Damage to teeth is the commonest cause of anesthesia-related medical negligence claims, accounting for between one-sixth and one-third of actions against anesthetists. At least one in two-hundred intubations for general anesthesia results in reported dental damage, and the figure for lesser injury may be considerably higher, .
Although healthy teeth may be fractured, loosened or knocked out, teeth which have previously been restored or which are weakened by disease are more susceptible to injury. Recent reviews have recommended dental pre-anesthetic checks and preventative surgery either routinely or if the anesthetist is in doubt.
Two-thirds of teeth injured during general anesthesia could and should have been identified as susceptible pre-operatively
The left upper incisors are the most frequently injured. After the laryngoscope blade has been inserted in the mouth, the anesthetist must resist the temptation to use the teeth as a fulcrum to lift the tongue and lower jaw out of the line of sight of the vocal cords, and instead make a straight lift.
Substandard manipulation of the laryngoscope blade causes some cases of dental damage
Various mouth guards to protect the teeth during intubation and extubation have been devised but are employed in selected cases only, and a New Zealand team found that nearly half the anesthetists surveyed never used them. A Finnish paper documents the loss of space and visibility, and other imperfections of current designs. There have nevertheless been calls for their routine use in the United States, Britain and France.
Tooth guards are available
but are not routinely used:
Japanese clinicians have suggested, as part of the solution, the use of laryngoscope blades which provide improved visibility
Copyright © 2008 Electronic Handbook of Legal Medicine