CaseReport
Ajit Auluck
Rajeev Desai
Accidental Swallowing of a
Prosthesis
Abstract: Fixed prostheses are commonly made in routine dental practice. However, accidental swallowing of these is an infrequent
emergency in dental clinics. We report a case in which the patient accidentally swallowed a 5-unit fixed denture and review the immediate
steps as well as preventive measures to be taken by dentists to avoid such a situation.
Clinical Relevance: Dentists must be able to manage emergency situations in which patients accidentally swallow dental instruments
during treatment.
Dent Update 2008; 35: 577-579
In routine dental practice instruments
are regularly placed into or removed
from the oral cavity during dental
treatment procedures. These items may
include artificial teeth, cast restorations,
restorative materials, endodontic burs
or rubber dam clamps. Accidental
swallowing or aspiration of these
foreign bodies can cause damage to
gastric mucosa, septic abscess, intestinal
perforation, complete or partial airway
obstruction, post obstructive pneumonia,
respiratory distress, pneumothorax
or haemorrhage.1 If these cases are
not properly managed and timely
intervention is not carried out, then it
can even lead to the death of a patient.1,2
Therefore, general dental practitioners
Dr Ajit Auluck, MDS, PhD student
Clinician Scientist/ Dentist British
Columbia Oral Cancer Prevention
Program and Faculty of Dentistry
University of British Columbia, Room No.
2-119, 675 West 10th Avenue, Vancouver,
BC, Canada V5Z 1L3 and Rajeev Desai,
MDS, Professor, Department of Oral
Pathology, Dr DY Patil Dental College &
Hospital, Pimpri, Pune, India.
October 2008
pg577-579 Accidental swallowing.indd 1
should be aware of a protocol for not
only management, but also prevention
of swallowing or the aspiration of
dental objects.
Case report
A 48-year-old patient, a case
of squamous cell carcinoma of the right
buccal mucosa, was advised to have
his fixed partial prosthesis removed
prior to radiation therapy. He had been
wearing this fixed prosthesis for the
past 12 years. The patient had limited
mouth opening of about 2 cm as the
squamous cell carcinoma had infiltrated
into the retromolar region and involved
muscles of mastication. Therefore, this
presented difficulty in removing the
fixed prosthesis from his mouth.
The patient attended his
general dental practitioner to have the
prosthesis removed. However, when this
was attempted, it accidentally slipped
into the pharynx and the patient
started choking. The GDP uprighted
the chair immediately (from the supine
position). Meanwhile, the patient
drank water from a glass kept near the
chairside and swallowed the bridge.
Fortunately, the bridge did not lodge
in his throat and the patient swallowed
the bridge without difficulty. He was
referred to the emergency department
of the hospital.
Thirty hours after swallowing
the denture, an abdominal x-ray was
taken which showed the presence
of a 5-unit bridge in the large
intestine (Figure 1). As the patient
was asymptomatic and not willing
to undergo surgery, he was advised
to attend for a routine follow-up.
Fortunately, the denture was passed
through the faeces after 4 days without
any complications.
Discussion
There are many reports
in the literature which describe
accidental ingestion or aspiration of
dental instruments, restorations and
prostheses during dental treatment.3-7
Any patient may swallow or aspirate
foreign objects, but the risk is greater
in elderly patients and those under the
effect of narcotics, sedation or nitrous
oxide because of diminished protective
reflexes.8 Recently a case has been
reported in which a patient aspirated a
2-unit bridge during deep sleep1 and a
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 CaseReport
Figure 1. Abdominal x-ray showing a 5-unit bridge in the large intestine.
radiographic plate became lodged in the
upper aerodigestive tract of a patient
during routine dental examination.9
Therefore, it is apparent that any patient
can aspirate or swallow a foreign body
and GDPs must be careful, not only
while working in clinics, but should
also instruct patients while delivering
prostheses.
There is no consensus in the
literature regarding the position of the
patient to minimize the risk of foreign
body aspiration. Neuhauser10 suggested
that patients in a supine position are
more or less prevented from swallowing
prostheses. Barkmeier11 et al stated that
the supine position increases the risk
578 DentalUpdate
pg577-579 Accidental swallowing.indd 2
of swallowing and aspiration. But it is
evident, from recently reported cases,1,9
that foreign bodies can be aspirated in
any patient position. In this case, the
patient swallowed the denture in the
upright position after being raised from a
supine position.
