Prevention and management of accidental foreign body ingestion and aspiration in orthodontic practice

Abstract

Among the myriad emergencies that could arise in the dental clinical setting there are a few that occur occasionally despite being entirely preventable. Ingestion or aspiration of dental materials, appliances, or instruments comprises this category. Regardless of incidence, foreign body ingestion or aspiration episodes are recognized as potential complications in the specialty of orthodontics. Despite their infrequent occurrence, the morbidity from a single incident and the amount of specialty medical care that may be needed to manage such incidents is too high to ignore. There is also the associated risk of malpractice litigation given the fact that these incidents are preventable. At present, no clear guidelines exist regarding prevention of this emergency in practice. This article attempts to review relevant literature and aims to formulate certain recommendations based on best available evidence to minimize the incidence of such events, while also suggesting guidelines toward making their management more effective. A flow chart outlining management options and strategies to aid the clinician in the event of such an emergency is also presented.

Spontaneous expulsion and migration of a bronchial foreign body: A flustering rare dental accident

“…Spontaneous expulsion of a foreign body occurs even more rarely in approximately 1-2% of cases. Thus, it is not recognized by physicians [1][2][3]. Although few cases of spontaneous expulsion have been described in literature, it is generally not focused on or studied; this may be why it is not reported [2,[4][5][6].…”

“…Accidental aspiration of foreign bodies during dental procedure does occur in extreme rare occasions [3]. In addition to its physical strain, the event is confusing for both patients and dentists.…”

“…Dental materials are mostly inorganic and likely to be expelled spontaneously, depending on its shape. When it occurs, the expelled objects are teeth, dentures, dental prostheses, dental instruments, and broken orthodontic appliances, which are sharp, large, and long, metallic materials; thus, they can be more hazardous [3]. This aspect of a dental accident must be addressed so dentists and emergency physicians can avoid additional complications.…”

Foreign body ingestion in a pediatric patient: Report of case and review of ingestion\aspiration incident management

“…All the necessary precautions have to be taken during dental procedures thus minimizing such incidents. [5] Many methods have been suggested for prevention of aspiration or inhalation of the foreign objects. During endodontic therapy rubber dam placement is most advised as it prevents the inhalation and aspiration and also leave a stress free environment, which provides complete infection control.…”

“…Orthodontic appliances or components loose dentures are the second most commonly ingested objects in adults. [5] Cast or prefabricated restorations, which are to be cemented have a higher chance of aspiration (Kurkciyan et al, 1996). Ingestion of foreign objects was observed during root canal treatment around 0.12 per 100000, whereas endodontic instrument ingestion was around 0.001 per 100,000.…”