title: Traumatic dental injuries during anaesthesia: part I: clinical evaluation.
abstract: Dental injuries represent the most common claims against the anaesthesiologist. Dental lesions are frequent complications of oro-tracheal intubation and major causal factors are (i) poor dentition, (ii) aggressive laryngoscopy, (iii) insufficient anaesthesia and curarization, (iv) emergency interventions and (v) lack of experience by the anaesthesiologist.
  
  
  METHODS
  We conducted a retrospective analysis of 83 cases of dental lesions occurring during elective, emergent and urgent surgery requiring general anaesthesia with tracheal tube placement in the years between 2000 and 2008. Preoperative evaluation of dental status was obtained from the anaesthesiology chart, filled by an experienced anaesthesiologist during the preoperative visit. Anaesthesiological records were inspected by physicians of Legal Medicine Department with the aim to attribute responsibility for the damage and manage potential reimbursements. Costs related to the required dental repair were also noted.
  
  
  RESULTS
  Eighty-three patients of a total of 60.000 surgical procedures (no day surgery) under general anaesthesia were affected by dental lesions (0.13%). Seventy-five per cent of lesions occurred during intubation manoeuvres for elective major surgery, 15% occurred at tracheal intubation for minor surgery and 10% were related to emergency surgery. Teeth avulsions accounted for 50% of lesions, followed by damage to crowns and bridges (14%), luxations and fractures (>15%).
  
  
  CONCLUSIONS
  The overall incidence of dental injury in our retrospective study was 1.38 per 1000 anaesthetics, which is slightly higher than those reported by some and lower with respect to others. Avulsion of a permanent tooth occurred in patients who were affected by severe mobility of native teeth while undergoing surgery. Even though the majority of anaesthesiologists were trained enough in the use of airway devices and aware of the potential damage while using excessive forces, some unexpected difficulties may have led to lesions. It is known that damage to teeth can occur even in the absence of negligence.
authors.affiliation: Department of Legal Medicine, University of Ferrara, Ferrara, Italy.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Gaudio
authors.forename: Gaudio
authors.initials: G
authors.lastname: Rosa Maria
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.forename: Feltracco
authors.initials: F
authors.lastname: Paolo
authors.forename: Stefania
authors.initials: S
authors.lastname: Barbieri
authors.forename: Barbieri
authors.initials: B
authors.lastname: Stefania
authors.forename: Letizia
authors.initials: L
authors.lastname: Tiano
authors.forename: Tiano
authors.initials: T
authors.lastname: Letizia
authors.forename: Martina
authors.initials: M
authors.lastname: Alberti
authors.forename: Alberti
authors.initials: A
authors.lastname: Martina
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Delantone
authors.forename: Delantone
authors.initials: D
authors.lastname: Massimiliano
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
authors.forename: Ori
authors.initials: O
authors.lastname: Carlo
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Avato
authors.forename: Avato Francesco
authors.initials: AF
authors.lastname: Maria
mesh_terms: D058109:Airway Management / Q000706:statistics & numerical data; D000766:Anesthesia, Dental / Q000706:statistics & numerical data*; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D003442:Crowns / Q000706:statistics & numerical data; D003792:Dental Records / Q000706:statistics & numerical data; D003829:Denture, Partial / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D007828:Laryngoscopy / Q000706:statistics & numerical data; D016365:Liability, Legal; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data; D008875:Middle Aged; D013511:Minor Surgical Procedures / Q000706:statistics & numerical data; D010510:Periodontal Diseases / Q000453:epidemiology; D012189:Retrospective Studies; D014084:Tooth Avulsion / Q000453:epidemiology; D014082:Tooth Fractures / Q000453:epidemiology; D018677:Tooth Injuries / Q000453:epidemiology*; D055815:Young Adult