When any dental instrument
or object is lost into the oropharynx
during dental treatment, the following
steps should be taken:
Keep the patients head low, turn it to
the side, and ask the patient to cough.
Administer sharp blows to the patients
back;
If the object is visible, grasp it with
small forceps, or use a suction tip, being
careful not to push it deeper into the
throat;
If it is not possible to grasp the object,
or if it is clear that the object is lodged in
the airway (as evidenced by difficulty in
breathing), the Heimlich manoeuvre may
be attempted.
In the Heimlich manoeuvre,
place both hands one on top of the other,
over the abdominal cavity just below
the ribs and press forcefully, using the
remaining air in the patients lungs to
pop out the obstruction. This manoeuvre
should not be used if there is a possibility
of the foreign body being swallowed.
To do so may result in injury to the
oesophagus or stomach, particularly if the
October 2008
1/10/08 14:58:32

objects are sharp. If respiratory distress
is severe, the GDP should immediately
call for emergency services. Until then,
the GDP must administer artificial
respiration, and if these procedures
fail, the patient should be referred to
a hospital where tracheotomy can be
performed under specialist care.
Aspiration of objects
into the airway usually presents a
more dangerous situation than does
swallowing. Foreign body aspiration
of dental origin usually involves the
right bronchus in adults because of
the anatomic configuration.1 It can
lead to laryngospasm, asphyxia, lung
abscess and pneumonia. Aspirated
teeth or dental prostheses carry with
them bacteria and oropharyngeal
secretions that create a risk of lung
abscess, emphysema and even death.1,12
Bronchoscopy is the method of choice
for the retrieval of foreign bodies.
However, if this fails, the patient must
undergo thoractomy or bronchotomy,
with these procedures being performed
by a specialist in a hospital. If a
foreign body is aspirated, then it is the
responsibility of the GDP to ask for
radiographic evaluation and refer the
patient to a specialist. Foreign bodies
may be obscured by the relatively
radio-opaque mediastinal structures, so
GDPs, together with radiologists, must
evaluate the chest X-ray for detecting
any aspirated dental foreign body.1
GDPs must use barrier
techniques, such as rubber dam and
throat shields, to prevent the aspiration
of foreign bodies by patients. For
endodontic treatment, the use of rubber
dam is mandatory.
A swallowed foreign body
may pass harmlessly through the
gastrointestinal tract within a few days,
or it may cause intestinal obstruction,
infection, perforation and peritonitis.13
Swallowing of a fixed bridge also
represents a serious medical situation
because the edges of the bridge
may traumatize the lining gastric
mucosa.13 A diet high in roughage
and frequent ingestion of soft food
items, like banana or moistened bread,
may aid in the passage of swallowed
foreign objects. If the object fails
to pass through the digestive tract,
October 2008
pg577-579 Accidental swallowing.indd 3
surgery may be necessary to remove
it. However, almost 90% of ingested
objects pass uneventfully within 2 to
12 days, and the remaining 10% may be
involved in impaction, septic abscess,
or perforation of the gastrointestinal
tract.14 In our case, the swallowed 5-unit
bridge passed in the faeces without any
complications.
A length of dental floss
should be tied to objects, such as rubber
dam clamps and fixed partial dentures
(during try in), so that these objects
can be retrieved if they accidentally slip
in the oral cavity. GDPs may also place
temporary loops on cast restorations for
threading the restoration with dental
floss.7 However, this can only be done
for castings of two or more units and
single crowns may be a problem. Jacob
and Shillenberg suggested the use of a
safety ring for a single fixed prosthesis
to which floss can be tied.15 Just prior
to cementation, the ring is removed
and the crown is polished. Alternatively,
dentists can use a 4x4 inch gauze
protective barrier in the oral cavity distal
to the area where small items are being
manipulated.
In the case reported here,
ideally dental floss should have been
tied around the fixed prosthesis prior
to its attempted removal. This would
have facilitated the retrieval of the
prosthesis when it became dislodged
and prevented the trauma which the
already ill patient suffered.
In summary, GDPs should
be aware of a protocol for not only the
management of swallowed or aspirated
dental foreign bodies, but should also
take the necessary steps to prevent
such emergencies happening in the first
place.
References
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DentalUpdate 579
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