Accidental ingestion or aspiration of a dental instrument is a rare but serious event. This incident occurs when a small instrument, component, or restoration is accidentally dropped or dislodged, disappearing into the back of the throat. The object is either swallowed (entering the digestive tract) or inhaled (entering the respiratory tract). Recognizing the difference between these two paths is the most important step in managing the situation.
Immediate Action: Airway Assessment and Stabilization
Determining if the patient’s airway is compromised is the primary concern when a dental instrument is lost. Inhaling an object, known as aspiration, is a medical emergency that can lead to life-threatening complications like complete airway obstruction. Signs of aspiration include coughing, choking, difficulty breathing, or the inability to speak.
If the patient exhibits these symptoms, emergency medical services must be contacted immediately. Life-saving measures, such as the Heimlich maneuver, should be performed if a complete blockage is suspected. If the patient is asymptomatic (showing no signs of distress), the object has likely been swallowed, or ingested, but a medical examination is still mandatory. Even if the patient appears fine, they should be referred to an emergency department for imaging to confirm the object’s location, as aspiration can sometimes be asymptomatic initially.
Factors Influencing Risk After Ingestion
Once a dental instrument is confirmed to have entered the gastrointestinal (GI) tract, the risk depends on the object’s physical characteristics. The instrument’s shape and size are the two most significant factors. Objects with sharp points, edges, or hooks, such as endodontic files or scaler tips, pose a greater risk of injuring the delicate lining of the esophagus or intestines.
These sharp objects can potentially lodge in the GI tract, increasing the risk of mucosal injury or perforation. The object’s material is also important. Metal instruments are radiopaque, meaning they are visible on standard X-ray imaging. Radiolucent materials, like some plastics or composite filling material, may require different imaging techniques to locate.
The Conservative Approach: Monitoring Safe Passage
Most accidentally ingested dental instruments pass through the digestive system without causing problems. This common outcome allows for a conservative management approach, monitoring the object’s natural passage through the body. The first action is obtaining plain frontal and lateral X-rays of the chest and abdomen to confirm the instrument’s exact location and rule out aspiration.
If the object is located in the stomach or intestines and is not large or sharp, the patient is usually sent home with instructions for careful monitoring. They must observe their stool to confirm the object’s excretion, which typically occurs within four days to two weeks, though passage can take up to 40 days. The patient must also watch for signs that indicate a complication, such as new or worsening abdominal pain, persistent vomiting, fever, or bloody stool.
If any of these symptoms appear during monitoring, it signals a potential issue like intestinal obstruction or perforation, requiring immediate medical attention. Follow-up X-rays may be performed to track the instrument’s movement, especially if it remains stationary for more than a week. The decision to continue monitoring or to intervene is re-evaluated based on the object’s progress and the patient’s overall well-being.
When Intervention is Required
Medical intervention becomes necessary if the object stalls, is high-risk, or causes symptoms. Any sharp or pointed instrument lodged in the esophagus requires immediate removal due to the high risk of perforation. The preferred non-surgical method for removing objects from the upper GI tract is endoscopy, which uses a flexible tube with a camera and grasping tools passed down the throat.
Endoscopy is highly successful, often exceeding 90% success for removing dental objects from the stomach and upper intestine. This method is also used if a blunt object remains stationary for more than a week or causes obstruction symptoms. Surgical intervention is reserved for the most serious and rare cases, such as when the instrument causes intestinal wall perforation or cannot be removed successfully by endoscopic techniques.