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My tooth was knocked out during surgery intubation!

Several times a year I have dental patients who come to my practice in Littleton, CO after their tooth was knocked out after general surgery. The whole tooth could be knocked out or a crown could be broken off the tooth. Having a tooth knocked out unexpectedly can be quite disturbing. Let me suggest a solution to prevent this problem: a simple biteguard or retainer.

General anesthesia is sedation that is deep enough to cause you to stop breathing. Intubation (inserting a breathing tube to the back of the throat) is part of the plan. Still it can be difficult to correctly position the tube depending on your weight, neck flexibility, how wide open your throat is, etc. The more difficult the intubation, the more work the anesthesiologist has to do to correctly place the tube, and the more likely it is that a tooth might be damaged.

If the intubation is done quickly in an emergency situation, the risk of damage to the teeth increases.

If you have gum disease, recession, or thin gums (all of these are signs of less bone support for the roots of your teeth), your risk of having a tooth knocked out is higher.

Consider these stories:

The Case of the Dislodged Tooth
http://mobile.csahq.org/pdf/bulletin/issue_7/pauker044.pdf

https://www.ncbi.nlm.nih.gov/pubmed/21078071

Having a tooth knocked out is a source of litigation.  Your surgeon will have you sign a waiver so they are not liable if it happens.

clear bite gaurdBefore undergoing general anesthesia surgery, have your dentist make a thin, custom-fit clear biteguard or retainer that you can wear during your surgery. This thin plastic is similar to an Invisalign retainer. Weaker teeth that are at risk of being knocked out will be connected to and supported by the stronger teeth. This is highly recommended if you have had gum disease, or if you’ve had a lot of dental work (multiple crowns, bridges, fillings, etc.)The solution and prevention that I suggest is a retainer. Would you rather spend a couple hundred dollars on a preventive retainer, or a thousand dollars on a crown, or several thousand on an implant if you lose a whole tooth?

Tell your surgeon and anesthesiologist that you’ll be wearing the retainer during surgery. Place it on your teeth before you are sedated, and you can leave it there until you have recovered and woken up later. It is thin enough that it won’t interfere with the intubation process. This can give you–and your anesthesiologist–peace of mind that your teeth won’t be damaged. You can focus on recovering from surgery instead of worrying about a broken tooth.


4 comments

  1. Robin Gavin
    September 18, 2018 at 12:42 pm

    I didn’t know about this trick. Just had cysts removed on my vocal chords. Had 4 gold crowns going into surgery and came out with 3. Unfortunately I do not remember a thing even going from the preop room, to the OR, to the recovery room, and then to home. Around 7 that evening I realized my crown was missing and the glaring red foundation for the crown was all that was left. I was asked at least 6 times by nurses, doctors if I had crowns or bridges to which I responded yes each time. I even filled out a form stating that I indeed had this. I had a dental hygienist checkup just two weeks prior and believe me the OCD hygienist would have noted if this crown was loose. So the ENT doc’s insurance say they are not responsible. I will next go to the hospital with the question but will probably get the same answer. They all have insurance but I am retired without dental insurance and will be out of pocket $1200. Who is responsible? What good is their insurance if they do not pay up? I know it must have been an accident and I’m not angry at anyone, just disgruntled at the fact that no one seems to care. Why ask if they don’t plan on restitution should you lose a crown or if they crack a bridge?

    Reply
    1. drmorris
      March 26, 2019 at 12:45 pm

      I have heard this story a few times. I have not yet heard the version where the hospital, anesthesiologist or anyone involved in the surgery paid to have a crown replaced. So sorry to hear about your experience, but given past experience, you may be out of luck.

      Reply
      1. Robin Gavin
        June 9, 2019 at 7:36 am

        Thank you for your response. There is more to add now. Approximately 6 weeks post op, I was just walking around in my home when I felt hard pieces in my mouth. They were pieces of two adjacent crowns to the one that was missing. This tunnel was between the two crowns and at the gum line. It was as if a battering ram had struck between the two teeth. I feel they were fractured at the time of the surgery and then loosened. At that time I was in the process of having the missing crown replaced. So now I needed yet another crown and filling and smoothing of the third crown. I had all this dental work done to the tune of $3,343. I am retired and without my previous dental insurance that my job provided.

        I’m hoping that I am not out of luck because I took this complaint to Small Claims Court this past Thursday. I went by myself, yet the surgeon and the anesthesiologist showed up with an attorney. I have never in my life gone to court over anything! It was a bit intimidating. I made it clear at the onset that I was not angry with anyone and that malpractice seemed like a huge umbrella term that was too toxic for what had occurred. The judge said he appreciated this and it was nice to begin the complaint this way.

