Anti-Toothbreaker: A Novel Low-Budget Device Enabling Contactless Dental Protection and a Forbidden Technique during Direct Laryngoscopy for Endotracheal Intubation

Abstract

Background: Iatrogenic dental injury is the most common complication of conventional laryngoscopy during orotracheal intubation. The main cause is unintended pressure and leverage forces from the hard metal blade of the laryngoscope. The aim of this pilot study was to introduce and test a novel, reusable low-budget device not only providing contactless dental protection during direct laryngoscopy for endotracheal intubation, but also enabling, in contrast to established tooth protectors, active levering with conventional laryngoscopes for easier visualization of the glottis. Methods: A constructed prototype for intrahospital usage was evaluated by seven participants on a simulation manikin for airway management. Endotracheal intubation was performed with and without the device using a conventional Macintosh laryngoscope (blade size 4) and a 7.5 mm endotracheal tube (Teleflex Medical GmbH, Fellbach, Germany). Necessary time and success of first pass were determined. Degree of visualization of the glottis with and without the device was stated by the participants according to the Cormack and Lehane (CL) classification system and the Percentage of Glottic Opening (POGO) scoring system. In addition, subjective physical effort, feeling of safety regarding successful intubation, and risk for dental injury were queried on a numeric scale between 1 and 10. Results: All participants except one stated that the intubation procedure was easier with usage of the device than without it. On average, this was subjectively perceived as being approximately 42% (range, 15–65%) easier. In addition, time to first pass success, as well as degree of glottis visualization, subjective physical effort, and feeling of safety regarding risk for dental injury, were clearly better with usage of the device. Concerning feeling of safety regarding successful intubation, there was only a minor advantage. No difference in first pass success rate and number of total attempts could be observed. Conclusion: The Anti-Toothbreaker is a novel, reusable low-budget device which might not only provide contactless dental protection during direct laryngoscopy for endotracheal intubation, but also enables, in contrast to established tooth protectors, active levering with conventional laryngoscopes for easier visualization of the glottis. Future human cadaveric studies are needed to investigate whether these advantages also prove themselves there.

Clinical Issues — July 2024

“…According to a study published in 2023, dental injury is a recognized risk for patients undergoing general anesthesia, resulting from the forces of the laryngoscope blade needed to intubate a patient for surgery 2 . In a study published in 2022, a team of researchers found that the incidence of dental injuries sustained during the perioperative period was low—101 injuries per 14,820 patients 3 —but the damage cannot be understated.…”

“…Additional studies revealed that incidence of dental injuries were found to be between 22% and 38% 5‐7 . Some flaws with commonly used dental‐protection products include an inability to withstand “active lever forces” 2 (p2) and the additional time needed to form a heat‐based, moldable protection device 2 . An alternative protection method is intriguing in light of the number of dental injuries sustained by patients under surgical care; however, facilities should ensure that they follow all the necessary steps when exploring new supply options.…”