Dental damage in anaesthesia

Intrusive luxation of tooth due to bite block after oral endotracheal intubation

Bodybuilding and cross-training exercises bring health benefits. However, orofacial injuries can occur during practice. This study aimed to map, analyze, interpret, and synthesize data from studies on the main orofacial injuries resulting from bodybuilding and cross-training practices. This scoping review followed the Joanna Briggs Institute and PRISMA-ScR methods, with high-sensitivity searches in PubMed, Web of Science, Scopus, ScienceDirect, Embase, Virtual Health Library and the Google Scholar. Original scientific articles published up to May 2024 were included, which evaluated the presence of self-reported or professionally diagnosed orofacial injuries by bodybuilding and cross-training practitioners aged 18 years or older. Literature reviews, editorials, and guidelines were excluded. Tables and figures were used to map and summarize the results. Out of 30.485 potentially eligible articles, four were included. The main orofacial injuries identified in both bodybuilding and cross-training practitioners were dental damage (n = 4), temporomandibular joint (TMJ) disorders (n = 3), and traumas to oral soft tissues (n = 2) and facial soft tissues (n = 2). Dental damage and TMJ disorders were the most prevalent conditions among bodybuilding and cross-training practitioners. Therefore, dental damage and TMJ disorders were the most prevalent conditions among bodybuilding and cross-training practitioners. However, further prospective studies with more in-depth methodological designs and fewer biases are necessary.

The aim of the study was to test the hypothesis that the results obtained with three different types of video laryngoscopes (UESCOPE VL-400, I-View, Non-Channeled Aitraq) with and without an endotracheal stylet should be better than the results obtained with a Macintosh laryngoscope in a simulated out-of-hospital scenario by a person without clinical experience. Primary outcome measures were the time taken to successfully achieve tracheal intubation (TI). Secondary outcomes included the grade of glottic view (Cormack and Lehane grades 1-4), the incidence of successful TI, the number of audible dental clicks indicating potential dental damage, the level of effort required to perform TI, and the operator's comfort during the procedure. The time required to achieve tracheal intubation successfully was significantly longer with the Macintosh laryngoscope and Airtraq than with the other video laryngoscopes. The use of the stylet significantly reduced the time required for tracheal intubation with the Macintosh laryngoscope (21.8 sec. vs. 24.0 sec., p = 0.026), UESCOPE VL 400 (18.1 sec. vs. 23.4 sec., p = 0.013), and Airtraq (22.7 sec. vs. 34.5 sec., p < 0.001). There were no significant differences in intubation time when using the I-View with or without stylets. No differences were observed in the Cormack-Lehane grading. The success rate of intubation was 100% for the Macintosh and I-View laryngoscopes used with or without stylets and for the UESCOPE VL 400 and Airtraq laryngoscopes used with stylets. Without stylets, the success rate of intubation was 96.6% for the UESCOPE VL 400 and 86.6% for the Airtraq. There were no significant differences in the risk of dental damage between the Macintosh, UESCOPE VL 400, I-View, and Airtraq laryngoscopes, regardless of the use of stylets (without and with stylets). The use of stylets significantly reduced dental damage only for the Airtraq laryngoscope: 8 (26.6%) vs. 2 (6.6%). Statistically significant differences in perceived exertion were observed between the mentioned laryngoscopes, both with and without stylets. However, there were no differences in the comfort of use between the laryngoscopes, regardless of the use of stylets (without and with stylets. The use of stylets led to better comfort in the case of the Macintosh (2.5 vs. 3, p = 0.043) and UESCOPE VL 400 (2 vs. 3, p = 0.008) laryngoscopes. In our study, the I-View and UESCOPE VL-400 video laryngoscopes provided better intubation results than the Macintosh laryngoscope in terms of time needed to intubate, glottis visibility, and reduction in dental damage. The use of the stylet did not significantly improve the intubation results compared to the results obtained in direct laryngoscopy. Due to the small study group and the manikin model, additional studies should be performed on a larger study group.

A review of the Accident Compensation Corporation (ACC) files on dental damage following anaesthesia or surgery was undertaken along with a survey of New Zealand anaesthetists asking about their practice with respect to protection of teeth during anaesthesia. These results confirm that damage is relatively common and that the majority of damaged teeth (62%) were known to have been previously restored, or weakened through periodontal disease prior to the damage occurring. The anaesthetists surveyed thought that dental damage was even more common than shown from the ACC records, and yet the vast majority of them did not routinely use specific protective guards and 45% of them did not ever use protective guards of any type.

