title: The effectiveness of preformed tooth protectors during endotracheal intubation: an upper jaw model.
abstract: BACKGROUND
  In anesthetic practice, tooth damage may impair patient safety and is a common reason for litigation. The use of dental shields may reduce this complication. In this study, we examined the effectiveness of dental shields for altering the force on the teeth during endotracheal intubation.
  
  
  METHODS
  Five preformed dental shields (Endoragard, Ormco, Nouveau Dispositif (ND), PEB, and Camo) were evaluated in three different categories: (a) horizontal force reduction, (b) axial force reduction, and (c) impact on the view of the oral cavity. Force reduction was examined by using an upper jaw model. The upper incisors of the model were covered with each of the dental shields and then loaded with a force of 150 N via a blade of a laryngoscope directed to the maxillary left central incisor (tooth 9). The force distributed to the four maxillary central and lateral incisors by the dental shield was also measured by strain gauges placed to estimate the force applied to each tooth. The reduction in oral view was determined by measuring the thickness of each dental shield with a micrometer.
  
  
  RESULTS
  Dental shield Ormco Sports-Guard achieved the highest force reduction results, followed by Camo and Endoragard. ND and PEB showed poor, but statistically significant, force reduction with either the worst axial (ND) or horizontal (PEB) results. In contrast, Ormco was the most voluminous model, followed by ND and Camo. PEB and Endoragard were the thinnest models.
  
  
  CONCLUSIONS
  Preformed dental shields are useful to reduce the force applied to the teeth and potentially reduce the probability of tooth damage during laryngoscopy. However, the shield with the most force reduction capability is rather large and also expensive, making general use impossible. Further prospective studies are needed to evaluate efficacy and safety of tooth protectors.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Hospital Cologne-Merheim, University of Witten/Herdecke, Germany. MonacaE@Kliniken-Koeln.de
authors.forename: Enrico
authors.initials: E
authors.lastname: Monaca
authors.forename: Norbert
authors.initials: N
authors.lastname: Fock
authors.forename: Manfred
authors.initials: M
authors.lastname: Doehn
authors.forename: Frank
authors.initials: F
authors.lastname: Wappler
mesh_terms: D004867:Equipment Design / Q000379:methods / Q000592:standards; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D008437:Maxilla / Q000033:anatomy & histology*; D008953:Models, Anatomic; D011482:Protective Devices / Q000592:standards; D018677:Tooth Injuries / Q000517:prevention & control*