- Email: [email protected]
Aspiration of denture base materials
Aspiration
of denture
Stephen S. Schneider, New York, N. Y.
base
D.D.S.,*
and
materials Seymour
Roistacher,
D.D.S.**
A
spirating or swallowing foreign bodies is a fairly common occurrence. Children who swallow buttons, coins, pins, and other small objects commonly found in the household are examined and usually treated by conservative methods which permit unaided passage in the stool. However, the swallowing of foreign bodies too large to pass through the gastrointestinal tract or those with sharp edges, points, or protuberances which cause delay, perforations, or abrasions of the tissues of the tract may require the utilization of extensive surgical procedures for their removal. Dental instruments, extracted teeth, and broken or displaced restorations also may be aspirated or swallowed.1-4 A significant number of dentures or denture fragments have been swallowed during sleep.5-7 LOCATING
FOREIGN
OBJECTS
Most foreign bodies that are swallowed are wholly or partly radiopaque making their localization in and progress through the gastrointestinal tract easily determined. Radiographic localization prior to surgical removal, makes the required procedure much less formidable.ll 6~* Aspirated foreign bodies create a more pressing problem, because it is imperative that all objects which are foreign to the tracheobronchial tree be removed. Those objects which are radiopaque are easily localized prior to treatment. However, the as,piration of radiolucent foreign bodies complicates both diagnosis and localization. Whereas, in the gastrointestinal tract, these objecti might pass unaided, foreign bodies in the tracheobronchial tree cannot be passed and may not be suspected or located until clinical and/or radiographic signs point to their position. By this time, bronchiectasis, atelectasis, and lung abscesses may have developed. Cardiac arrest may occur-r secondary to frank physical obstruction of the airway.gp lo -*Chief Resident, Center Affiliation.
**Director Affiliation, New York
Oral
Surgery,
of Dentistry, The and Professor of Dental at Stonybrook.
The
Long
Island
Jewish
Hospital-Queens
Long Island Jewish Hospital-Queens Medicine, School of Dental Medicine,
Hospital
Hospital Center State University of
493
494
Schneider and Roistacher
J. Prosth. Dent. May, 1971
NEED FOR RADIOPAQUE DENTURE BASE MATERIAL A number of reports deal with the problems of aspirating or swallowing fragments of radiolucent denture base material .5-71I1 Such occurrences point up the need for a radiopaque denture base material to be used in the construction of removable dental restorations.5l l2 These materials should be non toxic and must compare favorably with the more commonly used materials with regard to cost, strength, stability, color, color stability, and esthetics. The development of such a material can be a life-saving addition to the art and science of dentistry. CASE REPORTS Subject No. 1 The patient, a 60-year-old man, was initially examined in the emergency room of Queens Hospital Center after an auto accident. The patient was edentulous; his maxillary and mandibular prostheses had been fractured at the time of the accident. The admitting diagnoses were (1) cerebral concussion, (2) fractured mandible symphysis and bilateral condylar fractures, (3) multiple fractured ribs, (4) alcoholic intoxication, (5) possible intra-abdominal injuries, and (6) possible intrathoracic injuries. The patient was admitted for observation and for definitive treatment. The chest radiograph was read as negative with the exception of rib fractures. Physical examination reveaIed no cardiovascular or respiratory difficulties. On the second day in the hospital,, the patient developed severe chest pains and, on the following day, a cough which was productive of bright red blood. Physical examination revealed diminished breathing in both lung fields. A chest radiograph made on the fourth day revealed the original rib fractures and, in addition, bilateral blunting of the costophrenic angles due to accumulation of fluid since the initial examination. The patient was thought to have had an episode of pulmonary embolization and/or pulmonary infarction. An electrocardiogram revealed no cardiac pathosis. Repeated radiographic examinations on the sixth, eighth, and tenth hospital days revealed no changes other than those previously noted. The symptoms continued to be unchanged. Treatment of the mandibular fractures was delayed. On the eleventh day, the patient coughed up a piece of the flange of the fractured mandibular denture. Shortly afterward, the chest pains, cough, and hemoptysis all ceased, and the follow-up chest radiographs were read as negative. It was surmised that a pulmonary embolus and/or infarct had not occurred but rather that a foreign body lodged in the tracheobronchial tree had been the etiology. A review of previous radiographs did not provide evidence of a foreign body even with the knowledge of the clinical course of the patient. The hospital courSe was uneventful subsequent to this episode. The patient was discharged in an improved condition and became an outpatient. Subject No. 2 A 4%year-old woman was admitted to Queens Hospital Center, and a diagnosis of pneumonia was made. The past medical history included a cholecystectomy and
g$g.‘,”
Aspiration
of denture base materials
495
an episode of pneumonia. The patient related that she had been a heavy drinker since the age of 15 years consuming a variety of alcoholic beverages in amounts up to three or four gallons each week. Physical examination revealed hepatomegaly. On the second day, the patient swallowed her removable partial denture which became fixed in her hypopharynx. Radiographic examination revealed the metal denture framework, thereby localizing the foreign body. The denture was removed under general anesthesia without difficulty and with minimal trauma to the soft tissue of the pharynx. The patient exhibited no respiratory distress. After removal of the denture from the pharynx, the patient became hostile and incoherent with hallucinatory episodes. During psychiatric evaluation, she related swallowing the denture as an attempt at suicide. However, it was felt that the patient could have been in the hallucinatory period of delerium tremens. Medical and supportive care was continued until she was discharged ten days later.
