Mystery of the missing denture: an unusual cause of respiratory arrest in a nonagenarian

Abstract

To ask older people about loose or ill-fitting dentures is not common practice during a hospital admission. Our patient presented to the emergency department following a primary respiratory arrest. A dislodged denture was extracted from the hypo-pharynx under local anaesthesia and was presumably the cause of the respiratory arrest. Any delays in finding the missing denture and its extraction could have resulted in the patient being given a general anaesthetic and its associated complications. We suggest that asking about loose-fitting dentures should form part of comprehensive geriatric assessment.

Interventions for edentate elders – what is the evidence?

“…Physiological decline is further accelerated when neurodegenerative pathologies such as dementia are present, and the probability of denture use is known to be significantly reduced in cognitively impaired institutionalised patients. Although rare, it is possible to aspirate complete dentures. Brill concludes in his classic paper from 1959 that ‘we may even venture upon the conclusion that muscle activity transcends in importance all other factors responsible for denture retention, at least in those cases where the bony foundation of a lower denture is greatly resorbed’.…”

Dislocated dental bridge covering the larynx: usefulness of tracheal tube guides under video-assisted laryngoscopy for induction of general anesthesia, thus avoiding tracheostomy

“…Previous report mentioned that dentures need re-aligning or replacement with the passage of time and ongoing gum remodeling [ 3 ]. Loose dentures are relatively easy to dislodge and can cause life threatening airway obstruction [ 4 ]. Despite a large number of older people using dentures, assessment of loose-fitting dentures is not common practice, and is largely left to the discretion of patients and their dentists [ 4 ].…”

“…Loose dentures are relatively easy to dislodge and can cause life threatening airway obstruction [ 4 ]. Despite a large number of older people using dentures, assessment of loose-fitting dentures is not common practice, and is largely left to the discretion of patients and their dentists [ 4 ]. Particularly in older patients suffering from dementia, enquiries about loose-fitting dentures should be an integral part of comprehensive geriatric assessment, to prevent their dentures becoming dislodged.…”

“…Aspiration or ingestion of dentures with a fixed bridge potentially results in serious morbidity because, in addition to the edge of the bridge traumatizing the lining mucosa, it can cause airway obstruction [ 1 - 3 ]. Supra- or subglottic denture-related foreign bodies of dentures, while relatively uncommon, have been reported to present with acute life-threatening upper airway obstruction, necessitate tracheotomy [ 4 ]. We herein report a case of a dislodged dental bridge with clasps covering the vocal cords, in a patient who was successfully intubated using a tube introducer under video-assisted laryngoscopy, followed by removal of the dentures under general anesthesia.…”

Management of preventative care for an ageing population

“…A large proportion of the elderly population suffers from dysphagia and has swallowing problems. Figure 7 shows a denture that has been aspirated 18 . This is clearly possible, even if it is often claimed that a denture is too big.…”