c a s e r e p o r t
Dental Impression Material:
A Rare Cause of Small-Bowel Obstruction
Lemuel Dent, MD; Analeta Peterson; Danica Pruett, MD; Derrick Beech, MD
Small-bowel obstruction due to foreign bodies is unusual in
adults. Intestinal obstruction is occasionally caused by pits,
bezoars, endoscopy capsules, and gastrostomy tube but-
tons. We report a rare case of distal small-bowel obstruc-
tion due to dental impression material. Avoidance of this
potentially life-threatening complication may be achieved
by increased vigilance in accounting for all impression
material when dental impression trays are removed. Early
detection of swallowed dental material may afford endo-
scopic removal from the stomach, thus preventing intestinal
obstruction.
Keywords: intestines n obstruction
J Natl Med Assoc. 2009;101:1295-1296
Author Affiliations: Department of Surgery (Drs Dent, Pruett, and Beech; Ms
Peterson), Meharry Medical College, Nashville, Tennessee.
Corresponding Author: Lemuel Dent, MD FACS, 1005 Dr D.B. Todd Blvd,
Nashville, TN 37208 (ldent@mmc.edu).
Case report
A
67-year-old female presented to the emergency
room complaining of a 1-day history of increas-
ing abdominal pain, abdomen distension, and
nausea. She stated that she had anorexia and obstipa-
tion, but denied fever or dysuria. Her past medical his-
tory is significant for an open cholecystectomy and a
hysterectomy. In 1999 she suffered a left cerebral vascu-
lar accident with residual right-sided weakness and dys-
arthria, but no dysphagia. She also has hypertension and
hyperlipidemia. Her medications included furosemide,
enalapril, nifedipine, simvastatin, warfarin, amantidine,
famotidine, sertraline, and gabepentin.
Examination revealed that she was afebrile, with blood
pressure 117/61 mm Hg and pulse of 80/min. She was
alert and oriented but had difficulty speaking. Her abdo-
men was moderately distended, and she had surgical scars
in the right subcostal and the lower midline regions. Bowel
sounds were hypoactive. She was tender in the right lower
quadrant with rebound. No masses or hernias were noted.
The remainder of her exam was unremarkable.
Laboratory evaluation revealed a white blood cell
count of 9.75103/ml. Plain abdominal radiographs
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
showed nonspecific gas pattern with scant air fluid lev-
els, suggesting early small-bowel obstruction or ady-
namic ileus. A curvilinear density was noted projecting
over the right lower quadrant consistent with a foreign
body (Figure 1). A noncontrast CT scan of the abdomen
confirmed an elongated enhancing foreign body located
in the distal small bowel (Figure 2).
Additional history from the patient’s family revealed
that the patient had visited the dentist within the past
few days for adjustment of her dentures. The dentist
stated that a polysulfide-based impression material was
used to fit her dentures.
She underwent emergent laparotomy to relieve the
obstruction and remove the foreign body. There were
dense adhesions from previous surgical procedures,
which made the dissection challenging. A 5-cm segment
of distal ileum containing the foreign body was slightly
edematous without perforation or ischemia. The foreign
body was advanced to normal bowel and removed via a
small enterotomy followed by primary repair. The for-
eign body was a rubbery, cylindrical structure measur-
ing 6.05150.8 cm and consistent with dental impression
material. Postoperatively she did well, with the return of
bowel function within 1 week. Her diet was slowly
advanced, and she was discharged to home on postoper-
ative day 8.
Discussion
To our knowledge there has been only 1 previous
report of small bowel obstruction due to swallowing of
dental impression material.1 The polysulfide-based den-
tal impression material (Permlastic, Orange, California)
used in this patient contains lead dioxide. The high con-
centration of lead afforded good visualization on radio-
graphic evaluation and assisted with the diagnosis.
Intestinal complications from swallowed dental material
are rare. There is a report from England regarding an
appendicitis caused by a class II amalgam restoration.2 It
was thought that the amalgam obstructed the appendi-
ceal orifice leading to appendicitis.
The most common causes of small-bowel obstruc-
tion are postoperative adhesions, hernias, and malignant
tumors. Occasional causes of intestinal obstruction due
to foreign bodies in adults are pits,3 bezoars,4 endoscopy
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Small Bowel Obstruction
capsules,5 and gastrostomy tube internal flanges.6 Intes-
tinal obstruction due to foreign bodies such as coins and
toys are most commonly seen in children.7
Most ingested foreign bodies pass through the gas-
trointestinal tract without event. This patient had dense
adhesions from previous surgeries, thus reducing the
compliance of the terminal ileum and increasing the risk
Figure 1. Foreign Body in Right Lower Quadrant
Figure 2. Enhancing Foreign Body in Lumen of
Distal Small Bowel
1296 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
of intestinal obstruction. This has been seen previously
in patients with Crohn’s disease and narrowing of the
terminal ileum who present with obstruction due to fruit
pits8 or gastrostomy tube flanges.6 The distal ileum, a
common site of small-bowel obstruction, was the loca-
tion of obstruction in our patient.
This patient’s radiographs were not impressive for
high-grade obstruction. She had minimal air-fluid levels,
and there was air in the distal colon, suggesting a partial
small-bowel obstruction. Early operation was decided
upon due to the patient’s clinical exam, which was nota-
ble for rebound tenderness in the right lower quadrant.
This strategy is supported by the literature since patients
with clinical signs such as fever leukocytosis, peritonitis,
tachycardia, metabolic acidosis and continuous pain will
have compromised bowel 45% of the time.9
Bowel obstruction is a rare but potentially life-threat-
ening consequence of swallowed dental impressions.
Patients and their dental health providers should be
warned about the potential for dislodgement and swal-
lowing of such materials. A careful inspection of the
impression trays to account for missing impression mate-
rial may identify potential ingestions. Early identification
of ingestions may permit removal via endoscopy, thus
avoiding intestinal obstruction or perforation. As the
number of older patients with dentures increases, it is
likely that more of theses cases will be seen. It is expected
that the 10% decline in edentulism over the past 3 decades
will be more than offset by the 79% increase in the adult
population older than 55.10 The development of dental
impression material that can be digested in the stomach
would help prevent this complication.
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