Subject No. 3 A 72-year-old man was admitted to the Queens Hospital Center after having been injured in an automobile accident. The admitting diagnoses were (1) multiple rib fractures, (2) fracture of the body of the mandible and condyle on the right side, (3) fracture of the neck of the left femur, (4) fracture of the right malar complex, (5) fracture of the right wrist, and (6) a ruptured spleen. The patient was edentulous. He gave a history of having worn complete dentures although none was found at admission. Routine radiographs of the chest revealed a 1 by 1 cm., slightly opaque foreign body in the upper esophagus. The patient was brought to the operating room for reduction and fixation of fractures and removal of his spleen. An anesthetic was given using a cupped tracteostomy tube. Esophagoscopy revealed that the foreign body was a 3 by 3 cm. fragment of the lower denture including a distal flange and one tooth. Recovery proceeded uneventfully. The patient was discharged and was treated afterward on an outpatient basis.
Subject No. 4 A patient was admitted at the emergency room of the Queens Hospital Center with a history of having “swallowed” a small dental prosthesis. His chief complaints were an inability to swallow and severe pain in the chest. The physical examination revealed a normal chest with equal movement on both sides. Breathing sounds were normal. Radiographs of the chest revealed a foreign body at the level of the sixth and seventh cervical verterbrae. The urine was 4+ for acetone. After the initiation of intravenous fluids and antibiotics, a bronchoscopy procedure was attempted. The prosthesis was located and removed at the second attempt. The postoperative course was uneventful.
SUMMARY Automobile accidents occurring at high speeds frequently cause the fracture of dental prostheses. Since these restorations are usually constructed of radiolucent
496
Schneider and Roistacher
J. Prosth. Dent. May, 1971
materials, their aspiration may cause severe problems in diagnosis, localization, and treatment of seriously injured patients. Prosthetic r&orations made of radiopaque materials would diminish the problems of demonstrating and localizing suspected foreign bodies. References 1. Allen, J. G., et al.: Surgery-Principles and Practice, Philadelphia, 1966, J. B. Lippincott Company, p. 735. 2. Archer, W. H. : Oral Surgery, ed. 4, Philadelphia, 1966, W. B. Saunders Company, p. 694. 3. Fox, J,, and Moodnick, R. M.: The Case of the Missing File, New York Dent. J, 32: 25, 1966. 4. Shires, G. T., Editor: Care of the Trauma Patient, New York, 1966, McGraw-Hill Book Company, p. 328. 5. Bowman, H., and Grahame, R.: Dangers of Radiotranslucent Dental Plates, Brit. Med. J, 5458: 420, 1965. 6. Kerr, A. G.: Dangers of Radiotranslucent Dental Plates, Brit. Med. J. 5460: 535, 1965. 7. Pulvertaft, C. N., and Stayte, D. J.: Dangers of Radiotranslucent Dental Plates, Brit. Med. J. 5458: 420, 1965. 8. Paulsen, G. A.: Foreign Body Endoscopy, Amer. Surg. 31: 723, 1965. 9. Drinnan, A. J.: Dangers of Radiotranslucent Dental Plates, J. Amer. Dent. Ass. 74: 466, 1967. 10. Slim, M. S., and Yacoubian, H. D.: Complications of Foreign Bodies in the Tracheobronchial Tree, Arch. Surg. 92: 388, 1966. DR.
ROISTACHER
:
82-68 164~~ ST. JAMAICA, N. Y. 11432 DR. SCHNEIDER : CAPTAIN OF DENTAL REDSTONE ARSENAL HUNTSVILLE, ALA.
