Burns from Orthodontic Pliers

Summary

A case of burn injury from orthodontic pliers resulting in a partial-thickness burn is presented. A brief description of the injury, a review of the pertinent literature, and general guidelines for out-patient management of such burns are also presented.

Introduction

Iatrogenic injury is an intrinsic risk in all medical procedures. Various kinds of iatrogenic complications have been extensively reported and recognized. On occasion, among case reports of the various medicolegal defence organizations, mention is made of burns to the lips and oral soft tissues arising from contact with a heated instrument. We believe that iatrogenic burns from contact with heated surgical instruments are far more common in practice than the paucity of reported cases might suggest.

Case report

An otherwise healthy 23-yr-old woman was treated by an orthodontic in a multidisciplinary dental centre. Some months later she had a left inferior second premolar root canal therapy, in the same clinical tooth. The dentist, encountering some technical difficulties with the orthodontic structure, used pliers (probably Weingart Utility Pliers), which he sterilized in a glass bead sterilizer and then immediately used. The heated jaws of the pliers contacted the anaesthetized lower lip and vestibulum (obtained by mandibular block) causing a second-degree burn that resembled the pliers' jaw pattern (Figs. 1 , 2 ). The patient was treated by applying triamincinolone ointment and healed uneventfully within two weeks.

Fig. 1. Comma-like burn resembling an orthodontic pliers jaw-like pattern.

Fig. 2. A closer view.

Discussion and conclusion

Rosenberg and Baruchin ¹reported an ear, nose, and throat specialist who heated his laryngeal mirror over an alcohol lamp and as usual tested the mirror temperature against the dorsum of his hand - an act that resulted in a first-degree burn. Ho and Ying ²described two patients referred to hospital for iatrogenic flame burn caused by the breakage of an alcohol lamp during ENT examination. In 2000 we described a similar case of a contact burn to the lower lip inflicted with a heated tooth-extracting forceps. ³Skin injuries are sometimes mistaken for burns, and medical devices are immediately blamed as the cause; however, such a hasty conclusion may overlook the actual cause of the injury and delay the implementation of measures to prevent future occurrences. ^{4, 5}

In conclusion, although this type of injury fortunately represents only a small percentage of total burn injuries, it causes a particular type of lesion in which aesthetic sequelae and legal litigation are highly hazardous.

Certain precautions should be taken to assure that no morbidity is associated with the use of heated surgical instruments. Such precautions are especially important when the patient is fully or locally anaesthetised.