F@#! Pt swallowed the crown!!

[J2AZ]

If you are starting clinical be careful when seating upper posterior crowns b/c a perfect B1 shade #15 PFG is sitting in a patients stomach after my screw up this afternoon. Think back to what you were doing today at 3:50pm because that was about the time I was preparing to get my a$$ chewed by the doc I work for.

The pt has a very small mouth so it was hard to get back there to begin with. I thought about just letting the doc do it b/c of the very possibility of what happened happening. However, I figured hell, its in my job description to prep the crown for delivery so Ill just do it. The temp came off no problem, the cement was easy to clean off, and the contact was great.
All I had to do was check the bite and adjust. No problem the first time, yet on take two the crown vanished after she tapped on the bite paper. Bam! It was gone. Luckily it did not get stuck in her throat. The doc examined her, offered to have a radiograph taken of her abdominal cavity, and had her drink water to make sure everything was functioning ok.

The girl was cool with it until the doc informed her she would have to check her feces and notify us when it passed.

This was a crazy learning experience. Hopefully all you in clinic will be able to avoid this. Be careful with those upper posterior crown deliveries.
We will be making her new crown...$150 more in lab fees. I offered to pay but the doc told me not to worry about it.

In the end things could have been worse.

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[SocalDentist7]

If you are starting clinical be careful when seating upper posterior crowns b/c a perfect B1 shade #15 PFG is sitting in a patients stomach after my screw up this afternoon. Think back to what you were doing today at 3:50pm because that was about the time I was preparing to get my a$$ chewed by the doc I work for.

The pt has a very small mouth so it was hard to get back there to begin with. I thought about just letting the doc do it b/c of the very possibility of what happened happening. However, I figured hell, its in my job description to prep the crown for delivery so Ill just do it. The temp came off no problem, the cement was easy to clean off, and the contact was great.
All I had to do was check the bite and adjust. No problem the first time, yet on take two the crown vanished after she tapped on the bite paper. Bam! It was gone. Luckily it did not get stuck in her throat. The doc examined her, offered to have a radiograph taken of her abdominal cavity, and had her drink water to make sure everything was functioning ok.

The girl was cool with it until the doc informed her she would have to check her feces and notify us when it passed.

This was a crazy learning experience. Hopefully all you in clinic will be able to avoid this. Be careful with those upper posterior crown deliveries.
We will be making her new crown...$150 more in lab fees. I offered to pay but the doc told me not to worry about it.

In the end things could have been worse.

...seriously, good thing she didn't aspirate it. I had a med school friend who once aspirated a WHOLE oreo cookie. crazy.

 

[toofache32]

I had a classmate do this about 3 weeks prior to graduation and he didn't have time to submit a new impression to the lab. I told him to send his patient to the restroom with a box of gloves and a tongue depressor, but he wouldn't do it. I forgot what he ended up doing about it. Looking back, I would probably just send the patient home with a potato-masher and some cheese-cloth.

 

[Biogirl361]

I had a classmate do this about 3 weeks prior to graduation and he didn't have time to submit a new impression to the lab. I told him to send his patient to the restroom with a box of gloves and a tongue depressor, but he wouldn't do it. I forgot what he ended up doing about it. Looking back, I would probably just send the patient home with a potato-masher and some cheese-cloth.

gross.. heh.. too bad rubber dams are uncomfortable to the patient, it could prevent a lot of choking/swallowing hazards if they were more commonly used..

 

[toofache32]

gross.. heh.. too bad rubber dams are uncomfortable to the patient, it could prevent a lot of choking/swallowing hazards if they were more commonly used..

I don't see how you could really use a rubber dam for a try-in. Especially checking the occlusion.

 

[Yah-E]

Did you keep your cool or did you sh1t your pants. I once had a pt swallowed an intact whole mandibular posterior molar after an extraction, the sucker snuck right pass the gauze and sure didn't help when gag reflex activated. I just saw the tooth getting further and further into the throat and away from my grasp. After the storm settled (tears, heavy breathing, and all), we inform the pt that we do not believe that she had aspirated the tooth, but watch the toliet in the next couple of days. We then sent her to the radiology department for chest x-ray to confirm.