CORPS
35808
of denture
Stephen S. Schneider, New York, N. Y.
base
D.D.S.,*
and
materials Seymour
Roistacher,
D.D.S.**
A
spirating or swallowing foreign bodies is a fairly common occurrence. Children who swallow buttons, coins, pins, and other small objects commonly found in the household are examined and usually treated by conservative methods which permit unaided passage in the stool. However, the swallowing of foreign bodies too large to pass through the gastrointestinal tract or those with sharp edges, points, or protuberances which cause delay, perforations, or abrasions of the tissues of the tract may require the utilization of extensive surgical procedures for their removal. Dental instruments, extracted teeth, and broken or displaced restorations also may be aspirated or swallowed.1-4 A significant number of dentures or denture fragments have been swallowed during sleep.5-7 LOCATING
FOREIGN
OBJECTS
Most foreign bodies that are swallowed are wholly or partly radiopaque making their localization in and progress through the gastrointestinal tract easily determined. Radiographic localization prior to surgical removal, makes the required procedure much less formidable.ll 6~* Aspirated foreign bodies create a more pressing problem, because it is imperative that all objects which are foreign to the tracheobronchial tree be removed. Those objects which are radiopaque are easily localized prior to treatment. However, the as,piration of radiolucent foreign bodies complicates both diagnosis and localization. Whereas, in the gastrointestinal tract, these objecti might pass unaided, foreign bodies in the tracheobronchial tree cannot be passed and may not be suspected or located until clinical and/or radiographic signs point to their position. By this time, bronchiectasis, atelectasis, and lung abscesses may have developed. Cardiac arrest may occur-r secondary to frank physical obstruction of the airway.gp lo -*Chief Resident, Center Affiliation.
**Director Affiliation, New York
Oral
Surgery,
of Dentistry, The and Professor of Dental at Stonybrook.
The
Long
Island
Jewish
Hospital-Queens
Long Island Jewish Hospital-Queens Medicine, School of Dental Medicine,
Hospital
Hospital Center State University of
493
494
Schneider and Roistacher
J. Prosth. Dent. May, 1971
NEED FOR RADIOPAQUE DENTURE BASE MATERIAL A number of reports deal with the problems of aspirating or swallowing fragments of radiolucent denture base material .5-71I1 Such occurrences point up the need for a radiopaque denture base material to be used in the construction of removable dental restorations.5l l2 These materials should be non toxic and must compare favorably with the more commonly used materials with regard to cost, strength, stability, color, color stability, and esthetics. The development of such a material can be a life-saving addition to the art and science of dentistry. CASE REPORTS Subject No. 1 The patient, a 60-year-old man, was initially examined in the emergency room of Queens Hospital Center after an auto accident. The patient was edentulous; his maxillary and mandibular prostheses had been fractured at the time of the accident. The admitting diagnoses were (1) cerebral concussion, (2) fractured mandible symphysis and bilateral condylar fractures, (3) multiple fractured ribs, (4) alcoholic intoxication, (5) possible intra-abdominal injuries, and (6) possible intrathoracic injuries. The patient was admitted for observation and for definitive treatment. The chest radiograph was read as negative with the exception of rib fractures. Physical examination reveaIed no cardiovascular or respiratory difficulties. On the second day in the hospital,, the patient developed severe chest pains and, on the following day, a cough which was productive of bright red blood. Physical examination revealed diminished breathing in both lung fields. A chest radiograph made on the fourth day revealed the original rib fractures and, in addition, bilateral blunting of the costophrenic angles due to accumulation of fluid since the initial examination. The patient was thought to have had an episode of pulmonary embolization and/or pulmonary infarction. An electrocardiogram revealed no cardiac pathosis. Repeated radiographic examinations on the sixth, eighth, and tenth hospital days revealed no changes other than those previously noted. The symptoms continued to be unchanged. Treatment of the mandibular fractures was delayed. On the eleventh day, the patient coughed up a piece of the flange of the fractured mandibular denture. Shortly afterward, the chest pains, cough, and hemoptysis all ceased, and the follow-up chest radiographs were read as negative. It was surmised that a pulmonary embolus and/or infarct had not occurred but rather that a foreign body lodged in the tracheobronchial tree had been the etiology. A review of previous radiographs did not provide evidence of a foreign body even with the knowledge of the clinical course of the patient. The hospital courSe was uneventful subsequent to this episode. The patient was discharged in an improved condition and became an outpatient. Subject No. 2 A 4%year-old woman was admitted to Queens Hospital Center, and a diagnosis of pneumonia was made. The past medical history included a cholecystectomy and
g$g.‘,”
Aspiration
of denture base materials
495
an episode of pneumonia. The patient related that she had been a heavy drinker since the age of 15 years consuming a variety of alcoholic beverages in amounts up to three or four gallons each week. Physical examination revealed hepatomegaly. On the second day, the patient swallowed her removable partial denture which became fixed in her hypopharynx. Radiographic examination revealed the metal denture framework, thereby localizing the foreign body. The denture was removed under general anesthesia without difficulty and with minimal trauma to the soft tissue of the pharynx. The patient exhibited no respiratory distress. After removal of the denture from the pharynx, the patient became hostile and incoherent with hallucinatory episodes. During psychiatric evaluation, she related swallowing the denture as an attempt at suicide. However, it was felt that the patient could have been in the hallucinatory period of delerium tremens. Medical and supportive care was continued until she was discharged ten days later.
