected were the upper central incisors [17]. Kuo et al. reports that there were 15 lesions in the left central incisor; 9 injuries to the right central incisor; 3 injuries to the right lateral incisor; 5 injuries to the left lateral incisor; 4 injuries to the lower left central incisor; 2 injuries to the lower left lateral incisor [18]. Gaudio et al. reports that in their study 90% the teeth affected were upper incisors [19].

References

  1. Ansari, S.; Rajpurohit, V.; Dev, V. Dental Trauma due To Intubating during General Anaesthesia: Incidence, Risks Factors, and Prevention. Oral Health Dent. Manag. 2016, 15, 377.
  2. Sahni, V. Dental considerations in anaesthesia. JRSM Open 2016, 7, 2054270416675082.
  3. Lee, J.Y.; Divaris, K. Hidden consequences of dental trauma: The social and psychological effects. Pediatr. Dent. 2009, 31, 96–101.
  4. Zitzmann, N.; Krastl, G.; Weiger, R.; Kühl, S.; Sendi, P. Cost-effectiveness of Anterior Implants versus Fixed Dental Prostheses. J. Dent. Res. 2013, 92 (Suppl. 12), 183S–188S.
  5. Talwar, J.S.; Gaiser, R.R. Dental injury during general anesthesia and those who seek financial compensation: A retrospective study. J. Clin. Anesth. 2020, 63, 109757.
  6. de Sousa, J.M.; Mourão, J.I. Tooth injury in anaesthesiology. Braz. J. Anesthesiol. 2015, 65, 511–518.
  7. Nuzzolese, E.; Innocenzi, F.; Santovito, D.; Lupariello, F. Dental Injuries During General Anesthesia: Risk Management and Forensic Perspectives. In Proceedings of the 74th AAFS Annual Scientific Meeting, Seattle, WA, USA, 21–25 February 2022; pp. 707–708.
  8. Yasny, J.S. Perioperative Dental Considerations for the Anesthesiologist. Obstet. Anesth. Dig. 2009, 108, 1564–1573.
  9. Silva, D.; Miranda, R.; Ferreira, I.; Braga, A.; Mourão, J.; Pina-Vaz, I. Validation of a Suggested Pre-Operative Protocol for the Prevention of Traumatic Dental Injuries during Oroendotracheal Intubation: A Pilot Study. Appl. Sci. 2023, 13, 2091.
  10. Fukuda, T.; Sugimoto, Y.; Yamashita, S.; Toyooka, H.; Tanaka, M. Forces applied to the maxillary incisors during tracheal intubation and dental injury risks of intubation by beginners: A manikin study. Acta Anaesthesiol. Taiwanica 2011, 49, 12–15.
  11. Diakonoff, H.; De Rocquigny, G.; Tourtier, J.; Guigon, A. Medicolegal issues of peri-anaesthetic dental injuries: A 21-years review of liability lawsuits in France. Dent. Traumatol. 2022, 38, 391–396.
  12. Burton, J.F.; Baker, A.B. Dental Damage during Anaesthesia and Surgery. Anaesth. Intensiv. Care 1987, 15, 262–268.
  13. Lee, K.; Kim, S.-Y.; Park, K.-M.; Yang, S.; Kim, K.-D.; Park, W. Evaluation of dental status using a questionnaire before administration of general anesthesia for the prevention of dental injuries. J. Dent. Anesth. Pain. Med. 2023, 23, 9–17.
  14. Newland, M.C.; Ellis, S.J.; Peters, K.R.; Simonson, J.A.; Durham, T.M.; Ullrich, F.A.; Tinker, J.H. Dental injury associated with anesthesia: A report of 161,687 anesthetics given over 14 years. J. Clin. Anesth. 2007, 19, 339–345.
  15. Tan, Y.; Loganathan, N.; Thinn, K.K.; Liu, E.H.C.; Loh, N.-H.W. Dental injury in anaesthesia: A tertiary hospital’s experience. BMC Anesthesiol. 2018, 18, 108.
  16. Mourão, J.; Neto, J.; Luís, C.; Moreno, C.; Barbosa, J.; Carvalho, J.; Tavares, J. Dental injury after conventional direct laryngoscopy: A prospective observational study. Anaesthesia 2013, 68, 1059–1065.
  17. Watanabe, S.; Suga, A.; Asakura, N.; Takeshima, R.; Kimura, T.; Taguchi, N.; Kumagai, M. Determination of the distance between the laryngoscope blade and the upper incisors during direct laryngoscopy: Comparisons of a curved, an angulated straight, and two straight blades. Anesth. Analg. 1994, 79, 638–641.
  18. Kuo, Y.W.; Lu, I.C.; Yang, H.Y.; Chiu, S.L.; Hsu, H.T.; Cheng, K.I. Quality improvement program reduces perioperative dental injuries—A review of 64,718 anesthetic patients. J. Chin. Med. Assoc. 2016, 79, 678–682.
  19. Rosa Maria, G.; Paolo, F.; Stefania, B.; Letizia, T.; Martina, A.; Massimiliano, D.; Carlo, O.; Maria, A.F. Traumatic dental injuries during anaesthesia: Part I: Clinical evaluatio. Dent. Traumatol. 2010, 26, 459–465.
  20. Warner, M.E.; Benenfeld, S.M.; Warner, M.A.; Schroeder, D.R.; Maxson, P.M. Perianesthetic dental injuries: Frequency, outcomes, and risk factors. Anesthesiologists 1999, 90, 1302–1305.
  21. Martin, L.D.; Mhyre, J.M.; Shanks, A.M.; Tremper, K.K.; Kheterpal, S. 3423 emergency tracheal intubations at a university hospital: Airway outcomes and complications. Anesthesiology 2011, 114, 42–48.
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Subjects: Dentistry, Oral Surgery & Medicine
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
João M. Neto
,
Ana Rita Teles
,
Joselina Barbosa
,
Orquídea Santos
View Times: 324
Revisions: 2 times (View History)
Update Date: 01 Sep 2023
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