Stuff like this will happen to us all....shoot, I once extracted the wrong tooth as well! The tooth I extracted was supposed to be a posterior abutment tooth for a RPD! Oops, she now has a distal extension for her RPD! School is where you learn and the best place to make mistakes.

Good luck the second time around! 👍

 

[lnn2]

No problem the first time, yet on take two the crown vanished after she tapped on the bite paper. Bam! It was gone....
In the end things could have been worse.

Use the Fit Checker. It's very good for checking the margins and also holds the crown in place. That stuff works just like alginate.
My clinical instructor told me a story back in the days when he was a dental student. His patient called and told him she swallowed her gold crown. He asked the patient to look for it in her stool. Well, she found it! 😱 and brought it in to him. He cleaned, sterilized and inserted the same gold crown 😱 The patient asked, "Is this a new gold crown?" My instructor, "Why, yes, it's new!" 😱

 

[lnn2]

Stuff like this will happen to us all....shoot, I once extracted the wrong tooth as well! The tooth I extracted was supposed to be a posterior abutment tooth for a RPD! Oops, she now has a distal extension for her RPD! School is where you learn and the best place to make mistakes.

Good luck the second time around! 👍

What did you tell the patient?! That tooth just was not meant to be there?! 😀
I almost extracted the tooth once! I grabbed the periosteal and about to go to town with it. Suddenly a light bulb in my head turned on! maybe I should look at the chart again in addition to the pan (patient was from urgent care). Let me tell you, I almost **** in my paints when I found out the tooth that I was about to extract was the wrong one! It was also a very good thing that no one was in the room but me! Dude, after that incident, I count twice, sometimes three times and extract once, just like my instructor said!

 

[Yah-E]

What did you tell the patient?!

I had to break the bad news to the patient after consulting with the OMFS residents and faculty. I flat out told the patient that I screwed up and I was drunk (ok, maybe not latter)! We, school, offered the patient an "on the house implant", she refused to wait the healing period to get her dentures. I was sh1tting my pants for sure! I felt so bad, it couldn't have happened to a better and sweeter patient. She was completely understanding and empathetic.

I, too, started to count the teeth before I extract now.

 

[drhobie7]

Gauze partition
Chest X-ray

If anything 'disappears' from your Pt's mouth you should be getting a chest x-ray. A gauze partition might be a good idea to help discourage this sort of thing.

 

[rocknightmare]

Use the Fit Checker. It's very good for checking the margins and also holds the crown in place. That stuff works just like alginate.
My clinical instructor told me a story back in the days when he was a dental student. His patient called and told him she swallowed her gold crown. He asked the patient to look for it in her stool. Well, she found it! 😱 and brought it in to him. He cleaned, sterilized and inserted the same gold crown 😱 The patient asked, "Is this a new gold crown?" My instructor, "Why, yes, it's new!" 😱

LOL

 

[drat]

Stuff like this will happen to us all....

No, I doubt it. I never screw up.

In truth, I am not sure how I would keep my composure if I made a major boo-boo like extracting the wrong tooth. Is it an uncommon sight to see a dental student crying in her cubicle in front of a patient? 😳

 

[onetoothleft]

This is why it is a little cheaper for patients to come to clinic.

 

[DcS]

This happened to a classmate of mine. It happens all the time...just have to be honest with the patient, get a chest x-ray taken to make sure it's not been aspirated, and it will all work out.

Guaze or no gauze, sometimes working in the posterior with a crown covered in saliva going in and out for occlusion, it's bound to happen.

The worst thing that's happened to me so far in school is that while prepping #9 for a procera my bur must have cut the cord a little bit. So when I removed what I thought was the entire cord, a little piece remained on the lingual. Of course, patient comes back 3 wks later for crown to be cemented, and when she talks I notice marginal redness. I thought..."that's weird, that temp looked great, perfect line angles, embrasures were great...this can't be good". I sit down, flip a mirror to see the lingual and WAZAM...her gingiva was the size of a marble. She noticed but didn't think to call me 🙄 Needless to say, I always double check for cord remnants now! I just Rx chlorhexidine, looked great a week or so later.

