Breathing Difficulty Emergencies in the Office

Foreign body aspiration in the dental office usually occurs when a small object such as part or all of a tooth, filling material, or small instruments such as implant screw drivers or an endodontic file, is inhaled into a patient’s lungs.  This is usually diagnosed by direct observation of the patient along with any coughing and breathing difficulty they may have.

Aspiration is defined as a small amount of solid or liquid foreign material entering the lungs after passing through the vocal cords.  The object will immediately travel through the main bronchi, and lodge or come to rest in an air passage most closely related to the size of the inhaled object.

When aspiration occurs, the lungs will protectively begin to constrict through bronchospasm and breathing difficulty. Coughing, wheezing and rapid breathing can be observed. Depending on the severity of reaction and distress, the patient should be transferred to an emergency room for evaluation by a physician. Localization and removal of the object through bronchoscopy (a viewing tube placed into the lungs

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that can retrieve many aspired objects) should occur.

Protecting the patient’s airway with a barrier like a rubber dam, gauze or retractor can prevent most aspirations in the dental office. Easy retrieval can also be facilitated by securing any small object used in a procedure to a line of dental floss.

 

Signs and Symptoms:

  • Witnessed or presumed swallowing or inhaling of solid, semi-solid or liquid material that immediately results in patient having difficulty breathing
  • Choking, gasping, wheezing or coughing
  • Patient will usually lean forward to try to clear obstructing object

 

Prevention:

Use rubber dam or throat pack when introducing small objects into the patient’s mouth.

Tie dental floss to small objects such as implant wrenches or screwdrivers when using in the patient’s mouth.

Be extremely cautious if patient is sedated or exhibits sluggish reflexes.

 

Treatment:

Position the patient upright or sitting.

If air is being exchanged, as determined by coughing, wheezing, gasping, let the patient continue to try to clear obstruction.

Do not perform the Heimlich Maneuver unless there is a complete obstruction.

If object is not obviously cleared and depending on extent of breathing difficulty, activate EMS to have patient transported to hospital for x-ray localization of obstruction and further treatment. (removal, observation, medication).

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