Protecting teeth during intubation

[mahalo366]

What are people's various tricks for protecting the teeth during intubation? Obviously easy airways are not the concern here, but with the more challenging airways, or with patients with teeth that are already compromised (chipped, cracked or micro-fractured, or with bridges or caps), does anyone change their routine? Anyone care for the tooth guards, use alcohol swabs on the front teeth, or switch blades? Just curious....

Thanks,

Mahalo366

[Anisettes, BSN, RN]

I've only seen the alcohol swab packet over the front teeth used by a couple of CRNA's/Anesthesiologists. I haven't noted anything else.

Maybe if you post this in the CRNA or Perioperative forum you might get more responses. This thread is aimed more at general nursing where not many intubations are likely to be witnessed or taking place.

[mskate]

It depends on how urgent the intubation is... sometimes we will use an alcohol swab over the teeth - but most people don't like to use anything because if it moves, it is risky for an airway obstruction...

[lunarjuice]

It depends on how urgent the intubation is... sometimes we will use an alcohol swab over the teeth - but most people don't like to use anything because if it moves, it is risky for an airway obstruction...

agreed. if it's urgent, and a difficult airway, i could care less about the teeth. "A" comes way before "T" in the alphabet!! :) if it's an anticipated difficult airway AND a routine OR intubation, i typically have the glidescope. i typically use the miller blade anyway, so there's more room in the mouth, and less instance of chipping a tooth.

all in all, to answer your question. i'm careful. that's how i prevent chipping teeth.

[pedimac]

I'm with lunarjuice. Be careful and you won't chip a tooth.

Open the mouth as wide as you can, take your time, take slow deep breaths, easy progression with the blade, lift up and out. The last thing you want to do is get nervous/jumpy and start pounding teeth with metal or rock back on the handle.

For your last point, I'm not a fan of putting anything in the mouth that can fall and occlude an airway. And whether the teeth look bad or not, don't hit them.

[portland medic]

I have been a paramedic for 11 years so I have done many intubations, but am not an anesthesia provider (though I am starting the long and exciting process to become one). So take what I say with a grain of salt.

All of my intubations are emergency situations so they are not totally applicable to the more controlled settings of your guys and gals' OR's, but I am still careful to avoid the teeth, mostly with a delicate touch. I'm with the above posters that I don't want to introduce anything into a patients airway that could potentially become an obstruction. My medical director thought about putting tooth guards on our rigs, but decided against it with the same line of reasoning. When I have a difficult class 4 airway or someone with big teeth I use the miller 2 and keep the eschmann cath nearby, take a deep breath and get help from those around me. We just recently got airtraq's (rudimentary optic intubation tool) on our cars, but I haven't needed to use one yet. They're not nearly as good as the glidescopes though.

Haven't damaged a tooth yet in 11 years but probably haven't even come close to the number of tubes you all do. No one really cares if we damage teeth though. If a paramedic is intubating you than you got bigger problems than your teeth.