 

[J2AZ]

Gauze partition
Chest X-ray

If anything 'disappears' from your Pt's mouth you should be getting a chest x-ray. A gauze partition might be a good idea to help discourage this sort of thing.

You are right. However, in my case the pt refused the to go have an X-Ray after the doctor asked to have that done.

When you say gauze partition do you mean an unfolded 2x2. If so, I thought of that but didnt do it because I was unsure if it would hinder her breathing or get caught in her throat. If you are not talking about an unfolded 2x2 can I get these partitions from any dental supply company? I will also be checking out that fit checker suggested by Inn2.

 

[aphistis]

You are right. However, in my case the pt refused the to go have an X-Ray after the doctor asked to have that done.

When you say gauze partition do you mean an unfolded 2x2. If so, I thought of that but didnt do it because I was unsure if it would hinder her breathing or get caught in her throat. If you are not talking about an unfolded 2x2 can I get these partitions from any dental supply company? I will also be checking out that fit checker suggested by Inn2.

Fit Checker is awesome stuff. The very day I discovered it, I cremated every can of Occlude I could find in a ritual bonfire.

 

[12YearOldKid]

Fit Checker is awesome stuff. The very day I discovered it, I cremated every can of Occlude I could find in a ritual bonfire.

Depends on you point of view of I guess. I am kind of biased against it because one of our prosth faculty is obsessed with fit checker. He'll make you do it over and over and over. And over... and over... and over. I've finally figured out that the secret is to just make a big mess of cured fit checker on the table before asking him to come over so it looks like you've already done it about 10 times. Wasteful, but if it saves me 40 minutes of clinic time... 🙄

 

[jk5177]

He cleaned, sterilized and inserted the same gold crown 😱 The patient asked, "Is this a new gold crown?" My instructor, "Why, yes, it's new!" 😱

To the patient: "Why, yes, it's new! Newly cleaned, that is!!! You want to smell it? You can't tell the difference. Here, let me smell it, so you believe me. Voila. *sniff, sniff*"

 

[jk5177]

I once extracted the wrong tooth as well! The tooth I extracted was supposed to be a posterior abutment tooth for a RPD! 👍

Now. If something like this occur to a licensed practicing dentist, can he be sued?

 

[jk5177]

I had to break the bad news to the patient after consulting with the OMFS residents and faculty. I flat out told the patient that I screwed up and I was drunk (ok, maybe not latter)! We, school, offered the patient an "on the house implant", she refused to wait the healing period to get her dentures. I was sh1tting my pants for sure! I felt so bad, it couldn't have happened to a better and sweeter patient. She was completely understanding and empathetic.

Did she return and continue to be your patient? Probably did huh?

 

[drhobie7]

You are right. However, in my case the pt refused the to go have an X-Ray after the doctor asked to have that done.

When you say gauze partition do you mean an unfolded 2x2. If so, I thought of that but didnt do it because I was unsure if it would hinder her breathing or get caught in her throat. If you are not talking about an unfolded 2x2 can I get these partitions from any dental supply company? I will also be checking out that fit checker suggested by Inn2.

Yeah, I was talking about an unfolded 2X2. I think you could just ask the Pt to breathe through his nose. I've never used one before, but after these postings I'm going to do whenever possible.

 

[simpledoc]

I had a classmate do this about 3 weeks prior to graduation and he didn't have time to submit a new impression to the lab. I told him to send his patient to the restroom with a box of gloves and a tongue depressor, but he wouldn't do it. I forgot what he ended up doing about it. Looking back, I would probably just send the patient home with a potato-masher and some cheese-cloth.

a dental surgeon in the army once told me that an immediate remedy would be to make the patient eat a couple of bananas, and drink water....and later decide about the abdominal xray, chest xray etc etc..he said that most of the time this will work..but in prv practice the most important thing to do is to meticulously document the incident including all insructions given to the patient and have the patient sign an acknowledgement as well....that should keep one's a$$ covered

 

[lnn2]

Fit Checker is awesome stuff. The very day I discovered it, I cremated every can of Occlude I could find in a ritual bonfire.

