Dental Damage Policy

 
updated April 2008, R. Murray

See also Dental Damage Flowchart (pdf)

Explain briefly and in general terms that dental damage is an unfortunate complication which occurs infrequently, and despite our best efforts to avoid it. Provide a basic explanation of the intubation process, or whatever mechanism you believe was responsible for the damage. If the patient has poor dentition politely explain how that puts their teeth at particularly high risk. You may want to refer back to the consent and the risks outlined under General Anesthesia. It is appropriate to state "I am sorry" and to express concern and sympathy for the patient. Make no promises regarding reimbursement. IMPORTANT: Document your conversation with the patient in the patient medical record.

A. Follow up with the patient: see above "What to say to the patient"
B. Get Patient Name, DOB, Date of Incident, Location of Incident, other relevant information.
C. Notify the Spectrum office [Rebecca Murray at 482-7800 x107 or Michelle Day at 482-7800x116] to provide relevant details.
D. If Hospital Employee was responsible also notify the appropriate Risk Manager at the facility as follows:

• MMC Hospital Employee (CRNA, Resident) was responsible, then the physician should notify Risk Management at Maine Medical Center; contact person is Cindy Bridgham, RN (207) 662-2295.

• St. Joseph's Hospital Employee (Respiratory Therapist) or (EMT Student or other nonhospital employee) was responsible, then the physician should notify Risk Management at St. Joseph Hospital; contact person is Beth Dodge (207) 262-1750.

• SMMC Hospital Employee (CRNA or EMT student) was responsible, then the physician should do the following:

• Stephens Memorial Hospital (CRNA) was responsible, then the physician should notify Risk Management by calling Kathy Bonney, RN, VP Performance Improvement at 743-1562 x 322

Copies of the pre-anesthesia record, anesthesia record and anesthesia consent form are obtained from McKesson Billing and forwarded to the physician involved, as well as the Physician Dental Damage Coordinator (John Siegle, MD in the South; David Clement, MD in the North). This physician will review the facts surrounding the case and receive input from the physician involved with the case if necessary.

Michelle Day will send "Letter #1" which requests the patient to obtain a quote from the dentist (for the work to be performed related to the dental damage) and Release of Medical Information form and forward it to the Spectrum office. Once received, the dental quote will be reviewed with Physician Coordinator and physician involved to determine disposition. The Physician Coordinator and the physician involved, in conjunction with Medical Mutual (when appropriate), will determine whether dental damage settlement should occur or whether Spectrum should decline responsibility. In the event that Spectrum declines responsibility, Rebecca Murray/Michelle Day will issue the "Decline Letter" to the patient.

a) If Spectrum will pay for some or all of the dental services, send "Letter #2" to the patient, which requests they complete a "Release and Settlement of Claim" form and forward it with the dental bill for payment.
b) On receipt of release and bill (from dentist or patient), reimbursement of indicated amount will be made to patient.
c) In the event that after review of the records it is determined that the service is not "covered", the Decline Letter will be sent to the patient. (example: when there is a pre-existing condition that is discovered when obtaining information from the dentist)

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Overview

Please note: When you look at the tooth chart, you are looking into a person's mouth with the jaws open. You're facing the person, so their upper right jaw will be on the left of this image.

3rd Molar (wisdom tooth) 2nd Molar (12-yr molar) 1st Molar (6-yr molar) 2nd Bicuspid (2nd premolar) 1st Bicuspid (1st premolar) Cuspid (canine/eye tooth) Lateral incisor Central incisor Central incisor Lateral incisor Cuspid (canine/eye tooth) 1st Bicuspid (1st premolar) 2nd Bicuspid (2nd premolar) 1st Molar (6-yr molar) 2nd Molar (12-yr molar) 3rd Molar (wisdom tooth) 3rd Molar (wisdom tooth) 2nd Molar (12-yr molar) 1st Molar (6-yr molar) 2nd Bicuspid (2nd premolar) 1st Bicuspid (1st premolar) Cuspid (canine/eye tooth) Lateral incisor Central incisor Central incisor Lateral incisor Cuspid (canine/eye tooth) 1st Bicuspid (1st premolar) 2nd Bicuspid (2nd premolar) 1st Molar (6-yr molar) 2nd Molar (12-yr molar) 3rd Molar (wisdom tooth)

Intralipid for Local Anesthetic Toxicity

Treatment of cardiac arrest with lipid emulsion: (approximate doses are given in red for a 70-kg patient)

CALL FOR HELP
° Give an intravenous bolus injection of Intralipid® 20% 1.5 ml.kg-1 over 1 min
   o Give a bolus of 100 ml
° Continue CPR
° Start an intravenous infusion of Intralipid® 20% at 0.25 ml.kg-1.min-1
   o Give at a rate of 400 ml over 20 min
° Repeat the bolus injection twice at 5 min intervals if an adequate circulation has not been restored
   o Give two further boluses of 100 ml at 5 min intervals
° After another 5 min, increase the rate to 0.5 ml.kg-1.min-1 if an adequate circulation has not been restored
   o Give at a rate of 400 ml over 10 min
° Continue infusion until a stable and adequate circulation has been restored

Remember:
° Continue CPR throughout treatment with lipid emulsion
° Recovery from LA-induced cardiac arrest may take >1 hour
° Propofol is not a suitable substitute for Intralipid® 20%
° Replace your supply of Intralipid® 20% after use