This chapter is designed to raise awareness of the risks of damage to dental tissue during ECT, with the possible consequences to the patient, ECT team, psychiatrists and anaesthetists, and to place dental risk into context. Although the first section of the chapter is more applicable to psychiatrists and the second section to anaesthetists, the issue of dental risk bridges both specialties. The entire chapter should be read by all staff involved with the delivery of ECT.

Dental issues for psychiatrists

There is a general view among psychiatrists that any dental or jaw problems associated with ECT should be managed by the anaesthetist at the time of the treatment. It is expected that the anaesthetist, during their pre-anaesthetic assessment, will identify any dental risks and work towards their safe management.

Recent research from the USA (Watts et al, 2011) indicates that oral (dental and tongue) injuries are the most common complication of ECT. Patients seem to accept this risk identification and management process as being part of the anaesthetist's domain and do not see it as being related to the ECT itself. A literature search found that the risk of dental injury (excluding soft tissue injury) is about 1–2% (Beli & Bentham, 1998) and suggests that this process has worked well. Information from the Medical Defence Union indicates that litigation following dental injury or damage is rare and this is mirrored in American psychiatry (Slawson, 1989). However, recent developments including legal issues of risk management and consent, patient attitude to dental health, the role of private dentistry and technological advances in dentistry make a reappraisal of dental risk management within ECT appropriate.

Although the management of dental risks during the ECT session is likely to remain with the anaesthetist, the overall management of risks from ECT are the psychiatrist's responsibility. Injury to the teeth during ECT is a well-established risk (Beli & Bentham,1998) and therefore needs to be considered in the process of obtaining consent. See Chapter 22 for details on consenting and risk factors in ECT.

Risks to jaws and teeth during ECT are the direct result of the ECT and not the anaesthetic. Electroconvulsive therapy can cause dental damage by two means. First, bitemporal electrode placement leads directly to stimulation of the muscles of mastication during treatment (Fig. 9.1). Temporalis, being beneath the electrode, is totally stimulated.