International Journal of Pedodontic Rehabilitation

REVIEW ARTICLE
Year
: 2018  |  Volume : 3  |  Issue : 1  |  Page : 5--7

Accidental ingestion of foreign body in dental practice and its management


Vishnu Prasad 
 Department of Public Health Dentistry, Karpaga Vinayakga Dental College, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Vishnu Prasad
Department of Public Health Dentistry, Karpaga Vinayakga Dental College, Chennai, Tamil Nadu
India

Abstract

Foreign body aspiration or ingestion can be a potential complication or a life-threatening emergency situation. During routine dental treatment, the handling of dental objects requires particular care, especially with dental bridges and files. Precautionary measures have to be taken to avoid such situation. A dentist must be able to manage emergency situations in which accidental swallowing of dental instruments and materials occur. This article reviews the signs and symptoms, management, complications, and precautions of aspiration or ingestion of foreign bodies.



How to cite this article:
Prasad V. Accidental ingestion of foreign body in dental practice and its management.Int J Pedod Rehabil 2018;3:5-7


How to cite this URL:
Prasad V. Accidental ingestion of foreign body in dental practice and its management. Int J Pedod Rehabil [serial online] 2018 [cited 2021 Sep 21 ];3:5-7
Available from: https://www.ijpedor.org/text.asp?2018/3/1/5/227954


Full Text



 Introduction



Ingestion of foreign bodies is most commonly a problem in young children. In adults, it occurs accidentally more commonly among those with psychiatric disorder, mental retardation, use of local anesthetic, and altered consciousness associated with intravenous sedation. Swallowing of dental materials and devices may lead to serious complication during dental treatment. Any object routinely placed into or removed from the oral cavity during dental or surgical procedures can be aspirated or swallowed.[1],[2] These items can include teeth, restorations, restorative materials, instruments, implant parts, rubber dam clamps, gauze packs, and impression materials. The majority of foreign bodies that reach the gastrointestinal (GI) tract pass spontaneously. However, 10%–20% of cases require nonsurgical intervention while 1% or less may require surgery. Foreign body aspiration may cause damage to gastric mucosa, septic abscess, intestinal perforations, partial or complete airway obstruction, postobstructive pneumonia, respiratory distress, pneumothorax, or hemorrhage. If these cases are not properly managed and timely intervention is not carried out, it can be lethal. Therefore, general dental practitioners should be aware of a protocol of management and prevention of swallowing or aspiration of dental objects.[3]

 Incidence



Foreign body aspiration is rare in adults. Under the age of 15 years, it is seen around 18% of the cases. Around 27% of dental bridges have been reported to be aspirated. Orthodontic appliances, endodontic files, or components of loose dentures are the second most commonly ingested objects. Cast or prefabricated restorations, which are to be cemented, have a higher chance of aspiration.[4],[5],[6] Ingestion of foreign objects was observed during root canal treatment around 0.12/100,000, whereas endodontic instrument ingestion was around 0.001/100,000. Orthodontic appliances are less commonly aspirated but not less varied in types of involved appliances.

 Types of Foreign Bodies



Dental objects used during dental procedure and surgical procedures. These can range from teeth, instruments, to the clamp of rubber dam, restorative materials, gauze packs, and impression materials. Fixed prosthodontic appliances are the most common to ingest followed by orthodontic appliances among all dental specialties.[7],[8]

 Signs and Symptoms



This is highly variable and depends on whether it is a child or an adult. Any symptoms or signs are also largely dependent on where the object is impacted. About 75% of children who have an impacted foreign body will have it at the level of upper esophageal sphincter while roughly 70% of the adults have impaction at the level of the lower esophageal sphincter.[1],[3]

Foreign body at oropharyngeal level

Overall, about 60% of the foreign bodies become trapped at this level; patients usually have a clear sensation of something being trapped, discomfort, drooling of saliva, inability to swallow, airway compromise and also infection and perforation can also occur.[3]

Foreign body at esophageal level

In adults, there are acute sensation, vague presentation of something being struck at the center of the chest or epigastric region, dysphagia, and salivary drooling/pooling. In children, it presents with gagging, vomiting, retching, neck or throat pain, inability to feed, failure to thrive, fever, recurrent aspiration pneumonitis/pneumonia, or respiratory embarrassment/stridor (due to tracheal impingement).[1]

