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Audit of Perianesthetic Dental Injury As A Quality Indicator of Anaesthesia Care

E Lew, A Sia
Department of Women’s Anaesthesia
KK Women’s and Children’s Hospital

Perianaesthetic dental injuries (PDI) are considered to be one of the frequent anesthesia-related causes for medical claims. Defined as any notable change to a patient’s dentition during the perianaesthetic period that may or may not have required dental consultation or treatment, it is a complication related to airway manipulation during anaesthesia. Depending on the definition used, the incidence of PDI has been quoted to vary from 0.04% to 12%. It poses significant distress to both patients and anesthesiologists. Risk factors for PDI identified in previous studies include preexisting poor dentition or reconstructive work and general anaesthesia with tracheal intubation.

The aim of this retrospective study was to determine the frequency and characteristics of PDI among patients at a tertiary women’s hospital as a quality indicator for standard of anaesthetic care.

All critical incidents involving dental injuries were retrieved from the Department of Women’s Anaesthesia database since its implementation on June 1, 2004 and up to and including March 31, 2011. This database contains adverse events reported from an itemized assessment form that had to be completed by all anaesthesia providers for cases in which monitored care, sedation, general or regional anaesthesia had been administered. The medical record of each case of PDI was reviewed for information. Information pertaining to location and discovery of PDI was also recorded.

During the study period from June 1, 2004 to March 31, 2011, there were 120,665 anesthetics administered to adult patients requiring surgical procedures at the KK Women’s and Children’s Hospital. Of these, 82,155 were general anaesthetics while the remaining consisted of regional anaesthetic, sedation or monitored care cases.

Our retrospective audit identified 18 cases of perianesthetic dental injuries out of 120, 665 (or 1 in 45, 642) consecutive anaesthetics provided during the study period. This incidence is significantly lower than those quoted by others. In two large-scale case-control studies, incidence of PDI was found to be 78 in 161,786 anaesthetics (1 in 2073) and 132 in 598,904 anaesthetics (1 in 2805) respectively.

In KKH, the relatively low incidence of PDI could be attributed to the preferential use of regional anaesthetics (where feasible) among our patients. It could also reflect good anaesthesia care. Departmental guidelines have always been strictly enforced on the proper preoperative documentation and management of abnormal dentition, including a policy for dental referral for patients with abnormal dentition amenable to preoperative management to reduce risk of PDI in the perioperative period. An array of tooth protecting devices and difficult airway equipment are also available in operating theatres to facilitate airway management in the presence of abnormal dentition. The importance of patient counseling for dental injury risks has also been regularly reinforced to all anaesthesia care providers.

Continual effort would be made to maintain a low incidence of PDI through: encouraging the use of regional anaesthetics, enforcing departmental guidelines on the preoperative assessment and management of abnormal dentition and patient counseling of risks of PDI.

References

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Warner ME, Benenfeld SM, Warner MA et al: Perianesthethic Dental Injuries: Frequency, Outcomes, and Risk factors. Anesthesiol. 1999 May; 90(5):1302-1305

Givol N, Gershtansky Y, Halamish-Shani T et al: Perianesthetic dental injuries; analysis of incident reports. J Clin Anesth 16:173-176 2004

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