It is possible, though uncommon, for a person to swallow a mouthguard, which is a protective dental device. While mouthguards are usually fitted securely to prevent accidental swallowing, smaller dental appliances or a cracked or ill-fitting mouthguard can potentially be ingested.
Swallowing Versus Aspiration
When a foreign object is accidentally ingested, it can follow one of two paths: the digestive tract or the airway. This distinction is important because one scenario is far more dangerous than the other. Swallowing means the mouthguard has traveled down the esophagus and entered the stomach, which is the less urgent situation. Aspiration means the object has mistakenly entered the trachea, moving toward the lungs. This is an immediate medical emergency that can result in partial or complete airway obstruction.
Symptoms of aspiration are abrupt and severe. These include persistent, forceful coughing, difficulty breathing, wheezing, or a change in skin color, such as blue lips. If any signs of respiratory distress are present, immediate emergency medical services must be contacted.
Immediate Steps and Medical Assessment
Assuming no immediate signs of aspiration or choking are present, seek prompt medical attention, typically at an emergency room or urgent care facility. Even if the person feels fine, a swallowed foreign body can cause internal injury or create a blockage that is not immediately symptomatic. The medical team will first gather a detailed patient history, including the type of mouthguard, when the event occurred, and any symptoms experienced.
The primary tool for initial assessment is diagnostic imaging, most often an X-ray. Since mouthguards are typically made of plastic polymers, they are not naturally visible on an X-ray, which usually highlights dense materials like bone or metal. However, the medical team uses the X-ray to look for signs of obstruction or perforation in the chest or abdomen, or for small radiopaque components some dental devices may contain.
The doctor’s goal is to determine the object’s exact location, whether it is lodged in the esophagus, has passed into the stomach, or is moving through the small intestines. If the object is confirmed to be in the esophagus, it is often removed urgently, usually within 24 hours, because impaction can lead to complications. Once the object has passed into the stomach, the management strategy shifts to a more conservative approach.
Expectant Management and Resolution
If the mouthguard is confirmed via imaging to be in the stomach or lower gastrointestinal tract, and the patient is asymptomatic, a strategy known as “expectant management” is often employed. This approach involves monitoring the patient while waiting for the object to pass naturally through the digestive system and out of the body in the stool. This process typically takes 24 to 48 hours, but it may take several days depending on the individual’s bowel habits.
During this period, the patient is instructed to monitor for specific warning signs that would indicate an obstruction or complication. These concerning symptoms include:
- Persistent abdominal pain.
- Vomiting that does not stop.
- The presence of blood in the stool.
- An inability to pass gas or have a bowel movement.
The majority of blunt, ingested foreign objects will pass without incident.
If the object does not pass after a certain period, or if the patient develops signs of obstruction or internal injury, endoscopic or surgical removal may become necessary. Endoscopic procedures use a flexible tube with a camera inserted through the mouth to retrieve the object from the upper gastrointestinal tract. Surgical intervention is rarely required, typically only if the object is causing a severe complication like perforation.