Peri-anaesthetic dental injury in children: A retrospective audit in a tertiary paediatric centre

Abstract

Introduction: Dental injury is one of the most common adverse events related to anaesthesia with a reported incidence of 0.04-0.1%. It is a frequent cause of anaesthesia-related medico-legal claim. To date, there is a lack of data in the literature on paediatric peri-operative dental injury. Accidental aspiration of the avulsed teeth into the bronchus is potentially life-threatening. Dental injury of permanent teeth in children also carries significant implications. The aim of this study is to determine the incidence, risk factors and outcomes of peri-anaesthetic dental injury in children following 80,811 general anaesthetics over a twelve-year period in our tertiary paediatric institution. This will aid in the prevention and management of peri-operative dental injury. Methods: A retrospective audit of our department audit database for incidents of dental injury was conducted from 1 January 2000 to 30 June 2011. Results: The incidence of dental injury was 42 out of 80,811 anaesthetics (0.05%). Incidence is highest in children aged 5-8 years old. The majority of dental injuries (83.3%) occurred during elective surgeries. Ninety-two per cent of the intubated patients had a grade 1 Cormack-Lehane larynx at laryngoscopy. Sixty-two per cent of the dental injuries occurred in patients with an inaccurate history. Six patients with dental injuries detected in the recovery had an inaccurate dental history. Conclusion: The incidence of dental injury in our paediatric centre is 0.05% and is comparable to that widely reported in the adult population. An accurate pre-operative dental assessment and documentation in the anaesthesia record should be obtained by the attending anaesthesia team. History from the child is vital. Better communication, minimal handover between staff and continuing education are important measures. A high index of suspicion of injury and knowledge of the patient’s dentition state are critical for early intervention and minimising adverse events when dental injury occurs.