Accidentally swallowing a dental crown is a common occurrence, often happening when the adhesive bond fails during eating or sleeping. A dental crown is a tooth-shaped cap designed to restore a damaged tooth. Its materials are typically inert and non-toxic, including porcelain, ceramic, gold, or other metal alloys. Though the size and shape can vary, a crown is generally small enough to be ingested, and the majority pass through the body without issue.
Immediate Risk of Airway Obstruction
The most immediate risk of swallowing anything is aspiration, where the object enters the airway instead of the esophagus. The trachea is located right next to the esophagus, and a crown can accidentally be inhaled. If the crown partially or fully blocks the airway, it causes symptoms like sudden choking, severe coughing, or an inability to speak or breathe.
If the crown has entered the lung (bronchial tree), the danger remains high. It can lead to pneumonia, lung collapse, or infection if not removed promptly. Adults with neurological conditions, poor dentition, or those who have consumed alcohol are at a higher risk for aspiration. Any sign of acute respiratory distress, such as wheezing or noisy breathing, requires immediate medical attention.
How the Digestive System Handles Foreign Objects
Once the crown enters the esophagus, the object moves into the gastrointestinal (GI) tract. The stomach contains strong acids, but the inert materials of dental crowns are not corroded or dissolved. The crown remains whole and non-toxic as it travels through the body.
Muscular contractions of the digestive tract, known as peristalsis, propel the crown along the intestines. For most small, blunt objects, the passage is uneventful, typically taking 24 hours to about a week to be excreted. In most adult cases, the crown will pass spontaneously without medical intervention.
Specific Risks of Gastrointestinal Injury
While most crowns pass without incident, there is a small potential for them to cause injury within the GI tract, especially if the crown is fractured or has sharp edges. The crown may become lodged in areas of natural narrowing, such as the upper or lower esophageal sphincters, the pylorus, or the ileocecal valve, which connects the small and large intestines. This impaction can cause an obstruction, leading to persistent abdominal pain and vomiting.
A more serious, though rare, complication is perforation, where a sharp edge of the crown punctures the wall of the esophagus or intestine. If this occurs, it can lead to internal bleeding, infection, and a life-threatening condition called peritonitis. Crowns that are larger than two centimeters in width or five centimeters in length in adults are considered high-risk for causing an obstruction.
Recognizing When Medical Intervention is Necessary
After swallowing a crown, monitor your symptoms closely. Seek immediate medical care if you experience persistent vomiting, severe and localized abdominal pain, or blood in your stool or vomit. A high fever, indicating infection or perforation, necessitates urgent attention.
Medical professionals will often begin with an X-ray to confirm the crown’s location, as most crown materials are radiopaque. If the crown is lodged in the esophagus, an emergent endoscopic procedure is often required to remove it within 24 hours to prevent complications. If the crown is in the stomach and you are asymptomatic, the doctor may advise conservative management, which involves checking your stools for the object’s passage.