This narrative review aims to investigate extralaryngeal complications associated with laryngeal microsurgeries (LMS), focusing on their incidence, risk factors, and preventive strategies. Although LMS primarily target intralaryngeal pathologies, complications involving the teeth, oral mucosa, cranial nerves, and cardiovascular system can significantly impact postoperative recovery. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Cochrane, Google Scholar and OVID databases, covering the past 20 years. Studies reporting on extralaryngeal complications such as dental trauma, mucosal injuries, nerve damage, and cardiovascular events during LMS were included. Relevant data on incidence, risk factors, and preventive measures were analyzed and synthesized narratively. The most frequently reported complications included dental injuries, mucosal trauma, and nerve damage—particularly involving the lingual, glossopharyngeal, and hypoglossal nerves. Cardiovascular complications, although rare, were also documented. Identified risk factors included pre-existing dental disease, prolonged surgical duration, and inadequate protection during suspension laryngoscopy or intubation. Most complications were minor and self-limiting, but some resulted in prolonged recovery or patient discomfort. Extralaryngeal complications in LMS are common but largely preventable. Strategies such as preoperative dental assessment, the use of protective mouthguards, minimizing suspension time, and appropriate anesthetic management are essential to reduce these risks. Further research is warranted to evaluate long-term outcomes and improve preventive approaches, especially in high-risk and pediatric populations. Methods: Relevant literature was reviewed to assess the frequency and nature of extralaryngeal complications in laryngeal microsurgeries. Studies reporting on dental trauma, mucosal injuries, nerve damage, and cardiovascular complications were included. Data regarding the incidence, risk factors, and recommended preventive measures were analyzed. Results: The most common complications identified were dental injuries, mucosal trauma, and nerve damage. Dental injuries were notably more frequent in patients with pre-existing dental conditions and occurred more often during perioperative intubation compared to suspension laryngoscopy. Mucosal injuries, such as erosions and hematomas, were also common, with most cases resolving spontaneously. Nerve injuries, particularly involving the lingual and hypoglossal nerves, were less frequent but led to prolonged recovery times in some patients. Cardiovascular events, although rare, were reported in certain cases, especially in high-risk patients. Conclusion: While most extralaryngeal complications in laryngeal microsurgeries are minor and self-limiting, they can significantly impact patient comfort and prolong recovery. Preventive strategies, including the use of protective dental devices, limiting suspension time, and optimizing anesthesia, are crucial in minimizing these risks. Future research should focus on refining surgical techniques and developing better preventive measures to further reduce the incidence of these complications.

Nasotracheal intubation is a skill greatly appreciated by anaesthetists and surgeons in head and neck specialities and the recent review (Hall & Shutt. Anaesthesia 2003; 58: 249–6) was timely and interesting. Nasotracheal intubation can protect teeth as mentioned in the review, but is under-used for that purpose in general surgical and many other operations where orotracheal intubation is usually performed. Dental damage is one of the commonest negligence claims against anaesthetists. Cases tend to be settled out of court and the settlements represent 1% of negligence claims [1]. However, some damage could be avoided if nasotracheal rather then orotracheal intubation is used. Nasotracheal placement eliminates biting on the tube during recovery, and the tube can be withdrawn partially and used as a nasopharyngeal airway. This does not usually lead to nasal bleeds as the presence of the tube tamponades potential bleeding points in the nose. Bleeding may occasionally occur after the full removal of the tube, but protective reflexes should be present at this stage. The use of nasotracheal intubation for protection of teeth and dental prosthetic work is justified and under-used. Contraindications to nasotracheal intubation were clearly stated by the authors, but operations with a potentially large peri-operative blood loss where a coagulopathy may develop need special consideration with this extended indication. The era of fibreoptic laryngoscopy has changed difficult intubation techniques and blind nasal intubation is becoming a rare event, and a technique of the past. Bleeding, dislodging of nasal polyps, etc., and the possibility of aspiration, or even the penetration of the retropharyngeal tissues by the nasotracheal tube are strong arguments against its use. These concerns can be alleviated, and teeth and dental prosthetic work further protected with a modification of the blind nasotracheal intubation technique. Inspecting the tip of the tracheal tube after passage through the nose and nasopharynx is usually (unless opening of the mouth is limited) easily achieved using the light source of the laryngoscope. Dental damage tends to be caused by attempts to visualise the larynx, not the tip of the tube in the oropharynx. After inspection of the tip of the tube, it can be advanced gently into the trachea. Nasotracheal intubation is greatly facilitated if the patient's head is placed on a pillow with some extension of the atlanto-occipital joint – a position described as ‘sniffing the morning air’. The tip of the tube can be inspected in the oropharynx, then with the teeth occluded, the nasotracheal tube is advanced in the optimal anterior–posterior plane. It often deviates laterally (right in the case of right nostril and left if the left nostril is used) and indentation in the neck can be noticed. The tube then needs to be withdrawn to the upper part of the oropharynx and redirected after a rotation by about 30° or more. With occlusion maintained by an assistant, the larynx can be gently moved by the anaesthetist's hand laterally to meet the advancing tube. As this part of the procedure is blind, the use of force to advance the nasotracheal tube should be avoided. The number of attempts at blind intubation should be limited. If not successful, a laryngoscope may be used and the tube advanced under direct vision, while additional attention is paid to the teeth, which are now at increased risk. Direct observation of the anatomy in relation to the advance of the nasotracheal tube at this point increases experience for the future. Alternatively, the patient may be re-positioned and oxygenated for further attempts at a blind technique if dental protection is required. The technique described above applies to paralysed adult patients. It is our aim to intubate patients before additional oxygenation is needed. The success of blind intubation within this time constraint is about 70% in our hands.

