There have been five reports of swallowed dentures1–5
including delayed presentation5
of up to 3 months in paediatric patients. Dental and ENT history and examinations are rarely taught at medical school. Patients with a suspected swallowed denture should have a focused dental history included in the global history, and initially be examined with indirect laryngoscopy using a laryngeal mirror if there is no equipment available for direct laryngoscopy. If an adequate view is not obtained, such patients should be referred to ENT for direct laryngoscopy using a flexible nasal endoscope.
This particular case was relatively uncomplicated, but serious complications including oesophageal or colonic perforation, mediastinitis, pneumothorax and pneumopericardium can occur.2–4
Elderly patients, particularly those who have been sedated, are at risk,1
as are paediatric and psychiatric patients or those with learning disabilities.4
The senior author has removed partial dentures from an elderly patient who simply swallowed the denture while drinking a cup of tea, a person with epilepsy following a fit, and a patient who was intoxicated following excessive alcohol consumption. The latter patient required a thoracotomy to remove the partial denture, when the clasp became embedded in the mucosa of the thoracic oesophagus.
As partial dentures are fairly easily swallowed beyond the cricopharyngeus, they are also the most dangerous to retrieve owing to various projections, which form part of their structure. The minimal morbidity encountered in this case report is in fact unusual, the reason being that the denture was only partially obstructing the oesophagus, so did not cause total dysphagia, secondary airway compromise or systemic symptoms. It is also the reason for delayed diagnosis, which is in part due to the patient’s impatience in the emergency department and his lack of credibility as far as his primary physician was concerned.
The initial lateral cervical spine radiograph () demonstrates the diagnostic difficulty presented by radiolucent foreign bodies composed of polymethyl methacrylate,6
such as the denture in this case. In this particular case there was noticeable retropharyngeal soft tissue swelling (C5–C7), due to the delayed presentation. With the continued use of acrylic for dental prostheses,6
swallowed prostheses will continue to present radiological diagnostic difficulties. Using radio-opaque marker in the acrylic dentures may negate this problem.
- The authors recommend that such patients presenting to primary care or the emergency department doctors should have a focused dental history taken as part of the global history.
- Patients should be referred to ENT for direct laryngoscopy using a flexible nasal endoscope if an adequate view is not obtained.
- This article acknowledges a group of medical patients in which poor fitting removable dental prostheses are contraindicated. Often medical professionals are in a better position to identify this group of “at risk” patients than general dental practitioners. Appropriate referrals to dentists would minimise the inappropriate provision of dentures and provide suitable alternative treatments.
- There is a growing body of evidence supporting the inclusion of a radiopaque marker in acrylic based dentures.
- It would also appear that our patient received sub-optimal healthcare due to his poor socioeconomic situation. This should not arise as we all have a duty of care to all patients.7