Endoscopic retrieval of an accidentally ingested bur during a dental procedure: a case report

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Accidental ingestion of a dental bur during the dental procedure is a rare, but a potentially serious complication. Early recognition and foreign body retrieval is essential to prevent adverse patient outcomes.

Case presentation

A 76-year old male patient, presented to the department with a chief complaint of sensitivity in his upper right back tooth due to attrition. After assessing the pulp status, root canal therapy was planned for the tooth. During the procedure, it was noticed that the dental bur slipped out of the hand piece and the patient had accidentally ingested it. The patient was conscious and had no trouble while breathing at the time of ingestion of the bur although he had mild cough which lasted for a short duration. The dental procedure was aborted immediately and the patient was taken to the hospital for emergency care. The presence and location of the dental bur was confirmed using chest and abdominal x-rays and it was subsequently retrieved by esophagogastroduodenoscopy (EGD) procedure under general anaesthesia on the same day as a part of the emergency procedure. The analysis of this case reaffirms the importance of the use of physical barriers such as rubber dams and gauze screens as precautionary measures to prevent such incidents from occurring.

Conclusion

Ingestion of instruments are uncertain and hazardous complications to encounter during a dental procedure. The need for physical barrier like rubber dam is mandatory for all dental procedures. However, the dentist should be well trained to handle such medical emergencies and reassure the patient by taking them into confidence. Each incident encountered should be thoroughly documented to supply adequate guidance for treatment aspects. This would fulfil the professional responsibilities of the dentist/ clinician and may help avoid possible legal and ethical issues. This case report emphasizes on the need for the usage of physical barriers during dental procedures in order to avoid medical emergencies.

Related collections

Most cited references 17

Record: found
Abstract: found
Article: not found

Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

Michael Birk, Peter Bauerfeind, Pierre Deprez … (2016)

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the removal of foreign bodies in the upper gastrointestinal tract in adults. Recommendations Nonendoscopic measures 1 ESGE recommends diagnostic evaluation based on the patient's history and symptoms. ESGE recommends a physical examination focused on the patient's general condition and to assess signs of any complications (strong recommendation, low quality evidence). 2 ESGE does not recommend radiological evaluation for patients with nonbony food bolus impaction without complications. We recommend plain radiography to assess the presence, location, size, configuration, and number of ingested foreign bodies if ingestion of radiopaque objects is suspected or type of object is unknown (strong recommendation, low quality evidence). 3 ESGE recommends computed tomography (CT) scan in all patients with suspected perforation or other complication that may require surgery (strong recommendation, low quality evidence). 4 ESGE does not recommend barium swallow, because of the risk of aspiration and worsening of the endoscopic visualization (strong recommendation, low quality evidence). 5 ESGE recommends clinical observation without the need for endoscopic removal for management of asymptomatic patients with ingestion of blunt and small objects (except batteries and magnets). If feasible, outpatient management is appropriate (strong recommendation, low quality evidence). 6 ESGE recommends close observation in asymptomatic individuals who have concealed packets of drugs by swallowing ("body packing"). We recommend against endoscopic retrieval. We recommend surgical referral in cases of suspected packet rupture, failure of packets to progress, or intestinal obstruction (strong recommendation, low quality evidence). Endoscopic measures 7 ESGE recommends emergent (preferably within 2 hours, but at the latest within 6 hours) therapeutic esophagogastroduodenoscopy for foreign bodies inducing complete esophageal obstruction, and for sharp-pointed objects or batteries in the esophagus. We recommend urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for other esophageal foreign bodies without complete obstruction (strong recommendation, low quality evidence). 8 ESGE suggests treatment of food bolus impaction in the esophagus by gently pushing the bolus into the stomach. If this procedure is not successful, retrieval should be considered (weak recommendation, low quality evidence). The effectiveness of medical treatment of esophageal food bolus impaction is debated. It is therefore recommended, that medical treatment should not delay endoscopy (strong recommendation, low quality evidence). 9 In cases of food bolus impaction, ESGE recommends a diagnostic work-up for potential underlying disease, including histological evaluation, in addition to therapeutic endoscopy (strong recommendation, low quality evidence). 10 ESGE recommends urgent (within 24 hours) therapeutic esophagogastroduodenoscopy for foreign bodies in the stomach such as sharp-pointed objects, magnets, batteries and large/long objects. We suggest nonurgent (within 72 hours) therapeutic esophagogastroduodenoscopy for medium-sized blunt foreign bodies in the stomach (strong recommendation, low quality evidence). 11 ESGE recommends the use of a protective device in order to avoid esophagogastric/pharyngeal damage and aspiration during endoscopic extraction of sharp-pointed foreign bodies. Endotracheal intubation should be considered in the case of high risk of aspiration (strong recommendation, low quality evidence). 12 ESGE suggests the use of suitable extraction devices according to the type and location of the ingested foreign body (weak recommendation, low quality evidence). 13 After successful and uncomplicated endoscopic removal of ingested foreign bodies, ESGE suggests that the patient may be discharged. If foreign bodies are not or cannot be removed, a case-by-case approach depending on the size and type of the foreign body is suggested (weak recommendation, low quality evidence).

