|Year : 2011 | Volume
| Issue : 4 | Page : 336-338
Foreign body ingestion in dental practice
S Bhatnagar1, UM Das2, GD Chandan2, ST Prashanth2, L Gowda3, N Shiggaon4
1 Department of Pedodontics and Preventive Dentistry, Jodhpur Dental College General Hospital, Narnadi, Jodhpur, India
2 Department of Pedodontics and Preventive Dentistry, V. S. Dental College and Hospital, Bangalore, India
3 Department of Pedodontics and Preventive Dentistry, M R Ambedkar Dental College and Hospital, Bangalore, India
4 Department of Pedodontics and Preventive Dentistry, Rajiv Gandhi College of Dental Sciences, Bangalore, India
|Date of Web Publication||21-Oct-2011|
40 Hospital Road, C-scheme, Jaipur-302001, Rajasthan
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Most foreign bodies pass through the gastrointestinal tract uneventfully. The majority of the reported literature describes the management of ingested blunt objects. However, ingestion of sharp objects can still occur with a higher rate of perforation corresponding to treatment dilemmas. We report a case of inadvertently ingested sharp foreign body by a special child, which was retrieved by endoscopic guided forceps. Urgent endoscopic assessment and retrieval of recently ingested sharp dental foreign body is indicated and routine use of preventive measures such as rubber dam, gauze throat screens or floss ligatures is suggested.
Keywords: Aspiration, endoscopy, special child
|How to cite this article:|
Bhatnagar S, Das U M, Chandan G D, Prashanth S T, Gowda L, Shiggaon N. Foreign body ingestion in dental practice. J Indian Soc Pedod Prev Dent 2011;29:336-8
|How to cite this URL:|
Bhatnagar S, Das U M, Chandan G D, Prashanth S T, Gowda L, Shiggaon N. Foreign body ingestion in dental practice. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2019 May 22];29:336-8. Available from: http://www.jisppd.com/text.asp?2011/29/4/336/86387
| Introduction|| |
Accidental foreign body ingestion is a common clinical problem especially in children. Ingestion still occurs in adults but is often identified in elderly, mentally impaired or patients with alcohol dependency.  Although rare, ingestion or inhalation of endodontic instruments during treatment without rubber dam can result in clinical complications and subsequent legal proceedings. Grossman reported that such iatrogenic errors occurred most frequently when treating posterior mandibular teeth. 
The occurrence of an aspiration demands that a careful clinical examination be conducted and that it include obtaining radiographic studies to document the presence or absence of the object. Radiographs are the only diagnostic tool available to rule out ingestion or aspiration of a dental foreign object. These complications carry the risk of malpractice litigation against the dentist.  Use of rubber dams and gauze throat screens probably has reduced the number of these adverse events.  However, physical barrier methods alone do not completely prevent aspiration or ingestion. This report presents a case of ingestion of a hand Pro taper file in a special child during the dental treatment and discuss the available treatment options after such an accident.
| Case Report|| |
A 13-year-old female patient with an IQ level of 55 evaluated by Stanford-Binet intelligence scale was undergoing dental treatment in the Department of Pedodontics and Preventive Dentistry, VS Dental College and Hospital. Patient was able to speak and understand most of the communication needs. Patient was enrolled in a special school and was able to conduct her day to day activities without any help. She required dental treatments including some restorations and a root canal therapy for 26. In initial sittings, all the restorations were completed with patient responding to the commands of the dentist and allowing him to work in the oral cavity. After restorative procedures were finished patient was comfortable in the hospital atmosphere and was trained for dental procedures. Root canal treatment plan included multiple sittings. Patient was not allowing to put a rubber dam and was becoming uncooperative. It was decided not to use conscious sedation or general anaesthesia for the patient as patient was cooperative enough for prior treatment procedures. Rubber dam was not placed and treatment was started for the concerned tooth.
During the biomechanical preparation patient suddenly closed the mouth, due to this the file slipped from the dentist's hand and patient swallowed it. The procedure was stopped immediately and it was tried to retrieve the file from the posterior region of oral cavity, but patient had ingested the file.