The distribution of medico-legal claims in English anaesthetic practice is unreported. We studied National Health Service Litigation Authority claims related to anaesthesia since 1995. All claims were reviewed by three clinicians and variously categorised, including by type of incident, claimed outcome and cost. Anaesthesia-related claims account for 2.5% of all claims and 2.4% of the value of all claims. Of 841 relevant claims 366 (44%) were related to regional anaesthesia, 245 (29%) obstetric anaesthesia, 164 (20%) inadequate anaesthesia, 95 (11%) dental damage, 71 (8%) airway (excluding dental damage), 63 (7%) drug related (excluding allergy), 31 (4%) drug allergy related, 31 (4%) positioning, 29 (3%) respiratory, 26 (3%) consent, 21 (2%) central venous cannulation and 18 (2%) peripheral venous cannulation. Defining which cases are, from a medico-legal viewpoint, 'high risk' is uncertain, but the clinical categories with the largest number of claims were regional anaesthesia, obstetric anaesthesia, inadequate anaesthesia, dental damage and airway, those with the highest overall cost were regional anaesthesia, obstetric anaesthesia, and airway and those with the highest mean cost per closed claim were respiratory, central venous cannulation and drug error excluding allergy. The data currently available have limitations but offer useful information. A closed claims analysis similar to that in the USA would improve the clinical usefulness of analysis.

Children dental health is very beneficial for children's growth Parent’s motivation for taking their children dental for treatment before more serious dental damage can help to decrease the prevalence of children's dental damage, especially for patients who came to pedodontia clinic in the faculty of Dentistry Airlangga University. This study aimed to know the parents' motivation to take their children dental for treatment in Pedodontia clinic in the faculty of Dentistry Airlangga University by giving questionnaire to 42 patient’s parents. The result of this study suggested that clinic’s facilities (scored: 2.86) as the stimulating factor had the biggest influence in motivating patient’s parents.

Although anesthesiologists consistently work in the mouth of patients, they may not have been exposed to a comprehensive education of teeth, surrounding tissues, and intraoral prostheses. Since perioperative dental damage is one of the most common anesthesia-related adverse events and is responsible for the greatest number of malpractice claims against anesthesiologists, several dental considerations are warranted. The likelihood of perioperative dental trauma increases with the vulnerability of a patient's dentition and the presence of associated anesthesia risk factors. Minimizing dental injuries begins with the anesthesiologist's preoperative assessment of the patient's dentition and intraoral tissues. Clear documentation of the patient's preoperative dental condition and notifying the patient of the potential dental damage will diminish costs for any related postoperative dental treatment. Upon discovery of a potentially hazardous dental condition, a consultation with a dentist should be considered before proceeding with the surgical procedure. Exercising cautionary measures during provocative events, such as laryngoscopy and tracheal extubation, can aid in the prevention of dental trauma. In the event of such an injury, several management tactics can promote a swift and reasonable resolution. Establishing an increased awareness of intraoral conditions and the related perioperative risk factors may diminish the incidence of dental damage and financial costs.

ABSTRACTIn contrast to the suction-feeding, predominantly teuthophagous extant sperm whale, several Miocene physeteroids display proportionally larger teeth, deeply embedded in both upper and lower jaws. Together with other osteological features, these differences lead to the functional interpretation of these taxa as macroraptorial predators, using their teeth to capture and process large marine vertebrates. However, the assumption that strong forces applied to macroraptorial physeteroid teeth during powerful bites and contacts with bone material should result in major dental damage has not yet been tested. In the present work, we analyzed a large collection of physeteroid teeth with an enameled crown from the Miocene of the North Sea Basin. We especially focused on a set of 45 teeth of Scaldicetus caretti discovered in Antwerp (Belgium, southern North Sea Basin) and tentatively dated to the Tortonian (early late Miocene). Visual inspection and computed tomography (CT) scans revealed dental damage, including wear and breaks. The latter could be interpreted as chipping fractures, occurring along the crown, and vertical root fractures, observed along the apical part of the massive root. Chipping fractures are most likely due to contacts with hard material, whereas vertical root fractures may result from the application of strong and repetitive bite forces and/or contacts with hard material. Such results further support the interpretation of a series of Miocene physeteroids with proportionally large teeth as macroraptorial (rather than suction-feeding) top predators. Considering the size of the teeth of S. caretti, its most likely prey items were other large marine vertebrates.

