Accidental Ingestion of Twin Block - Final.pptx

This journal club highlights upon the incidences of ingesting a Fractured Twin Block Appliances and the management protocols followed.

1. Accidental Ingestion of Fractured Twin Block Dr. Saif Alam JR – 1 Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

2. Introduction Orthodontic appliances or parts of orthodontic appliances that become dislodged can cause problems in the airway or the gastrointestinal tract. Accidental ingestion of an appliance during a chair-side procedure or later, because of inadequate retention of the appliance, can create a medical emergency that can lead to serious complications, including death from aspiration. Tamura et al, in a review article, reported that the range was 3.6% to 27.7% of all foreign bodies, with the number considerably higher in adults than in children.

3. Expansion Key Transpalatal arch Lingual Spring Retainer Activation of the Expansion Appliance

4. Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

5. Case Report A 12-year-old boy, with the chief complaint of pain in the auricular region during wide opening of the mouth for 2 months, sought orthodontic treatment. On clinical examination, he had tenderness of the masticatory muscles, and clicking of the temporomandibular joint during mouth opening. The dental findings included features of Angle Class II Division I malocclusion. The cephalometric findings indicated a Skeletal Class II malocclusion with a normal maxilla and a retrognathic mandible. MRI showed an anteriorly displaced disc, which was recaptured on mouth opening, confirming the diagnosis of anterior disc displacement with reduction. Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

6. Treatment was planned with the following objectives :- Relieve the pain, Recapture the anteriorly placed articular disc, and Obtain a Class I relationship with growth modification. To fulfill the objectives, the patient was given a Twin-block myofunctional appliance. Twin-block postures the mandible in a forward position until a normal disc-condyle relationship is obtained. It also acts as a splint, brings about disocclusion of the teeth, and also improves the facial muscle balance. Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

7. While the patient was wearing the Twin-block appliance, the lower portion broke after it was dropped (Fig 1). Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

8. Despite the breakage, he continued to wear the appliance by approximating the broken fragments; he did not report the breakage. While sleeping, he accidentally swallowed a fragment of the appliance; waking up breathless with a severe cough. The patient moved around and his father hit him on the back. These efforts to dislodge the obstruction were ineffective, and instead it became lodged in the esophagus; which was later confirmed by endoscopy (Fig 2). Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

9. The patient was immediately admitted to the hospital, and the broken fragment was removed from the esophagus (Fig 3). He was discharged the same day with no further complications. Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

10. Discussion This case report illustrates the ease with which removable appliances can become dislodged if retention is inadequate. Foreign body ingestion or aspiration has the potential to result in acute medical and life-threatening emergencies, such as :- Bronchial stenosis Bronchiectasis Lung abscess Tissue ulceration or erosion Esophageal perforation Pneumothorax Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

11. The orthodontist should take certain precautions during the use of removable appliances, such as:- All the components of the appliance should be smooth and rounded. Hooked or C-clasps should be avoided if possible or alternative retentive components be used to reduce the risk of puncturing the lining of alimentary canal. All appliances must be suitably retentive and of adequate size. Mandibular removable appliances have a tendency to fracture from the inadequate bulk of the acrylic, especially in the anterior lingual sulcus. So the appliance can be strengthened through incorporation of a rigid wire in the acrylic. 5. Use of different colored acrylic, rather than clear or pink, for removable appliances and retainers has been suggested to avoid the problems of visualizing the acrylic on bronchoscopy or endoscopy. 6. Patient should always be advised both verbally and with written instructions at the time of appliance delivery that they should not try to reinsert damaged, ill-fitting, or broken fragments of any appliance. Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

12. The orthodontist and the general dentist must be able to recognize the signs and symptoms of air obstruction in case a dental object is lost into the oropharynx. According to the Mayo Clinic website, the universal sign for choking is, “ Hands clutched to the throat” Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

13. If the person does not give the signal, one should look for:- Inability to talk. Difficulty in breathing or noisy breathing. Inability to cough forcefully. Skin, lips and nails turning blue or dusky. Loss of consciousness. Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5.

