Authors: Yamamura Y et al.
Cureus. 17(12): e98235, December 01, 2025. DOI: 10.7759/cureus.98235
Summary:
This retrospective study evaluated the effectiveness of a preoperative oral screening program performed by dental hygienists to reduce dental injuries during anesthesia. Dental trauma during intubation and extubation is a well-recognized complication of general anesthesia and accounts for a notable portion of anesthesia-related claims. Because the hospital performs approximately 11,000 anesthetics per year, screening all patients by dentists was not feasible, prompting the creation of a selective intervention system staffed by dental hygienists beginning in November 2019.
The study compared dental incidents occurring during general anesthesia before (2012–2019) and after (2019–2024) implementation of the oral screening clinic. Thirty-two dental incidents were identified across the 12-year period, including tooth fractures, loss of prosthetic devices, and dislodgement of loose teeth. Incidents decreased significantly from 3.5 per 10,000 anesthesia cases before screening implementation to 1.5 per 10,000 after implementation. Several injuries occurred during intubation and extubation, both before and after screening initiation.
Dental hygienists conducted a five-minute oral screening assessing loose teeth, dentures, orthodontic appliances, prosthetic devices, temporomandibular joint symptoms, and oral hygiene. Findings were documented in the anesthesia record using standardized symbols. Patients identified with dental risks were advised to undergo dental treatment before surgery, although some declined. Anesthesiologists reported that documentation from the oral screening improved their awareness of dental risks and informed airway management decisions.
Approximately 15% of surgical patients were referred to the dental department for treatment, often for fabrication of protective mouthguards, addressing tartar buildup, or evaluation of loose teeth. Mouthguards were found especially useful for protecting maxillary anterior teeth—the site most frequently involved in dental injuries.
The screening system, however, has limitations. Dental hygienists cannot evaluate radiographic findings or detect jawbone pathology. The hospital also lacks a postoperative oral care program, even though postoperative oral hygiene degradation is known to increase infection risk. The retrospective design may underestimate true event rates, and the small number of dental incidents limits statistical power. Nonetheless, the combination of objective incident reduction and anesthesiologist-reported benefits supports the usefulness of preoperative oral screening.
Overall, the study shows that a selective intervention system led by dental hygienists improves communication, increases awareness of dental risk, and reduces dental injuries during anesthesia in a high-volume hospital setting.
What You Should Know
• Dental injury is a recognized complication of general anesthesia and can lead to significant patient dissatisfaction and legal claims.
• Implementing preoperative oral screening by dental hygienists reduced dental incidents from 3.5 to 1.5 per 10,000 cases.
• Screening identifies loose or fragile teeth, prosthetic risks, and oral hygiene issues, allowing preventive action such as mouthguard fabrication.
• Anesthesiologists found screening documentation highly useful for anticipating airway-related dental risks.
• Dental injuries most commonly occurred during intubation and extubation, emphasizing the importance of targeted prevention.
• Screening cannot replace full dental evaluation; radiographic assessment and postoperative oral care remain unmet needs.
• Noncompliance with preoperative dental recommendations contributed to some dental injuries.
Key Points
• Preoperative dental screening by hygienists significantly reduces anesthesia-related dental complications.
• Most injuries involve maxillary anterior teeth and occur during intubation or extubation.
• Screening improves interdisciplinary communication and increases anesthesiologist awareness of dental risk.
• Selective intervention systems are feasible in high-volume centers where full dental evaluation is impractical.
• Radiographic limitations and postoperative dental management remain challenges requiring further system improvement.
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