🎯 Background & Rationale
Foreign body aspiration of dental materials is an uncommon but potentially serious complication of dental and orthodontic procedures, posing significant clinical challenges due to the smooth contours or sharp edges of dental devices. While dental object ingestion is frequently studied, there is a distinct paucity of synthesized data regarding dental object aspiration and retrieval from the respiratory tract. This study aims to address this knowledge gap by comprehensively reviewing published cases of dental object aspiration to evaluate clinical presentations, complications, success rates of various bronchoscopic approaches, and the specific tools utilized.
👥 Study Design & Population
This publication is a Retrospective Case Review / Literature Review analyzing 100 adult patients derived from 74 case reports and case series published between 1984 and 2023. Included cases involved adult patients (age 18 and older) requiring healthcare intervention for airway aspiration of dental objects located in the lower airway or upper airway managed via bronchoscopy.
- Demographics: The mean patient age was 63.5 years, and 18% were female.
- Comorbidities: Common comorbidities included cognitive impairment (6%), hypertension (6%), and coronary artery disease (5%).
- Referral Source: Most cases were referred from a dental clinic (43%) or home/ambulatory settings (26%).
📈 Methodology & Rigor
The authors performed a narrative literature review via a PubMed search using the terms "dental," "aspiration," and "bronchoscopy" from 1984 through 2023. Pediatric cases (age 17 and under), cases without healthcare intervention, and those with inadequate information were excluded. Evaluated variables encompassed demographics, medical history, presenting symptoms, aspiration complications, object characteristics (type, shape, location, laterality), diagnostic imaging, treatment approaches (initial vs. backup), tools utilized, number of attempts, procedural success, and treatment complications. Statistical comparisons were performed using Fisher’s exact test to assess associations between treatment success and object laterality, shape, and initial approach.
🔬 Key Findings
- Object Characteristics: The most frequently aspirated objects were dental prostheses (29%), dental crowns (22%), and implant drivers (17%). Blunt-shaped objects predominated (61%) over sharp objects (33%).
- Anatomic Location: Objects were most frequently lodged in the right lower lobe (26%) and the right mainstem bronchus (21%), with an overall right-sided predominance (74%).
- Diagnostic Assessment: Chest X-ray was the initial imaging modality in 92% of cases, and the majority of cases (70%) required no follow-up or confirmatory CT/MRI.
- Procedural Approach & Success:
- Flexible bronchoscopy was the preferred initial retrieval approach (59%), followed by rigid bronchoscopy (36%).
- Bronchial forceps was the most commonly used retrieval tool (34% alone, 6% in combination).
- Initial retrieval was successful in 75% of cases.
- When a backup approach was required, it was successful in 94.7% (18/19) of cases.
- Complications & Mortality: Initial retrieval was uncomplicated in 96% of cases. Overall study mortality was 2%.
⚖️ Critical Appraisal
As a retrospective literature review aggregating heterogeneous case reports and case series, this study represents a low level of clinical evidence and is subject to significant inherent limitations. These include potential reporting and publication bias (favoring successful or unusual outcomes), lack of long-term follow-up data, uncaptured confounders such as operator experience and institutional equipment availability (e.g., rigid bronchoscopy access), and missing data points across older publications. Furthermore, statistical analyses are exploratory and hypothesis-generating due to small sample sizes and variability in reporting standards.
💡 The Clinical Bottom Line
Elderly and cognitively impaired patients are disproportionately at risk for dental object aspiration due to blunted gag reflexes and dysphagia. When dental foreign body aspiration occurs, a standard chest X-ray is typically sufficient for initial treatment planning. Flexible bronchoscopy paired with bronchial forceps is the most commonly utilized and highly successful initial management strategy. Interventional pulmonologists should keep bronchial forceps readily available and maintain a high index of suspicion for right-sided bronchial lodging when evaluating patients presenting with cough or respiratory distress following dental procedures.