|Year : 2013 | Volume
| Issue : 1 | Page : 31-33
Retrieval of swallowed endodontic file with gastro-scope
Anand K Tavargeri, Rajesh T Anegundi, Shruthi B Patil, Vijay Trasad, Prashanth Battepatti
Department of Pediatric Dentistry, S.D.M. College of Dental Sciences and Hospital, Sattur, Dharwad, Karnataka, India
|Date of Web Publication||7-Aug-2013|
Anand K Tavargeri
Department of Pediatric Dentistry, S.D.M. College of Dental Sciences and Hospital, Sattur, Dharwad - 580 009, Karnataka
Source of Support: None, Conflict of Interest: None
Swallowing or aspiration of dental instruments and objects can occur in every field of dentistry. These instruments and objects vary in sizes, shapes and quality which make it difficult to locate their position. Gastro scope is a versatile instrument used in both diagnostic as well as interventional surgical procedures. This report emphasizes on the important of using rubber dam during root canal treatment and the use of gastroscope as an emergency procedure when the swallowed instrument has been located in stomach; to prevents further complications.
Keywords: Aspiration, endodontic file, gastroscope
|How to cite this article:|
Tavargeri AK, Anegundi RT, Patil SB, Trasad V, Battepatti P. Retrieval of swallowed endodontic file with gastro-scope. Saudi Endod J 2013;3:31-3
| Introduction|| |
Swallowing or aspiration of endodontic files, reamers,  irrigation needles,  rubber dam clamps,  crowns, inlays, onlays and posts  has been reported in dental literature resulting from endodontic and prosthodontic procedures without the use of rubber dam. These instruments or prosthesis traverse the digestive tract in a period ranging from few hours to month  or may lie in stomach, duodenum, colon or appendix in which case a surgical intervention is necessary to prevent complications. Complications include impactation, obstruction or perforation of digestive or respiratory tract.  Grossman (1971)  noted 87% of foreign bodies entered alimentary tract where as 13% aspirated into respiratory tract. According to Webb (1988)  10-20% of cases require non- surgical intervention, while 1% or less require surgery. 
This report highlights the importance of Endoscope in a patient who accidentally swallowed an endodontic file during emergency endodontic procedure performed on lower right primary molar without rubber dam and subsequently the file was located and retrieved with the aid of gastro scope.
| Case Report|| |
A 6 year old female child reported to the Department of Pediatric Dentistry, SDM College of Dental Sciences complaining of pain and swelling in the oral cavity in the right lower back jaw since 4 days. Intra oral examination revealed deep dental caries in relation to right mandibular second primary molar associated with gingival swelling with the same after radiographic examination; a diagnosis of acute periapical abscess was made.
The patient was apparently cooperative, and hence a decision to carry out emergency access cavity preparation to facilitate abscess drainage under antibiotics coverage was made. Rubber dam application was not possible because of associated swelling. During the extirpation of the pulp with an endodontic file the child experienced pain and suddenly moved with jerky movements leading to slipping of the file from the operators fingers, which the patient swallowed. All the emergency protocol to retrieve the aspirated foreign objects was carried out including thumping on the back, trendelenburg position, and Heimlich maneuver.  The child was immediately examined and as there were no signs of respiratory obstruction (dyspnea or cyanosis). There was mild gagging, coughing and slight increase in breathing, probably caused by anxiety. Otherwise the child was cooperative.
The child was rushed to the emergency room of Department of Radiology where the anterior - posterior X-ray of chest and abdomen was taken half an hour after the incident. The file was located in the stomach from the X-ray [Figure 1]a and was decided to retrieve the file by gastro scope to prevent further complications, considering that the file is a sharp endodontic instrument. During endoscope procedure that was done under general anesthesia after parents consent and medical fitness, the upper GIT was normal, with no evidence of lacerations or bleeding from the mucosal lining. The gastroscope located the file which had pierced mucosal lining in the region of pylorus sphincter [Figure 1]b and retrieved the file with special nipper successfully [Figure 1]c and d. The patient was discharged the next day without any post operative complications.
|Figure 1: (a) Chest radiograph revealing endodontic file in gastric region (b) gastroscope located the file close to pylorus sphincter (c) gastroscope nipper retrieving the Endodontic file (d) post retrieval of endodontic file|
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| Discussion|| |
Deciding whether removal of an ingested foreign body is necessary depends on the object's type and location.  In most instances, these foreign objects pass through the digestive tract atraumatically and without any symptoms or complications in 7 to 12 days.  However, sharp endodontic instruments fail to pass through curves of gastrointestinal tract which can be detrimental to the health of individual resulting in abscess, fistulas, peritonitis, appendicitis or septicemia, as a result of instruments being lodged in stomach, duodenum, appendix, colon or cecum. , These foreign bodies may also get impacted within the narrowing mucosal folds or sphincter such as pylorus, the ligament of Treitz, the ileocecal valve, recto sigmoid junction, and the anus.  Hence early attempts should be made to remove them before the instrument reaches the small intestine.  But if the swallowed object does not present any sharp surfaces (clamps, crowns or small prosthesis) they pass through digestive system in 2 to 5 days.  Radiographic monitoring of the progress of such an object is advised and meantime use of high fiber rich diet may be helpful, however there is no scientific evidence of any special diet to support such object's passage. , In some instances, in children the foreign bodies may enter the respiratory tract and get localized in the left bronchus and in adults in the lower lobe of right lung due to anatomical variations  leading to complications such as acute dyspnea, asphyxia, cardiac arrest and laryngeal edema.  Thus, prompt emergency protocol by shifting the patient to X-ray procedures can identify the location of the swallowed instrument which was followed in our patient. Frontal and lateral chest and abdominal X-rays should reveal whether the foreign object has been swallowed or inhaled. If the foreign object has entered gastrointestinal tract, attempts may be made to recover the object by gastroscopy, which is the procedure of choice for extracting such objects.  As the file was located in the stomach, on further radiographic investigation and consultation with gastroenterologist, it was decided to retrieve the file with a gastroscope. In our case eventual surgical intervention was avoided as the instrument had pierced the mucosal lining. In this situation the passage of instrument through the intestine tract is not possible, as it could have lead to complications of perforations, septicemia, and peritonitis. , However it has been categorically and imperatively stated that all endodontic procedures should be carried out under rubber dam application, to prevent risk of accidental aspiration or ingestion and inhalation of endodontic instruments or dental prosthesis and to avoid potential malpractice litigation. 
| Conclusion|| |
Endoscopes/gastroscopes are an excellent diagnostic instrument to retrieve foreign objects lodged in upper gastrointestinal tract. Emphasis on prevention of complications that otherwise can be detrimental to the patients health by sending the patient in the belief that foreign object swallowed or ingested will clear the gastrointestinal tract. Hence every attempt should be made to retrieve the object with gastroscope if the object is located the stomach. The significance of this case report is that it highlights the importance of gastro-scope as an interventional diagnostic procedure. In addition, root canal treatment without rubber dam should not be performed and it is considered below the accepted standard of care.
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