Dental trauma in anaesthesia

Abstract

Dental trauma is the largest single reason for successful malpractice claims against anaesthetists. The purpose of this article is to familiarize the anaesthetist with basic tooth anatomy and pathology and to provide an update on the different types of dental treatment and appliances which one may encounter in anaesthetic practice. Traumatic fractures to teeth are classified into six categories; Class I - fracture into the enamel layer, Class II - fracture into the dentinal layer, Class III - fracture into the pulp of a tooth, Class IV - fracture of the root of a tooth, Class V - subluxation of a tooth, and Class VI - avulsion of a tooth. Treatment for each class of fracture is described as well as certain preventative ideas. Some of the more recent developments in dental therapy such as the butterfly bridge, titanium implants and porcelain laminate veneers are described. Such developments in their turn have led to new and different problems. Care must be taken when using the laryngoscope as these teeth may be more easily fractured or dislodged. Several investigations into malpractice claims found that the oral airway was responsible for up to 55 per cent of dental complications. Prevention of dental trauma begins with an understanding of basic tooth anatomy and pathology and a recognition of the different dental treatments and appliances at the preoperative visit. The value of an appropriate preoperative dental consultation must not be underestimated.

Injuries associated with anaesthesia. A global perspective

“…Fear of damaging teeth may lead some anaesthetists to take unreasonable risks of other complications. 22 Dental damage was avoided in one vulnerable, obese patient who required Caesarean section; a face mask was used, but she died after massive aspiration of gastric fluid. 38…”

Reshaping the Macintosh blade using biomechanical modelling#A prospective comparative study in patients

“…The Macintosh laryngoscope blade is widely used despite evidence that during its routine use large forces are exerted on the maxillary incisors [1][2][3]. As a result one of the most frequent complications arising from its use -and that of many other blades -is dental damage [1,4,5]. This results from contact between the blade and the teeth and is related to the experience of the intubator [6], anatomical characteristics of the patient's upper airway and the design of the blade.…”

Lésions iatrogènes dento-maxillaires en relation avec les actes pratiqués par les anesthésiologistes

“…1 Toute visite pré-anesthésique devrait comporter une anamnèse dentaire et un examen rigoureux de la denture, en s'appuyant de préférence sur des protocoles standardisés. 2 Dans le cadre du consentement éclairé, le patient devrait être informé du risque de traumatisme dentaire, en raison de la fréquence élevée des traumatismes liés aux actes des anesthésiolog-istes.…”