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Anesthesiology/ect - cracked teeth/bite blocks?

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Expert: - 6/12/2009


Question

dentalbiteblock.jpg
Dear Dr. Starkman,

I'm 34. I've had ETC 55 times in the last 14 months.

The first time I woke up before I could breathe, which was very frightening. I was 240lbs and they gave me 100 mg pentothal, then another 50mg, and 70mg sux. Subsequently they've given me 300mg pentothal and I've had no real problems since except my teeth are chipping and cracking. After a few months part of the filling in a premolar chipped and about 6 months later another chipped. No big deal, I had them fixed but 2 months ago 2 molars cracked enough to expose the roots. I stopped the ECT and had root canals. My endodontist and dentist thought it best not to put crowns on immediately because they were badly infected.

I'm not the only one whose teeth have cracked/chipped/shattered. There are 3 other ECT regulars (although they're 70+): the only one who hasn't had a problem with her teeth wears full dentures. My psychiatrist said that I "wasn't properly anaesthetized"; otherwise it "shouldn't happen". But I thought that with ECT it's the actual shock that causes your jaws to clamp, sux doesn't prevent it, and teeth do sometimes chip/crack, especially molars with huge fillings.

I had been getting ECT every 2 weeks (we were trying to decrease the frequency from weekly) but I'd been getting more depressed. After 2 months off ECT I'm too depressed to put it off any longer. I'm going next Wednesday.

I'm afraid those 2 molars will shatter and I'll need implants rather than crowns. There isn't time to get them crowned before I go. My dentist gave me one of his bite blocks, one of those black rubber wedges dentists cram between your teeth on one side to keep your mouth open. I'll try and attach a picture of one. It looks nothing like the bite block used for ECT.

Could the anaesthesiologist even use the dental wedge? Would it prevent adequate bagging? I think it would be difficult or impossible to remove until I could keep my mouth open upon request. Do they leave the ECT bite block in just for the seizure? My psychiatrist told me to buy the smallest hockey mouth guard - maybe that would be best?

Thank you for answering my questions,

Jenn.  

Answer
I think it's a shame that you've had not one problem, but several, with respect to dental problems following your ECT treatments at the hand of an experienced anesthesiologist.  There are any number of bite blocks, tooth protectors, airway management devices, etc that are available to us anesthesiologists to prevent what you have described.

Unless your teeth are in unusually poor condition, I really am not sure how such a problem continues to arise!  

Tell your anesthesiologist that you'd like to use the dentist-recommended wedge to protect your teeth.  If he tells you that he won't be able to adequately ventilate you with it in place then THAT will be the last clue you'll need to get another anesthesiologist for your ECT.
    Questioner's Rating
    Rating(1-10)Knowledgeability = 10Clarity of Response = 10Politeness = 10
    CommentThank you for answering my questions. I'll take my dentist's bite block and hope for the best. Jenn.


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JM Starkman, MD

Experience

Over twenty-five years of adult and pediatric, inpatient and outpatient clinical anesthesia practice--some private, some group.

Organizations
American Association of Physicians and Surgeons. My county medical society.

Publications
[not a researcher]

Education/Credentials
American medical school graduate. Board Certified. Fellowship trained Cardiovascular and Pediatric anesthesia subspecialist.

Past/Present Clients
Over 20,000 anesthetics, the majority of which have been personally managed, with less than 5% consisting of supervising nurse anesthetists or in-training resident physicians.

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