Dental foreign body ingestion is a rare but life-threatening medical emergency. These objects are either aspirated or ingested.[1] Ingestion is shown to be more prevalent than aspiration.[2] Orthodontic materials in the form of wire segments, brackets, and molar bands are the second most common of dental foreign bodies to be ingested.[3] Majority of ingested smooth dental foreign bodies that have passed the duodenal sweep pass through the gastrointestinal (GI) tract uneventfully while materials with rough surfaces and projections pose risk of obstruction, impaction, or fatal perforation.[4] Patient anxiety and possible malpractice litigation are other possible concerns. We report a case of accidental ingestion of a tube pre-welded molar band at the time of luting. The foreign body with a projecting hook was located in the stomach within an hour and was retrieved using endoscopy.

A 14-year-old male patient reported to the outpatient clinic for his orthodontic treatment with fixed appliance mechanotherapy. During the try in of a tube pre-welded molar band in the lower left mandibular first permanent molar, the band dropped into the lingual vestibule and the patient accidentally swallowed it. The patient was positioned supine during the procedure. He was immediately made to turn to his side and a swift examination under bright light was done inside the oral cavity to rule out its presence there. The oral cavity was clear. The patient was asked to cough vigorously to evict the band from oropharynx. Following failure of this exercise, the patient and the parent were informed of the accident and its implication. They were apprised of the management protocol and taken for X-rays. Lateral and posteroanterior views of the X-ray [Figure 1] did not reveal the presence of the band. A computed tomography was taken which revealed the band as a hyper dense field in the stomach [Figure 2]. The patient was taken for a gastroenterological consultation where an endoscopy was advised. The band was located and retrieved by endoscopy without complication [Figures 3 and 4] [Video 1].

Figure 1:: Posteroanterior view and lateral view of chest.

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Figure 2:: CT image showing band as a hyper dense field.

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Figure 3:: Band location and retrieval by endoscopy.

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Figure 4:: Retreived molar band.

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Supine position of patient during orthodontic procedures, small size of objects, and salivary field of work have been attributed as factors that predispose orthodontic materials for accidental ingestion.[5] About 92.5% of swallowed foreign bodies have been shown to enter the GI tract while 7.5% are aspirated into the tracheobronchial system.[6] Cleft lip/palate patients with compromised velopharyngeal competency and patients with reduced laryngeal closure are at risk of aspiration compared to others.[7] Ingested foreign bodies have a spectrum of sequelae. Majority of them that have passed the Duodenal sweep exit the GI tract asymptomatically within 3 days of ingestion.[8,9] However obstruction or impaction in cases of objects with projections as in this instance of a hook in the band can result in dysphagia, abdominal pain, abdominal distention, sepsis, and perforation which can be fatal.[4] Early location and an immediate attempt to remove the object are the preferred protocol. In our case, immediate location and referral resulted in an uneventful resolution of the crisis that would have otherwise resulted in patient anxiety which is an important ethical and medicolegal concern.

A cautious clinical protocol can effectively prevent this avoidable phenomenon of accidental ingestions. The following recommendations have been proposed as preventive measures.[10]

Distractions during procedures such as mobile phones need to be avoided both by the patient as well as the auxiliaries

A textured glove is recommended for better grip

A high speed suction with pharyngeal tip should be at hand during intraoral procedures

Activation keys, molar bands, and palatal arches should always be secured with sterile threads or floss during activation, fit checks, and insertions, respectively

Gauze pads should be placed as barriers

Distal end cutters should be examined for cut ends after use and trapped tips removed before the next use

Safety holds of distal end cutters should be periodically checked and replaced in case of failure

Mini screws temporary anchorage devices (TADs) should be tied to the primary arch wire with ligatures

Review appointments for patients complaining loose components should not be delayed and necessary adjustments should be done forthwith

All intra oral appliances should be having a radio opaque component to help in radiographic visualization and they also need to be checked for sharp edges, margins, and failure margins.

Accidental ingestion of orthodontic materials is an avoidable medical emergency. Supine patient position, salivary field, and small size of objects make orthodontic materials prone for accidental ingestion. This however is not a justification for an accident. All necessary precautions should be taken to prevent such an occurrence. In the event that it occurs, early location and retrieval, particularly of materials with projections and rough surfaces, are the preferred management.