Incidence of Oral Injury and Risk Factors Associated with Oral Injury in Psychiatric Patients Undergoing Electroconvulsive Therapy in Siriraj Hospital

Abstract

Objective: Oral injury during Electroconvulsive therapy (ECT) has been mitigated by modified ECT and the use of mouth protection. However, the number of reports of oral structure injuries remains high. The objectives of our study were to find out the incidence and possible risk factors of oral injury in patients undergone ECT.

Methods: Fifty one psychiatric patients undergoing ECT over a one-year period were reviewed. Patients’ demographics, pos- sible risk factors of oral injury, drugs used to anesthetize patients and the locations of oral structure injury were collected. The primary outcome was the incidence of oral injury, and the secondary outcome was factors affecting oral injury in modified ECT.

Results: ECT was performed 217 times among the 51 patients. There were 24 males and 27 females aged 44 ± 15 years old. Psychiatric problems were schizophrenia (80.4%), mood disorder (13.7%), depression (3.9%) and others (2%). Incidence of oral injury was 10.1% (22/217). Injury characteristics were abrasion at lips and mucosa (72.8%), bleeding at the gum (22.7%) and tooth avulsion (4.5%). Patients who received of a lower dose of succinycholine (0.9 versus 1 mg/kg) were more likely to have oral injury (p=0.009).

Conclusion: The incidence of oral injury in ECT was 10.1%. Abrasion at the lips and mucosa was common. A multidis- ciplinary approach, adjustment of the anesthetic drugs dosage and the use of delicate mouth protections might decrease the incidence of oral injury.