Swallowing a brace bracket can be a frightening experience, but it is a relatively common occurrence during orthodontic treatment. A brace bracket is a small piece of metal or ceramic bonded to the tooth surface. The small size and composition of these items mean they often pass through the body without issue. This guide explains the difference between a serious airway concern and the more common digestive tract passage, offering clear guidance on what to do next.
Immediate Assessment: Airway vs. Digestive Tract
The first step after a bracket is swallowed is to determine its path, which is either into the airway or the digestive tract. If the bracket has been inhaled and is lodged in the trachea or lungs, it presents an immediate medical crisis. Symptoms of airway obstruction include persistent coughing, wheezing, gasping for breath, or difficulty speaking.
Any sign of breathing distress requires an immediate call to emergency services. This indicates the bracket has gone “down the wrong pipe,” which is a form of aspiration that can be extremely dangerous and life-threatening. If the person is breathing normally, the bracket has almost certainly passed into the esophagus, and the concern shifts to the gastrointestinal system.
If breathing is unimpaired, the situation is usually not an emergency, but monitoring remains important. Trying to induce vomiting is not recommended, as it can cause the bracket to scratch the esophagus or get lodged on the way back up. The main focus immediately after swallowing is confirming the bracket did not enter the respiratory system before proceeding to the next steps.
The Expected Path Through the Digestive System
In the majority of cases, a swallowed brace bracket travels smoothly through the gastrointestinal tract. Brackets are made from durable materials like stainless steel or ceramic, which are resistant to stomach acid and will not dissolve during passage. The object moves from the stomach into the small intestine and then the large intestine, propelled by the muscular contractions known as peristalsis.
Once the bracket reaches the stomach, it has a high probability of passing without complication. The process typically takes between two and seven days, though some sources suggest it can be as quick as 24 to 48 hours, depending on individual digestive speed. The small size of the bracket allows it to navigate the tight turns of the intestines successfully.
While monitoring is not necessary, some people choose to check their stool to confirm the bracket’s passage. If you choose to do this, consuming a high-fiber diet, such as whole-grain bread or mashed potatoes, may help encapsulate the bracket and encourage its movement. Once the bracket is observed, the immediate concern is resolved.
Warning Signs and Medical Intervention
Although most brackets pass uneventfully, it is important to watch for specific warning signs that indicate a complication has occurred. If the bracket becomes lodged or causes injury, symptoms will typically begin within a few days. These signs require immediate medical attention:
- The patient experiences persistent and severe abdominal pain, chest pain, or lasting discomfort in the throat.
- Vomiting occurs, especially if the vomit contains blood.
- Blood is observed in the stool.
- A fever or chills develops, which can suggest a rare but serious infection or perforation of the gastrointestinal tract.
If any of these symptoms appear, an emergency room visit is necessary. Medical professionals will typically begin by using diagnostic tools like an X-ray to locate the bracket, as its metal composition makes it radiopaque and easily visible.
Removal Procedures
If the bracket is lodged in the esophagus, it is usually removed via an endoscopy. This is a non-surgical procedure where a flexible tube with a camera is inserted through the mouth to retrieve the object. If the bracket has passed into the stomach but is causing symptoms, an upper endoscopy may still be used for retrieval.
If the bracket is causing an obstruction further down in the lower intestines, a colonoscopy may be performed. Alternatively, the patient may simply be monitored for spontaneous passage. Endoscopic removal is always preferred over surgical intervention, which is reserved only for the rarest cases where the bracket has caused a perforation or cannot be retrieved non-surgically. After the immediate health concern is resolved, the patient should contact their orthodontist to have the missing bracket replaced.