Dental trauma in endoscopy: A systematic review and experience of a tertiary endoscopy centre

Table 1 Summary of studies on dental trauma in endoscopy

Ref.	Type	Description	n	Dental events
Evers et al[8], 1967	Cohort study	Adverse dental events in cohort of patients having orahesive applied prior to endoscopy or general anaesthesia	110	No adverse dental events reported
Ackerman et al[9], 1996	Cohort study	Observational study on adverse dental events following upper endoscopy over 3 years	5000	Major adverse eventsa: 2; No minor adverse eventsb studied
Min et al[10], 2008	RCT	Dental related complications following use of TPM and MB-142 mouth guards assessed via structured questionnaire 3-4 after index upper endoscopy	865	Major adverse events: 2; Minor adverse events: 19
Mogrovejo et al[11], 2015	Case series	Report on 3 cases of dental injury sustained after upper endoscopy

^aMajor adverse event includes cases of tooth fracture, tooth avulsion, tooth subluxation.

^bMinor adverse events includes gum discomfort, masticatory pain, toothache and cancellations due to dental reasons.

RCT: Randomized control trial; TPM: Teeth-protecting mouthpiece

Table 2 Outpatient endoscopy cases during a two-year period

Type	No.
Oesophagogastroduodenoscopy/antegrade enteroscopy	10142
Colonoscopy/sigmoidoscopy	10263
Endoscopic ultrasound	423
Endoscopic retrograde cholangiopancreatography	248
Bronchoscopy	452
Others (e.g., thoracoscopy)	11
Total number of upper endoscopy cases	11265
Total number of cases	21539

Table 3 Summary of dental related events

Cancellations	32
Oesophagogastroduodenoscopy	30
Endoscopic ultrasound	2
Dental injury	1

Table 4 Pooled adverse dental event rate

Ref.	n	Major eventsa	Minor eventsb
Evers et al[8],1967	110	0	Not studied
Ackerman et al[9],1996	5000	2	Not studied
Min et al[10],2008	865	2	19
Our centre experience	11265	1	32
Event rate
Rate of major events: 5/17240 = 0.029%
Rate of minor eventsc: 51/12130 = 0.42%
Overall event rate: 56/17240 = 0.33%

^aMajor Adverse Event includes cases of tooth fracture, tooth avulsion, tooth subluxation.

^bMinor Adverse Events includes gum discomfort, masticatory pain, toothache and cancellations due to dental reasons.

^cOnly studies reporting minor adverse events were included in the calculation.

Table 5 Restorative and reconstructive dental treatments[18,21]

Type of treatment	Description and related problems
Direct restoration (filled in single procedure with material being placed, adapted and shaped by clinician)
Filling	May comprise amalgam, ceramic or precious metals. Susceptible to expansion or shrinkage when setting, which might cause tooth fracture or further decay
Indirect restoration (filling created outside of mouth, either from impression or digital scan of tooth)
Inlays/onlays	An inlay is a filling made outside the mouth, then bonded to the teeth. This is less prone to expansion or shrinkage. An onlay refers to an inlay which covers a dental cusp
Crown	An onlay which fully covers the tooth which is required in the setting of marked tooth damage
Veneer	A thin layer bonded to the tooth surface to enhance appearance of fractured or discoloured teeth
Prosthesis
Bridge	Fixed partial denture secured to adjacent teeth
Denture	Removable prosthesis which may be attached to remnant teeth via clasps
Implant	Permanent prosthesis integrated into alveolar bone via screws and cement. Eventual recession of gingiva may result in implant weakening

Table 6 Millers index of grading tooth mobility

Grade	Description
0	“Physiological” mobility measured at the crown level. The tooth is mobile within the alveolus to approximately 0.1-0.2mm in a horizontal direction
1	Increased mobility of the crown of the tooth to at the most 1 mm in a horizontal direction
2	Visually increased mobility of the crown of the tooth exceeding 1 mm in a horizontal direction
3	Severe mobility of the crown of the tooth in both horizontal and vertical directions impinging on the function of the tooth