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With our patients generally supine, there is always the risk of dental instruments and materials being swallowed or even inhaled. When this happens, there may be an immediate danger to the airway. Subsequently, the patient may face an unpleasant procedure to remove the item if it gets lodged in the airway or does not pass through the digestive tract.
The use of a dental dam is a well-recognised strategy not only to maximise the quality and predictability of outcomes during dental treatment, but also as a means of controlling the risk of inhaling or ingesting any of the instruments and materials used in the mouth.
Although a dental dam is routinely advised for endodontic procedures, it is not routinely used for other dental procedures such as restorative dentistry, prosthodontics, orthodontics or implant dentistry. All these procedures result in small items being placed in the mouth with an associated element of risk. Although the risk is small, if something goes wrong the event can be very distressing for the patient and the dental team. Should the offending item become lodged deep in the lungs, subsequent retrieval can involve major surgery.
The list of surprising bits and pieces that have recently been found in patients’ guts or airways includes:
cast post and core
crowns
veneers
inlays
implant healing caps
orthodontic wire, bands, and brackets
copper rings
dental burs
a denture clasp
ultrasonic scaler tip
the ‘screwdriver’ for an intra-oral screw post system
Be seen to act and don’t abandon patients – if this patient had not been so well cared for (just told that they might want to go to hospital and not contacted again) then a regulatory complaint would be much more likely to occur.
Adverse incidents occur – how we manage them will influence the outcome. If possible, follow up with a meeting to ensure all the patient’s concerns are addressed and the patient is reassured.