Foreign body at subesophageal level

It may present with no symptoms such as abdominal distension and discomfort, fever, recurrent vomiting, passing rectal blood, and melena, and other symptoms of acute or subacute intestinal obstruction may also be present.[1]

Symptoms due to gastrointestinal perforation

It present with acute mediastinitis with chest pain, dyspnea, and severe odynophagia along with signs of pneumonitis/pleural effusion and acute/subacute peritonitis.[1]

Foreign body in airway

It is an acute emergency and presents with the respiratory arrest, stridor, and classic triad of wheezing, coughing, and dyspnea.[1]

 Diagnosing Methods



Careful examination of the entire oral cavity, pharynx, larynx, and esophagus should be the initial step taken. Investigations such as abdominal and chest X-rays, endoscopy, and computed tomography scans of thorax and abdomen are the secondary diagnosing methods to be taken if necessary.[3]

 Complications



Oropharyngeal foreign bodies

Scratches and lacerations of oropharyngeal mucosaPerforationRetropharyngeal abscessSoft tissue infection and abscess.[6]

Esophageal foreign bodies

Scratches, lacerations, or abrasions of mucosaEsophageal necrosisRetropharyngeal abscessEsophageal strictureEsophageal perforation and subsequent paraesophageal abscessMediastinitisPneumothorax and pneumomediastinumPericarditis/cardiac tampanodeTracheoesophageal fistula.[6]

Gastric small intestine foreign bodies

Entrapment of object within Meckel's diverticulumPerforation leading to peritonitis and advanced sepsisAcute and subacute small intestinal obstruction.[6]

 Management



When any dental instrument is aspirated/swallowed

Act quickly to locate and remove any object that may be causing acute upper airway obstruction. Keep the patients head low, turn it to the side, ask the patient to cough, and administer sharp blows on the patients backIf an object is visible, grasp it with small forceps, or use a suction tip, being careful not to push it deeper into the throatIf it is not possible to grasp the object or if it is evident that the object is lodged in the airway (difficulty in breathing), then Heimlich maneuver may be attempted. In the Heimlich maneuver, place both hands one on top of the other, over the abdominal cavity just below the ribs, and pressed forcefully, the remaining air in the patient lungs is used to popout the obstruction. This maneuver should not be used, if there is a possibility of the foreign body being swallowedAspirations of objects into the airway are usually present a more dangerous situation than does swallowing foreign body. Aspiration into the lungs usually involves right bronchus in adults because of the anatomic configurationWhere airway obstruction is life-threatening and an object cannot be removed, then obtain urgent senior anesthetic/ear-nose-throat advice and/or consider cricothyroidectomy as a life-saving procedurePatients outside of hospital with significant airway/GI obstruction should be transferred as an emergency, in a sitting position, with a suction catheter available for them to use in removing excess saliva secretion [3]Children with upper GI obstruction and/or airway compromise should be allowed to stay in their patient's arms while being transferred to or assessed in hospital to reduce anxiety and worsening airway embarrassment.[1],[3],[5],[6],[9]

Indications of instability or a need for urgent transfer to hospital

Airway compromiseDroolingInability to swallow fluidsSepsisSuspicion of intestinal perforationEvidence of active bleedingStable patients who have swallowed small, smooth objects to have no evidence of esophageal entrapment, otherwise negative imaging with no evidence of damage, can often be managed conservatively with follow-up at 24 h or so to check that they remain well; passage of objects in stool may take days to weeks and parents should observe for their presenceA diet high in roughage and frequent ingestion of soft food items, such as banana or moistened bread, may aid in the passage of swallowed foreign object.[3]

Preventive precautions

Using rubber dam for restorationsPlacing gauze screen across the oropharynxInstruct patients to suppress the swallowing reflex and turn their head down if any object falls on tongueTreatment can be given in upright position whenever possibleTemporary restorations adequately fixed and removable appliances retainedThe acrylic used on fabrication should be of radiopaque since it will be easier to locate after ingestion.[2],[6]

 Conclusion



Early recognition of swallowed foreign bodies during any surgical or nonsurgical procedures related to oral cavity is the key to avoid catastrophic effects. Conscientious patient selection, meticulous adherence to clinical procedures, periodic inspection of instruments and appliances for were and timely replacement if warranted, appropriate use of high-volume suction during high-risk procedures, as well as proper patient education are all vital factors in prevention. In this litigious era, it is our recommendation that appropriate consideration is to be given to the inclusion of such emergencies and their management in contemporary graduate curricula.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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