tooth

[Gas you down]

So I had a patient with a prior documented loose top front R incisor, who then had to be intubated in the unit, and re-intubated twice within 36hrs(my intubation was the 3rd). Not the easiest intubation, and of course, it came out.
How do you guys deal with this? I mean of course who pays for it, or do we even have to?
I just documented the prior loose tooth, that it came out and was retrieved, and spoke to the family about it. I'm just wondering what my next step should be when she comes around asking about it...

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[jwk]

So I had a patient with a prior documented loose top front R incisor, who then had to be intubated in the unit, and re-intubated twice within 36hrs(my intubation was the 3rd). Not the easiest intubation, and of course, it came out.
How do you guys deal with this? I mean of course who pays for it, or do we even have to?
I just documented the prior loose tooth, that it came out and was retrieved, and spoke to the family about it. I'm just wondering what my next step should be when she comes around asking about it...

We deal with it on a case by case basis, but we rarely pay for damage. All our OR patients are advised of the possibility of dental trauma, and in the case of loose and/or damaged teeth, we tell them we'll be as careful as possible but that there is a significant chance that a tooth could be dislodged and that we won't be responsible for any costs associated with that.

Caps, crowns, and bridges really should be treated the same way. Those patients get the same chat about risks of dental trauma. I think the only time it's really reasonable to pay for damage is if you think it was preventable - for example, maybe a student knocked out an incisor due to poor technique. But if it's a difficult airway and you were otherwise careful, sorry - **** happens.

Honesty is always the best policy, and especially in a case where there is already documentation of poor dentition, you just tell them what happened and move on.

 

[Bertelman]

Talk to your group. This can't be the first time a Pt has had dental damage.

 

[cincincyreds]

I agree with the above. I ask about any teeth issues and if there is a chance of something coming out, I tell the family that and we don't pay to fix these things. If the case is elective I just cancel the case and tell the patient to see either the dentist or tooth fairy first.

 

[pgg]

If the case is elective I just cancel the case and tell the patient to see either the dentist or tooth fairy first.

You cancel cases for bad teeth?

 

[PMPMD]

If the tooth is very loose, I will tie a silk suture around it, then tape the ends to the face. (After induction prior to intubation). This way, if it becomes dislodged, it won't get lost in the airway requiring an ENT consult.

 

[Apollyon]

Almost 10 years ago, when I was a resident, I was at a place that is close to the boonies - as such, it was not uncommon for a patient to come from 45 minutes or an hour away who was REALLY rural.

I was doing my anesthesia block, and there was one of these guys - as snaggle-toothed as anyone you've ever seen. One of his upper central incisors was just hanging. The CRNA removed it, and didn't even have to yank - it was that loose.

After the surgery, the patient said, "Why didn't you pull the rest of 'em?" (True story.)

 

[cincincyreds]

You cancel cases for bad teeth?

Yeah, for elective ones. It is a pain when you need a bronch to remove that tooth from a bronchial lumen.

 

[Dejavu]

Admittedly, I work at a major institution, but for any tooth damage occurring intra-op, we have a admin contact person to whom we send the pt's name and clinic number as well as the tooth specifics. That admin person writes the pt and tells them to get it fixed by their home dentist and send the bill to the Clinic. We see the pt postoperatively and tell them that this process has been put in motion.

Way nice for us in the trenches, because the process is out of our hands. Probably cheaper than fighting any little battles from the institution's perspective.

We don't even question who should pay, who is at fault or anything, just easier in the long run.

 

[rsgillmd]

If the tooth is very loose, I will tie a silk suture around it, then tape the ends to the face. (After induction prior to intubation). This way, if it becomes dislodged, it won't get lost in the airway requiring an ENT consult.

During residency one of my attendings had me do this for a patient with several loose teeth. Same very logical rationale.

Everything went fine. I didn't knock out any teeth on intubation or extubation. However, I have to admit I was more nervous about knocking out this guy's teeth trying to undo the darn suture in recovery room than I was about knocking out a tooth during laryngoscopy.

 

[Bertelman]

during residency one of my attendings had me do this for a patient with several loose teeth. Same very logical rationale.

Everything went fine. I didn't knock out any teeth on intubation or extubation. However, i have to admit i was more nervous about knocking out this guy's teeth trying to undo the darn suture in recovery room than i was about knocking out a tooth during laryngoscopy.

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