Preventing and Managing Aspiration and Ingestion in Dentistry

Laura M. Cascella, MA, CPHRM

Aspiration or ingestion of foreign material is a potential adverse event that can occur in the practice of dentistry. Dental patients can aspirate (inhale) or ingest (swallow) various types of foreign bodies, such as extracted teeth, crowns, orthodontic wires, dental burs, drills, files, implant materials, clamps, posts, pins, and more.¹

Aspiration and ingestion do not occur frequently, but these situations do continue to persist — and they are problematic in various ways. First and foremost, aspiration and ingestion can lead to various degrees of patient harm, including death. Other negative consequences include financial impact (e.g., to provide adequate patient care after the event), liability exposure, and reputational harm.

Dentists and dental staff should take precautions to prevent aspiration and ingestion events from happening. For example:

• Be aware of patients who might be at higher risk for aspirating or ingesting foreign bodies, such as young children, older adults, patients who are sedated or under general anesthesia, patients who have a decreased gag reflex, or patients who have impaired swallowing or protective airway mechanisms.
• Use a rubber dam during procedures when possible. When not possible, consider other protective techniques, such as oropharyngeal drapes, high-speed suction, floss ligatures, upright patient positioning, etc.
• Tie long sections of floss around or through dental attachments and instruments (if possible) to aid in retrieval if the items are displaced.
• Prior to use, evaluate dental equipment to ensure its integrity and verify that various components are secure.
• Make sure that the components of dental instruments are compatible (e.g., dental handpieces and burs).
• Follow manufacturers’ instructions for operating and maintaining dental equipment, and do not reuse single-use items.²

Although taking steps to prevent aspiration and ingestion of foreign bodies is crucial, preparing to respond to these situations is equally important. Dental practices should have a clear-cut emergency response plan for managing aspiration and ingestion events. Additionally, dentists and dental staff should assume that any object placed into the mouth that is lost from sight has been aspirated or swallowed, and they should activate their emergency response plan.

Suggestions for developing a thorough response plan include the following:

• Create an algorithm, decision tree, and/or specific process for how to handle aspiration and ingestion events. The first step should focus on whether the patient has symptoms of airway obstruction.
  • If so, a member of the dental team should promptly call emergency medical services (EMS) to transport the patient to the emergency department (ED). At the same time, other members of the team should perform life-saving measures (e.g., the Heimlich maneuver) and provide basic life support until EMS arrives.
  • If not, other steps in the process might include:
    • Performing a thorough oral examination to locate foreign material and remove it if possible.
    • Having the patient cough or using other techniques to expel the foreign material (e.g., back blows).
    • Sending the patient to an urgent care facility for imaging and next-step recommendations.
• Educate all providers and staff members about the emergency plan and process for responding to aspiration or ingestion of foreign bodies. Periodically practice the response as part of emergency drills.
• Make sure providers and staff members have training in basic life support, understand their roles in responding to an emergency, and know how to quickly access emergency equipment and supplies.
• If aspiration or ingestion does occur, remain calm, inform the patient about the situation and potential complications, and reassure them that you are taking appropriate steps to manage the situation.
• If a patient must go to an urgent care facility or ED, send a provider or staff member to accompany them whenever possible (not as the driver). Even when not possible, a dental team member should follow up with the patient after handoff to medical personnel to express concern and ensure resolution of the situation.
• Document the aspiration or ingestion event in the patient’s health record, including factual details about what occurred, any protective measures in place, and steps taken to provide appropriate care and support.
• If the aspiration or ingestion potentially occurred because of faulty or malfunctioning equipment, sequester and secure the tool or device and contact your professional liability insurance company for further guidance. Do not return the equipment to the manufacturer or allow a manufacturer’s representative to access it.³

To learn more about aspiration/ingestion of foreign bodies in dentistry, see MedPro’s case studies Negligence Leads to Aspirated Foreign Object and Lawsuit and How Vicarious Liability Affects Dental Practice. For more information on general emergency response, see MedPro’s article Managing Medical Emergencies: A Three-Pronged Approach for Healthcare Practices.

Endnotes

¹ Yadav, R. K., Yadav, H. K., Chandra, A., Yadav, S., Verma, P., & Shakya, V. K. (2015). Accidental aspiration/ingestion of foreign bodies in dentistry: A clinical and legal perspective. National Journal of Maxillofacial Surgery, 6(2), 144–151. doi: https://doi.org/10.4103/0975-5950.183855; Bashutski, J., Budd, M., & Perez, J. (2020, June 15). Gulp! Preventing and managing accidental ingestion and aspiration in dentistry. The Wire. Retrieved from www.dentalcorp.ca/site/blog/2020/06/15/gulp-preventing-and-managing-accidental-ingestion-and-aspiration-in-dentistry

² Yadav, et al., Accidental aspiration/ingestion of foreign bodies in dentistry: A clinical and legal perspective; Shin, Y., Hong, S. O., Kim, R., & Jee, Y. J. (2022). Strategies for dental aspiration and ingestion accidents that can lead to serious complications: A report of three cases and a review of articles. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 48(5), 318–325. doi: https://doi.org/10.5125/jkaoms.2022.48.5.318; Passineau, T. (2018). Case study: Patient aspirates foreign material during dental restoration procedure. MedPro Group. Retrieved from www.medpro.com/cs-dental-burraspiration; ECRI. (n.d.). Preventing ingested or aspirated objects during dental procedures. Get Safe! Simple Steps to Improve Patient Care. Retrieved from https://www.ecri.org/EmailResources/PSRQ/ClinRiskMgmt/Get%20Safe%20-%20Preventing%20Ingested%20or%20Aspirated%20Objects%20during%20Dental%20Procedures.pdf; Bashutski, et al., Gulp! Preventing and managing accidental ingestion and aspiration in dentistry.

³ Ibid.

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