        Since I was the one bringing suit, the judge told me that it was up to me to prove my case. I came with copies of my dental bills, a copy of my full mouth x-ray, copies of x-rays showing the damage between the two adjacent crowns, and the letter sent to the hospital after the incident occurred.

        So this complaint lasted one hour and 30 minutes. All I know is that I went into the OR with four lower gold molar crowns and came out with only three and then had unexplained fracture between two adjacent crowns. The other side seemed to concentrate on the fact that this was a risk that I consented to. Well of course I signed the boiler plate consent in the pre-op room and the ENT physician said that he warned me in is office that this could happen. He did not. No matter what, If I had not signed the consent on the day of surgery or found the risk unacceptable had he mentioned it in the office, then the surgery would not have been done. Their approach reminded me of something I learned from a course in high school. This involved an establishment where you might hang your coat and there is a sign saying not responsible for missing or lost items above the rack. The teacher said that the sign really did not relieve the establishment of responsibility. Or a more drastic example would be the statement in a medical consent form saying by signing this form, the patient recognizes they could die as a result of the anesthesia or the surgery itself. If the physicians had done something wrong and it resulted in a person’s death or disability, then absolutely they could be liable.

        The attorney for the Defendants emphasized that I did not have expert witnesses such as an Anesthesiologist nor a surgeon to attest that the Standards of Practice were not followed. Even if I had them, how would they know since they would not have been in the OR room to witness the surgery? They would have to believe the testimony of the physicians. Anyway, it was this comment several times by the attorney in addition to the gap of finding the missing crown, the gap of subsequent fractures to the other two crowns, and that I was told damage to the teeth could occur. I did wonder if my being asked multiple times if I had crowns, caps, bridges, dentures, and to open my mouth multiple times so they could look meant anything.

        Two things happened early on in that courtroom. I did not tout my credentials nor sprinkle my complaint with medical terms. I suppose enough came through that the judge asked if I had a medical background. I then said I was a Registered Nurse. I answered his and the attorney’s questions as to the facts that I worked in the ED, am still licensed in the State of New York, retired a year ago, have been an RN since 1968. The judge then said he had an unusual case in that I had knowledge of procedure and was not required to have expert witnesses. (Actually to me, anyone no matter what their background was should have been given the same consideration.) He then said that although Medical Malpractice suits are difficult to prove, there is some IPSA something where there can be no other explanation as to how something occurred. He also pointed out that I was only asking for the cost of the dental work done and liked that I had not tried to pad this amount with pain and suffering. So all this sounds good for me but we will see.

        Long story short and awaiting the outcome, the judge said he would have to consider what was said and review some malpractice guidelines. He will be rendering his decision in writing in thirty days. I was in that courtroom until 12:30 PM as all cases had to be there by 9:00 AM. every other case took 10 to maybe 20 minutes and a judgement was rendered. We were the last case and as I mentioned the judgement will come in 30 days. I also wonder why the physicians would hire an attorney, take time away from their practice? Surely the amount of money I am requesting would be less than what they will realize via their measures. Is it that their malpractice insurance will go up significantly? Having a black mark of malpractice on their name a threat? I don’t know. They must carry malpractice insurance and what is it for if not for a complaint such as mine?

        This is probably more than you expected to read or hear but I’m a firm believer in doing the right thing and am extremely honest in my approach to life. I expect others to be the same but of course they are not always.

        Reply
        1. drmorris
          July 2, 2019 at 8:21 am

          I read your story with great interest. Thank you for the explanation. I’d be interested to hear how the judge rules in your case.

          I think they are interested in presenting a defense because a judgment in your favor would allow for other judgments against them in cases of dental damage during intubation. So it is worth their time in the big scheme of things.

          It is excellent that you had your dental x-rays to show. Maybe an expert witness on your side could have been a dentist who made statements on your risk of dental decay. High caries rate would alleviate the anesthesiologist of fault. Low caries rate would work in your favor.

          One factor that is not likely to be considered by either side of the argument is the Ferrule effect, but could be very central to why the crown came off. Google “Ferrule effect” if you’d like to learn about it. It means that a short tooth is more likely to have a crown fall off. A crown on a long tooth is much more likely to stay in place on the tooth. It may be that your crown had a short Ferrule that was good enough to withstand everyday chewing, but not a rough intubation.

          Of course, I am on the sidelines of your story, and you shouldn’t take this information for legal advice. It may lead you to ask questions of someone who can give you legal advice.

          Going back to the original point of the blog entry, I want to remind anyone reading your story – a $200 clear retainer could have avoided your dental bills and the time you’ve spent in court and for follow-up dental care. I wish you the best in your efforts.

          Reply

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