simple question re: preoping pt's dental history

[cleansocks]

How does asking about permanent caps/crowns change your management? I don't understand why everyone asks this. Are you extra extra extra extra extra careful instead of just extra extra extra careful when DL'ing?

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[psychbender]

Nope. Regarding teeth, I just ask if anything is loose/chipped/broken/easily removable/dentures. I document pre-existing damage (had one pt try to blame me for pre-existing damage), ask them to remove anything removable for the OR, and let them know that if anything is _really_ loose, then it might come out (like the people with only one super-rotted tooth left in the mouth).

 

[BuzzPhreed]

Some caps on the front teeth (especially #8, #9) can become dislodged. They're not as strong as normal teeth. You don't want any surprises or extra dental bills. You can put a bite guard in if you are really concerned. Worth documenting in my opinion. The ones on the molars I could care less about. Never been a factor since I started regularly putting breathing tubes into airways in July 2004.

 

[jwk]

We ask patients about false/loose teeth and caps/crowns 1) so we're aware of them and 2) we let then know that we'll do our best to take good care of them but their life is more important than their teeth. This is an accepted risk, spelled out in our anesthesia consent, and on the rare occasions something happens, we generally don't pay for it.

The only tooth I've ever lost came out because it was embedded in a rubber oral airway. I've never (knock on wood) knocked one out with intubation in 33 years. Front teeth should never be touched and IMHO tooth guards are unnecessary and do next to nothing to actually protect the teeth, given the force that can be exerted by poor laryngoscopic technique. Nowadays, if we're that concerned, the GlideScope is a great option.