Anaesthetic dental damage

• Many Avant anaesthetic claims relate to dental damage.
• It is best practice to discuss the risks of dental damage with the patient before surgery and document this discussion contemporaneously.
• Notify Avant if you are contacted by a patient or hospital about dental damage

Anaesthetists have a duty of care to minimise foreseeable risks to their patients. Dental damage is a recognised complication of anaesthesia, particularly during intubation. Several factors may increase a patient’s risk, including:

• Poor dental health (e.g. loose or diseased teeth, gum disease)
• Pre-existing dental work (e.g. crowns, fillings, bridges, implants)
• Chronic conditions (e.g. autoimmune disease, diabetes, leukaemia, obesity)
• History of smoking
• Presence of baby teeth
• Patient positioning during surgery
• Limited jaw or neck mobility, which may complicate intubation

Routine practice should include a thorough pre-operative examination of the patient’s dentition, mouth opening, and airway. Document your findings and discuss any risks of dental damage with the patient. Asking about past dental procedures or injuries (e.g. crowns, caps, trauma) can help inform your risk assessment.

Dental damage may be unavoidable in some cases, especially during emergency intubation. It’s essential to discuss this risk with all patients during the pre-operative consultation - even those not expected to undergo general anaesthesia.

Topics to cover include:

• General risks of anaesthesia
• Common side effects and complications
• Rare but serious adverse outcomes
• Risks specific to the patient’s circumstances
• The proposed anaesthetic approach and any uncertainties, including alternative techniques

If a patient is assessed as high risk for dental damage, spend extra time addressing their concerns. Explain any modifications you’ll make to reduce risk, such as using video scopes, plastic equipment, or a mouthguard. This not only informs and reassures the patient but also strengthens the consent process.

Providing pre-operative printed information to patients is a useful way of informing patients about the anaesthetic process, the general risks of the procedure and what information you will be seeking before surgery. Printed information sheets can support this discussion, but should never replace it.

A detailed, contemporaneous record of your consent discussion is essential. It carries more weight than a general reference in the surgeon’s consent form. Even if dental risks are covered in general consent, note in the anaesthetic record that dental damage was discussed — regardless of the patient’s risk level.

For low-risk patients, a standard note such as “Dentition examined, and risks discussed” is sufficient. For high-risk patients, ensure your notes reflect the depth of the discussion.

If no discussion was held due to an emergency, document the reason clearly.

Dental damage may occur unexpectedly and be difficult to pinpoint. If discovered intraoperatively:

• Prioritise airway management, especially if bleeding is involved
• Provide immediate care for any dislodged teeth
• Consult a maxillofacial surgeon if appropriate
• Notify the post-anaesthetic care team
• Inform the patient as soon as practical
• Recommend follow-up with a dentist
• Provide written clinical information for future anaesthetic care

If damage is reported post-operatively:

• Advise the patient on care and recommend prompt dental review
• Document the incident, including extent and timing of notification
• Notify the hospital via the adverse event process
• Inform the surgeon as a professional courtesy

When dental damage occurs, follow an open disclosure process once the patient has recovered. This may be in person or by phone. Be transparent, answer questions, and remain available for follow-up. Importantly, express empathy: “I’m sorry that this happened.” This is not an admission of liability, but a respectful acknowledgment of the patient’s experience.

If the risk was discussed and documented, and your care met professional standards, we are in a strong position to defend any claim. If you realise post-operatively that your documentation was incomplete, you may add a retrospective note - but it must be dated and timed accurately and reflect your honest recollection. If the risk was not discussed at all, this may affect our ability to defend a claim. Contact us immediately for advice. Never falsify documentation. Attempts to conceal information can significantly worsen the situation.

If you believe the damage was not caused by your care, it may be appropriate to explain this to the patient.

If a patient sustains dental damage, please notify Avant via the medico-legal notifications page, where you can submit an online form or call for assistance. If approached by a patient or hospital regarding dental restoration costs, we generally advise against offering to pay out-of-pocket - at least initially. However, as a gesture of goodwill (and without admitting liability), you may consider:

• waiving your gap fees
• not pursuing unpaid fees.

This allows the patient to redirect those funds toward dental treatment. Ultimately, this decision is yours. You may ask the patient to submit their request in writing, along with receipts or quotes supporting their claim. Let them know you will consider their request and respond within a reasonable timeframe. We recommend contacting Avant to discuss the best approach to resolving the situation.

Regardless of your efforts, patients retain the right to make a claim or complaint. Maintain a courteous and transparent approach and keep them informed of the steps you're taking - including if you're seeking advice.