To the Editor:
A loose tooth or teeth always pose a problem for the anesthesiologist during laryngoscopy and endotracheal intubation. This problem is aggravated if the loose tooth happens to be one of the upper incisors and if associated with difficult intubation. Preoperative extraction is one possibility during planned surgery, but during emergency surgery it may not be feasible. We face this problem more frequently because of poor oro-dental hygiene in the patients. We have resolved this problem in a simple, practical, and economical way. Before the start of anesthesia, the patient is asked to open his or her mouth. We identify a loose tooth or teeth, particularly the upper and lower incisors; then, a silk thread is taken and passed across the loose tooth through interdental clefts and a knot is tied at its base. One end of thread is cut short, and other end is placed by the side of cheek and fixed with a small piece of adhesive. At the end of operation, once the patient is awake, the knot is cut and the thread removed. If the tooth gets dislodged during laryngoscopy, there is no scope of its misplacement into either the larynx or the esophagus. The anesthesiologist can proceed with endotracheal intubation without wasting time and later pull the tooth out with the help of the thread. We have used this method for the last several years and found it very useful.
S. K. Singhal, MD
B. Chhabra, MD
Department of Anaesthesia and Critical Care
Postgraduate Institute of Medical Sciences