Quality improvement program reduces perioperative dental injuries - A review of 64,718 anesthetic patients

Abstract

Background: Perioperative dental injury (PDI) is a common adverse event associated with anesthesia that can easily lead to medicolegal litigation. A quality improvement program was conducted with the electronic, standardized dental chart to document dentition before anesthesia and dentist consultation when necessary. This study aimed to reduce PDIs through execution of a quality improvement program.

Methods: We reviewed the 42-month interval anesthetic records of 64,718 patients who underwent anesthesia. A standardized electronic dental chart was designed to identify any dental prosthetics, fixed and removable dentures, and degree of loose teeth. The incidence of dental injuries associated with anesthesia was separated into three time periods: baseline, initiative (Phase I), and execution (Phase II). Primary outcome measurement was the incidence of PDIs related to anesthesia.

Results: The overall incidence of dental injury related to anesthesia was 0.059% (38/64,718 patients). During the baseline period, the dental injury rate was 0.108% (26/24,137 patients), and it decreased from 0.051% in the initiative period (10/19,711 patients) to 0.009% in the execution period (2/20,870 patients) during implementation of the quality improvement program. Most dental injuries were associated with laryngeal mask airway (42.1%) and laryngoscopy (28.9%). The most commonly involved teeth were the upper incisors.

Conclusion: Dental injury incidence was significantly reduced and remained at low levels after implementation of the quality improvement program. We suggest the implementation of a standardized dental examination into the preoperative evaluation system adding pathologic teeth fixed or protected devices to minimize dental injury associated with anesthesia.

Keywords: perioperative dental injury (PDI); preoperative evaluation; quality improvement.