Dental Damage

Damage to teeth is the commonest cause of anesthesia-related medical negligence claims, accounting for between one-sixth[1] and one-third[2] 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[3], [4].

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[1] or if the anesthetist is in doubt[2].

PRACTICE POINT

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[5].

PRACTICE POINT

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[4] that nearly half the anesthetists surveyed never used them. A Finnish paper[6] 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[1], Britain[2] and France[7].

PRACTICE POINT

Tooth guards are available but are not routinely used:
Community standards may be found to be unacceptable
Improved design may be needed

Japanese clinicians[8] have suggested, as part of the solution, the use of laryngoscope blades which provide improved visibility