Accidental ingestion of a dental instrument is a rare but serious event that can occur during various procedures, necessitating an immediate and structured medical response. The instruments most commonly involved are small, such as endodontic files, burs, crowns, or implant components, which can slip from the working area into the back of the throat. The typical medical protocol is well-established to ensure patient safety and the eventual safe retrieval or passage of the item. This management process prioritizes a careful assessment to confirm the object’s location and determine the least invasive path for its resolution.
Initial Response and Patient Stabilization
The first step upon losing sight of a dental instrument is determining whether the patient has ingested it (swallowed) or aspirated it (inhaled into the lungs). Aspiration is a life-threatening emergency, often indicated by sudden, violent coughing, choking, labored breathing, or a change in voice, requiring immediate activation of emergency medical services and airway management. If the patient is talking, breathing comfortably, and showing no signs of respiratory distress, the object is presumed to have passed into the digestive tract.
Once aspiration is ruled out, the dental procedure must be stopped, and the patient should be calmly reassured. The patient must be sat upright, which helps prevent the object from entering the airway, and instructed not to eat or drink anything. The dental team must document the exact size, shape, and type of instrument swallowed, as this information is crucial for the subsequent medical team. The patient is then immediately transferred to an emergency medical facility for urgent diagnostic imaging and further medical management.
Determining the Instrument’s Location
Upon arrival at the emergency department, medical professionals initiate diagnostic procedures to pinpoint the instrument’s exact location. Plain film radiography (X-ray) is the standard first-line imaging technique. Since dental materials frequently contain metals, they are typically radiopaque, showing up clearly on an X-ray image for easy visualization.
A series of X-rays, including the chest, neck, and abdomen, confirm the object is in the gastrointestinal (GI) tract and not the lungs. The chest X-ray is important to rule out the instrument lodging in the bronchial tree. Once the location is confirmed, its size, orientation, and shape are assessed to predict the likelihood of safe, spontaneous passage. If the instrument is not easily visible or if soft tissue injury is suspected, a computed tomography (CT) scan may be used for a more detailed view.
Treatment Pathways and Removal Methods
Management follows two primary pathways: expectant management or active intervention, based on the object’s characteristics and location. Expectant management is the most common approach, as 80 to 90 percent of ingested foreign bodies pass safely through the GI tract without intervention. This passive monitoring is chosen for small, blunt objects that have entered the stomach and for patients who remain asymptomatic.
Patients under expectant management are usually discharged with instructions to monitor their stools for the instrument’s passage, a process that can take days to several weeks. They are often advised to return for follow-up X-rays to track the object’s progress. Intervention becomes necessary if the instrument lodges in a non-gastric location, such as the esophagus, or if it is a sharp object, like an endodontic file.
Active removal is primarily performed using endoscopy, a minimally invasive procedure where a flexible tube with a camera and grasping tools is passed through the mouth. An upper endoscopy is the preferred method for removing objects lodged in the esophagus or stomach, offering a high success rate. This procedure is performed urgently if the object is stuck in the esophagus, as this location carries a higher risk of complications. Surgical intervention, involving open abdominal surgery, is reserved for extremely rare circumstances where the object has caused a perforation or an intestinal obstruction unmanageable endoscopically.
Risks Associated with Foreign Body Ingestion
While most ingested dental instruments pass without incident, specific risks necessitate the structured medical protocol. If an object passes into the lungs, the primary danger is airway obstruction, which is life-threatening, or subsequent respiratory complications like pneumonia. Once the instrument is confirmed to be in the GI tract, the main concerns shift to injury or obstruction along the digestive pathway.
Sharp or pointed objects, such as broken burs or endodontic files, pose a higher risk because they can become impacted or pierce the mucosal lining. Perforation is the most feared complication, where the instrument creates a hole in the stomach or intestine wall, potentially leading to a severe infection called peritonitis. Obstruction occurs when a larger object becomes trapped in a narrow area, such as the pylorus or the ileocecal valve, causing pain, vomiting, and abdominal distension. Prompt diagnosis and management result in a high success rate for safe resolution.