IDDF2021-ABS-0144 Dental injury during endoscopy: an underrecognized teething safety issue

Abstract

<h3>Background</h3> Dental injury is an underrecognized preventable complication during endoscopy. An audit of same-day procedure cancellation in our endoscopy center showed that 43% of cases are related to tooth safety concerns. A review of the literature showed that dental injury was under-reported in endoscopy related journals but an important issue in anaesthesia. Dental injury in anaesthesia is variably estimated to occur at a rate of approximately one in 1,000 to 4,500. It represents up to half of all anaesthetic claims. We reviewed the preventive measures and management strategy of dental injury. <h3>Methods</h3> We have reviewed the available literature and worked with a dental expert to suggest a few steps to improve tooth safety during endoscopy: <h3>Results</h3> Key steps in preventive measures: 1) Pre-endoscopic tooth screening: Optimal pre-endoscopic assessment should include a comprehensive dental assessment, documentation and explanation of individualized risk involved. 2) Identification of risk factors: Evidence of periodontal disease and its infective complications, pre-existing dental pathology such as missing or loose teeth, and dental restorations. 3) Comprehensive documentation of pre-existing dental defects prior to endoscopy should be done. Key steps in dental injury management: 1) Early involvement of dentist: If a dental injury occurs or a missing tooth is found during endoscopy, a dentist should be called to do an on-table consult. 2) Tooth retrieval whenever possible: If the dentist is unavailable or delayed, the missing tooth should be localised and retrieved. Upon retrieval of the tooth or tooth fragments, the dental officer on-call should be consulted for specific management. 3) Radiographic assistance: If localisation is not possible, a chest X-ray should be done, with the consultation of Thoracic Surgery. <h3>Conclusions</h3> We encourage these simple measures to be implemented in the clinic and endoscopy center to prevent dental injury during endoscopy.