I. Policy on Dental Problems Associated with Anesthesia
Dental injuries during anesthesia are a risk of the procedure and are not uncommon, particularly in patients who have pre-existing dental disease. Any injury to the teeth should receive immediate attention.

A. Preoperatively:  Carefully assess AND DOCUMENT the patient’s dental condition preoperatively.
1. Document (by number, if possible) any pre-existing injury or condition.
2. If there are pre-existing tooth derangements and intraoperative worsening of the condition seems a reasonable possibility, inform the patient of this risk, and document in the chart that the patient specifically understands and accepts the risk.
3. For significant pre-existing conditions which can cause potential intraoperative problems, consider a pre-operative Oral Medicine/Surgery consult. The patient should understand that this preoperative consult is for his/her benefit and protection, and that no obligation for postoperative treatment is assumed.
4. Inform the patient that risks to the oral cavity are part of any anesthetic management.

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B. Intraoperatively: If a tooth should be dislodged during anesthesia:
1. Save the tooth or tooth fragment(s).
2. Call the Oral Surgery resident rotating on Anesthesia into the O.R. if he’s available.  He can assist in determining if all segments of the tooth have been recovered.  If the Oral Surgery resident is not available, consult the Oral Medicine Service.
3. If you are uncertain that you have recovered all tooth fragments, obtain an intraoperative chest x-ray to ensure that no portion of tooth is lodged in the airway.

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C. Postoperatively: Attending should participate in making decisions re: management
1. If any injury to the teeth occurs or is suspected, document (by number if possible) the location and extent of damage.
2. Discuss the injury with the patient.  It is appropriate to express concern over the problem; however, do not make statements placing blame or guilt.
3. Obtain consultation for Oral Medicine or Oral Surgery.
a. Encourage the patient to agree to the consultation rather than allowing the patient to casually dismiss the injury - consultation is in everyone’s best interest.
b. The consult will evaluate the nature and extent of injury and estimate the cost of any necessary restoration or treatment.
c. The patient has the option of receiving treatment from UNC staff or their private dentist.
4. If asked, the patient should be informed that he or she will be charged the usual rate for the necessary Oral Medicine or Oral Surgery consult and treatment.  However, if there are circumstances which warrant an adjustment in the charges, the Anesthesiologist should contact Risk Management at 6-3041.  No promises should be made to the patient that charges will be adjusted prior to consultation with Risk Management.

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II. Protocol for Obtaining Oral Surgery or Oral Medicine Consultation
If the injury will require restorative work (e.g. a chipped tooth or loose bridge), Oral Medicine should be consulted.  If the tooth itself is a risk (e.g. dislodged, loosened, avulsed), Oral Surgery is the appropriate consultant service.
To arrange an Oral Medicine or Oral Surgery consult, contact the Oral Medicine or Oral Surgery resident on call for that given day and provide him or her with the necessary information.

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