Mercedes Gallas Torreira, Stomatology Department, Faculty of Medicine and Dentistry, Rua Entrerríos, S/N, Santiago de Compostela, C.P. 15782, A Coruña, Spain. Tel.: +34 981 563100 ext 12354 Fax: +34 981 562226 E-mail: email@example.com
Unnoticed swallowing of a unilateral removable partial denture
Objective: This paper presents a case report about an unnoticed swallowing of a partial denture impacted in the esophagus in a 74-year old man without serious complications.
Background data: Dental prostheses (removable/fixed dental prostheses or fragments of dentures) appear to constitute a significant proportion of swallowed of impacted foreign bodies in the orolaryngopharynx.
Conclusion: This case emphazises that is advisable to contraindicate this type of unilateral removable partial denture to replace teeth as temporary or definitive dental prosthesis.
Unnoticed swallowing of a dental prosthesis is not uncommon in the adult population. Swallowing of foreign bodies in the orolaryngopharynx is a relatively common incident. The most frequent foreign bodies impacted in the oesophagus of adult people are fish or chicken bones, while for the trachea, they are usually some form of fruit seed or nut. The incidence of an impacted foreign body of dental origin is unknown. Abdullah et al.1 reported in 1998 a study of 200 patients with a known history of an impacted foreign body in trachea or oesophagus. In this paper, dental prostheses accounted for 11.5% of the cases. The delay in diagnosis can result in a significant morbidity. Most of the foreign bodies entering the oropharynx will pass into the alimentary canal without incidence; however, retained foreign body can lead to significant edema, obstruction and/or perforation, which can have very serious consequences including death. If the swallowed prosthesis is a unilateral partial removable denture, the presence of clasps to retain the denture has a high risk of perforation of the oesophagus or bowel.
This article presents a case report of an unnoticed swallowing of a partial denture in a 74-year-old man without serious complications.
A 74-year-old male patient was referred to the Department of Thoracic Surgery of our hospital with the diagnosis of a foreign body lodged in the superior-third of the oesophagus. The patient had no background history of any significant or important medical problems. He did not remember the episode of choking, but he presented ‘some discomfort’ and dysphagia for solids 15 days before, noticing the disappearance of the removable denture in the mouth. He was in good physical and mental health. A preliminary diagnosis of foreign body in the oesophagus was made at the referral hospital with a chest radiograph and a digestive endoscopy (Fig. 1). He was referred to our department because of the possible complications after the retrieving of the foreign body, such as perforation or mediastinitis. A computed tomography (CT) was made showing the presence of the foreign body in the superior-third of the oesophagus and the absence of mediastinitis data (Fig. 2). Under general anaesthesia, a digestive endoscopy was performed to remove the dental prosthesis, observing that the clasps of the foreign body were inserted in the lateral walls of the oesophagus with signs of edema. Besides, we could observe that a clasp of the dental prosthesis was broken; this fact probably caused an inadequate retention and the consequential swallowing (Fig. 3). The patient was maintained with parenteral feeding and antibiotics. He remained afebrile and without evidence of infection. A further esophagogram was performed 7 days later, confirming the absence of perforation. The patient initiated progressive tolerance and was discharged to home with a good progress.
Aspiration or ingestion of foreign bodies has frequently been reported in the paediatric population; however, it is not uncommon in the adult population2. It has been suggested that foreign body aspiration or swallowing is more frequent in selected groups including prisoners, psychotics, alcohol and/or drug abusers, mentally retarded, hyperactive individuals, elderly and patients with an excessive gag reflex3–5.
The inadvertent swallowing of a dental prosthesis is not a rare incident in the dental literature1,2,6. The most frequent symptom after swallowing of a denture is dysphagia; other symptoms depend on how far the denture has progressed and time since swallowing. Sore throats, choking sensation, retrosternal pain, sweating, raised temperature and hemoptysis have also been described7. Many of the signs and symptoms vary depending on the size and shape of the swallowed object: whether it is a sharp object, if it is capable of cutting and/or piercing and its mobility. If it can move freely or not. As in the case we report, the presence of interproximal extensions or clasps may difficult the removal of the prosthesis from the oropharynx or oesophagus because the clasps may be firmly embedded in the oropharynx or oesophagus walls. In this case, the risk of perforation is higher and surgical removal is the only possible treatment8,9.
Endoscopy is the treatment of choice for the removal of a foreign body in the gastrointestinal tract. If it is not possible using flexible endoscopy, rigid endoscopy is recommended, but this procedure must be carried out under general anaesthesia and is not without risk2,10. Moghissi11 reported that ten of 39 cases with oesophagus perforation occurred during removal of the foreign body; the patient was referred to our department because of this fact. This author reported a mortality rate of 48% in cases of thoracic oesophageal perforation. In addition, Delince12 described three cases of mediastinitis following unsuccessful removal of swallowed dentures. In cases of failure of the foreign body extraction and if foreign body progresses beyond ileocaecal valve, colonoscopic extraction may be indicated13,14. Ileocaecal region is the most frequent site of perforation especially when the swallowed object has sharp edges like clasps of a removable denture.
To avoid a complication like that reported in the current study, the use of this unilateral removable partial denture to replace only one or two teeth must be completely contraindicated like a temporary prosthesis or like definitive dental prosthesis15. The possibility of accidental ingestion should be considered in the treatment planning with the patient, whether a fixed or removable replacement for missing teeth is indicated. It is important to recognise situations that predispose patients to this problem. In consequence, in case of a suspected ingestion, the anamnesis must be directed to and the patient should go to a hospital as quick as possible because of the risk of perforation and mediastinitis.