Wednesday, May 9, 2018

Dentoalveolar injury related to general anesthesia: A 14 years review and a statement from the surgical point of view based on a retrospective analysis of the documentation of a university hospital.


Department of Pediatric Dentistry
NYU Langone Dental Medicine

Resident’s Name: Albert Yamoah, DDS                                                                                                                   Date: 5/16/2018
Article Title Dentoalveolar injury related to general anesthesia: A 14 years review and a statement from the surgical point of view based on a retrospective analysis of the documentation of a university hospital.
Author(s):  Adolphs N, Kessler B, Heymann C, Achterberg E, Spies C, Menneking H, Hoffmeister B
Journal:  Journal of Dental Traumatology
Date: 2011
Type of Article: Retrospective Study
Main Purpose: Evaluate dentoalveolar injury related to general anesthesia.

INTRODUCTION:

·       Damage to dentoalveolar structures related to general anesthesia is a well-known complication and may represent a relevant morbidity for affected patients
·       Central documentation of perioperative dentoalveolar injuries was performed since 1990 in the Department of Anesthesiology and Intensive Care Medicine in cooperation with the Department of Oral and Maxillofacial Surgery at the Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum. Documentation of perioperative dentoalveolar injury consisted of anesthesia charts, reports of the anesthesiologists and consultant maxillofacial surgeons.

MATERIALS AND METHODS:

·       Retrospective analysis of the data from 1990 to 2004 was performed according to this documentation with respect to incidence, matter, distribution of dental injury and therapeutic consequences.

RESULTS:

·       Within 14 years 82 'dental injuries' with 103 affected teeth were documented in 375,000 general anesthesia cases.
·       Incidence of 0.02% was very constant with an average of 5.5 events/year.
·       89% of the documented injuries occurred during scheduled operative procedures.
·       Only 32.9% of the injuries took place during endotracheal intubation.
·       In about 50% the injury was not related to intubation or extubation but happened during general anesthesia.
·       In 80%, the dental injury was estimated by the anesthesiologist as 'not avoidable'.
·       In 83% pre-existing affection or structural injury of intraoral tissues was documented, in 32.7% of the affections sufficient therapy could be provided already during in-hospital stay.

CONCLUSION:

·       Perioperative dentoalveolar injury is surely an annoying complication of general anesthesia. However incidence is rare and seems to be unavoidable.
·       Pre-existing damage to dentoalveolar structures is the main risk for additional injuries related to general anesthesia. Adequate therapy can be provided by interdisciplinary concepts.
·       There should be a fair balance between the benefit of the surgical procedure and the risk of dental injury related to general anesthesia.
·       Awareness of the problem and proper documentation are important factors for adequate management in liability cases.
Assessment of Article:
Level of Evidence/Comments: III



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