Subject No. 3 A 72-year-old man was admitted to the Queens Hospital Center after having been injured in an automobile accident. The admitting diagnoses were (1) multiple rib fractures, (2) fracture of the body of the mandible and condyle on the right side, (3) fracture of the neck of the left femur, (4) fracture of the right malar complex, (5) fracture of the right wrist, and (6) a ruptured spleen. The patient was edentulous. He gave a history of having worn complete dentures although none was found at admission. Routine radiographs of the chest revealed a 1 by 1 cm., slightly opaque foreign body in the upper esophagus. The patient was brought to the operating room for reduction and fixation of fractures and removal of his spleen. An anesthetic was given using a cupped tracteostomy tube. Esophagoscopy revealed that the foreign body was a 3 by 3 cm. fragment of the lower denture including a distal flange and one tooth. Recovery proceeded uneventfully. The patient was discharged and was treated afterward on an outpatient basis.
Subject No. 4 A patient was admitted at the emergency room of the Queens Hospital Center with a history of having “swallowed” a small dental prosthesis. His chief complaints were an inability to swallow and severe pain in the chest. The physical examination revealed a normal chest with equal movement on both sides. Breathing sounds were normal. Radiographs of the chest revealed a foreign body at the level of the sixth and seventh cervical verterbrae. The urine was 4+ for acetone. After the initiation of intravenous fluids and antibiotics, a bronchoscopy procedure was attempted. The prosthesis was located and removed at the second attempt. The postoperative course was uneventful.
SUMMARY Automobile accidents occurring at high speeds frequently cause the fracture of dental prostheses. Since these restorations are usually constructed of radiolucent
496
Schneider and Roistacher
J. Prosth. Dent. May, 1971
materials, their aspiration may cause severe problems in diagnosis, localization, and treatment of seriously injured patients. Prosthetic r&orations made of radiopaque materials would diminish the problems of demonstrating and localizing suspected foreign bodies. References 1. Allen, J. G., et al.: Surgery-Principles and Practice, Philadelphia, 1966, J. B. Lippincott Company, p. 735. 2. Archer, W. H. : Oral Surgery, ed. 4, Philadelphia, 1966, W. B. Saunders Company, p. 694. 3. Fox, J,, and Moodnick, R. M.: The Case of the Missing File, New York Dent. J, 32: 25, 1966. 4. Shires, G. T., Editor: Care of the Trauma Patient, New York, 1966, McGraw-Hill Book Company, p. 328. 5. Bowman, H., and Grahame, R.: Dangers of Radiotranslucent Dental Plates, Brit. Med. J, 5458: 420, 1965. 6. Kerr, A. G.: Dangers of Radiotranslucent Dental Plates, Brit. Med. J. 5460: 535, 1965. 7. Pulvertaft, C. N., and Stayte, D. J.: Dangers of Radiotranslucent Dental Plates, Brit. Med. J. 5458: 420, 1965. 8. Paulsen, G. A.: Foreign Body Endoscopy, Amer. Surg. 31: 723, 1965. 9. Drinnan, A. J.: Dangers of Radiotranslucent Dental Plates, J. Amer. Dent. Ass. 74: 466, 1967. 10. Slim, M. S., and Yacoubian, H. D.: Complications of Foreign Bodies in the Tracheobronchial Tree, Arch. Surg. 92: 388, 1966. DR.
ROISTACHER
:
82-68 164~~ ST. JAMAICA, N. Y. 11432 DR. SCHNEIDER : CAPTAIN OF DENTAL REDSTONE ARSENAL HUNTSVILLE, ALA.
CORPS
35808