Introduction: Foreign body ingestion during dental procedures is a rare but recognized complication that often requires medical evaluation and specialist consultation. There is little existing literature on management of dental foreign body ingestion (DFBI) in the hospital setting. Appropriate care for this patient population requires collaboration between the Dental, Emergency, Internal medicine, and Gastroenterology (GI) teams. We aim to develop a multidisciplinary protocol to help minimize DFBI occurrence and to optimize management.
Methods: A retrospective review of DFBI cases at a tertiary care center was conducted between 2015-2022. On 6/2019, a quality improvement intervention was effected involving a unique collaboration and simultaneous implementation of two separate protocols by the College of Dentistry (CoD) and GI teams. The CoD protocol was multifaceted including determining indications for ED referral after DFBI, maintaining patients NPO, and comprehensive education of practitioners. The GI protocol defined the response to a DFBI consultation, parameters for endoscopy, and how to conservatively monitor stable patients without indication for endoscopy. These protocols were disseminated among both teams with the goal of improving communication, maximizing safety, and providing education on clinical management of DFBI.
Results: A total of 27 patients were included, with 20 cases identified prior to the intervention (over a span of 53 months) and only 7 occurring after the intervention (spanning 32 months). Table 1 summarizes the clinical course before and after the intervention. 7 patients (35%) were admitted to the hospital pre-intervention and just 1 (14%) was admitted after. Specialists were consulted on 9 cases prior (45%) and 1 case post (14%). Endoscopies were performed in 4 patients, 3 pre (15%) and 1 post (14%). The complication rate was 0% before and after the intervention.
Discussion: A targeted intervention implemented to improve outcomes following DFBI led to a 42% decrease in the incidence of overall cases adjusted over time, developed a clear path of action, and streamlined the process for improved patient safety. Further larger cohort studies would be beneficial to further assess the impact of the intervention. Our study provides preliminary guidance on the management of DFBI.
