Managing inhaled or swallowed objects in dental practice
An inhaled or swallowed object can present a significant risk to the patient.
Use preventive measures to minimise the risk of an object being inhaled or swallowed during dental treatment (see Preventive measures to minimise the risk of inhaled or swallowed objects during dental treatment).
If possible, use a rubber dam for procedures with a high risk of inhaling or swallowing a foreign object.
If the procedure precludes the use of a rubber dam, other precautions include:
- ensuring a careful and unrushed approach
- having the patient reclined rather than supine
- having instruments and facilities available that can be used to retrieve an object from the oropharynx
- tying dental floss to any object that can be dropped (if appropriate)
- placing gauze across the back of the tongue to trap small items (eg crowns) that may be dropped
- rotating the patient’s head so that a dropped object will fall to the side of the mouth
- using high-volume suction.
Although swallowed objects usually pass through the gastrointestinal tract without causing harm, occasionally they require removal.
Foreign objects in the airways and lungs (inhaled objects) must be removed urgently. Partial or complete airway obstruction can occur following inhalation of a foreign body. If the patient can breathe, speak, cry or cough, some movement of air is occurring, and the obstruction is partial. See Signs of airway obstruction for signs of partial and complete airway obstruction.
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Signs of partial airway obstruction |
Signs of complete airway obstruction |
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breathing is laboured breathing may be noisy some movement of air can be felt from the mouth |
there may be attempts to breathe no breathing sounds air does not emit from nose or mouth |
Note:
Source: Australian and New Zealand Committee on Resuscitation (ANZCOR). ANZCOR Guideline 4: Airway. East Melbourne: ANZCOR; 2016. [URL]
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[NB1]
In the event that an object appears to have fallen down the oropharynx:
- Stop dental treatment.
- Check whether the object is present in the patient’s mouth or clothes and, if so, remove it.
- If the object is not found, put the patient into an upright position.
- Although the majority of ingested foreign bodies will pass through the gastrointestinal tract without incident, refer the patient for further medical assessment and management. If the patient is stable and asymptomatic, it may be appropriate to complete dental treatment before doing so.
If the patient is conscious with signs of airway obstruction (see Signs of airway obstruction):
- Call 000.
- Reassure the patient and encourage them to relax, breathe deeply and try to dislodge the object by coughing.
- If coughing is ineffective, give up to 5 back blows between the shoulder blades using the heel of the hand (checking for effectiveness between each blow).
- If back blows are unsuccessful, give up to 5 chest thrusts delivered at the same compression point as for CPR (checking for effectiveness between each chest thrust).
- Continue to alternate between back blows and chest thrusts until the obstruction is relieved or assistance arrives.
If the patient with airway obstruction becomes unconscious:
- Call 000.
- Inspect the back of the throat for the foreign object and remove it if possible.
- Start CPR (for ‘Basic life support flow chart’, see Basic life support flow chart).
- Clinicians with appropriate expertise and equipment should consider performing cricothyroidotomy.
- Abdominal thrusts, such as those described in the Heimlich manoeuvre, can cause internal organ damage so are not recommended.
CPR = cardiopulmonary resuscitation
NB1: A flow chart for the management of choking can be downloaded from the Australian Resuscitation Council website.