Accidental ingestion of orthodontic band loop

Aspiration or ingestion of whole or part of an orthodontic appliance occurs occasionally in orthodontics but needs to be considered as an emergency as it can be a cause of accidental death.¹ Orthodontic components are mostly small and, in combination with saliva, handling can sometimes be difficult. With the current concept of dental care delivery that involves sit-down, four-handed dentistry, the patient is usually placed in a supine or semi-supine position to aid access to the oral cavity and to improve the comfort of the patient and clinician. In a supine position, there is the risk of a dropped object falling into the oropharynx and being swallowed or inhaled.^2,3,4

The incidence of swallowing or aspiration of foreign bodies of dental origin varies considerably in the literature; however, the range varies from 3.6–27.7% of all foreign bodies and the incidence is higher among adults than among children.⁵ Limper and Prakash reported that the second most common cause of foreign body aspiration in the lungs was of dental origin.⁶ Swallowing of foreign bodies of orthodontic origin ranges from upper removable appliances,⁷ expansion appliance keys,⁸ lower spring retainers⁹ and fragments of upper removable appliances,¹⁰ to a piece of archwire,^4,11 TPA during its removal,¹² habit-breaking appliances, ie upper removable appliances fitted with only osenklammer type retainers,¹³ orthodontic brackets,⁴ sectional archwire with loop,⁴ and fractured twin block appliances.¹⁴ This case report describes the accidental swallowing of a piece of orthodontic band material and its subsequent management, together with recommendations to avoid such a consequence, and contemporary thinking on prevention and management of foreign body ingestion.