Dental injury associated with anesthesia: a report of 161,687 anesthetics given over 14 years

Study Objective: To determine the frequency, outcomes, and risk factors for dental injury related to anesthesia. Design: Case-control study. Setting: Tertiary-care university hospital. Patients: Patients who had a perianesthetic dental injury between August of 1989 and December 31, 2003. Measurements: A 1:2 case control study was done to identify the frequency, outcomes, and risk factors for dental injury. Perianesthetic dental injuries were defined as any notable change to the patient's dentition during the perianesthetic period that may or may not have required dental consultation or treatment. Main Results: Seventy-eight patients with perianesthetic dental injury were identified. The incidence of dental injury was one per 2,073 anesthetics. Eighty-six percent of dental injuries were discovered by the anesthesia provider. Maxillary incisors were the most frequently injured teeth. The most commonly reported injuries were enamel fracture, loosened or subluxated teeth, tooth avulsion, and crown or root fracture. Patients with poor dentition or reconstructive work, whose tracheas were moderately difficult or difficult to intubate, were at much higher risk (approximately 20-fold) of dental injury than those with good dentition and found to be easy to intubate. Among those whose tracheas were easy to intubate, patients with poor dentition or reconstructive work were 3.4 times more likely to have dental injuries related to anesthesia. Conclusions: Dental injury is one of the most common adverse events reported in association with anesthesia. Risk factors include preexisting poor dentition or reconstructive work and moderately difficult to difficult intubation.