As a dental resident at Mount Sinai Medical Center in New York, one of my responsibilities was to round on the patients who were having surgery the next day. My primary duty was to see if these patients had any loose teeth in the front of their mouths (in either the upper or lower jaw). Patients with loose teeth were required to have them either extracted or fastened with a silk string to prevent aspiration (having the tooth sucked into the lung) during a procedure called endotracheal intubation.
During endotracheal intubation, a flexible plastic tube is placed in the mouth and then into the trachea to allow a patient to receive air while under general anesthesia. Loose teeth can present a considerable problem for the anesthesiologist who must negotiate the tube with keen precision and limited access from the oral cavity.
When I visited these patients in their hospital beds, I wondered why their dental needs were not taken care of before going into the hospital for surgery. The vast majority of these patients were coming to the hospital for a planned surgery and not on an emergency basis. As a resident, I was placed in the awkward position of having to make a decision about whether a patient's front teeth should be extracted right then and there -- almost always without X-rays or a comprehensive clinical examination. There was also additional tension due to the apprehension many patients feel the night before surgery, as well as pressure from the anesthesiologist and the surgical team. In these cases, I always asked myself the question, "How would I treat this patient if I saw them in my private practice? Is removal of their teeth the best option?" These decisions were often hampered by a lack of time and information. Perhaps a better question would be "How can patients avoid being put in this position in the first place?"
The answer involves the patient's surgeon, dentist and their own desire to seek out information to make important decisions about their health. Specifically, the surgeon should tell every patient who requires general anesthesia to receive a comprehensive dental examination prior to surgery. The dentist should be informed of any upcoming surgery by their patient, and then treat all dental cavities and other dental infections, as well as remove any unsalvageable loose teeth. Teeth that are loose, but should be saved, can be splinted (joined) together to improve their strength and prevent aspiration during endotracheal intubation. Finally, the patient should always ask questions to their physicians, dentists and other health care providers before important treatment decisions are made.
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