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Anesthesia

Tooth problem after Surgery

01/24/2007

Question:

Recently after a hernia surgery I experienced lots of pain on my tongue. I noticed a day after the surgery that my tooth (#3 upper) was missing except for a point on the end which was cutting my tongue. This is the same tooth that I has a root canal and endo fill done 15 months before the surgery. It was causing me no problems and was not loose. The hospital is claiming that it could not have happen during my surgery. What do you think? My dentist says it will need to be extracted and a bridge put on. I feel the tooth was knocked out during surgery. What is your professional opinion? Thank You.

Answer:

Tooth injuries certainly can happen during, and after, surgery. When a breathing tube, also called an endotracheal tube, is inserted, a metal instrument, called a laryngoscope, is used. The laryngoscope allows the anesthesiologist to see down your throat and visualize the vocal cords. The breathing tube is placed through the cords. This instrument may chip or even break a tooth, particularly if the space is narrow, or the structures don't line up, making the procedure of intubation more difficult and therefore requiring more pressure to be applied to the laryngoscope. The teeth most commonly affected are the upper central teeth on the right hand side - the incisors and canines (teeth #8-11). Tooth #3 is a premolar on the left and not likely to be affected by laryngoscopy.

Tooth injuries can also occur at other times, for example if the patient actively bites down. This happens fairly commonly at the end of the surgery when the person is waking up. If enough force is applied during a bite on a fragile tooth or dental prosthesis, an injury may result. Tooth injuries can also occur during the recovery period, after transfer from the operating room, under similar circumstances. Because the person is still recovering from the effects of the anesthetic she may be unaware of the bite, nor may she notice that the tooth has been damaged at that time.

The fact that your tooth was apparently normal when you went in to the hospital, and is now damaged may suggest that the hospital and its staff were responsible. However, in a dispute it may be difficult to prove either way. The hospital might say there is no evidence you had a normal tooth when you were admitted, and you had work done on it previously. Your tooth may not have been in the good condition you think it was, so a small amount of pressure might have injured it.

In our hospital we try to make a point of taking a proper dental history, and documenting it. This is so that we can take extra care to avoid damaging fragile teeth (occasionally this is impossible), make alternate plans that avoid intubation entirely, or even postpone procedures in order to take care of a severe dental problem first. We have even, on occasion, called our dental colleagues in to do a procedure immediately before, during, or after the planned surgical procedure.

When dental injuries do occur in our practice, we refer our patients to a trusted, expert, university-based dentist for diagnosis and treatment and try to come to a reasonable arrangement. As a matter of routine, I warn my patients about the possibility of dental injury during anesthesia, as unfortunately it may be considered one of the "normal" risks of general anesthesia.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University