Accidental swallowing of foreign objects in dentistry

JOURNAL CLUB: 

J OURNAL CLUB By M anish S. T iwari

ACCIDENTAL SWALLOWING OF FOREIGN OBJECTS IN DENTISTRY: 

A CCIDENTAL SWALLOWING OF FOREIGN OBJECTS IN DENTISTRY

Slide 3: 

F oreign bodies in the upper GI tract are usually swallowed, a ccidentally or p urposefully . Indigestible objects may be intentionally swallowed by c hildren and demented adults. Denture wearers, the elderly, and inebriated people are prone to a ccidentally swallowing inadequately masticated food (particularly meat), which may become impacted in the esophagus.

Slide 4: 

Accidental swallowing of root canal instrument during procedure due to carelessness of operator. Smugglers who p urposefully swallow drug-filled balloons, vials, or packages to escape detection may develop intestinal obstruction. The packaging may rupture, leading to drug overdose. Prisoners may swallow objects either to hide them from authorities or to seek medical care. In the case of razor blades, they often tape the sharp edge to avoid injury.

Slide 5: 

A variety of foreign bodies may enter the GI tract. Many pass spontaneously, but some become impacted, causing symptoms of obstruction. Perforation may occur. The esophagus is the most common (75%) site of impaction. Nearly all impacted objects can be removed endoscopically, but surgery is occasionally necessary.

Slide 6: 

To be considered: Intestinal perforation by a foreign body is uncommon, and normally affects the ileocecal and rectosigmoid regions, in which it is unusual to find pneumoperitoneum preoperatively. It must be considered in the differential diagnosis of such conditions as acute appendicitis and diverticulitis.

A case of swallowed dental root canal instrument : 

A case of swallowed dental root canal instrument 1.

Slide 8: 

A 77-Yearold retired engineer and presented with right upper abdominal pain for 7 years occurring during movement of the upper part of the body, especially when ironing his shirts. With the exception of selective proximal vagotomy 30 years before for peptic ulcer disease, his case history was unremarkable. Chest x-ray (posterior anterior) excluded a vertebral cause of his complaint but revealed a foreign body in the right upper abdomen.

Slide 9: 

showing foreign body in the right upper abdomen C hest x-ray

Slide 10: 

The previous 2 obviously inattentive esophagogastroduodenoscopies performed in outpatient clinic revealed only minimal Helicobactor - negative gastritis. The 3 rd esophagogastroduodenoscopies showed a needle-like foreign body sticking deep in the thickened posterior duodenal wall, protruding widely into the duodenal lumen.

Esophagogastroduodenoscopy: 

E sophagogastroduodenoscopy needle-like foreign body sticking deep in the duodenal wall

Slide 12: 

the object was removed by forceful extraction with a rat tooth forceps and identified as a dental root canal instrument, distinctly changed by gastric acid. E xtracted instrument O riginal instrument

Slide 13: 

The patient then remembered that the pain was started after a dental root canal treatment under local anesthetics. The pain was probably due to the irritation of the duodenal wall by needle while moving the upper part of the body during ironing.

Slide 14: 

Generally foreign bodies passes through the gastro intestinal tract within 1 week, but might get stuck especially when sharp. Earliest symptom is d ysphagia . An ingestion of such an instrument is extremely r are i.e. 0.12/100,000 root canal treatments.

References: 

R eferences F ields RT Jr, Schow SR. Aspiration of foreign bodies in oral and maxillofacial surgery: a review of the literature and report of five cases. J Oral Maxillofac surg 1998;56:1091-1098. S usini G, Pommel L, Camps J. Accidental ingestion and aspiration of root canal instruments and other dental foreign bodies in a French population. Int Endod J 2007;40:585-589.

A case of swallowed Dental Prosthesis : 

2. A case of swallowed D ental P rosthesis

Complete Endoscopic Sequence : 

C omplete Endoscopic Sequence Endoscopy of Dental Prothesis Found in the Jejuno This 63 year-old woman, inadvertently ingested her dental bridge at midnight, 12 hours later ask for medical assistance, a plain abdominal radiograph suggest that this foreign body is located immediately after the T reitz angle.

Plain abdominal radiograph: 

P lain abdominal radiograph Abdominal Rx suggest that this foreign body is located immediately after the Treitz angle.

Endoscopic Sequence 1 : 

E ndoscopic Sequence 1 Endoscopic view is showing the metallic object i.e. denture.

Endoscopic Sequence 2: 

E ndoscopic Sequence 2 An enteroscope was used to manipulate this prosthesis using a diathermy loop.

Endoscopic Sequence 3 : 

E ndoscopic Sequence 3

Endoscopic Sequence 4 : 

E ndoscopic Sequence 4

Endoscopic Sequence 5 : 

The Endoscopic view shows the extraction from jejunum to the mouth, here the image shows that foreign body is at the esophagus. E ndoscopic Sequence 5

Extracted Prosthesis: 

The prosthesis was a successfully managed endoscopically. Observe at the right of the dental bridge has a sharp edge. E xtracted P rosthesis

Slide 25: 

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