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 Table of Contents  
Year : 2015  |  Volume : 2  |  Issue : 2  |  Page : 144-145

Mouth guard appliance to prevent accidental intraoperative avulsion of teeth

1 Department of Maxillofacial Surgery, Amala Institute of Medical Sciences, Thrissur, Kerala, India
2 Otorhinolaryngology, Amala Institute of Medical Sciences, Thrissur, Kerala, India

Date of Web Publication31-Dec-2015

Correspondence Address:
Arakkal Nellissery Chakkappan John
Department of Maxillofacial Surgery, Amala Institute of Medical Sciences, Amala Nagar, Thrissur - 680 555, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2349-4220.172918

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How to cite this article:
Chakkappan John AN, Anie MT. Mouth guard appliance to prevent accidental intraoperative avulsion of teeth. Int J Adv Med Health Res 2015;2:144-5

How to cite this URL:
Chakkappan John AN, Anie MT. Mouth guard appliance to prevent accidental intraoperative avulsion of teeth. Int J Adv Med Health Res [serial online] 2015 [cited 2021 Oct 19];2:144-5. Available from: https://www.ijamhrjournal.org/text.asp?2015/2/2/144/172918


In the ugly duckling stage, the teeth will have a physiological mobility due to the lack of complete root; whereas in adults, the tooth mobility may be associated with changes that occur during orthodontic tooth movement. In either case, iatrogenic avulsion may happen if proper care has not been taken during the intubation or application of teeth retaining retractors. The use of mouth guard appliance during anesthesia for the patient is essential to prevent iatrogenic avulsion of teeth during any intraoral procedures such as tonsillectomy and cleft palate repair procedures. Recently, Gaudio et al. reported that in intubation procedures without using the protective devices dental subluxation/luxation occurred in 55% of patients, dental avulsion in 43%, and exfoliation in 2%. [1] Hence, the surgeons who do endoscopy under general anesthesia should have a comprehensive awareness of root formation of teeth.

Accidental intraoperative avulsion of teeth is common in intraoral procedures, with teeth retaining retractors, which are performed in maxillofacial, otolaryngology, and anesthesia. [2] Minimizing dental injuries begin with the assessment of the patient's dentition and intraoral tissues. Bak has recently reported a case of accidental tooth avulsion during tonsillectomy. [3] The upper left incisors were involved most frequently at the time of tracheal intubation. [4] Therefore, intraoral instrumentation for procedures associated with the application of tooth attached retractors often gives adequate access to the surgical field as well as keeps the tongue out of the working field [Figure 1]. Exercising cautionary measures during events, such as laryngoscopy and tracheal extubation, can aid in the prevention of dental trauma. Apart from all these precautions, any mishaps such as slipping of retractors can occur during the procedures, and an iatrogenic injury may dislodge the vulnerable tooth. [5] This can be prevented by placing a flexible, thin, and easily placed mouth guard appliance, on the teeth, during the procedure [Figure 2]. The patients with mouth guards had significantly lower incidence of dental injury compared with those without mouth guards (0.06% vs. 0.37%). [4] Apart from its therapeutic purposes, the mouth guards are commonly used by patients with a habit of bruxism. Mouth guards are made of a heat-cured acrylic resin. Soft acrylic or light cured composite, or vinyl splints may be made more quickly and cheaply, but are not as durable and are more commonly made for short-term use. They generally cover all the teeth of the upper or lower arch. Soft splints are also used for children. The mouth guard appliance can be placed safely during the procedure in maxillofacial, otolaryngology, and anesthesia to prevent the injuries to teeth.
Figure 1: (a and b) Teeth attached retractors for the surgical fi eld

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Figure 2: A fl exible, thin mouth guard appliance on the teeth

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Gaudio RM, Barbieri S, Feltracco P, Tiano L, Galligioni H, Uberti M, et al. Traumatic dental injuries during anaesthesia. Part II: Medico-legal evaluation and liability. Dent Traumatol 2011;27:40-5.  Back to cited text no. 1
Yasny JS. Perioperative dental considerations for the anesthesiologist. Anesth Analg 2009;108:1564-73.  Back to cited text no. 2
Bak NB. Accidental tooth avulsion during tonsillectomy. Ugeskr Laeger 2010;172:1611-2.  Back to cited text no. 3
Ueda N, Kirita T, Imai Y, Inagake K, Matsusue Y, Inoue S, et al. Dental injury associated with general anesthesia and the preventive measures. Masui 2010;59:597-603.  Back to cited text no. 4
Madan K, Aggarwal AN, Bhagat H, Singh N. Acute respiratory failure following traumatic tooth aspiration. BMJ Case Rep 2013;2013:1-3.  Back to cited text no. 5


  [Figure 1], [Figure 2]


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