Authors: Hirose N, et al.
Cureus 17(9): e91688, September 5, 2025. doi:10.7759/cureus.91688
This randomized crossover simulation study compared dental contact patterns during orotracheal intubation with three laryngoscopes: the Macintosh (#3 blade), McGrath MAC® video laryngoscope (#3 blade), and Pentax-AWS Airway Scope® (SL blade). Fifteen anesthesiologists performed intubations on two simulator models, with colored articulating papers marking blade-tooth contact.
On average, the Macintosh and McGrath touched about 4 teeth per attempt, most frequently the left maxillary central incisor (>80%) and left mandibular central incisor (>60%). Neither device typically contacted molars. In contrast, the Pentax-AWS contacted an average of 13 teeth per attempt, with >80% contact across bilateral maxillary and mandibular incisors and lateral incisors, and occasional contact with premolars (>20%).
What You Should Know:
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Incisors—especially the left maxillary and mandibular centrals—are most at risk for blade contact with Macintosh and McGrath devices.
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The Pentax-AWS contacts significantly more teeth, including premolars, suggesting higher potential for dental injury.
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Molars are generally spared with Macintosh and McGrath blades but may be at risk with AWS.
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Device selection can influence dental injury risk, and awareness of contact patterns may inform protective strategies such as bite blocks or padding.
Clinical Relevance:
Dental injury remains a leading medicolegal concern in anesthesia. While videolaryngoscopes like McGrath may not increase dental risk compared to traditional Macintosh blades, alternative designs such as the AWS may increase contact with multiple teeth. Simulation-based findings underscore the importance of device-specific caution and protective measures during airway management.
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