Dental trauma in anaesthesia

Abstract

Dental trauma is the largest single reason for successful malpractice claims against anaesthetists. The purpose of this article is to familiarize the anaesthetist with basic tooth anatomy and pathology and to provide an update on the different types of dental treatment and appliances which one may encounter in anaesthetic practice. Traumatic fractures to teeth are classified into six categories; Class I - fracture into the enamel layer, Class II - fracture into the dentinal layer, Class III - fracture into the pulp of a tooth, Class IV - fracture of the root of a tooth, Class V - subluxation of a tooth, and Class VI - avulsion of a tooth. Treatment for each class of fracture is described as well as certain preventative ideas. Some of the more recent developments in dental therapy such as the butterfly bridge, titanium implants and porcelain laminate veneers are described. Such developments in their turn have led to new and different problems. Care must be taken when using the laryngoscope as these teeth may be more easily fractured or dislodged. Several investigations into malpractice claims found that the oral airway was responsible for up to 55 per cent of dental complications. Prevention of dental trauma begins with an understanding of basic tooth anatomy and pathology and a recognition of the different dental treatments and appliances at the preoperative visit. The value of an appropriate preoperative dental consultation must not be underestimated. © 1989 Canadian Anesthesiologists.