From Molars to Bronchus; The Tale of an Aspirated Dental Instrument.

Abstract

Background: Aspiration of dental instruments is a rare event that carries potentially serious complications when it occurs, especially in older patients, where protective reflexes are diminished. Clinical management may be difficult because of the risk of granulation tissue and different retrieval strategies according to the object's characteristics. In this report, we describe the case of an 84-year-old man who aspirated a dental bur during a routine dental procedure, necessitating immediate intervention. Timely and precise management was essential to avert severe complications.

Case presentation: During a routine dental procedure, an 84-year-old man aspirated a bud-shaped cross-cut carbide dental bur. Despite initial stability, within an hour he developed a cough and hemoptysis. A chest X-ray confirmed the presence of the foreign body in the right mainstem bronchus. After administering intravenous methylprednisolone, bronchoscopy was conducted using a flexible scope and laryngeal mask airway. Initial attempts at retrieval with forceps were unsuccessful, but the subsequent use of a foreign body "grabber" led to successful and intact removal of the bur. The patient recovered swiftly post-procedure and was discharged within a few hours.

Conclusion: Swift bronchoscopic intervention is vital in managing aspirated dental instruments, especially in older patients. This case highlights the significance of preventive measures in clinical dentistry, using rubber dams and throat packs along with clear emergency protocols. The importance of timely identification and management is also equally emphasized. Furthermore, the administration of corticosteroids played a crucial role in this case by mitigating inflammation and preventing granulation tissue formation, and facilitating successful retrieval. Incorporating the use of corticosteroids for the management of aspirated dental instruments has the potential for better outcomes and fewer complications, particularly when used in older patients with weakened airway defense mechanisms.