Worried about foreign body aspiration in patient's mouth.

[PARRYJUDGE559]

Hello, I am a D2 student with a few months left before working on real people. I have a bad habit of dropping wedges and matrix bands in the mannequin's mouth. I have improved compared to D1 but I still make this mistake on occasion.

The typodonts we use have tight contacts, and a wedge does not create real separation unlike real tooth, as I was told by a D3. Sometimes the wedge breaks or falls, when I try to use a larger wedge between teeth, or if the teeth are tightly screwed.

I was just wondering if this is a purely technique problem or something else. Did anyone here have this problem and what helped. Also its protocol in our school, to tell the patient to get an X-ray if something falls down in their mouth, in the rare case it was aspirated. Does this apply to every object, no exceptions?

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[Thehighwind87]

I’ve never dropped anything in 10+ years.

Just use more common sense in removing bands and wedges.
It’s not hard.

 

[PARRYJUDGE559]

I’ve never dropped anything in 10+ years.

Just use more common sense in removing bands and wedges.
It’s not hard.

Okay, you're saying it's mostly a common sense issue. But anyone can make mistakes, if you do drop a wedge or matrix band in pt's mouth. Does it warrant an X-ray, for the small chance it is aspirated even if it wasn't protocol at our school?

 

[cooliyak]

Are you not using some kind of isolation technique like a rubber dam or isodry? If not, I’d recommend doing so at least until you get the hang of things more. Dropping anything in a patient’s mouth is not a small deal.
Also, switch to a Palodent or Garrison as soon as you can, even if you have to buy it yourself. With those systems, the ring creates the separation for the contact, not the wedge, so that can help your situation.

 

[yappy]

Use eye glasses, bite block/rubber dam or isolite on every patient. Use a throat shield for extractions. Do not compromise.

 

[tinman831]

Okay, you're saying it's mostly a common sense issue. But anyone can make mistakes, if you do drop a wedge or matrix band in pt's mouth. Does it warrant an X-ray, for the small chance it is aspirated even if it wasn't protocol at our school?

If you drop something in the patients mouth and you did not retrieve it and you can't find it, then it's best to send them for a chest xray. Better safe than sorry.

 

[Molar Whisperer]

State Boards (particularly mine) want documentation of what barriers and isolation you use for every procedure. A classmate of mine during school had a pt aspirate a crown. She and the attending instructor had to take the pt to the Hosp ER for imaging and surgery. Restoring implants can get you into trouble when you lose those tiny parts. Prepare for Murphy's Law especially when you're running behind.

 

[Gen. Beauregard]

If I'm delivering a maxillary posterior crown I tell the patient ahead of time, "everything I'm working with is small, and slippery, and heavy. If you feel something drop, don't swallow. Lean forward and we'll use gravity to help get it out." Then I'll frequently sit them up so if it does fall, it falls down and not back. It's possible to blast an uncemented crown off with the air syringe, or spring it off with the explorer or floss when checking contacts. Keep a finger on it when you're flossing. Pic-n-sticks are handy when I'm working on little old ladies. Rope wax on a microbrush head is basically the same thing. All my implant drivers, ring clamps, and bite blocks get floss ties. Patients will do most of the goalie work with their tongue. Don't be afraid to sit them up and ask them to get it out if you don't have an assistant in the clinic, and don't be afraid to unfold a 2x2 gauze as a throat pack if you're spooked. Chest films are the SOP if anything is swallowed that could have been aspirated or cause a GI perf. Poop happens, just plan for it and don't panic when it happens.

 

[lol105]

Use Isodry/Mr.Thirsty for operative procedures. Worst case, unfold your 2x2 gauze and place it in the throat when you're inserting/removing small things.

If you're really worried, then you can place rubber dam on. I found it very cumbersome for fillings.

 

[SuxDrugs&Rocuronium]

Use Isodry/Mr.Thirsty for operative procedures. Worst case, unfold your 2x2 gauze and place it in the throat when you're inserting/removing small things.

If you're really worried, then you can place rubber dam on. I found it very cumbersome for fillings.

Please use 4x4’s instead, there have been cases of patients aspirating 2x2’s