DENTAL INJURIES DURING GENERAL-ANESTHESIA

Although most anaesthetic textbooks cite dental injury as a complicati on of endotracheal intubation few studies have examined the extent and nature of the problem. Such damage however, formed the basis for one- third of all confirmed or potential anaesthetic claims notified to the Medical Protection Society between 1977 and 1986. This article seeks to explore the extent of the problem, outline predisposing factors, su mmarise current prophylactic measures and make recommendations to redu ce the overall incidence. Increased awareness of the problem, by both anaesthetists and dental surgeons, coupled with appropriate prophylact ic measures may result in a reduced incidence of dental injury arising from general anaesthesia. Given the high incidence of dental damage w e recommend that all patients undergoing a surgical operation under en dotracheal intubation should have a pre-operative dental check whereve r possible. Clearly, the first dental examination would be conducted b y an anaesthetist familiar with the predisposing factors. Where he/she considers there to be a higher than average risk of dental damage occ urring during intubation a more specialised examination should be cond ucted by a dental surgeon. It may, where appropriate, be possible for remedial dental treatment to be carried out and customised mouth guard s to be constructed prior to the operation. Obviously such recommendat ions have certain financial implications and would have to be subject to controlled cost-benefit analysis before their widespread applicatio n.