From the Guidelines
No, you should not intubate a patient with dentures in place, as it can lead to serious complications such as airway obstruction, damage to the dentures, and difficulty in visualizing the airway. According to the most recent and highest quality study, removing dentures prior to intubation is crucial to prevent these complications 1. The study highlights the importance of ensuring optimal conditions for intubation, and removing dentures is a key step in achieving this. Leaving dentures in during intubation can cause them to become dislodged, damaged, or pushed into the trachea or esophagus, which can have severe consequences for the patient's morbidity, mortality, and quality of life.
Key Considerations
- Removing dentures prior to intubation can help prevent airway obstruction and other complications
- Dentures can interfere with proper visualization of the airway and make it difficult to achieve a proper seal when ventilating with a bag-mask device
- In emergency situations, dentures might be left in place temporarily to assist with bag-mask ventilation, but they should be removed before the actual intubation attempt
- After intubation is complete, dentures should be stored safely with the patient's belongings and documented in the medical record
Clinical Implications
The decision to remove dentures prior to intubation is based on the principle of prioritizing patient safety and minimizing the risk of complications. By removing dentures, healthcare providers can ensure optimal conditions for intubation and reduce the risk of adverse outcomes. This approach is supported by the latest evidence and guidelines, including the Society of Critical Care Medicine's clinical practice guidelines for rapid sequence intubation in the critically ill adult patient 1.
Recommendations
- Remove dentures prior to intubation to prevent complications and ensure optimal conditions for the procedure
- Document the removal and storage of dentures in the patient's medical record
- Consider the patient's individual needs and circumstances when deciding whether to remove dentures, but prioritize patient safety and the prevention of complications.
From the Research
Intubation with Dentures
- The decision to intubate with dentures in place depends on various factors, including the patient's overall health, the type of surgery, and the anesthesiologist's expertise 2.
- Leaving dentures in place during bag-mask ventilation at induction of general anesthesia can make the process easier, with a higher success rate compared to removing them 2.
- However, there is a risk of dental damage during intubation, especially if the patient has poor dental condition or if excessive pressure is applied during the procedure 3, 4.
- The use of a laryngeal mask airway can be an alternative to endotracheal intubation in patients with a history of difficult intubation or dental injuries 5.
- To minimize the risk of dental trauma, anesthesiologists should be aware of the patient's dentition and choose the best approach for each specific situation, considering the use of elastic mouthguards or other protective measures 4.
Key Considerations
- The anesthesiologist's experience and skill level play a crucial role in preventing dental damage during intubation 3, 4.
- Patients with a high risk of sustaining an injury during endotracheal intubation should be identified and equipped with protective measures, such as elastic mouthguards 4.
- The type of airway management used, such as endotracheal intubation or laryngeal mask airway, can affect the risk of dental damage 3, 5.