Effects of Accidental Swallowing of Orthodontic Appliance on Gastrointestinal Tract and Airway: An Evidence-Based Review of Case Reports

Abstract

Background: Contemporarily, the use of innovative orthodontic appliances or their components has increased for safer, quicker results, and more comfort of the patient. But, researchers rarely highlight the potential demerits of accidental ingestion of these appliances. Thus, the present study aimed to investigate the evidence-based literature on the accidental swallowing of these appliances and their effect on the gastrointestinal tract (GIT) and airway. Method: An electronic search was performed on PubMed, Medline, Scopus, The Cochrane Library, and EMBASE until April 11, 2021. Methodological quality and synthesis of case series and case report tool (MQCC) was applied to determine the quality of these case reports and series. The outcome variable was to assess its effect on airway and GIT, and methods of removal of these foreign bodies. Meta-analysis was not performed as the study included case reports and case series in which no control groups were present. Results: Out of 113 case reports and series, 29 articles were included in this systematic review. Only 31% of articles have satisfied the MQCC scale and maintained as high-quality case reports, 43% of articles were medium to high quality, and 26% designated as low quality. Conclusions: Eighty percent of the accidental ingested orthodontic appliances that pass uneventfully through the gastrointestinal system require a fiber-rich diet and laxatives. A total of 10% to 20% lacerates oral, pharyngeal, and gastrointestinal mucosa result in pain, bleeding requires laryngoscope, endoscopically and laparoscopy with use of Magill’s forceps. Only 1% of cases have presented with a high morbidity and mortality alarming for surgical removal of ingested component. Thus, the precautions to be taken to overcome such incidences are tying silk thread to activation key, use of recent bonding method, use of contrast colors of removable appliances as the color merges with mucosal color, and operator position should be 7 O′ clock.