0 comments Cited 128 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Conservative management of ingested foreign bodies.

Steven Weiland, Michael J. Schurr (2015)

We reviewed the clinical benefits of hospitalization, esophagogastroduodenoscopy, and surgical intervention for ingested foreign bodies in adults. Patients with esophageal foreign bodies were not included in the study group. A 10-year experience is reported. Each patient's physical examination findings at presentation, white blood cell count, length of hospital stay, number and types of foreign bodies ingested, endoscopic interventions, surgical interventions, and complications were reviewed. There were 75 separate hospitalizations, all occurring in 22 male prison inmates. A total of 256 foreign bodies were ingested. Patients incurred 281 hospitalization days (average 3.7 days per admission). One patient had signs of peritonitis. White blood cell count was less than 10 K/microL in 85%. Sixty-four endoscopies were performed with removal of 79 of 163 foreign bodies (48% success rate). Five patients required general anesthesia because of a lack of cooperation. Complications occurred in four of them, one requiring laparotomy. Eight additional laparotomies were performed. One was performed for an acute abdomen on admission and one for the development of an acute abdomen after conservative management. Two were performed to remove metal bezoars. Four additional laparotomies were performed because of surgeon preference. Among the 23 patients admitted and managed conservatively, 77 (97%) of 79 foreign bodies passed spontaneously. One patient required laparotomy. Of the 256 ingested foreign bodies, 79 were removed endoscopically, 71 were removed surgically, and 106 passed spontaneously. The size, shape, and number were not predictive of the ability to transit the gastrointestinal tract. Foreign body ingestion is problematic in prison inmates. With conservative management, most foreign bodies will pass spontaneously. Endoscopy has a high failure rate and is associated with significant complications. Surgical intervention should be reserved for those who have acute conditions in the abdomen or large bezoars.

0 comments Cited 33 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Foreign body aspiration in dentistry: a review.

W Whitlock, Gary M. Tabor, Richard S. Cameron (1996)

This article reviews the dangers of aspirating foreign bodies of dental origin. Two illustrative cases are presented, including an unusual case involving aspiration of an elastomeric impression material. The authors describe the techniques used to identify the foreign body. A radiodensimetric study of four impression materials demonstrates the difficulty of identifying most impression materials. The authors also present some strategies for reducing the risk of aspiration during dental procedures.

0 comments Cited 23 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Keerthana Kunaparaju:

ORCID: https://orcid.org/0000-0001-5197-0961

drkeerthana7495@gmail.com

Karthik Shetty:

ORCID: https://orcid.org/0000-0002-1901-4029

karthik.shetty@manipal.edu

Vinod Jathanna:

ORCID: https://orcid.org/0000-0003-0524-1594

vinod.jathanna@manipal.edu

Kartik Nath:

ORCID: https://orcid.org/0000-0003-3393-7919

kartik.nath014@gmail.com

Roma M:

ORCID: https://orcid.org/0000-0003-4159-1233

roma.m@manipal.edu

Journal

Journal ID (nlm-ta): Patient Saf Surg

Journal ID (iso-abbrev): Patient Saf Surg

Title: Patient Safety in Surgery

Publisher: BioMed Central (London )

ISSN (Electronic): 1754-9493

Publication date (Electronic): 5 January 2021

Publication date PMC-release: 5 January 2021

Publication date Collection: 2021

Volume: 15

Electronic Location Identifier: 1

Affiliations

[1 ]GRID grid.411639.8, ISNI 0000 0001 0571 5193, Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, , Affiliated to Manipal Academy of Higher Education, Manipal, ; Karnataka, India

[2 ]GRID grid.480482.2, Faculty of Dentistry, Department of Conservative Dentistry and Endodontics, , Melaka Manipal Medical College, ; Manipal, India

Author information

Keerthana Kunaparaju https://orcid.org/0000-0001-5197-0961

Karthik Shetty https://orcid.org/0000-0002-1901-4029

Vinod Jathanna https://orcid.org/0000-0003-0524-1594

Kartik Nath https://orcid.org/0000-0003-3393-7919

Roma M https://orcid.org/0000-0003-4159-1233

Article

Publisher ID: 273

DOI: 10.1186/s13037-020-00273-3

PMC ID: 7786993

PubMed ID: 33402200

SO-VID: 04623985-b862-4bd5-ad51-8719a5952e5b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 9 November 2020

Date accepted : 3 December 2020

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: foreign body,dental bur,rubber dam,esophagogastroduodenoscopy (egd)

Data availability:

ScienceOpen disciplines: Surgery

Keywords: foreign body, dental bur, rubber dam, esophagogastroduodenoscopy (egd)

Endoscopic retrieval of an accidentally ingested bur during a dental procedure: a case report

Read this article at

Abstract

Background

Case presentation

Conclusion

Related collections

ScienceOpen Clinical Case Reports Collection

Most cited references 17

Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

Conservative management of ingested foreign bodies.

Foreign body aspiration in dentistry: a review.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 157

Cited by 14

Most referenced authors 129