Accidental ingestion of a dental object during a periodontal surgical procedure on an IV sedated patient: Case management

Abstract

Introduction

Foreign-body aspiration (FBA) and ingestion (FBI) are rare but serious events that occur in dental offices throughout the world every year. Such events can have significant medical, legal, and financial consequences for both the dental clinician and the patient. By presenting this case study, we aim to highlight the proper management and possible sequelae of such an event.

Methods and Results

A 72-year-old woman underwent a dental procedure with intravenous sedation. In the process of dental treatment, a dental bur was accidentally ingested. The patient was promptly referred to an urgent care clinic, where serial abdominal radiographs were taken over several days to track the course of the bur through the digestive system. The bur was successfully removed without complication.

Conclusion

Prompt management and referral of dental FBA and FBI cases, followed by successful object retrieval, lead to uncomplicated resolution of the event.

Key points

Why is this case new information?

• This case presents the proper management of the FBA and FBI, particularly for IV sedated patients who require immediate action to mitigate and prevent serious complications.

What are the keys to the successful management of this case and how can the risk of FBA and FBI be mitigated?

• The use of throat packs or rubber dams helps prevent foreign body aspiration and ingestion.
• Attaching floss to appliances and objects when appliances are used intraorally. (Specifically, to implant guide pins and implant screwdrivers.)
• Thorough isolation of the oropharynx from the mouth using a barrier, such as a gauze pad or rubber dam, during bracket placement, orthodontic appliance adjustment, and screwing or cementing of implant crowns
• Short and extra short implants should be connected by ligature to the implant handpiece.

What are the primary limitations to success in this case?

• Lack of a throat pack
• Failure to confirm connection of bur to handpiece
• Patient's anatomy (redundant colon) preventing natural expulsion of the bur