SUBMITTED BY

V.SIBI PRIYA
CRRI
INTRODUCTION
 Ingestion of foreign bodies is most commonly a
problem in young children.
 In adults,occurs accidentally among those with
psychiatric disorder,mental retardation,use of local
anesthetic,altered consciousness associated with
intravenous sedation.
 Swallowing of dental materials and devices may lead
to serious complication.
`
 Foreign body aspiration may cause damage to gastric
mucosa septic abscess,intestinal perforations,airway
obstruction.
 If these cases are not properly managed,it can be lethal
 Therefore general dental practitioners should be aware
of protocol of management & prevention of
swallowing of aspiration of dental objects.
INCIDENCE
 Aspiration –rare in adults.
 27% dental bridges reported to be aspirated.
 Orthodontic appliances,endodontic files,components
of loose dentures 2nd most commonly ingested items.
 Cast or pre fabricated restorations which are to be
cemented have higher chances of aspiration.
TYPES OF FOREIGN BODIES
 These items can include teeth,restorations,restorative
materrials,instruments,implant parts,rubber dam
clamps,gauze packs,impression materials
 Fixed prosthodontic appliances are the most common
to ingest followed by orthodontic appliances
SIGNS AND SYMPTOMS
 Highly variable & depends upon whether it is a child or
adult.
 About 75% of children will have it at the level of upper
oesophageal sphincter
 While 70% have at the level of the lower oesophageal
sphincter.
AT OROPHARYNGEAL LEVEL
 60% trapped.
 have clear sensation of something being
trapped,discomfort,drooling of saliva,difficult to
swallow,airway obstruction,perforation,infection.
 AT OESOPHAGEAL LEVEL
 adults-acute sensation,vague presentation of
something struck at the center of the
chest,dysphagia,salivary drooping.
 children-gaging,vomitting,retching,neck/ throat
pain,fever,recurrent aspiration
AT SUBESOPHAGEAL LEVEL
symptoms of acute or sub acute intestinal obstruction
 DUE TO GASTROINTESTINAL PERFORATION
Present with acute mediastinitis with chest
pain,dyspnea,severe odynophagia along with signs of
pneumonitis/pleural effusion and acute/sub acute
peritonitis.
FOREIGN BODY IN AIRWAY
Acute emergency
respiratory arrest,stridor,classic triad of
wheezing,coughing,dyspnea.
DIAGNOSTIC METHODS
 Careful examination of the entire
cavity,pharynx,larynx,oesophagus-initial step.
 Investigations –abdominal & chest x ray,endoscopy,CT
scan of thorax & abdomen
COMPLICATIONS
 Scratches and lacerations,perforation,retropharyngeal
abscess,soft tissue infection & abscess.esophageal
necrosis,pneumothorax
 GASTRIC SMALL INTESTINE FOREIGN BODIES
 Entrapment of object within meckel’s diverticulum
 Perforation leading to peritonitis & advanced sepsis
 Acute &subacute small intestinal obstruction.
MANAGEMENT
 Act quickly to locate / remove object causing acute upper
airway obstruction.
 Keep the patients head low,turn to side,ask to cough,sharp
blows on patients back.
 If object is visible,grasp it with small forceps/suction tip
but not to push deep.
 If not possible to grasp,then HEIMLICH MANEUVER,place
both hands one on top of other,over abdominal cavity just
below the ribs,pressed forcefully,remaining air is popped
out.
 Aspirations of objects into the airway-dangerous
obstruction. Then obtain urgent senior anesthetic/ear
nose throat advice / cricothyroidectomy as a life saving
procedure.
 Patients with airway / GI obstruction transferred as an
emergency in a sitting position,with a suction catheter
to remove excess saliva excretion.
INDICATIONS FOR URGENT
TRANSFER
 Airway compromise
 Drooling
 Inability to swallow fluids
 Sepsis
 Intestinal perforation
PREVENTIVE PRECAUTIONS
 Using rubber dam for restorations.
 Place gauze screen across the oropharynx.
 Instruct patients to suppress the swallowing reflex &
turn their head down if any object falls on tongue.
 Treatment can be given in upright position
 Acrylic used on fabrication should be of radiopaque
since it will be easier to locate after ingestion.
CONCLUSIONS
 Early recognition of swallowed foreign bodies during
any surgical / non surgical procedures related to oral
cavity is the key to avoid catastrophic effects.
 Conscientious patient selection,meticulous adherence
to clinical procedures,periodic inspection of
instruments.
REFERENCES
 REVIEW ARTICLE: INTERNATIONAL JOURNAL OF
PEDODONTIC REHABILITATION VOL 3 ISSUE 1
JANUARY –JUNE 2018 BY VISHNU PRASAD.