14. Milton TM, Hearing SD, Ireland AJ. Ingested foreign bodies associated with orthodontic treatment: report of three cases and review of ingestion/aspiration incident management. British dental journal. 2001 Jun;190(11):592-6.

15. Milton TM, Hearing SD, Ireland AJ. Ingested foreign bodies associated with orthodontic treatment: report of three cases and review of ingestion/aspiration incident management. British dental journal. 2001 Jun;190(11):592-6.

16. Milton TM, Hearing SD, Ireland AJ. Ingested foreign bodies associated with orthodontic treatment: report of three cases and review of ingestion/aspiration incident management. British dental journal. 2001 Jun;190(11):592-6.

17. Negi N, Vaid S, Chainta D, Negi KS. Accidental Ingestion of a Foreign Body in Orthodontics. J Ind Orthod Soc 2013;47(4):225-228.

18. Negi N, Vaid S, Chainta D, Negi KS. Accidental Ingestion of a Foreign Body in Orthodontics. J Ind Orthod Soc 2013;47(4):225-228.

19. Negi N, Vaid S, Chainta D, Negi KS. Accidental Ingestion of a Foreign Body in Orthodontics. J Ind Orthod Soc 2013;47(4):225-228.

20. Management of ingested/aspirated dental objects

21. Chair position If equipment is not readily available chairside to retrieve the object, the patient should be turned onto his or her side and leaned into a head down (Trendelenburg) position with the upper body hanging over the side of the dental chair. This position uses gravity to the patient’s advantage, allowing the object to fall from the patient’s mouth.

22. Abdominal thrust (Heimlich Manoeuvre) The subdiaphragmatic abdominal thrust, or abdominal thrust, or Heimlich Manoeuvre, was first described in 1975 by Dr. Henry J. Heimlich. Today this manoeuvre is the recommended primary technique for relief of foreign body airway obstruction in victims 1 year of age and older.

23. Kneel or stand behind the victim and wrap your arms around the victim’s waist. Stabilize yourself so as not to fall backward when the procedure is carried out. Make a fist with one hand. Place the thumb side of the fist against the victim’s abdomen. The hand should rest in the midline, slightly above the umbilicus and well below the tip of the xiphoid process ( Figure A ). 5. Grab your fist with your other hand and press your fist into the victim’s abdomen with a quick, forceful upward thrust ( Figure B ).

24. 6. Repeat these forceful inward and upward thrusts until the foreign body is expelled or the victim loses consciousness (see Figure 11-20 ). 7. Each individual thrust should be forceful enough to dislodge the foreign object. 8. The successfully treated victim should be evaluated for possible complications before being dismissed.

25. Negi N, Vaid S, Chainta D, Negi KS. Accidental Ingestion of a Foreign Body in Orthodontics. J Ind Orthod Soc 2013;47(4):225-228. Conclusion Medical emergencies may happen during any orthodontic procedure but what is important are the precautions taken and the preparedness on the part of orthodontists in managing these episodes. Should such an unfortunate accident happen, orthodontist must be capable of providing basic life support measures. Any foreign object suspected of being ingested or inhaled should be localized radiographically and the decision to manage it conservatively or surgically must be taken based on its size, shape, nature and location.

26. References Rohida NS, Bhad WA. Accidental ingestion of a fractured Twin-block appliance. American journal of orthodontics and dentofacial orthopedics . 2011 Jan 1;139(1):123-5. Milton TM, Hearing SD, Ireland AJ. Ingested foreign bodies associated with orthodontic treatment: report of three cases and review of ingestion/aspiration incident management. British dental journal. 2001 Jun;190(11):592-6. Negi N, Vaid S, Chainta D, Negi KS. Accidental Ingestion of a Foreign Body in Orthodontics. J Ind Orthod Soc 2013;47(4):225-228. Medical Emergencies in Dental Office (Seventh Edition) - STANLEY F. MALAMED