Protect Your Patients from Accidental Ingestion of a Foreign Body

Accidentally Losing Control of an Object into the Oropharynx

The risk of accidentally losing control of an object into the oropharynx during a clinical procedure is a known risk of dental treatment. There are inherent challenges associated with dental procedures that can lead to this risk, including:

• Working with small, slippery objects
• Maneuvering in a confined space
• A sudden unexpected patient movement
• Patients often being in the supine position
  
  

An Ounce of Prevention

Protecting patients from this known complication is the hallmark of a responsible and prudent dentist. Failing to implement various preventive measures places the practitioner in a position where it could be argued that there has been a breach of duty if this unfortunate complication were to occur.

Taking these precautions may help mitigate the probability of this happening:

• Use of a rubber dam, or some form of a throat screening device, and a floss ligature
• Proper positioning of the patient
• An awareness of certain patient-related factors such as a strong gag reflex
• Utilization of four-handed dentistry with effective high-speed evacuation
• Adequate maintenance of rotary instruments
• An inspection of all instruments for signs of excessive wear or damage

It makes sense that failing to take every reasonable precaution increases the likelihood of this complication. Discuss with the patient the potential for losing control of an object in advance. This could alert them and enable them to “catch” the object or spit it out before a problem arises. Even with the best protocols, complications can occur, so be prepared.

Always Be Prepared

If such a complication occurs, swift and decisive action is necessary. Establish a plan and discuss it with your team. If the patient is experiencing immediate distress, such as throat obstruction, dyspnea, choking, labored breathing, or cyanosis, do the following:

• Call 911!
• After alerting 911, attempt to dislodge the foreign body with the Heimlich maneuver or by altering the patient's position.
• Comfort the patient, explain the situation, and, without hesitation, refer the patient to the emergency room for a radiographic examination to locate the object's exact position. 

The location of the foreign body should not be assumed; it is difficult or impossible to determine with certainty where the object has gone. Advice suggesting that it will probably pass and sending the patient home is not recommended. The problem with this advice is that it speculates that the object has entered the digestive system while disregarding the possibility that it may have been aspirated. Be empathetic and monitor the patient's progress in seeking medical resolution for the complication. 

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The information contained on the DentistCare Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. All information contained on the blog is subject to change.