• The aim of this study is to determine the risk factors and outcomes of peri-anaesthetic dental injury in children
  • A high index of suspicion of injury and knowledge of the patient’s dentition state are critical for early intervention 

Dental injury is one of the most common adverse events related to anaesthesia, and is also one of the frequent patient complaints associated with medico-legal claims. The focus of most studies on the incidence of dental trauma is in the adult population, with little to none on the paediatric population.  

With a lack of data on peri-operative dental injury in children, Dr Tracy Tan, Consultant from the Department of Paediatric Anaesthesia at KK Women's and Children's Hospital (KKH), together with three other clinicians, embarked on a study to better manage and minimise this recurrent problem. For patients undergoing anaesthesia, an accurate dental history is crucial to ensure their safety.

The insertion of the breathing tube can potentially cause a chip in the upper incisors, dislodge a loose tooth or loosen a previously healthy milk or adult tooth. It can become life-threatening when the dislodged tooth goes missing.  

“The tooth may fall into the windpipe or be swallowed into the stomach. In both scenarios, additional investigation such as chest radiography is required to locate the missing tooth. Interventions such as bronchoscopy or gastroscopy may be needed to retrieve the tooth from the lungs or stomach respectively,” explained Dr Tan. 

“Parents are subjected to additional worries when their children have to be exposed to unnecessary radiation, or have to undergo another general anaesthesia to retrieve the missing tooth,” said Dr Tan.

The team investigated the incidence, risk factors and outcomes of peri-operative dental injury in children by analysing 80,811 general anaesthetics over a 12-year period in KKH. Of these cases, a total of 42 dental injuries were reported. Dental injury occurred in patients aged two to 15 years old, with the highest frequency in children aged five to eight years old. 

The study found that the accuracy of pre-operative dental history has an effect on the incidence of dental injury. Patients with inaccurate dental history (n=26) were more likely to sustain dental injury as compared to those with accurate dental history (n=16).

Inaccurate dental history can also delay the detection of dental damage. Of the 16 patients with accurate dental history, 14 dental injuries were detected prior to the removal of the breathing tube. All of the six patients with dental injuries detected only after the operation had an inaccurate dental history. 

According to Dr Tan, apart from obtaining an accurate and detailed pre-operative dental assessment, continuing education and better communication among staff are other key factors in preventing peri-anaesthetic dental injury.

In recognition of this, KKH has implemented several measures to minimise the incidence of dental damage. Some of these include regular education and reminders for in-house anaesthetists, conducting preoperative dental screening and discussing the child’s fitness for surgery with their parents. 

This article was first published in Proceedings of Singapore Healthcare Vol. 24, No. 2.

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