The Anaesthetic Dental Trauma Pathway

Objectives: 1. To reduce the number of dental trauma cases due to general anaesthesia (GA) intubation
2. To establish an anaesthetic dental trauma referral pathway
3. To assess the impact of pre-GA assessment team training using a pre- and post-training questionnaire and review of the number of referrals
4. To review the referrals and determine if there were opportunities to identify high risk patients prior to GA.
Methods: 1. In 2017, key stakeholders in the pre-GA assessment team at a London-based teaching hospital were identified.
2. Integration of examination of the mouth as a routine part of pre-GA assessment through training.
3. Design of a referral form and pathway.
4. Impact of training assessed by: questionnaire on oral assessment and review of referrals
Results: 1. Impact of training: feedback indicated that the assessment team felt more confident in identifying oral signs and symptoms requiring management prior to GA.
2. Number of referrals pre-GA: nil; this may have been due to the advice to direct at risk patients to local general dental practitioner.
3. Number of referrals post-GA: 3 in a six months period post implementation of new pathway. All dental injury resulted in mobility of teeth. All had pre-existing oral pathology; caries and/or periodontal disease. Two of three (67%) were noted to have poor oral health at pre-GA assessment. One patient (33%) had predicted difficult intubation.
Conclusions: It has been reported that 1 in 4500 patients sustain dental injury requiring intervention during GA, which can have a significant impact on the patient’s function and appearance. Training of pre-GA assessment teams is essential to minimise this. The impact of this service development increased the confidence of pre-GA staff in undertaking oral assessments. Further training is required to ensure that patients at risk are identified prior to GA.