A Novel Custom Fabricated Teeth Guard for Boyle Davis Mouth Gag- A Feasibility Study

Introduction: Despite increase in the knowledge about reduction of dental injuries after tonsillectomy, the incidence is still considerable to attract attention. Presently gauze pieces, rubber or soft plastic materials are used. Hence, it was attempted to use a soft elastomeric putty dental material for this purpose which moulds perfectly to the shape of the upper dentition when applied and also gives full coverage of teeth with no reduction of the space when mouth is opened for surgery. It also gives better protection to the upper dentition as the gag fits perfectly on to it when applied. This, unlike gauze piece threads does not get interwined between the gaps of malaligned, prominent or crooked teeth, thereby offering superior protection.

Aim: To describe the feasibility of custom fabricated teeth guard for Boyle Davis mouth gag in oral and oropharyngeal surgeries.

Materials and Methods: An cross-sectional study was conducted in the Department of Ear, Nose and Throat, Mahatma Gandhi Medical College, Puducherry, India, in association with Indira Gandhi Institute of Dental Sciences, kerala, India, from February to April 2019. The equipment was simple, comprising of a paste of elastomeric silicone putty which had a base and catalyst which was custom made for the patient, just minutes before application over the patient’s upper dentition and over which the Boyle Davis mouth gag was applied and then the mouth opened for surgery. Total 50 consecutive patients, in the age group of 6-18 posted for tonsillectomy, were inserted with the equipment before application of Boyle Davis (BD) gag. The ease of insertion with a score of 1-4 was recorded from the surgeon. Postoperatively, once the gag was removed along with the custom made putty, the patient’s upper dentition was examined to look for any dental injuries that might have occurred due to gag insertion. The comfort level was assessed by a targeted questionnaire over a scale of difficulty from 1-4, 1 being comfortable and 4 being difficult.

Results: The mean age of the patients was 10.56 years with the mean weight of 38.55 kilograms. There were 27 males and 23 females. In all the patients, pre and perioperative period was uneventful. The ease of insertion score was 1 in all the 50 patients; there were no oral injuries and no residual side-effects due to the material used. The mean score for comfort level was 1.8.

Conclusion: An indigenously made elastomeric teeth guard is extremely effective in preventing dental injuries after application of Boyle Davis mouth gags in cases of adenotonsillectomy under controlled general anaesthesia.