## 4 Discussion  
The present investigation made it possible to meet the defined objectives, namely the development of a succinct clinical evaluation protocol of registration strategy for a routine dental examination in every patient scheduled for general anaesthesia. The reliability of this protocol was demonstrated by the high correlation values obtained between the two observers, a senior dental student and an internal physician specialised in anaesthisology. The \"presence of orthodontic treatment\", \"dental fracture\", \"history of trauma\" and \"presence of fixed prosthesis\" are examples that stood out due to the excellent agreement achieved. It should be noted that the interobserver accordance was only lower in the situations of \"restorations detection\" and \"caries lesions\"; it is understandable that caries lesions without enamel destruction, for example, are hardly detectable without the ideal conditions of lighting in a dental clinic. Furthermore, changes in colour or indirect signs such as swelling or bleeding in the adjacent gingiva to the curious lesion are difficult to detect by a professional without dental experience. The same is true for small restorations with aesthetic materials. Contrary to the presence of isolated or fractured teeth, which can be clearly perceived, major aesthetic restorations and periodontal involvement were also reported as risk factors for dental injury in the anaesthetic act and may present higher diagnosis difficulties for professionals without dental training or the ideal logistical conditions [3; 7; 8; 11; 12; 13]. Thus, it is imperative to define clear oral parameters representative of the potential risk that endotracheal intubation can imply and of reliable application by the anaestologists prior to surgical procedures. For this, the brief training of the intern anaesthisologist on oral observation and registration proved to be essential, as well as the selected strategy of identification and evaluation of 'index teeth'. These are mentioned as representative of the risk of dental injury during endotracheal intubation procedures [4; 7; 10; 11; 16]. Patients with worse dentition status, with prosthetic work or more difficult airways, are reported as having a higher risk (approximately 20\(\times\) higher) of dental damage than those who present \"good dentition\" and an \"easier\" airway [18]. Moreover, among patients classified as \"easy to intubate\", in those with \"worst dentition\", the probability of suffering dental injuries related to anaesthesia was three to four times higher [18]. Other authors highlight the pre-existing periodontal disease as the most likely cause of dental injury. It is also mentioned that, in patients with Angle Class II, Division 1 malocclusion, in which there is a pro-inclination of the central maxillary incisors, the risk of dental injury may increase. Recent studies reveal that in 90% of the patients with class I malocclusion, Angle division II and Mallampati score 3, there is contact between the blade and the teeth [8]. Thus, pre-surgical anaesthetic evaluation is reported as one of the relevant approaches that should be taken to minimize the risk of dental injury. Through the data collected by the questionnaire, 20% of the patients who underwent surgery never brushed their teeth, the majority (77.1%) never used a mouthwash and nearly 50% had only been to the dentist as recently as 1 year ago, many of them for tooth extraction. Dental mobility was not a complaint reported by most patients, which can be explained by the reduced number of teeth present in the mouth. These data allowed us to anticipate that we were present to a population with a critical/poor oral status. This was confirmed by the clinical observation and reflected in an average of about 18 missing teeth per individual, a generalized bleeding on probing and a significant number of isolated teeth.