As an effective method for the treatment of pulpitis and periapical periodontitis, 97% of the teeth can be retained in the mouth for about 8 years after treatment. However, the instruments required for root canal therapy are various, the steps are complex and time-consuming, and the rubber barrier is not widely used Once this kind of adverse event occurs, it will not only cause contradictions between doctors and patients, but also bring serious psychological problems to patients. Therefore, we must take positive measures to prevent the occurrence of such events and master effective treatment measures to reduce the harm to patients as far as possible.
this case mainly describes the treatment process of patients after swallowing root canal files during root canal treatment
1. Case report
On November 21, 2015, a 36 year old male patient suffered from pain and swelling of the left mandibular first molar for more than one week;
special examination: 36 distal occlusal surface deep caries, percussion pain (+ +), no reaction to pulp vitality test.
auxiliary examination: X-ray apical film showed 36 caries and pulp, low density shadow around the apex.
was diagnosed as chronic periapical periodontitis and was planned to be treated with root canal therapy The patient was fully communicated with the patient and signed the informed consent. The patient was in supine position for treatment
During the treatment, the patient was very nervous, and communicated with him whether to continue the treatment or not, and the patient said that he could insist.
However, in the process of using protaperf1 (21mm) to clean the pulp cavity, the doctor slipped the instrument into the patient’s mouth due to hand sliding. Without waiting for the doctor’s advice, the patient immediately sat up, turned his head to the low position, held the throat tightly, and coughed hard.
confirmed that the patient had swallowed the instrument after emotional stability
As the patient showed no signs of dyspnea, we transferred the patient to the emergency room to take CT to determine the location of the device.
CT results showed that there was an opaque object about 21mm long at the bottom of the stomach (Fig. 1).
According to the clinical and imaging examination, the emergency department doctors give two suggestions: first, take out the instrument from the stomach by endoscopic operation; second, wait for the instrument to be discharged with the excretion with gastrointestinal peristalsis, but there may be complications such as gastrointestinal perforation. Patients with
should choose endoscopic surgery to remove the instruments after fully aware of it However, because a series of preoperative examinations took a lot of time, the instrument could not be found in the stomach when the endoscope was used (Fig. 2). The abdominal X-ray film of
showed that the instrument had entered the small intestine (Fig. 3a), and the patient stayed in the emergency department for observation to prevent complications such as gastrointestinal perforation During this period, high fiber diet can help gastrointestinal motility, and a series of abdominal X-rays can locate the device.
X-ray films show that the device is located at the end of the small intestine (Fig. 3b) at the end of the small intestine nearly 20 h, the ascending colon of the large intestine (Fig. 3C) nearly 30 h, and the descending colon of the large intestine after 54 H (Fig. 3D) Finally, the device was found in the patient’s feces after 57 hours. During this period, the patient had no other symptoms.
in the following 20 months of active follow-up, the patient did not appear any adverse symptoms or signs
Fig. 1 chest CT results of one hour after aspiration of root canal file.
A: no foreign body in respiratory tract; B: foreign body at the bottom of stomach (as shown by arrow)
Figure 2 endoscopy was performed 3 hours after the device was mistakenly swallowed. The results showed that the display device was not in the stomach.
A: esophagus; B: cardia; C: gastric fundus; D: Gastric horn; E: gastric antrum; F: duodenal bulb; G: descending part of duodenum; H: descending duodenum
A: the root canal file is located in the small intestine after about 4 hours; B: the root canal file is located at the end of the small intestine after about 20 hours; C: the root canal file is located in the ascending colon of the large intestine after about 30 hours; D: the descending colon of the large intestine after about 54 hours
Recently, it has been reported that in the process of oral diagnosis and treatment, accidental swallowing and aspiration often occur, usually in children, and rarely in adults.
root canal removal, implant surgery, orthodontic treatment, and aspiration often occur, and these foreign bodies mainly include root canal file, screw driver, crown, drill and rubber barrier forceps This paper mainly reports the process of root canal file being swallowed by mistake in the process of root canal therapy. The causes of aspiration and swallowing of
can be attributed to the following aspects: the position of the affected teeth, the general mandibular molars close to the pharynx, and the instruments are easy to slide into the pharynx; the patients’ emotional anxiety, accidental movement and uncoordinated treatment process; the patients’ anxiety, accidental movement and uncooperative treatment process; The doctor did not use rubber barrier during the operation, the patient’s body position was too backward, the size of gloves was not suitable, the operation process was not familiar with the technique, the operation environment was not fully moisture proof, etc
The patient showed anxiety and tension in the process of treatment. After communication with the patient, the patient’s mood was still not improved, and doctors did not pay enough attention to it. Moreover, due to the serious caries of mandibular molars, it was difficult to use the rubber barrier. Therefore, the doctor did not insist on using the rubber barrier, and the patient accidentally moved his head, resulting in the equipment swallowing The clinical doctors should take active and effective measures to deal with this kind of incidents When the foreign body enters the mouth by mistake, the doctor should first remove the foreign body as soon as possible. If it fails, the patient should be encouraged to bow his head and cough, and then communicate with the patient fully to keep the patient calm. A series of imaging examinations should be used to carefully evaluate the location of the foreign body and determine whether it enters the digestive tract or respiratory tract, so as to determine the follow-up treatment plan
It has been reported that about 87% of the instruments were swallowed into the digestive tract and 13% were inhaled into the respiratory tract. The common aspiration symptoms of
mainly include cough, wheezing, dyspnea and other severe airway obstruction Once aspiration occurs, the clinician should immediately level the treatment chair, make the patient lie on his back and keep calm, so as to avoid the foreign body falling into the deeper part. Meanwhile, X-ray film beside the chair should be taken to determine the location of the foreign body Because of the anatomical characteristics, in adults, the diameter and length of the right main bronchus are wider and shorter than those of the left main bronchus. Therefore, foreign bodies may enter the right main bronchus, and the foreign bodies can be removed by bronchoscope If foreign bodies enter the digestive tract, generally speaking, most of them can be discharged asymptotically, but if they are sharp instruments, they may lead to gastrointestinal perforation and other serious complications. Therefore, it is necessary to locate the position of the instruments and take them out in time
It is necessary to take a series of X-ray or CT films to check the position and size of the foreign body.
in this case, we used CT to evaluate the position of the instrument. We observed that the instrument was located at the bottom of the stomach. Due to the sharp root canal file, the patient wanted to remove the instrument through endoscope However, because the preoperative examination and operation can only be carried out 4 hours after eating, the instruments are no longer available.
has reported that the best time to remove foreign body by endoscope is within 2 hours, and should not exceed 6 hours at the latest. Once the time is too long, the foreign body may enter the duodenum through the pyloric sphincter If the foreign body enters the intestine, close observation is needed until the foreign body is discharged
During the observation period, patients can eat high fiber food and closely observe the clinical symptoms of intestinal perforation. Once this happens, surgical intervention is needed.
finally, active follow-up is needed.
in this case, no obvious discomfort symptoms were found during the 20 month follow-up period To reduce the incidence of foreign body aspiration and swallowing in the process of oral diagnosis and treatment, prevention should be given priority to. Clinicians should actively prevent, communicate with patients effectively, operate cautiously and regularly, and master solid operation techniques. Rubber barrier should be used correctly during root canal treatment, so as to isolate patients’ oral saliva and operate smoothly with clear vision and less interference In case of accidental ingestion and aspiration, the first aid process should be mastered to reduce the incidence of complications
A case report of foreign body aspiration during root canal therapy [J]. Stomatology, 2019,39 (02): 158-160