Dental Injury with Video Versus Direct Laryngoscopy: A Secondary Analysis of Published Aggregate Data

Background/Objectives: Dental injury is an uncommon complication of tracheal intubation. We examined its association with video laryngoscopy (VL) versus direct laryngoscopy (DL). Methods: Published aggregate dental-injury counts from a Cochrane review were compared across Macintosh-style, hyperangulated, and channeled VL categories. Two-sided Fisher exact tests, unadjusted odds ratios (ORs), relative risk (RR), and log-Wald 95% confidence intervals (CIs) were calculated. Aggregation did not retain trial-level stratification. Results: Dental injury occurred in 5/4,233 VL cases (0.118%) and 15/3,936 DL cases (0.381%). The aggregate OR was 0.309 (95% CI 0.112–0.851; p = 0.023), and the RR was 0.310 (95% CI 0.113–0.852). The absolute difference was 0.263 percentage points, or 2.6 fewer observed injuries per 1,000 intubations with VL. No individual VL category differed significantly from DL (p ≥ 0.091). Conclusions: VL was associated with fewer observed dental injuries in this descriptive aggregate comparison. Rare events, possible shared controls, loss of trial-level stratification, and clinical heterogeneity limit interpretation. The findings are hypothesis-generating and do not establish causation or superiority of a particular device design.