Perianesthetic dental injuries: analysis of incident reports.
OBJECTIVE
To conduct a retrospective analysis of incident reports concerning dental injury, the most common cause for litigation against anesthesiologists, to determine specific risk factors that will help in formulating a risk reduction strategy for this clinical problem.


METHODS
Retrospective chart review of a large professional liability insurer.


METHODS
Of 40 hospitals that report to the MRM Co. as part of the professional liability insurance, during the years 1992-1999, 18 hospitals reported dental injury. A Maxillofacial surgeon (GN) and an anesthesiologist (ES), using a structured form, reviewed the reports. Evaluation of the cost of injury was determined from the patient's claims or from an evaluation of rehabilitation plan constructed by the maxillofacial surgery consultants to the company.


RESULTS
There were 203 incidents due to dental injury. The patients were most commonly in their 5(th) to 7(th) decade. Eighty six percent of the injured teeth were the upper incisors. Lower incisors were more likely to be injured during an urgent intubation, or due to airway manipulation other than intubation. (i.e., oral airway insertion) In only 38 (18.6%) cases was there a previous assessment of an expected difficult intubation. Dentition was judged to be pathological in 32% of the patients.


CONCLUSIONS
In elective intubation, the teeth most likely to be injured are the upper incisors, in patients aged 50-70 years. In most cases dental injury is not associated with a pre-event prediction of difficult intubation.
Givol
Navot
N
Sheba Medical Center, Goldshager School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
Gershtansky
Yael
Y
Halamish-Shani
Talia
T
Taicher
Shlomo
S
Perel
Azriel
A
Segal
Eran
E
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects*; D000761:Anesthesia Department, Hospital / Q000331:legislation & jurisprudence; D000776:Anesthesiology / Q000295:instrumentation / Q000331:legislation & jurisprudence; D002648:Child; D005260:Female; D006801:Humans; D007351:Insurance, Liability / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012308:Risk Management / Q000706:statistics & numerical data*; D018677:Tooth Injuries / Q000191:economics / Q000209:etiology*