4.8 Dental Damage

Question 1

a) List the anaesthetic factors that predispose to perioperative dental damage. (6 marks)

Answer 1

> > Limited mouth opening.*

> > LMA use.

> > Laryngoscopy.

> > Tracheal intubation.

> > Difficult intubation.

Question 2

b) List the dental factors that predispose to perioperative dental damage. (4 marks)

Answer 2

> > Primary teeth.

> > Poor dental health.

> > Crowns, fillings and bridges.

> > Patient age over 50 years.

> > Prominent upper incisors.

> > Isolated teeth.

> > Previously traumatised teeth.

Question 3

c) You have anaesthetised a 22-year-old man and you notice a missing front tooth after intubation. What
is your initial management of this situation? (6 marks)

Answer 3

Assess for possibility of airway compromise as a result:
» Alert team, call for senior assistance.
Assess airway and ventilation.
Check for obvious presence of tooth in airway,
check oxygen saturations,
auscultate chest, ensure airway pressures
and volumes appropriate.

Manage loss of tooth:
» Look for tooth in mouth, on laryngoscope etc. If tooth intact and patient
not immunocompromised, insert tooth into the gum, taking care to
avoid touching the root. Hold in place for several minutes. Decision as to
whether to proceed with surgery depends on urgency and possibility of
further trauma to the mouth and teeth. If tooth cannot be reimplanted, it
should be stored in saline or milk.

Locate missing tooth:
» If tooth not found on examination of mouth and airway, a chest
radiograph should be performed. If tooth has been aspirated, discussion
with ENT surgeon regarding retrieval should take place.

Question 4

d) How would you follow this patient up? (4 marks)

Answer 4

> > Written referral to dentist
(or onsite dental service if available). Information
to be included:

• Patient’s full details.
• Details of damage.
• Action taken at the time.
• Analgesia given and further 
recommendations for analgesia if required.
• Instructions for self-care.
• Details of referrer with contact numbers 
of anaesthetic department/
named person to contact.

> > In line with Duty of Candour,
speak with the patient postoperatively to
explain what has happened,
give apologies and explain follow-up.

> > Letter to be sent to patient
documenting all of the above.

> > Complete critical incident form.