Preventing Foreign Body Aspiration and Ingestion with a Damp Gauze in Clinics

Implantable medical devices and prostheses are inherently recognized as foreign bodies by the human body. Foreign body aspiration and ingestion are serious emergencies that can still occur in clinical settings, particularly during dental procedures; this necessitates prompt and appropriate management to ensure patient safety. This Editorial proposes a straightforward and effective approach to preventing foreign body aspiration and ingestion incidents. The suggested method is applicable across various procedures, including cement removal, the handling of implant components (such as cover screws, healing abutments, and impression copings), the manipulation of abutment and prosthetic screws, the management of endodontic files, and the removal of both intracoronal and extracoronal restorations.

1. Introduction

Foreign body aspiration (FBA) and foreign body ingestion (FBI) are emergencies that can still occur in dental clinics, and require proper management to ensure patient safety [1,2]. These are fairly frequent complications; a retrospective study at the Tokyo Dental College Chiba Hospital reported 40 cases over four years (2008–2012); data from two insurance companies representing 24,651 French general dentists described 508 incidents from 1994 to 2004; and the Korea Consumer Agency reported 112 incidents of FBA and FBI during dental procedures from 2019 to 2023 [3,4,5]. Aspirated or swallowed dental objects include prosthetic crowns, teeth, endodontic files, dental burs, and surgical drills [2,6]. With the increasing use of dental implants, implant screwdrivers, abutment screws, abutments, and very small prosthetic screws are also easily inhaled or ingested during dental treatment [1,7].

Approximately 10% of these incidents are classified as FBA, which is very dangerous, while most are classed as FBI, which can also be life-threatening [1,2,3,4,5,8]. Dental clinicians should exercise caution when working with dental objects that can fall into the gastrointestinal tract or airway, potentially causing severe complications, such as lung abscesses and pneumonia [2,6]. While several techniques have been introduced to prevent these incidents, these methods typically involve modifying the prosthesis and tying dental floss to it [9,10,11], which requires additional laboratory procedures and cannot be applied to other types of foreign bodies, such as healing abutments and cement remnants. In this Editorial, we offer a simple method using damp gauze to prevent FBA/FBI accidents. This approach requires no additional equipment and is highly cost-effective, considering the various other methods available to avoid these undesirable events.

2. Clinical Guidelines for the Prevention of FBA/FBI

One of the authors (Yang JH) discovered that patients felt more comfortable breathing with a damp gauze in their mouths, leading to the development of this approach for prevention. A dry gauze tends to induce coughing, especially when it contacts the uvula. The authors confirmed the difference between damp and dry gauze by applying them directly to their own mouths. Based on these experiences, a straightforward solution is proposed, as follows:

• Soak a sterilized gauze (10 × 10 cm) in tap water (Figure 1A);
• Squeeze the gauze slightly;
• Spread the gauze inside the oral cavity, covering the uvula to ensure that no foreign bodies can pass into the throat. Expose only the teeth and the specific area required for the procedure, while covering any unnecessary areas for the procedure (Figure 1B);
• An assistant should gently hold the gauze with a mirror, and a suction tip should be applied lightly over the gauze.

This method is applicable to both conscious and sedated patients, though the risks and considerations differ between these groups [12]. For conscious patients, the use of a damp gauze helps prevent aspiration and ingestion by maintaining a clear airway and acting as a barrier, while allowing the patient to remain alert and responsive [13]. However, for sedated or dementia patients, who may not exhibit the same level of responsiveness, the procedure requires increased caution and monitoring [1,7].

While this technique offers simplicity and ease of use, it has certain limitations. One key drawback is that the effectiveness of the gauze relies on the proper placement and the attentiveness of the clinician and assistant. Improper application could still lead to foreign body aspiration or ingestion, particularly in more complex procedures involving multiple small components. A comparison with other methods, such as the use of dental floss ligatures or rubber dams, reveals that while these methods may provide additional security, they also present challenges related to time and equipment availability [4].

3. Conclusions

FBA and FBI are frequent complications occurring during dental treatment and can sometimes be life-threatening. The simple approach proposed in this Editorial is considered effective in preventing FBA and FBI incidents. This solution appears to be straightforward for preventing the inhalation or ingestion of foreign bodies during dental procedures including cement removal, handling implant cover screws, healing abutments and impression copings, manipulating abutment and prosthetic screws, handling endodontic files, and removing intracoronal and extracoronal restorations.