Case Report DOI: 10.18231/2395-499X .2017.0025 International Journal of Oral Health Dentistry; April-June 2017;3(2):110-113 110 Management of accidental ingestion of an endodontic file by a 3 year old child patient -A case report Amina Sultan 1,* , Akanksha Juneja 2 1 Associate Professor, 2 Assistant Professor, Dept. of Pediatric Dentistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi *Corresponding Author: Email: aminasultan.jmi@gmail.com, amina255@yahoo.com Abstract Accidental aspiration and ingestion is a potential clinical complication commonly seen in all the field of dentistry where the manipulation of instruments and materials in the oral cavity creates an environment of risk. Incidence of accidental ingestion and aspiration have been reported in various articles and reviews in dental literature and it is observed that ingestion is the most prevalent emergency during dental procedures and is more common in pediatric population with 80% of cases occurring in children and peak incidents in the age group of 6 months to 3years of ages. 80-90% of ingested foreign items will pass through the gastrointestinal tract uneventfully while 10%-20% may require endoscopic removal but only 1% or less may necessitate surgical intervention. While these events occur infrequently in dentistry but the potential morbidity with a single episode is too high to ignore. Hence general practitioners and pedodontist should be aware of the associated risks of such mishaps and the importance of timely and appropriate intervention. Keywords: Ingestion, Aspiration, Endodontic, Gastrointestinal tract, Endoscopy, Emergency Introduction Accidental aspiration and ingestion is a potential clinical complication commonly seen in all the fields of dentistry where the manipulation of instruments and materials in the oral cavity creates an environment of risk. (1,2,3,4) While undergoing dental treatment patient can swallow or aspirate any foreign object of a varied shape or size ranging from small burs, endodontic files, crowns, copper bands, orthodontic bands to a large dental prosthesis or components of restorative or impression materials. (1,3,5) However ingestion of foreign bodies during a routine intraoral examination is very rare. (4) Incidence of accidental ingestion and aspiration have been reported in various articles and reviews in dental literature and it is observed that iatrogenic ingestion is the most prevalent emergency during dental procedures. (1,7,8) and is more frequent in pediatric population (2,5,6,7) with 80% of cases occurring in children and peak incidents in the age group of 6 months to 3years of ages. (5,6,7) In adults ingestion occurs in certain vulnerable groups such as elderly, mentally impaired, in patients with altered consciousness or during sedation or in alcoholics. (1,2,3,5,6,7,8,9,10) Tamura et al(1996) in a survey reported 3.6-27.7% of the ingested foreign bodies were dental in origin. (5) In the data provided by G Susini et al, endodontic instruments represent 18% of ingested items with a frequency of 0.12 per100, 000 root canal treatments. (1,7) Although rare, ingestion or inhalation of endodontic instrument during dental treatment can result in adverse reactions leading to anxiety and sometimes legal problems. (11, 12) The use of rubber dam is of paramount importance in practicing endodontic but as reported by various researchers of different countries, treatments are carried out routinely without the application of rubber dam especially in pediatric patients. (10,12,13) The delivery of the oral care in supine position to gain a better access also increases the risk of objects entering the oropharynx. (5,7,10,14) At present there are no strict and specific guidelines whether the ingested foreign object should be managed conservatively or endoscopically or surgically, (7) as 80-90% of ingested foreign items will pass through the gastrointestinal tract uneventfully while 10%-20% may require endoscopic removal but only 1% or less may necessitate surgical intervention. (1,2,5,6,11,12) When an accidental ingestion occurs during the dental treatment, the dental practitioner should have the basic knowledge about the diagnostic procedure, complications involved, methods of retrieval as well as the ability to reassure and immediately escort to medical facilities for appropriate management regardless of how well the patient appears. (3,5,7,12) This article presents the management of ingestion of an endodontic K-file by a 3year old child while undergoing treatment by a general practitioner without the application of a rubber dam. Case Report A 3 year old, male patient was referred to the department of Pediatric & Preventive dentistry, following an accidental ingestion of an endodontic instrument, by a general dental practitioner under whom the child was undergoing RCT in relation to 54. The parents of the child were acutely anxious as accidental slippage of an instrument had occurred due to patient’s uncontrolled movement during the treatment. The dentist was performing the root canal therapy without the rubber dam isolation and had made attempt to retrieve the K-file that had accidentally fallen in child’s oropharynx, but was unsuccessful. As the instrument