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Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction

From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphy...

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Autores principales: Ito, Hiroshi, Kawaai, Hiroyoshi, Yamazaki, Shinya, Suzuki, Yosuke
Formato: Texto
Lenguaje:English
Publicado: Dove Medical Press 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878958/
https://www.ncbi.nlm.nih.gov/pubmed/20526442
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author Ito, Hiroshi
Kawaai, Hiroyoshi
Yamazaki, Shinya
Suzuki, Yosuke
author_facet Ito, Hiroshi
Kawaai, Hiroyoshi
Yamazaki, Shinya
Suzuki, Yosuke
author_sort Ito, Hiroshi
collection PubMed
description From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphyxia by affecting the upper airway. Therefore, we assessed the morphological changes of the upper airway following maximal opening of the mouth. In 13 healthy adult volunteers, the sagittal diameter of the upper airway on lateral cephalogram was measured between the two conditions; closed mouth and maximally open mouth. The dyspnea in each state was evaluated by a visual analog scale. In one subject, a computed tomograph (CT) was taken to assess the three-dimensional changes in the upper airway. A significant difference was detected in the mean sagittal diameter of the upper airway following use of the prop (closed mouth: 18.5 ± 3.8 mm, maximally open mouth: 10.4 ± 3.0 mm). All subjects indicated upper airway constriction and significant dyspnea when their mouth was maximally open. Although a CT scan indicated upper airway constriction when the mouth was maximally open, muscular compensation was admitted. Our results further indicate that the maximal opening of the mouth narrows the upper airway diameter and leads to dyspnea. The use of a prop for the patient who has communication problems or poor neuromuscular function can lead to asphyxia. When the prop is used for patient refusal in dentistry, the respiratory condition should be monitored strictly, and it should be kept in mind that the “sniffing position” is effective for avoiding upper airway constriction. Practitioners should therefore consider applying not only systematic desensitization, but also general anesthesia to the patient who refuses treatment, because the safety of general anesthesia has advanced, and general anesthesia may be safer than the use of a prop and restraints.
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spelling pubmed-28789582010-06-04 Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction Ito, Hiroshi Kawaai, Hiroyoshi Yamazaki, Shinya Suzuki, Yosuke Ther Clin Risk Manag Original Research From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphyxia by affecting the upper airway. Therefore, we assessed the morphological changes of the upper airway following maximal opening of the mouth. In 13 healthy adult volunteers, the sagittal diameter of the upper airway on lateral cephalogram was measured between the two conditions; closed mouth and maximally open mouth. The dyspnea in each state was evaluated by a visual analog scale. In one subject, a computed tomograph (CT) was taken to assess the three-dimensional changes in the upper airway. A significant difference was detected in the mean sagittal diameter of the upper airway following use of the prop (closed mouth: 18.5 ± 3.8 mm, maximally open mouth: 10.4 ± 3.0 mm). All subjects indicated upper airway constriction and significant dyspnea when their mouth was maximally open. Although a CT scan indicated upper airway constriction when the mouth was maximally open, muscular compensation was admitted. Our results further indicate that the maximal opening of the mouth narrows the upper airway diameter and leads to dyspnea. The use of a prop for the patient who has communication problems or poor neuromuscular function can lead to asphyxia. When the prop is used for patient refusal in dentistry, the respiratory condition should be monitored strictly, and it should be kept in mind that the “sniffing position” is effective for avoiding upper airway constriction. Practitioners should therefore consider applying not only systematic desensitization, but also general anesthesia to the patient who refuses treatment, because the safety of general anesthesia has advanced, and general anesthesia may be safer than the use of a prop and restraints. Dove Medical Press 2010 2010-05-25 /pmc/articles/PMC2878958/ /pubmed/20526442 Text en © 2010 Ito et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
spellingShingle Original Research
Ito, Hiroshi
Kawaai, Hiroyoshi
Yamazaki, Shinya
Suzuki, Yosuke
Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction
title Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction
title_full Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction
title_fullStr Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction
title_full_unstemmed Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction
title_short Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction
title_sort maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878958/
https://www.ncbi.nlm.nih.gov/pubmed/20526442
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