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LETTER TO EDITOR
Year : 2010  |  Volume : 54  |  Issue : 2  |  Page : 178 Table of Contents     

Approach to loose teeth: An alternative solution


Department of Anaesthesiology and Intensive Care, P.G.I.M.E.R, Dr. Ram Manohar Lohia Hospital, New Delhi, India

Date of Web Publication24-May-2010

Correspondence Address:
Pradeep Karunagaran
B-23, Golf View Apartments, Saket, New Delhi - 110 017
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.63640

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How to cite this article:
Gupta N, Karunagaran P, Pawar M. Approach to loose teeth: An alternative solution. Indian J Anaesth 2010;54:178

How to cite this URL:
Gupta N, Karunagaran P, Pawar M. Approach to loose teeth: An alternative solution. Indian J Anaesth [serial online] 2010 [cited 2020 Oct 24];54:178. Available from: https://www.ijaweb.org/text.asp?2010/54/2/178/63640

Sir,

A loose tooth or teeth always pose a problem for the anaesthesiologist during laryngoscopy and endotracheal intubation. This problem is aggravated if the loose tooth happens to be one of the upper incisors, especially in anticipated difficult intubation. We face this problem more frequently because of poor oro-dental hygiene in the patients.

Preoperative extraction is one possibility during planned surgery. A few other measures have been tried to avoid trauma to the loose teeth and to prevent their accidental dislodgement into the airway. Singhal [1] et al. have tried passing a silk thread across the loose tooth through the interdental cleft and tying the knot at the base of the tooth.

In case of the loose teeth being the upper incisors, we felt that a molar approach to intubation would avoid contact with the loose teeth. The left molar approach to intubation with optimal external laryngeal manipulation (OELM) has been found to improve the laryngeal view in patients with difficult laryngoscopy and has been found to offer a better laryngoscopic view than a right molar approach. [2]

We have tried the left molar approach to intubation using a Macintosh 3 blade in 10 patients with loose upper incisors. The procedure was explained to all the patients and written informed consent was taken from them. We were able to successfully intubate all the patients in the first attempt with the use of stylet along with OELM. With this approach, the possibility of trauma to the loose teeth and their dislodgement is eliminated. We therefore feel that the left molar approach to intubation is a safe and effective method of securing the airway in patients with loose upper incisors.

 
   References Top

1.Singhal SK, Chhabra B. Loose tooth: A problem. Anesth Analg 1996;83:1352.  Back to cited text no. 1      
2.Yamamoto K, Tsubokawa T, Ohmura S, Itoh H, Kobayashi T. Left molar approach improves the laryngeal view in patients with difficult laryngoscopy. Anesthesiology 2000;92:70-4.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  




 

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