A practical guide to managing dental damage

Case study

Dr Singh, an anaesthetist, consulted with a patient in hospital the morning of her parotidectomy procedure. During the consultation, Dr Singh took a detailed medical history from the patient. No questions were asked regarding dentition, and the patient did not volunteer details of previous restoration. Dr Singh didn’t discuss the potential risk of dental damage as part of his general consent process.

The parotidectomy was uneventful, and Dr Singh didn’t encounter any difficulties with intubation. No dental damage was noted prior to the procedure, and although Dr Singh heard a cracking noise on extubation, he didn’t check her teeth for damage.

The day after surgery, the patient reported to the surgeon that her left upper bridge was cracked. The surgeon recommended she seek urgent dental review. The patient consulted her usual dentist and subsequently advised Dr Singh that she had sustained a porcelain fracture on tooth 11, which had a full coverage crown.

The patient was unhappy that the damage had not been reported to her by Dr Singh immediately after her surgery, and that she had not been warned of the possibility of dental damage during her pre-operative consultation.

The patient requested Dr Singh to cover the costs of having her crown replaced.

Duty to warn

Dental damage is a well-recognised complication of anaesthesia, and there is a positive obligation to warn patients about this risk prior to a procedure. It’s not appropriate that you rely on the surgeon to provide these warnings to the patient.

During your pre-operative consultation with the patient, it’s important to take a detailed medical history, including details of any pre-existing dental conditions. In the event the patient has had restorative dental work, an examination may be needed to enable you to consider the most appropriate airway management to minimise any potential risk during the procedure.

Informed consent must be obtained from all patients, and the general risk of dental damage should be discussed with every patient, regardless of their dentition. If you identify a patient as having a higher risk for dental damage, you should discuss ways in which you may be able to minimise the risk of damage.

Some anaesthetists provide patients with an information sheet outlining the risks of anaesthesia. While this can be a useful tool to guide your discussion with the patient regarding risks, it should not be used in place of a discussion.

Documenting consent

It’s important to document consent, because it provides a potential defence in the event of a claim. Contemporaneous records outlining all pre-existing dental conditions identified during the consultation should be documented clearly in the clinical records, together with a detailed account of your discussions regarding the risk of dental damage. If the patient is high risk, your clinical records should reflect a more extensive discussion. You should also document the patient’s understanding of the risks and their willingness to proceed.

Our Support in Practice team can assist you in developing an appropriate consent form or reviewing your existing consent process.

If damage occurs

In the unfortunate event that your patient experiences dental damage, and this is identified during or after the procedure, it should be clearly documented in the notes.

Talk to the patient as soon as practicable so they are aware of the damage. Open disclosure is encouraged, and while you can say you’re sorry the patient has suffered damage, it’s important you do not admit liability until you have sought advice. In the meantime, you can recommend that the patient seek an urgent review from their dentist.

If the patient asks you to pay for the cost of any necessary dental treatment, you can suggest they put their request in writing and provide copies of any treatment quotes or invoices for you to consider. Do not agree to pay the costs of dental treatment without first seeking advice from MDA National. If the patient was appropriately warned, and there’s no evidence that you’ve departed from accepted standards, there may not be any basis on which the patient can recover these costs.

On occasion, the damage may occur while the patient is in recovery. In this situation, we encourage you to speak to your private hospital regarding indemnity.

Checklist

☑ Take a detailed medical history from the patient, including any dental issues.
☑ Warn every patient about the risk of dental damage during anaesthesia.
☑ Obtain the patient’s informed consents.
☑ Carefully document your discussion around risks and consent in the clinical records.
☑ If dental damage occurs during the procedure, engage in open disclosure with the patient as soon as practicable.
☑ Contact MDA National for advice.

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