Accidental aspiration/ingestion of foreign bodies in dentistry: A clinical and legal perspective

Abstract

The potential of foreign body aspiration or ingestion is a worldwide health problem in dentistry. The general dental practitioners should be extremely attentive in handling of minor instruments during any intervention related to the oral cavity, especially in the supine or semi-recumbent position of the patient. Aspiration cases are usually more critical and less common than ingestion. We report a case of iatrogenic aspiration of an endodontic broach, which gets disclosed during the recording of past dental history of the patient. The patient was asymptomatic during that time. A quick posterior-anterior chest radiograph was taken which revealed the presence of broach in the lower lobe of the left lung. The patient was immediately referred to the pulmonary medicine department where the fiberoptic bronchoscope retrieval was planned, and the same was carried out successfully under local anesthesia. Although such accidents have rare occurrence, the associated risks and morbidity are too high to be overlooked, especially from the viewpoint of special care, resources, and the associated financial cost required for their management. Moreover, practitioners are also liable for malpractice litigation given the fact that such cases are avoidable. This article also discusses relevant review literature, risk factors, symptoms, and management of such iatrogenic accidents along with drawing attention to the significance of preventive measures and their role in avoiding meritorious legal and ethical issues.

An All‐Zirconia Crown Discovered 2 Years Following Aspiration

“…Generally if no symptoms of airway obstruction caused by the foreign body are observed, the first step is to confirm the location of the foreign body by taking immediate radiographic examination of cervical spine, thorax, and abdomen. Then measures such as inspecting stools until expulsion or retrieving the foreign bodies by bronchoscopy can be taken . In this instance, the dentist lacked knowledge of the management of accidental ingestion or aspiration, did not realize that patients with aspiration of foreign bodies could be asymptomatic, and thus surmised the crown was ingested by the patient without conformational imagining and instructed the patient to watch his stool for a week.…”

“…Nevertheless, the guidelines for standard management set by any specialist national organization are templates, not legal mandates. The court will finally decide whether the dentist is negligent if the patient prosecutes …”

“…Accidental aspiration and ingestion of dental prostheses and instruments can occur during dental treatment, as most dental procedures are performed with the patient in a supine position or semi‐recumbent position . Furthermore, salivary contact of a dental prosthesis can make the prosthesis slippery, thus even more difficult to handle in an already limited oral cavity working space . It has been reported that 80% of these accidents are ingestion, and the remaining 20% are aspiration .…”

Ingestion and aspiration of foreign bodies in dental practice

“…9 Szczególnie groźne są aspiracje, które często prowadzą do dalszego leczenia szpitalnego, a także połknięcia ostrych przedmiotów, mogących uszkadzać poszczególne odcinki przewodu pokarmowego. 1,10 Pilnej interwencji wymaga również połknięcie dużego przedmiotu, którego pasaż przez cały przewód pokarmowy jest niemożliwy. 11,12 Należy pamiętać, że opisywane komplikacje nie występują jedynie podczas wizyty w gabinecie dentystycznym, ale także w dowolnym czasie, nawet po wielu latach od zaistnienia takiej sytuacji połknięcia ciała obcego przez pacjenta.…”

“…9 Particularly dangerous are aspirations, which often lead to further hospital treatment, as well as swallowing sharp objects that may damage individual sections of the gastrointestinal tract. 1,10 The ingestion of large object, whose passage through the entire digestive tract is impossible, also requires urgent intervention. 11,12 It should be remembered that the complications described above may not occur only during a visit to the dentist's office, but also at any time, even after many years from the occurrence of such a situation like ingestion by the patient.…”