Dental damage during intubation: A case-based guide for clinicians

Dr F was an anaesthesiologist providing general anaesthesia to Patient N for a surgical procedure. The patient was intubated for the procedure and, on awakening from anaesthesia, the patient bit down on the endotracheal tube and one of their front incisors was chipped by the tube. 

When Patient N had fully awakened, Dr F discussed what had happened with them and referred the patient to a dentist for evaluation. The patient then requested Dr F to pay for the repair of the tooth. 

Dr F contacted Medical Protection, who advised them to keep an open line of communication with Patient N and to be open and honest with them about their involvement in the procedure and what had happened post-operatively.

Medical Protection also advised Dr F to be empathetic to the patient’s situation, but to stick to the facts about what occurred in any correspondence with them and avoid discussing blame or liability.

It was determined by Medical Protection that the member had not mentioned possible dental damage from the endotracheal tube as a risk in the consent discussion, that there were no notes regarding this consent discussion, and that the patient had mentioned to the member that they had had dental work done on the tooth in question.

Medical Protection supported Dr F in drafting an email response to Patient N acknowledging the request and responding to their concerns. The matter was resolved swiftly via a small claim settlement, avoiding any further escalation.

Learning points 

• The complaint was resolved quickly due to the prompt involvement of Medical Protection in managing the matter. Members are advised to report any complications or adverse incidents to Medical Protection as soon as they become aware that a patient is unsatisfied with the treatment or clinical management provided in order to attempt early resolution. 

• Ensure you have sufficient time to undertake a pre-operative assessment of the patient’s airway and teeth. Remember to ask if the patient has had any dental work undertaken or has any dental problems such as loose teeth. Questions should be specifically directed to checking for existing crowns or bridgework, which are more likely to lead to the tooth being susceptible to fracture or damage. 

• Remember to undertake a thorough consent process: ensure the patient is aware of the risks, benefits and complications of the chosen procedure, including the possible risk of dental damage. 

• Document fully in your records any discussions regarding assessment and consent. 

• Consider the use of supporting information such as patient information leaflets to ensure full patient understanding. The use of these should also be documented in the records.

• Consider what steps could be taken to reduce the risk of dental damage (e.g. bite gag) particularly in patients with fragile dentition or teeth that may be susceptible to damage. 

• If dental damage does occur be open and honest with the patient by providing a clear explanation of what has happened and apologise if appropriate. Ensure you document any discussions for later reference. 

Check out our presentation on dental damage occurring during anaesthesia if you would like to find out more about this topic - Dental Damage During Anaesthesia: Introduction