Dental Protection During Endotracheal Intubation

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PROTECTION of the patient's dental structures during surgical procedures is a matter of increasing concern to anesthesiologists. Confidence in the increasing efficacy of muscle relaxants has resulted in greater use of intubation of the trachea — expanding the field of risk and the number of possible complications. Among these complications is damage to the teeth or to dental prostheses, the results of which may be serious. Not only may there be cosmetic disfigurement, but if the patient aspirates a dislodged tooth or fragment there may occur grave pulmonary complications or the surgical procedure may have to be prolonged in order to locate and remove the aspirated object.

Formerly, the presence of porcelain jacket crowns, synthetic fillings, gold inlays, and small bridges were possible contraindications to the use of endotracheal anesthesia. Now, because of the excellent muscular relaxation achieved with the newer drugs and improved technics, these dental conditions have become accepted risks. However, emergency conditions sometimes arise: the airway suddenly is compromised or hypoxia develops—the patient's life is in danger and immediate intubation of the trachea becomes mandatory. To visualize the larynx as quickly as possible, the patient's upper incisors become the pivot point for the laryngoscope (Fig. 1), providing leverage against anterior pharyngeal structures. This force may be so great as to damage normal teeth; but, in this situation, concern for the integrity of the incisor ridge is superseded by the immediate necessity of establishing an airway. If a tooth or dental prosthesis is damaged and the fragments are. . .



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