Protect Your Patient, Protect Yourself
Dental injuries are the most common cause of claims against anesthesia providers.1,2,4 The decade-long use of LMA© devices has not reduced the incidence of dental injuries.1,2 The phenomenon of “Emergence Clenching” explains why.1,2,3,5
Our data, covering nearly one million anesthetics, confirm the notion that diseased and restored teeth are more susceptible to injury than healthy native teeth. Our findings document that lower (mandibular) as well as upper (maxillary) incisors are primarily at risk.1,2
Dental Injury by Position (2) (Excerpted from [2] by permission.)
The new wrinkle in the equation is the National Practitioner Data Bank. A written patient demand for dental repair, if paid by the physician’s corporation or insurance provider, automatically generates a report to the National Practitioner Data Bank.3
Protect Your Patients’ Dentition and Protect Yourself
With these three simple steps, we believe that you can reduce the incidence of dental claims in your practice:
- Every preoperative evaluation should include an airway and dental examination. Every pre-op risk discussion should include the possibility of airway trauma.
(Dentures, caps, bridges, decay, periodontal disease? Ankylosis, micrognathia, sleep apnea? Every now and then regional or local cases require airway manipulation. Dentures break too.2 Don’t be caught unprepared.)
- Protect maxillary incisors during rigid laryngoscopy.
Athletic tooth guards protect upper incisors.
Handy inexpensive athletic tooth guards can protect upper incisors from the metal laryngoscope blade.6
- Prepare for Emergence Clenching.
LMA, Guedel airway, or ET tubes, if positioned mid-line, prevent the molars from contacting. This leaves the upper and lower incisors to bear the brunt of extraordinary clenching pressures.
Shift clenching pressures posteriorly and away from your patient’s incisors (upper and lower) by employing homemade or commercial devices. Healthy premolars are designed to withstand the excess pressures of clenching (whereas incisors may loosen or break).
Some commercially available devices.
Inverted oral airway can splint premolars during emergence.
By employing and documenting these three steps, you will protect your patient and be in a firm defensive position should a dental claim arise.
J4255 05/07
References
Excerpts and paraphrasing from ASA documents 1 and 2 below by permission of the American Society of Anesthesiologists (ASA). A copy of the full text can be obtained from ASA, 520 N. Northwest Highway, Park Ridge, Illinois, 60068-2573.
- Tolan T, Clark T, Irving D, Westerfield S. Dental injuries in anesthesia: incidence and preventive strategies. Anesthesiology Supplement. ASA Meeting Abstracts, October 2000.
- Tolan T, et al. Dental injuries in anesthesia: frequency, causes, and preventive strategies. Anesthesiology Supplement. ASA Meeting Abstracts, October 2004.
- Carlson R. Emergence clenching produces dental trauma. ASA Annual Meeting News. October 16, 2000;16.
- Warner M, et al. Perianesthetic dental injuries: frequency, outcomes, risk factors. Anesthesiology. 1999;90:1302–05.
- Ravi R, et al. Dental injury with a cuffed oropharyngeal airway. Am. Jr. Anesthesiology. 1999;26(3):129.
- Nakahashi K, et al. Effect of teeth protection on dental injuries during general anesthesia. Japanese Journal of Anesthesiology. January 2003;52(1):26–31.
About the Author
This article, published in 2007, was written by Tod Tolan, MD, a board certified anesthesiologist practicing with the Oregon Anesthesiology Group, PC.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.