Accidental Ingestion of Instruments in Pediatric Dental Patients: Report of Three Cases

Abstract

Very young children are at risk of swallowing or aspirating numerous household things. This risk is enhanced during dental procedures of these children as they tend to be very unco-operative due to their age and lack of maturity to understand the importance of the treatment. Use of physical barriers, sedation or general anesthesia is not practically possible in every child scheduled for dental treatment. Dentist must be able to manage emergency situations in which patients accidentally swallow dental instruments or materials during treatment and procedures. This article presents ingestion of dental objects in 3 children and attempts to discuss the management and prevention of such mishaps. 1 young children, and especially peaks in children aged six months to three years. In adults, it occurs accidentally more commonly among those with psychiatric disorder, mental retardation, and altered consciousness associated with 2 intravenous sedation. Swallowing of dental materials and devices may lead to serious complication during dental treatment. Any object routinely placed into or removed from the oral cavity during dental or surgical procedures can be aspirated or swallowed. These items can include teeth, restorations, restorative materials, instruments, implant parts, 3-7 rubber dam clamps, gauze packs and impression materials. The incidence of aspiration or swallowing of foreign bodies of dental origin varies considerably in the literature. Tamura 8 et al (1996) in a review reported the range being 3.6-27.7 % of all foreign bodies. The majority of foreign bodies that reach the gastrointestinal tract pass spontaneously. However, 10-20% of cases require nonsurgical intervention, while 1% or less may require surgery. Patients swallowing foreign bodies are usually asymptomatic but symptoms may arise later. Foreign body aspiration or ingestion may cause damage to gastric mucosa, septic abscess, intestinal perforations, partial or complete airway obstruction, post obstructive pneumonia, respiratory distress, pnuemothorax or 9-11 haemorrhage. If these cases are not properly managed and 12 timely intervention is not carried out, it can be lethal. Therefore, pediatric as well as general dental practitioners should be aware of a protocol of management and prevention of swallowing or aspiration of dental objects.