There was no gagging or discomfort reported by the patient. On examination there was no evidence of airway compromise or respiratory distress suggesting passage of file into upper gastrointestinal tract. Patient was immediately admitted to emergency room for evaluation. Postero-anterior radiograph of abdomen demonstrated the presence of a sharp foreign body overlying the pyloric region at the level of T 11 vertebral body [Figure 1]. It was decided to do an oesophago-gastroscopy to retrieve the file. The patient was kept nil by the mouth with regular observation and was taken under general anaesthesia and file was removed from gastric region by endoscopic-guided forceps [Figure 2]. Patient was subsequently discharged with no complain of discomfort on follow ups.
| Discussion|| |
Ninety percent of ingested foreign bodies pass through the gastrointestinal tract uneventfully. Endodontic files have been previously reported to pass out through the gastro-intestinal system within 3-days without incident.  Approximately 10% necessitate endoscopic removal while only 1% will ever require surgical intervention.  Because of the shape and sharpness of the endodontic file, there was a high risk of perforation. Hence, once an instrument is lost into the oropharynx, it is critical to immediately determine whether it has entered the gastrointestinal or the respiratory tract. 
Through this case report I intend to throw light on the fact that special children are more prone to accidental ingestion of dental instruments and require correct diagnosis and prompt intervention. Such high risk of aspirating or ingesting dental foreign objects is because of reduced neuromuscular control and diminished patient's protective airway reflexes, resulting in their having difficulty following verbal commands from the dentist as happened in this case.
The very first step in managing such cases is accurate determination of the foreign body lodgement site. This can be done through plain radiographs, ultrasound scanning, computerised tomography, or magnetic resonance imaging. Upper and lower gastro-intestinal endoscopy and bronchoscopy can be used diagnostically as well as therapeutically.
Urgent endoscopic retrieval is indicated when there is a history of a recently ingested sharp foreign body or if clinical suspicion suggests that the object is located within the oesophagus. Hence, the common conception among dentists that feeding of cotton or banana should not be encouraged as it makes the retrieval difficult. Conservative management is advocated if the object has passed through the pylorus with serial clinical assessments including daily radiographs. If a sharp object has progressed beyond the duodenum or endoscopy has proved unsuccessful in retrieving the object, the patient should remain under strict observation with daily radiographs.  Generally, endodontic instruments that enter the gastrointestinal tract pass asymptomatically and atraumatically within 4 days to 2 weeks.  Abdominal pain and/or a positive stool occult blood test may indicate signs of intestinal perforation, impaction or obstruction; and medical or surgical intervention for removal is required in such cases.
Dentists must be aware of the risk and associated complications of accidental ingestion or aspiration of dental instruments during root canal treatments. Such potential morbidities can be avoided if under mentioned protocols are followed by the dentist during performing various dental procedures. Dentists should use rubber dams routinely instead of cotton roll isolation to prevent the patient from aspirating or ingesting dental foreign objects. Using a gauze throat screen to catch objects before they fall into the patient's posterior pharynx is another method of preventing aspiration or ingestion in cases in which a rubber dam is not warranted. Tethering small instruments or clasps with floss is yet another way to prevent aspiration or ingestion of foreign objects. 
| Conclusions|| |
The clinical implication of this case report includes Urgent endoscopic assessment and retrieval of recently ingested sharp dental foreign body and routine use of preventive measures such as rubber dam, gauze throat screens or floss ligatures.
| References|| |
|1.||Pavlidis TE, Marakis GN, Triantafyllou A, Psarras K, Kontoulis TM, Sakantamis AK. Management of ingested foreign bodies: How justifiable is a waiting policy? Surg Laparosc Endosc Percutan Tech 2008;18:286-7. |
|2.||Grossman LI. Endodontic Practice. 8th ed. Philadellphia: Lea and Febiger; 1974. p. 151-8. |
|3.||Seals ML, Andry JM, Kellar PN. Pulmonary aspiration of a metal casting: Report of case. J Am Dent Assoc 1988;117:587-8. |
|4.||Fields RT Jr, Schow SR. Aspiration and ingestion of foreign bodies in oral and maxillofacial surgery: A review of the literature and report of five cases. J Oral Maxillofac Surg 1998;56:1091-8. |
|5.||Kuo SC, Chen YL. Accidental swallowing of an endodontic file. Int Endod J 2008;41:617-22. |
|6.||Rosenberg R. Hazards of endodontics without the rubber dam: Reports of three cases. Ann Dent 1965;24:29-32. |
|7.||Dhandapani RG, Kumar S, O'Donnell ME, McNaboe T, Cranley B, Blake G. Dental root canal treatment complicated by foreign body ingestion: A case report. Cases J 2009;2:117. |
|8.||Govila CP. Accidental swallowing of an endodontic instrument. A report of two cases. Oral Surg Oral Med Oral Pathol 1979;48:269-71. |
|9.||Wilcox CW, Wilwerding TM. Aid for preventing aspiration/ingestion of single crowns. J Prosthet Dent 1999;81:370-1. |
[Figure 1], [Figure 2]