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Using preformed tooth protectors during endotracheal intubation

AORN Journal, March, 2008 by George Allen

Anesthesia & Analgesia

November 2007

The incidence of dental injuries during endotracheal intubation procedures ranges from 0.05% to 12.1%. Such injuries have been attributed to poor technique; however, they can occur in the case of a difficult intubation or in an emergency situation when endotracheal intubation is a life-saving procedure and securing the airway takes precedence over protecting the teeth. Seventy-five percent of perioperative dental injuries occur during endotracheal intubation, 16% during extubation, and 9% during the recovery phase.

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Two types of dental shields have been developed. One type consists of individually adaptable shields using thermoplastic material, cellulose-acetate foil, or ethylene vinyl acetate, and the other type consists of preformed shields, which are fast and convenient to use but limit or prevent individual adaptation to the upper jaw. Because there are no data that document which model of dental shield is most effective at reducing the risk of tooth damage during endotracheal intubation, the purpose of this experimental study was to compare different preformed shields in an experimental setting using a modified upper jaw model to simulate conditions that may effect the front teeth during endotracheal intubation and to measure axial and sagittal paraxial forces of each incisor.

Five preformed dental shields (ie, Endoragard, Ormco Sports-Guard, Nouveau Dispositif, PEB, Camo Bag) were evaluated in three categories:

* horizontal force reduction,

* axial force reduction, and

* impact on the view of the oral cavity.

The upper incisors of the model were covered with one of the dental shields and then loaded with a force of 150 N via a laparoscope blade directed to the maxillary left central incisor (ie, tooth 9). The force distributed to the four maxillary central and lateral incisors by the dental shield was measured by strain gauges. Each measurement was performed for 16 seconds, with the loading force being applied gradually over 10 seconds and the maximum load being maintained for one second. Each measurement was taken 10 times, and the reduction in oral view was determined by measuring the thickness of each dental shield with a micrometer. Common statistical procedures including the t test were used to analyze the data.

FINDINGS. The dental shields differed markedly with respect to their ability to decrease forces applied to tooth 9. Forces transmitted to tooth 9 were reduced to 75.7 [+ or -] 2.1% (PEB) and 45.4 [+ or -] 2.0% (Ormco), respectively, in the horizontal axis, and to 67.5 [+ or -] 1.8% (Nouveau Dispositif) and 35.5 [+ or -] 1.9% (Ormco) in the axial direction. The force reduction of all the dental shields was statistically significant against the reference load in the horizontal and axial directions (P < .01). The Ormco shield achieved the highest force reduction results, followed by the Camo Bag and Endoragard shields.

CLINICAL IMPLICATIONS, The authors concluded that there is no question that a dental shield protects teeth from trauma, and the Ormco device was the most effective dental shield for reducing the loaded force in the axial and horizontal directions. They noted, however, that the high cost of this protector (ie, approximately $23.02 per piece) makes its general use in all patients at risk for dental injury impractical. Additionally, they noted that this study does not prove that a preformed device will provide protection from dental injury in a clinical setting. Perioperative managers should consider the use of these dental protectors in patient who have been identified as being at high risk for tooth damage during endotracheal intubation.

Editor's notes: Endoragard is a trademark of Cadco Medical, Oxnard, CA; Ormco Sports-Guard is a trademark of Ormco, Corp, Glendora, CA; Nouveau Dispositif is a trademark of C Magnin, Lyon Cedex, France; PEB dental shield is a trademark of HICO, Cologne, Germany; Camo Bag is a trademark of Svenska Dental Instruments, Upp-lands Vasby, Sweden.

Monaca E, Fock N, Doehn M, Wappler F. The effectiveness of preformed tooth protectors during endotracheal intubation: an upper jaw model. Anesth Analg. 2007;105(5):1326-1332.

GEORGE ALLEN PHD, RN, CNOR, CIC

DIRECTOR OF INFECTION CONTROL

DOWNSTATE MEDICAL CENTER

BROOKLYN, NY

Health Care Industry

Using preformed tooth protectors during endotracheal intubation

AORN Journal, March, 2008 by George Allen

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