The MDDUS have issued a statement warning of the dangers of patients accidentally swallowing dental instruments. Emergency assessment is required when an object is inhaled, but swallowing an instrument can be just as dangerous.
MDDUS dental adviser Claire Renton said: “Swallowing a crown or amalgam could pose a reduced risk to the patient but for endodontic instruments such as hand files or fractured tips of dental instruments such as scalers, patients should be referred to hospital immediately for assessment.
“MDDUS has dealt with cases where patients have swallowed an endodontic instrument or the fractured sharp end of an ultrasonic scaler during a scale and polish and even parts of faulty handpieces. While all professionals should be aware of the seriousness of inhaling objects, some believe that there is no need to refer a patient who ingests a dental instrument.
“However, in these cases, the practitioner should explain to the patient that they need to be examined and assessed at the hospital as a precaution.
“While swallowing an object may pose a reduced risk, a medical practitioner should be the one making the judgement and so the patient should be referred to A&E, complete with letter containing their dental history.
“It may be beneficial to provide an identical object to help the doctor with their assessment. This gives the doctor sufficient information to judge whether a ‘watch and wait’ approach can be adopted or if surgery is required to retrieve the object before it does harm to the gut.
“Practitioners should make a clear note of the incident in the patient’s records, outlining the treatment given and whether a referral was made.”
Dentists can reduce the risk in the first instance by using rubber dam where appropriate, for example, during restorative and endodontic procedures. “Some dentists might be tempted to access a canal with a file without rubber dam as they find it difficult to place or believe they can work just as effectively without it,” says Mrs Renton.
“We have encountered cases where patients have swallowed a dental instrument during root canal treatment when no rubber dam was used. One of the most important functions of rubber dam is airway protection and unfortunately there is simply no defence for an inhaled or swallowed file during root canal treatment performed with no rubber dam in place.”
Practitioners should also ensure equipment is in good condition and regularly checked. “All equipment should be handled and stored carefully to avoid potential breakage,” adds Mrs Renton.