Comment: This manikin study agrees with previous human studies that a significant axial force is applied to the tongue and maxillary incisors during intubation. Dental damage is much more likely with increased lateral forces (which were not assessed), and, therefore, this study does not provide information on dental risk during laryngoscopy. This study is also limited by inherent differences between the manikin model and clinical situations. Clinically, the technique of the laryngoscopist is a significant factor, and dental damage is more likely to be related to experience.

Diabetes mellitus (DM) induced mitochondrial oxidative stress (OS) can lead to severe injury of dental pulp. The cerium oxide nanoparticles (CNP) have been proven to have excellent antioxidative activity. However, whether CNP can relieve dental pulp damage caused by DM and the underlying mechanisms remain unclear. In this study, we modified ceria with hyaluronic acid to prepare nanoceria with good biocompatibility, water solubility, and stability, namely, HACNP (hyaluronic acid cerium oxide nanoparticles). We demonstrated the protective effect of HACNP on diabetic OS-induced mitochondrial apoptosis in dental pulp-like cells. As far as the mechanism of action was concerned, glucose oxidase (GO) treatment promoted the activation of phosphoglycerate mutase family 5 (PGAM5) leading to mitochondrial abnormalities and apoptosis in an odontoblast-like cell line (mDPC6T). Knockdown or overexpression of PGAM5 further validate these results. Meanwhile, HACNP remitted GO-related toxicity via down-regulating PGAM5 expression, whereas overexpression of PGAM5 abolished the beneficial effect of HACNP. Furthermore, in the constructed animal research model of diabetic pulp injury, we also confirmed that HACNP alleviated apoptosis and mitochondrial injury of dental pulp and decreased the expression level of PGAM5 in diabetic pulp tissue. In conclusion, these results revealed that HACNP played a protective role on diabetes-associated dental pulp injury through targeting the PGAM5-mediated mitochondrial pathway, providing an idea and method for the prevention or treatment of diabetes-induced dental pulp damage.

As a result of aging process, the state of human body homeostasis undergoes the changes. In the tooth-jaw system, such changes lead to a shift of the balance in the remodeling-demineralization processes. Their intensity and dynamics depend on the properties of oral fluid, which plays an important role for the ensuring of physiological processes of oral cavity. The purpose of the work was clinical assessment of the dental status, examination of calcium homeostasis, activity of phosphatases and protein metabolism of oral fluid in patients of different age groups and their features under conditions of dental prosthetics. 103 patients aged from 18 to 89 years were examined who were assessed for the intensity of dental caries damage (DMF index), the state of hygiene and soft tissues (OHI-S and PMA indexes). The level of total and ionized calcium, the activity of acid and alkaline phosphatases, the content of total protein, and the state of its acid-base balance (pH) were determined in the oral fluid. It was found that with the age in the oral fluid the concentration of total and ionized calcium increases, acid and alkaline phosphatases become active, the content of total protein rises against the background of a decrease the intensity of salivation, the acid-base balance shifts to the alkaline side, the mineralization of tooth enamel increases, and the risk of hard dental deposits formation increases. Age characteristics of oral fluid resistance correlate with the intensity of dental caries damage, the state of hygiene and periodontal tissues. The changes of studied parameters in persons of the older age groups correlate with the results, that were found in patients with significant tooth loss (most of them are advanced and senile). It was found that the use of prostheses for replacement of dentition defects has a positive effect on the parameters of oral fluid, which ensure the resistance of hard teeth tissues and the bone base of the alveolar processes.

Complications in Transpalatal Distraction Osteogenesis: A Retrospective Clinical Study

Objective To explore the application effect of quality control circle （ QCC ） activities in reducing the damage rate of dental instruments .Methods Totals of 2 192 dental instruments were used from January to June 2013 and they were regarded as the control group （before QCC）, and 2 255 dental instruments were used from July to December 2013 and they were regarded as the study group （ in QCC） .We established the QCC team and determined the activity subject .QCC team investigated and analyzed the reasons of dental instruments damage and set goals and formulated countermeasures .Results The instruments damage rate was 3.88%in the control group and 1.33%in the study group, and the difference was statistically significant （χ2 =27.63,P 〈0.05）.The rate of goal attainment was 105.8%.Conclusions QCC activities can reduce the dental instruments damage rate obviously and save the cost in maintenance cost and purchase funds . Key words: Dental instruments; Quality control circle; Damage