Oral health and dental management
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Oral Health Dent Manag · Jun 2014
Dental trauma related to general anesthesia: should the anesthesiologist perform a preanesthetic dental evaluation?
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; therefore, several dental considerations are warranted. A thorough evaluation may necessitate a dentist's help, requires that anesthesiologists receive more formal training regarding oral and dental anatomy, and enables performing the treatments necessary to minimize the risks of dental injuries. Nevertheless, this preanesthetic assessment is frequently overlooked by surgeons and anesthesiologists. ⋯ The dental examination should especially include an assessment of the patient's upper incisors--the teeth most likely to be injured during the perioperative period--for pre-existing damage. Preoperative notes should record any damages or missing teeth. In addition, anesthesiologists must take adequate intraprocedure precautions to prevent/minimize iatrogenic dental injury.
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Trauma to the mouth involves not only the teeth but also the dental pulp, the periodontal ligament, bone, gingiva and other associated structures. There are many different types of injuries with varying severity in each case and often more than one injury to a tooth at the same time. ⋯ It is imperative that dentists have a thorough understanding of the possible tissue responses so appropriate treatment can be provided to minimise the consequences of trauma. The five main strategies to reduce these consequences are to: 1) perform a thorough examination and accurate diagnosis to identify all injuries and to assess the likely healing responses; 2) reposition and stabilise the teeth and bones to provide optimum conditions for healing; 3) carefully manage soft tissues to help healing; 4) commence root canal treatment immediately in specific situations to prevent external inflammatory resorption; and 5) follow-up and review all traumatised teeth to identify and manage any adverse consequences as soon as they occur in order to minimise their effects on the patient.