Medicolegal issues of peri‐anaesthetic dental injuries: A 21‐years review of liability lawsuits in France

Abstract

Background/Aim Peri‐anaesthetic dental injuries (PDI) represent a major source of potential malpractice claims against anesthesiologists. Studies about the medico‐legal aspects of PDI have mainly focused on liability insurance cases thus not encompassing those cases brought to court. The aim of this study was to assess the medico‐legal issues of PDI‐related liability lawsuits in France. Material and Methods A review of judicial decisions pertaining to PDI was conducted on a French legal database, spanning the period between January 2000 and October 2021. Characteristics of decisions, patients and anesthesiologists, peri‐operative care, dental injuries, and convictions were collected when available for analysis. Results Twenty‐four judicial decisions fulfilled the inclusion criteria and were analyzed. All cases of dental injuries took place during elective surgery, 16 in the private sector and 8 in the public sector. Most injuries concerned two or more teeth and the most predominant dental injuries were luxation or avulsion (70.8% of cases). Eight cases resulted in a final verdict in favor of the plaintiff, four in the private sector (conviction rate: 25%), and four in the public sector (conviction rate: 50%). The causes of conviction were either a lack of information (5/8), a breach in the standard of care or technical negligence (3/8). The average amount of indemnification for the plaintiff was 3614 Euros (3753 Euros in 2022 inflation‐adjusted Euros) excluding legal fees. Conclusions The analysis of PDI‐related liability lawsuits shows that medico‐legal issues differ from those of PDI‐related insurance claims. Avulsion and luxation of multiple anterior teeth during elective surgery appear to be a risk factor for liability lawsuits. In addition, inadequacy of patient information about PDI‐risk seems to be a risk factor for conviction. Lastly, dental injuries are less at risk of civil conviction than other anesthesia‐related damages.

Medico-legal liability of injuries arising from laryngoscopy

“…A recent comprehensive review of a French legal database identified just 24 lawsuits involving peri-operative dental injuries. 43 This relatively low case number highlights the rarity of these trials and reaffirms our assertation that the present review successfully captures all available court records on laryngoscope-mediated dental injuries. This report, therefore, may represent a valuable resource for predicting future litigation outcomes and may be referenced by expert witnesses under oath as precedent to justify verdicts.…”

Teeth Damage during General Anesthesia

“…Although this is an event that occurs less than two in a hundred patients, according to most of the included studies, they are common complications of general anesthesia and account for a significant proportion of all medicolegal claims against anesthesiologists, especially in France, where they represent 40% of these claims [ 11 , 16 , 24 ].…”

“…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 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 ].…”

“…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 ].…”