To the Editor:
Dental injury is a well recognized complication of laryngoscopy and intubation. In a recent study, it was seen that approximately 1:4500 patients who receive general anesthesia sustain a dental injury (1). The consequences of dental trauma during general anesthesia are varied but the most dreaded outcome of a dental injury is the endobronchial aspiration of an avulsed tooth.
We present a technique for the retrieval of a tooth in case of avulsion to prevent its aspiration into the airway. Identify the loose tooth, especially the upper incisors, and tie a silk suture around the narrowest part of the tooth. The knot should be tight and secure to prevent it from slipping off. The long strands of the suture should be left intact. In case of avulsion of the tooth, the presence of the black colored suture makes it easy to locate and retrieve it, especially in the presence of blood.
Under ordinary circumstances an avulsed tooth can get lost either in the mouth or the drapes. If the tooth is not found, a complete radiography of the head, neck, chest and abdomen may be required. To prevent this, teeth protectors may be used but are awkward and can obstruct vision (2).
Our technique of tying the suture around the loose tooth is an easy, safe and economical method of retrieval of an avulsed tooth and thus prevent it being aspirated.
Moreover a quick retrieval may also make the reimplantation of the avulsed tooth possible as teeth reimplanted within 30 minutes can usually be retained (3).
Vimi Rewari, MBBS, MD
Rajender Singh Rawat, MBBS, MD
1. Warner ME, Benenfeld SM, Warner MA, Schroeder DR, Maxson PM. Perianesthetic dental injuries – Frequency, outcomes and risk factors. Anesthesiology 1999; 90: 1302–5.
2. Herlich A, Garber JG and Orkin FK: Dental and salivary gland complications.In Gravenstein N and Kirby RR (ed): Complications in anaesthesiology. 2nd
ed. Lippincott – Raven, Philadelphia, 1996; 163–173.
3. Hale ML. Traumatic injuries of the teeth and the alveolar processes.In Kruger GO (ed): The textbook of oral surgery, 6th
ed. St Louis: CV Mosby 1984; 357–371.