Prevention and Post-extubation Screening of Perioperative Traumatic Dental Injury in Pediatric Anesthesia

Abstract

Adenotonsillectomy is a routine pediatric procedure often requiring general anesthesia and endotracheal intubation. While generally safe, traumatic dental injuries (TDIs) represent a significant and often under-recognized complication, particularly in children with mobile primary teeth and anatomical risk factors. Although preoperative dental evaluations are commonly performed, current anesthetic protocols rarely include post-extubation dental screening. We present the case of a five-year-old male who underwent an uncomplicated adenotonsillectomy and was later found to have an avulsed and ingested lower central incisor, identified postoperatively by a caregiver. This case underscores the need for targeted oral examinations immediately after extubation, with attention to the anterior teeth and signs of fresh gingival trauma. We highlight the importance of both pre- and post-intubation dental assessments in pediatric patients and advocate for the adoption of structured protocols that improve early recognition of dental injuries, reduce medico-legal risk, and enhance patient safety.