Abstract
Perioperative dental injury is the result of mechanical trauma typically sustained during upper airway management for general anesthesia. Despite well-documented risk factors and a simplistic mechanism, iatrogenic damage to the dentition remains very prevalent. In fact, both the Accreditation Council for Graduate Medical Education and the American Association of Oral and Maxillofacial Surgeons have had to publish guidelines specifically addressing this complication (Miller and Pardo (2011). Airway management. Basics of anesthesia, 6th edn. Elsevier, Philadelphia, p 219–251; AAOMS parameters of care: clinical practice guidelines for oral and maxillofacial surgery. (AAOMS ParCare 2012)). A decrease in the rate of patient edentulism coupled with an increased predominance and cost of dental restorations has made this complication even more significant (Thomson and Ma. Singap Dent J 35:3–8, 2014). This chapter briefly discusses the most common causes of perioperative dental injury with specific focus on direct laryngoscopy and tracheal intubation. Risk factors are also discussed with the most pertinent including preexisting dental disease as well as a predicted difficult intubation (de Sousa and Mourao. Braz J Anesthesiol 65(6):511–518, 2013). A review of the necessary dental anatomy, dental pathology, and dental restorations is provided for the perioperative personnel without dental training. Next reviewed are preventative measures including correct laryngoscopy technique, preoperative patient-provider communication, and various other clinical aids to minimize risk. The treatment of perioperative dental injury always begins with a rapid diagnosis in order to identify any possible acute stage treatment necessary to prevent further damage. Once stable, the provider must then consult the treating service with an urgency determined by the morbidity of the injury. Finally, a discussion of the most relevant medical legal implications is provided.
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Ghali, G.E., Meram, A.T., Garrett, B.C. (2019). Dental Injury: Anatomy, Pathogenesis, and Anesthesia Considerations and Implications. In: Fox, III, C., Cornett, E., Ghali, G. (eds) Catastrophic Perioperative Complications and Management. Springer, Cham. https://doi.org/10.1007/978-3-319-96125-5_6
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DOI: https://doi.org/10.1007/978-3-319-96125-5_6
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