Sir, a three-year-old boy presented to the Accident and Emergency Department with his mother. He had hit his face after colliding with another child in a fall that was witnessed by his parents. There was no loss of consciousness. Examination revealed traumatic dental injuries including an avulsed upper primary incisor (62) which was unaccounted for. In line with international guidelines,1 a chest radiograph was requested and Figure 1 shows a radiopaque object projecting adjacent to the left aspect of the L4 vertebral body, crucially indicating that the avulsed tooth had been ingested rather than inhaled.

Fig.1
figure 1

A chest radiograph showing the avulsed 62 clearly visible to the left of the L4 vertebral body

Full size image

We would like to emphasise that both the child and his parents were not aware, or perhaps in the case of the child, did not communicate that the tooth was swallowed during the sudden collision. This tooth could well have been inhaled. When considering that inhalation of foreign bodies in children has a 'lack of clinical manifestation' and is therefore often not diagnosed immediately, ensuring that the child has a chest radiograph undertaken is important.2 A lack of intervention when a foreign body has been inhaled can have serious consequences.3We appreciate, especially when based in primary care, that having this imaging undertaken via the local hospital can be a time-consuming process, but we urge colleagues to consider if this is clinically necessary for some patients presenting with traumatic dental injuries.