Ingestion of Foreign Body During Dental Procedures

In the complications of wisdom teeth page on this site http://www.teethremoval.com/complications.html I have discussed cases of teeth being displaced into various places of the body. A tooth can also either be aspirated and end up in the respiratory tract or ingested and likely pass several days after being swallowed. Dental instruments can also break off during surgery and end up in various places of the body.

Some recent studies and cases have emerged for other dental procedures where foreign bodies were ingested. An article titled ” Precautions for accidental ingestion of a foreign body,” appears in J Can Dent Assoc 2013;79:d5, located over at http://www.jcda.ca/article/d5. This article describes a case where a 58 year old man underwent treatment for a dental crown and accidentally ingested a 20 mm stainless steel post intended to support the prosthesis. An imaging study revealed the post in the mid-abdomen and the patient, since he was not in distrust, was told to monitor for it to be passed. The patient never saw the post pass in his GI tract but subsequent imaging studies did not reveal it so it is presumed to have passed. This of course, opens up the possibility that maybe there is a better way to monitor a foreign body if it has been ingested to make sure it passes in the GI tract. This article cites another study conducted in 2011, Obinata K, Satoh T, Towfik AM, Nakamura M. An investigation of accidental ingestion during dental procedures. J Oral Sci. 2011;53(4):495-500.

This article presents 23 cases of accidental ingestion of foreign bodies occurring during dental procedures at the Center for Dental Clinics of Hokkaido University Hospital between 2006 and 2010. The authors found that most cases occurred when practitioners had less than 5 years of experience. Some of the cases of accidental ingestion presented include a scaler tip, a metal core, a metal crown, a metal onlay, and a bur. Three (3) of the 23 cases had to be retrieved by endoscopic procedures whereas the remaining 20 cases of passed through the GI tract within 10 days with no adverse events. It appears one case involved a wisdom tooth but it is not clear if it was being extracted or some other type of treatment was performed.

The authors mention that the incidence of accidental ingestion during dental procedures was found to be 0.0041% and 0.0044% at 2 prior dental colleges in Japan. In this study the number was found to be 0.0037% (case/patients) per year of accidental ingestion.  The authors state

“Moreover, the occurrence (cases/dentists) per year was 0.018, being very close to the figure of 0.021 reported from 2 French insurance companies representing 24,651 French general dental practitioners over an 11-year period (1994-2004).”

Near the end of the study the author state

“In the treatment of molars, the present authors suggest inclining the head of the patient to one side to help catch objects in the buccal pouch. However, the best countermeasure is still meticulous care to fix burs tightly and to use dental instruments in the properly prescribed way. Additionally, practitioners can make patients aware of the possibility of dental objects dropping in such cases, and instruct them to spit out any dropped objects.”

It appears that more foreign bodies are accidental ingested than aspirated. Further, most foreign bodies that are accidentally ingested are safely passed through the GI tract with 7 to 10 days.

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