Tooth lost into Oropharynx
Occasionally, the crown of a tooth or an entire tooth might be lost down the oropharynx. If this occurs, the patient should be turned toward the dentist, into a mouth-down position, as much as possible. The suction device can then be used to help remove the teeth. The patient should be encouraged to cough and spit the tooth’ out onto the floor. In spite of these efforts, the tooth may be swallowed or aspirated. If the patient has no coughing or respiratory distress, it is most likely that the tooth was swallowed and
has traveled down the esophagus into the stomach. However, if the patient has a violent episode of coughing that continues, the tooth may have been aspirated beyond the larynx into the trachea. In either case the patient should be transported to an emergency room and chest and abdominal radio graphs taken to determine the specific location of the tooth. If the tooth has been aspirated, consultation should. be requested regarding the possibility of removing. the tooth with a bronchoscope. The urgent management of aspiration is to maintain the patient’s airway and breathing. Supplemental oxygen may be appropriate if respiratory
distress appears to be occurring. If the tooth has been swallowed, it is highly probable that it will pass through the gastrointestinal. (GI) tract
‘within 2 to 4 days. Because teeth are not usually jagged or sharp, unimpeded passage occurs in almost all situations. However, it may be prudent to have the patient go to an emergency room and have a radio graph of the abdomen taken to confirm the tooth’s presence in the GI tract instead of in the respiratory tract. Follow-up radiographs
are probably not necessary, because the usual fate of swallowed
teeth is passage.
INJURIES TO ADJACENT TEETH
When the dentist extracts a tooth, the focus of attention is on that particular tooth and the application of forces to luxate and deliver it. When the surgeon’s total attention is thus focused, likelihood of injury to the adjacent teeth increases. The surgeon should mentally step back from time to time to survey the entire surgical field to prevent injury to adjacent teeth.