Prolonged neonatal intubation: Prosthodontics beyond dentistry

Abstract

Neonates with respiratory distress, inadequate gag reflex, poor sucking, and swallowing commonly require intubation as a routine treatment modality in the neonatal intensive care unit. It can be done by the nasal or oral route. Although nasotracheal intubation reduces the movement of the tube, it has some serious repercussions such as airway obstruction and possible hypoxia, leading to labored breathing, occlusion of the nasal aperture during a crucial period of development, nasal infections, and hypertrophy of the nasal lining. Hence, oral route is preferred over the nasal route as the oral mucosa is less susceptible to infection. However, an infant with an orotracheal tube is at risk for complications such as accidental extubation, damage to the maxillary alveolar ridge, development of a cleft palate, defective dentition, tracheal mucosal damage, subglottic stenosis, and laryngeal damage. Therefore, in an effort to reduce these complications, an appropriate recognition and dental intervention is required by the prosthodontist who by conferring with the prescribing physician could device a customized intraoral appliance for the neonate on prolonged intubation. Various intraoral appliances are being used to stabilize the tubes for infants who require prolonged intubation. For the present review, the database from various digital platforms was searched for studies published on prolonged neonatal intubation. The palatal appliances effectively stabilize the orotracheal and orogastric intubation tubes and prevent the associated complications. Thus, this early prosthodontic treatment for neonates requiring prolonged intubation further expands the scope of prosthetic dentistry to newer horizons in patient care and management.