You're way ahead of the curve, Bill! 👍 Occlude and Fit Checker are one of the most important things I've learned from my pros instructor.
I don't see many students using them. That's probably why they have problems sitting their crowns.

 

[radrag]

QUOTE

The girl was cool with it until the doc informed her she would have to check her feces and notify us when it passed.
[/QUOTE]

I swallowed a crown and did the very thing that is quoted above -- and found it. (excitement and disgust rolled into one) How and what should I use to disinfect it?

 

[DrReo]

QUOTE

The girl was cool with it until the doc informed her she would have to check her feces and notify us when it passed.

I swallowed a crown and did the very thing that is quoted above -- and found it. (excitement and disgust rolled into one) How and what should I use to disinfect it?[/QUOTE]

 

[toofache32]

I swallowed a crown and did the very thing that is quoted above -- and found it. (excitement and disgust rolled into one) How and what should I use to disinfect it?

[/QUOTE]

OK.....just for the record, you're going to hell for making fun of the dead guy.

 

[tinman831]

I swallowed a crown and did the very thing that is quoted above -- and found it. (excitement and disgust rolled into one) How and what should I use to disinfect it?

Give it to your dentist and he'll know what to do with it.

As for everyone else here, what's the protocol you follow when a patient has something disappear from sight? I've been told always get a chest xray because you never know if the patient swallowed the item or aspirated it and it could be a while before symptoms show. Do you actually recommend your patient dig through their own excrement to retrieve their crown?

 

[toofache32]

....Do you actually recommend your patient dig through their own excrement to retrieve their crown?

Give them a box of gloves and a cheese grater.

 

[DrReo]

Give them a box of gloves and a cheese grater.

You're too kind.... that cuts into profits- dontcha know?

 

[setdoc7]

When I was a resident one of my OMFS attendings had a kid in his private office for an extraction. Used a 2x2 to prevent aspiration of the extracted tooth or remnants. Kid inhaled the 2x2 and occluded. Attending could not unobstruct the airway and the kid died in the chair. That was it for this attending.

Case 2: I was supervising an OR case on a kid at one of my old hospitals where I was director. Kid went to sleep on the table no problem. Kid was draped, and I placed a molt in the mouth to open the oral cavity to place a bite block and a throat pack. The molt literally breaks in half where the center screw should be. My bet is the screw was never there, but who knew? Next step was a CXR, even though the kid was intubated, to see if we could locate the now "foreign body". Never saw it on chest or abdominal film. Lesson---check instuments before using. Things happen.

 

[aphistis]

When I was a resident one of my OMFS attendings had a kid in his private office for an extraction. Used a 2x2 to prevent aspiration of the extracted tooth or remnants. Kid inhaled the 2x2 and occluded. Attending could not unobstruct the airway and the kid died in the chair. That was it for this attending.

This is a difficult story to believe, unless you personally witnessed the event itself and/or the fallout afterward.

If it's true, the attending assuredly got crucified at M&M for not having intubating equipment and/or skill at their disposal. Barring craniofacial deformities, you should be able to intubate a healthy kid from the opposite side of the room. There's no way an event like that should ever have happened.

 

[radrag]

OK.....just for the record, you're going to hell for making fun of the dead guy.[/QUOTE]

VERY FUNNY!🙁

 

[radrag]

Give it to your dentist and he'll know what to do with it.

As for everyone else here, what's the protocol you follow when a patient has something disappear from sight? I've been told always get a chest xray because you never know if the patient swallowed the item or aspirated it and it could be a while before symptoms show. Do you actually recommend your patient dig through their own excrement to retrieve their crown?

The crown was expensive back in the early 90's. Can't imagine how much it would cost now. (sigh) That's what motivated me to "search" for it. I have 6 children and certainly have changed enough diapers! But this was a whole new dirty ballgame and hope to never do it ever again!

