A night guard (occlusal splint) is a custom-fitted dental appliance worn over the teeth, typically during sleep, to prevent damage from teeth grinding (bruxism) or clenching. Although these devices are generally too large to pass easily, accidental ingestion or aspiration is possible, though rare. If the guard becomes dislodged during the night, it presents a risk of entering the airway or the digestive tract.
Mechanisms of Accidental Ingestion
The most common factor contributing to a night guard being swallowed is a poor or compromised fit. An appliance that is loose, incorrectly sized, or not custom-made is far more likely to become dislodged from the teeth during deep sleep. Over-the-counter “boil-and-bite” guards, which lack the precise fit of a custom appliance, may shift more easily, increasing the risk of accidental swallowing.
Smaller appliances, such as the NTI-tss splint which only covers the two front teeth, have been reported in case studies as having a higher risk for ingestion or aspiration. Furthermore, the natural deterioration of any night guard over time can create a hazard. Cracks or significant wear can cause pieces of the material to break off, which are much smaller and easier to accidentally swallow than the whole appliance.
Immediate Consequences and Symptoms
When a night guard is accidentally swallowed, the consequences depend on whether the appliance enters the airway (aspiration) or the digestive tract (ingestion). Aspiration, where the guard or a piece of it enters the lungs, is the most dangerous outcome and requires immediate emergency medical attention. Symptoms of aspiration include a sudden, persistent cough, difficulty speaking or breathing, wheezing, and in severe cases, a bluish tint to the skin (cyanosis).
Ingestion into the digestive tract is more common and less immediately life-threatening, though complications are possible. The immediate sensation may include feeling like something is stuck in the throat or chest, often accompanied by minor discomfort. Most non-sharp foreign objects pass through the digestive system naturally, typically within 24 to 48 hours. However, the complex shape and size of a full-arch night guard can create a risk of obstruction or, in rare cases, perforation, especially if the object is sharp or jagged.
What to Do If Ingestion Occurs
The immediate action required depends on the presence of aspiration symptoms. If the person is experiencing difficulty breathing, choking, or a persistent cough, call emergency services immediately, as this indicates a potential airway obstruction. In this emergency scenario, the priority is to maintain the patient’s airway until professional medical help arrives.
If ingestion is suspected but the person is breathing normally, they should seek medical assessment immediately. Even if symptoms are mild, a medical consultation is necessary to locate the night guard and determine the appropriate course of action. Diagnostic procedures, such as frontal and lateral X-rays, are used to locate the object and confirm its path.
If the guard is lodged in the esophagus, it usually requires prompt endoscopic removal, often within 24 hours, to prevent ulceration or perforation. If the object has successfully passed into the stomach and the patient remains asymptomatic, a “wait and see” approach is often adopted. Close monitoring, including follow-up imaging and checking stool for passage of the object, is necessary to ensure it does not cause a future obstruction in the intestines.
Preventing Loss or Swallowing
Ensuring the night guard is custom-fitted by a dentist minimizes the risk of accidental ingestion. A well-fitting appliance is designed to clip securely onto the teeth, making spontaneous dislodgement less likely. Regular dental check-ups are important to assess the guard’s fit and integrity, as the shape of the mouth can change over time.
The appliance should be inspected frequently for signs of damage like cracks, chips, or thinning, and replaced immediately if deterioration is noted. Proper storage is a simple preventive measure; keeping the guard in its case when not in use prevents it from being misplaced or accidentally accessed by pets or children.