The Incidence and Risk Factors for Dental Injury in Patients Undergoing General Anesthesia: A Case-Control Study

Dental injury is a known complication of endotracheal intubation during general anesthesia (GA), yet data on its incidence and associated risk factors remain limited. This study aimed to evaluate the incidence, risk factors, and outcomes of dental injury in patients undergoing GA.

This retrospective case-control study was conducted between January 2021 and June 2024. A total of 42,826 patients underwent GA during the study period; 72 cases of dental injury were identified from the departmental database. Controls were time-matched patients who underwent surgery in the same anatomical region, using a case-to-control ratio of 1:4. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors for dental injury.

The incidence of dental injury was 0.17%. Univariate analysis identified the following factors as associated with dental injury: age ≥ 60 years, pre-existing dental pathology, Mallampati classification ≥ 3, anticipated difficult intubation, and difficult airway. In the multivariable logistic regression analysis, pre-existing dental pathology (adjusted OR 3.87, 95% CI: 1.92-7.81, p < 0.001), anticipated difficult intubation (adjusted OR 4.99, 95% CI: 1.84-13.50, p = 0.002), and difficult intubation (laryngoscopic view grade ≥ 3) (adjusted OR 10.56, 95% CI: 4.24-26.29, p < 0.001) remained significant independent predictors of dental injury during GA. The most common complication was bleeding.

Dental injury during GA is uncommon, with an incidence of 0.17%. Pre-existing dental pathology, anticipated difficult intubation, and poor laryngoscopic view (grade ≥ 3) were identified as independent risk factors. Awareness and thorough preoperative assessment of these factors may help reduce the risk of dental injury and related complications.