​Dentists and other staff in health centers and free clinics should be aware of ingestion or aspiration risks that exist during dental procedures. Items that may be ingested by patients include crowns, extracted teeth, dental burs, and root canal files. While most cases of ingestion do not cause serious injury to patients, significant harm can occur if an object becomes lodged in the patient's airway.

Dentists and staff in clinics that offer dental services can use this checklist to minimize risks associated with objects being ingested or aspirated during dental procedures:

	Periodically check all dental equipment to ensure that handpieces hold burs securely and that other small objects on the equipment are affixed securely.
	Use a rubber dam at all times during root canal procedures in order to reduce the risk of ingestion or aspiration.
	Be aware that even when a rubber dam or other method to reduce the risk of ingestion or aspiration is used, root canal files or other objects may become dislodged (at the time of taking intraoperative radiographs) and may be ingested or aspirated by the patient. Ensure that proper risk management strategies are followed for every procedure. (For more information, see the November 2012 issue of the Academy of General Dentistry [AGD] Impact [available by subscription]).
	Use gauze to cover the oropharynx of sedated patients if a rubber dam is not used and during all dental extractions.
	Ensure that the clinic's policies for handling dental emergencies include guidelines for responding to cases of ingestion and aspiration and that all staff are educated on these policies (see the January 2011 issue of the Journal of the American Dental Association [available by subscription] and Management of Medical Emergencies in a Dental Office).
	If a patient ingests an object during a dental procedure, refer the patient to his or her physician's office or emergency department for an x-ray to confirm that the object was ingested and not aspirated. The referral site must also have a specialist available to perform a bronchoscopy or esophagogastroduodenoscopy (EGD) to remove the object.
	Consider implementing policies requiring that the dentist involved in the incident accompanies the patient for x-rays. Ensure that the dentist brings a sample of the specific object that was ingested so that imaging professionals are aware of which object to look for during imaging studies.
	Ensure that dentists and staff are aware of signs or symptoms of airway obstruction. In such cases, staff should call emergency services and provide appropriate treatment until emergency personnel arrive.
	Ensure that oxygen via nasal tube is available in the health center or clinic in case a foreign object becomes lodged in a patient's airway.
	Document all actions taken to prevent items from being ingested by the patient (e.g., use of a rubber dam) as well as actions taken in response to cases of ingestion that occur. (See Get Safe: The Importance of Good Medical Record Documentation for general documentation tips.)

Want to learn more? Refer to the guidance article Unintentionally Retained Surgical Items on the Clinical Risk Management Program website. All resources are provided for FREE by ECRI Institute on behalf of HRSA. Don't have access or want to attend a free, live demonstration of the website? E-mail Clinical_RM_Program@ecri.org or call (610) 825-6000, ext. 5200.

Information provided by ECRI Institute is intended as guidance to be used consistent with the internal needs of your organization. This information is not to be viewed as required by ECRI Institute or the Health Resources and Services Administration.