A 65-year-old patient’s front tooth was accidentally knocked out during intubation. The risk of dental injury was not discussed during the preoperative consent process. As the anesthesiologist, there is an ethical obligation to address the incident promptly and professionally.
The dislodged tooth should be carefully retrieved and stored in normal saline or milk to preserve the periodontal ligament. Bleeding should be controlled with gauze pressure, and the dental or surgical team should be notified without delay. The incident must be documented in detail, including the time of injury, the intubation method used, the condition of the tooth, and whether the airway was difficult.
References
Warner ME, Benenfeld SM, Warner MA, Schroeder DR, Maxson PM. Perianesthetic dental injuries: frequency, outcomes, and risk factors. Anesthesiology. 1999;90(5):1302–1305. doi:10.1097/00000542-199905000-00013
Owen H, Waddell-Smith I. Dental trauma associated with anaesthesia. Anaesthesia and Intensive Care. 2000;28(2):133–145. doi:10.1177/0310057X0002800202
American Dental Association. Management of avulsed permanent teeth. J Am Dent Assoc. 2013;144(6):670. doi:10.14219/jada.archive.2013.0175
Disclosure should be clear, empathetic, and transparent. Defensive language must be avoided. The explanation should cover the nature of the injury, how it occurred, and the steps being taken to address it.
References
Gallagher TH, Studdert D, Levinson W. Disclosing harmful medical errors to patients. N Engl J Med. 2007;356(26):2713–2719. doi:10.1056/NEJMra070568
Australian and New Zealand College of Anaesthetists. PS09: Guidelines on informing patients about potential dental injury during anaesthesia. 2021. Available from: https://www.anzca.edu.au/resources/professional-documents/standards-(1)/ps09-guidelines-on-informing-patients-about-pot.pdf
Patients should be visually examined for loose, prosthetic, or prominent teeth, and questioned about prior dental work or recent dental problems. The risk of dental injury should be documented and discussed as part of the informed consent process.
References
Yasny JS. Perioperative dental considerations for the anesthesiologist. Anesth Analg. 2009;108(5):1564–1573. doi:10.1213/ane.0b013e31819d1d14
Fung D, Schwartz R. Airway management and dental trauma: a review. J Can Dent Assoc. 2007;73(6):527–530. Available from: https://www.cda-adc.ca/jcda/vol-73/issue-6/527.html
Dental risk checklists should be incorporated into pre-anesthesia evaluation forms. Patients can be stratified into risk categories such as high risk for mobile or prosthetic teeth. Electronic medical records should include dental diagrams and alert systems for fragile teeth.
References
Cheng S, Stevenson M, Yeoh C. Dental injury in anaesthesia: a 10-year review from a tertiary hospital. Anaesth Intensive Care. 2019;47(3):235–242. doi:10.1177/0310057X19844768
Givol N, Gershtansky Y, Halamish-Shani T, Taicher S. Perianesthetic dental injuries: analysis of incident reports. J Clin Anesth. 2004;16(3):173–176. doi:10.1016/j.jclinane.2003.07.006
Several factors increase the risk of dental trauma during anesthesia.
