The potential of foreign body ingestion or aspiration is a universal concern in dentistry, so it’s important for clinicians to avoid errors before they lead to an adverse event like the one above (image by A.Prof Frank Gaillard). Here are a few things to think about in recognition of National Patient Safety Awareness Week.
Dental journals are bursting at the seams with cases of accidental ingestion and aspiration. Some reported foreign objects being swallowed or inhaled include whole teeth, root tips, screwdrivers, brackets, orthodontic wires, expansion keys, drill bits, amalgam pieces, temporary crowns, prosthodontic appliances, pins, posts, rubber dam clamps, apical locators, endo files and syringe tips. When items like these are aspirated or ingested, they can end up wedged in the gastrointestinal or respiratory tract.
Clinicians face the challenge of handling small, slippery items every day. The limited working space, unexpected patient movements, inadequate lighting, adverse environment, unavailable assistance, unexpected instrument breakage, poor-quality instruments, and lack of airway protection protocol all pose increased risks.
Additionally, dental patients are treated in the supine position, because it provides better visibility, access and ergonomic comfort for clinicians. But in this vulnerable position, the patient’s airway is more susceptible to accidental ingestion and aspiration of foreign bodies due to gravity.
According to a study, there is a higher risk (80%) of accidental aspiration of foreign bodies among children under age 3. Geriatric, sedated, health compromised and special needs patients are also at higher risk.
The risk of morbidity, emergency medical expenses, and the potential liability for negligence and malpractice are too high to be ignored. Improper risk management can damage your reputation and career if you aren’t careful.
Accidental aspiration and ingestion can occur during routine periodontal maintenance as easily as it can during an implant case. Protect your patient. Protect yourself. Take every precaution you can every time. Here are a few steps you can take to minimize airway-related emergencies at your practice:
- Establish emergency protocol with your team.
- Have a well-stocked emergency medical kit.
- Confirm patient ICE (in case of emergency) contact prior to treatment.
- Review patient medical history and medications prior to treatment.
- Perform a comprehensive exam prior to treatment (including airway assessment).
- Review scheduled treatment with patient.
- Discuss and document the risks associated with treatment (and non-treatment).
- Have an appropriate informed consent document (per rule of law).
- Advise the patient to eat a light meal prior to treatment (general anesthesia excluded).
- Advise the patient to abstain from caffeine, alcohol and recreational drugs prior to treatment.
- Inspect all instruments for signs of damage or wear prior to use.
- Discuss airway safety SOP (standard operating procedure) with the patient to gain compliance.
- Cotton roll isolation alone is inadequate. Use an airway safety shield (e.g., rubber dam, gauze throat screen, Isolite, etc.)
- Secure all rubber dam clamps and prosthetic appliances with floss ligature.
- Maintain proper records of treatment and protocol to reduce claim liability.
From single-tooth restorations to full-mouth reconstruction, dental treatment is challenging and technically difficult, so accidents can happen. The best rules of thumb are to minimize potential harm, recognize problematic situations, adopt risk management into daily protocol and avoid placing the patient at an unreasonable risk.