Abstract
Dental trauma is the largest single reason for successful malpractice claims against anaesthetists. The purpose of this article is to familiarize the anaesthetist with basic tooth anatomy and pathology and to provide an update on the different types of dental treatment and appliances which one may encounter in anaesthetic practice. Traumatic fractures to teeth are classified into six categories; Class I — fracture into the enamel layer, Class II — fracture into the dentinal layer, Class III — fracture into the pulp of a tooth, Class IV — fracture of the root of a tooth, Class V — subluxation of a tooth, and Class VI — avulsion of a tooth. Treatment for each class of fracture is described as well as certain preventative ideas. Some of the more recent developments in dental therapy such as the butterfly bridge, titanium implants and porcelain laminate veneers are described. Such developments in their turn have led to new and different problems. Care must be taken when using the laryngoscope as these teeth may be more easily fractured or dislodged. Several investigations into malpractice claims found that the oral airway was responsible for up to 55 per cent of dental complications. Prevention of dental trauma begins with an understanding of basic tooth anatomy and pathology and a recognition of the different dental treatments and appliances at the preoperative visit. The value of an appropriate preoperative dental consultation must not be underestimated.
Résumé
Les traumatismes dentaires sont à l’origine du plus grand nombre de réclamations contre les anesthésistes. Nous faisons d’abord un bref rappel de l’anatomie et des pathologies dentaires puis nous voyons les différents types de traitements et d’attirails dentaires qu’on peut rencontrer. Il y a six degrés de fracture dentaire: I, seul l’émail est impliqué; II, la dentine est compromise; III, la fracture s’étend à la pulpe dentaire; IV, la ratine est fracturée; V, il y subluxation; VI, l’avulsion est complète. Nous discutons du traitement approprié à chaque type de fracture et de la façon de les prévenir. L’apparition des implants de titanium, des ponts-papillons, et de la porcelaine laminée a amené son cortège de nouveaux problèmes. Entre autres, ces dents sont plus fragiles et il faut faire d’autant plus attention avec le laryngoscope. L’utilisation d’une Canute oro-pharyngée semble par ailleurs responsable de près de 55 pour cent des accidents. La prévention des traumatismes passe par une bonne connaissance de l’anatomie et de la pathologie dentaire et par la reconnaissance en pré-opératoire des différents traitements subis. A cet égard, une consultation avec les dentistes pourrait souvent être utile.
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Clokie, C., Metcalf, I. & Holland, A. Dental trauma in anaesthesia. Can J Anaesth 36, 675–680 (1989). https://doi.org/10.1007/BF03005420
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DOI: https://doi.org/10.1007/BF03005420