Jill Bashutski, DDS, MS, FRCD(C); Michelle Budd, D.D.S, Patient Safety Consultant, dentalcorp; Julian Perez, Vice President, Risk Management & Compliance, dentalcorp
In oral healthcare, ingestion or aspiration of foreign objects are significant iatrogenic events. These mishaps are by their very nature unexpected, and successful prevention and management are key to minimizing potential adverse consequences. While relatively rare, dental literature is filled with reports of ingested or aspirated dental burs, implant components, endodontic files, amalgam fragments, crowns, extracted teeth, pins, posts, rubber dam clamps, impression materials, and many more. Clinicians who practice long enough are likely to encounter this type of event at some point in their career and so knowledge of management strategies for these situations is essential.
Whenever possible, it is important to take precautionary measures to prevent such incidents – the use of rubber dams is one of the most effective forms of prevention. The use of gauze screens, floss ligatures, and modified chair positions are other commonly employed methods of reducing patient risk.
While prevention is far better than a cure, it is still vital to be prepared to manage the situation if accidental ingestion or aspiration occurs. In the majority of cases, ingested objects pass through the GI tract within a few days without repercussion. Still, in as many as 20% of cases of accidental ingestion, some form of intervention may be necessary, especially with sharper objects where there is increased risk of gastrointestinal perforation. Accidental aspiration of an object is a more significant patient safety incident. Thankfully, due to the body’s own protective measures like protective swallowing, it is also less common.
Even though most foreign objects that are accidentally ingested are passed without consequence, this should still be treated as a medical emergency. There is no definitive way to know whether the object was ingested or aspirated while in a dental clinical setting. Therefore, prompt and effective medical attention is required even when the patient exhibits no signs of respiratory distress and seems asymptomatic after ingesting a foreign object.
What to do in the event of accidental ingestion/aspiration:
- The clinical team should remain calm, stop treatment, and immediately disclose the matter to the patient. If the patient is in respiratory distress, encourage them to cough and follow basic life support emergency protocols, including calling 911 as needed
- The patient should promptly attend the hospital (preferably accompanied by a staff member) for investigations such as chest and/or abdominal x-rays to determine the location of the lost object;
- The responsible clinician should follow up with the patient until the object has passed, or the medical issue is otherwise resolved. If the patient is admitted to the hospital, a call or visit to the hospital may be appreciated;
- The event must be documented in the patient record, including any referrals and recommendations made. An incident report should be filed with the local provincial college or governing organization;
- The responsible clinician should follow any advisements from their governing organization as well as contact his/her risk manager and/or professional malpractice carrier for advice;
- If the patient safety incident involved the malfunction of a product, the manufacturer and supplier should be promptly notified in case a recall is required.