 

[texas_dds]

Now. If something like this occur to a licensed practicing dentist, can he be sued?

i would assume so

 

[texas_dds]

i had a dental school classmate whose patient swallowed a 3 unit gold FPD! and it was the student's FPD competency test! Chest film negative, thank god. They "retrieved" it a day or two later - and melted it down, cast a new FPD. gross!

lately i had a 10 year old swallow a telescoping arm from a Herbst appliance (think 1.5 inch long rod about 3mm in diameter - it telescopes to about 2 inches) breathing and swallowing were ok - but i had my stomach in my throat as i walked over to tell her dad in the waiting room. thank goodness it was not in the chest film - she passed it a few days later

 

[Denture95]

I have one 7 year old pt swallowed the one-unite space mainteiner(#T) when I try to remove it last week. I havefollowed up with pt's mom twice . However, the mom said she didnot find it and she said she may miss it because pt may poo-poo in school. Should I suggest pt to take cxr and abdominal x-ray? If it shows on abdominal x-ray, does it need surgeon to take it out? I do't think so, then what's going to happen?

 

[doc3232]

OK.....just for the record, you're going to hell for making fun of the dead guy.[/QUOTE]

Didn't they find out he extremely overdosed on multiple things?

 

[davefan]

I have one 7 year old pt swallowed the one-unite space mainteiner(#T) when I try to remove it last week. I havefollowed up with pt's mom twice . However, the mom said she didnot find it and she said she may miss it because pt may poo-poo in school. Should I suggest pt to take cxr and abdominal x-ray? If it shows on abdominal x-ray, does it need surgeon to take it out? I do't think so, then what's going to happen?

Yes. After a pt swallows a crown, space maitainer etc. you should always offer a chest x-ray on your dime right away. If the pt/parent refuses document it and follow up as it sounds like you have. As long as the child didn't aspirate it, which, evidently they did not, there shouldn't be a problem...

I always use a 2x2. Sec's story is crazy... Hopefully something like that will never happen... However, we must be prepared.

 

[Denture95]

Yes. After a pt swallows a crown, space maitainer etc. you should always offer a chest x-ray on your dime right away. If the pt/parent refuses document it and follow up as it sounds like you have. As long as the child didn't aspirate it, which, evidently they did not, there shouldn't be a problem...

I always use a 2x2. Sec's story is crazy... Hopefully something like that will never happen... However, we must be prepared.

Is there any symptoms/signs if pt aspirated it? How soon we will know that.

 

[OMSDoc]

I have one 7 year old pt swallowed the one-unite space mainteiner(#T) when I try to remove it last week. I havefollowed up with pt's mom twice . However, the mom said she didnot find it and she said she may miss it because pt may poo-poo in school. Should I suggest pt to take cxr and abdominal x-ray? If it shows on abdominal x-ray, does it need surgeon to take it out? I do't think so, then what's going to happen?

Any dental instrument or restoration that goes down the throat requires a chest x-ray and possibly an abdominal film. If the appliances lodges in the intestine, then the patient could potentially loses a portion of bowel. if you are a dental student, then the school should pay for it.

When I took our state board at the end of my senior year of dental school, one of my classmates had a patient who swallowed their gold inlay just prior to seating it. My classmate got the patient up, took them down one floor in our building, and offered the patient $50 to stick their finger in their throat. The patient did, threw up the inlay (did not bend a margin), and my friend took the patient back upstairs, cemented the inlay, and passed the boards.

Uffda!

 

[tinman831]

Is there any symptoms/signs if pt aspirated it? How soon we will know that.

A patient can aspirate a foreign object and not show symptoms for hours. If you suspect that a patient may have swallowed/aspirated something, insist that an xray taken to be sure. You don't want to send the patient home and have them develop complications then.

 

[tinman831]

When I took our state board at the end of my senior year of dental school, one of my classmates had a patient who swallowed their gold inlay just prior to seating it. My classmate got the patient up, took them down one floor in our building, and offered the patient $50 to stick their finger in their throat. The patient did, threw up the inlay (did not bend a margin), and my friend took the patient back upstairs, cemented the inlay, and passed the boards.

Uffda!

 

[Denture95]

Sometimes we do need to be lucky