Accidental impaction of a unilateral removable partial denture: A clinical report Celia Marisa Rizzatti-Barbosa, DDS, MSc, PhD,a Fernanda L. Cunha, DDS,b Walter A. Bianchini, MDS,c Jose Ricardo de Albergaria-Barbosa, DDS, MSc, PhD,d and Brenda P.F.A. Gomes, DDS, MSc, PhDe State University of Campinas, Piracicaba Dental School, Piracicaba, Sao Paulo, Brazil
Several studies have shown that swallowing or aspiration of a removable partial denture (RPD) is not uncommon.1-6 It occurs more frequently in the elderly or mentally ill population,7 and represents a serious medical situation. The complications arising from swallowed removable prostheses include, but are not limited to, laceration, perforation, and hemorrhage of the esophagus and gastrointestinal tract, which can in turn cause peritonitis, septicemia, or result in foreign body granulomas; abscess formation, fistulas, or even penetration into the kidneys.2,8-10 When a RPD is ingested, immediate medical intervention is required to prevent complications. This clinical report describes the treatment of a patient who swallowed a unilateral RPD.
A
B
Fig. 1. Frontal (A) and lateral (B) radiographs showing denture lodged mid esophagus.
CLINICAL REPORT A 39-year-old man was admitted to a hospital emergency room in Campinas, Sao Paulo, after accidentally swallowing his single tooth RPD while eating dinner. At the time of ingestion, the patient was in good physical and mental health. Immediately after ingesting the RPD, the patient experienced painful retching, but the denture was not expelled. A subsequent radiographic examination of his chest by a radiologist revealed the presence of the RPD lodged in the mild esophagus, in a region immediately behind the left atrium (Fig. 1). Endoscopy performed under general anesthetic confirmed the presence of the RPD lodged within the mild esophagus. The prosthesis (Fig. 2) was removed with a rigid endoscope. After the denture was removed, intravenous antibiotic (amoxyllin and gentamycin) and morphine were prescribed. The patient was permitted 30 mL water sips hourly. Late on the second evening, the patient’s condition had improved enough to stop the intravenous therapy and to begin soft diet and fluids. He was placed on oral antibiotics (amoxyllin) and was discharged 7 days after the incident. A month later the patient had the modification space restored with a fixed partial denture.
Fig. 2. Retrieved partial denture.
DISCUSSION aAssistant
Professor, Department of Removable Prosthodontics. Dental Practitioner, Campinas, Brazil. cPhysician, Medical Center of Campinas. dAssistant Professor, Department of Oral Surgery. eAssistant Professor, Department of Endodontics. J Prosthet Dent 1999;82:270-1. bGeneral
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The use of a unilateral RPD to replace 1 or 2 teeth represents an unnecessary risk for the patient because the small size makes it easy for a patient to ingest or aspirate this prosthesis, with potentially serious consequences. When swallowed, the presence of interproxiVOLUME 82 NUMBER 3
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mal extensions or claps may make the removal of a prosthesis from the oropharynx or esophagus extremely difficult.3 The retrieval of removable prostheses invariably involves surgical interventions such as thoractomy and esphagotomy.4,7 Fortunately, in this situation, the prosthesis was removed by a rigid endoscopy, which contributed to the patient’s rapid recovery. Difficulty has been reported in identification and location of a prosthesis when it is made out of radiolucent acrylic resin with little or no metal framework. The inclusion of radiopaque materials into these types of prostheses is strongly advised. Computerized tomography (CT) may be useful in locating the prosthesis because it has greater contrast resolution than conventional radiography and may reveal a radiolucent foreign body of dental origin. CT may also be used to localize the offending object in 3 dimension.3,7,10
CONCLUSION This clinical report illustrates a maxillary unilateral removable partial denture that was swallowed and impacted in the esophagus. This clinical report demonstrates the need for proper design and adequate retention of removable partial dentures.
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3. Cooke LD, Baxter PW. Accidental impaction of partial dental prostheses in the upper gastrointestinal tract. Br Dent J 1992;172:451-2. 4. Dunn JR. Patient swallows removable partial denture: a clinical report. J Prosthet Dent 1996;76:571-2. 5. Pain F, Deffez JP, Korngold H. Accidents connected with swallowing or inhaling dental prostheses. [in French] Rev Stomatol Chir Maxillofac 1970;71:723-30. 6. Carbery A, Provencal M. A case of swallowing a lower partial denture. [in French] J Can Dent Assoc 1993;59:841-4. 7. Brunello DL, Mandikos MN. A denture swallowed: case report. Aust Dent J 1996;40:349-51. 8. Cleator IG, Christie J. An unusual case of swallowed dental plate and perforation of the sigmoid colon. Br J Surg 1973;60:163-5. 9. Sherman BM, Karliner JS, Kikkawa Y, Oka M, Goldin R. Fatal traumatic ingestion of a radiolucent dental prosthesis. N Engl J Med 1968;279: 1275-6. 10. Treska TP, Smith CC. Swallowed partial denture. Oral Surg Oral Med Oral Pathol 1991;72:756-7.
Reprint requests to: DR CELIA MARISA RIZZATTI BARBOSA FACULDADE DE ODONTOLOGIA DE PIRACICABA DEPARTAMENTO DE PROTESE E PERIODONTIA AVENIDA LIMEIRA, 901. BAIRRO AREIAO PIRACICABA—SAO PAULO CEP 13414—018 BRAZIL FAX: (55)19-430-5218 E-MAIL:
[email protected] Copyright © 1999 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/99/$8.00 + 0. 10/1/99817
REFERENCES 1. Matheson I. Foreign bodies in the esophagus. A review of 602 cases. J Laryngol Otol 1949;63:435-5. 2. Nimmo SS, Nimmo A, Chin GA. Ingestion of a unilateral removable partial denture causing serious complication. Oral Surg Oral Med Oral Pathol 1988;66:24-6.
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