Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. email@example.com. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space. Readers may now comment on letters via the BDJ website (www.bdj.co.uk). A 'Readers' Comments' section appears at the end of the full text of each letter online.
Sir, I recently came across an article regarding a lady who ingested a piece of orthodontic archwire during her treatment ten years previously. She had no recollection of this occurring but presented to hospital with abdominal pain as the archwire had pierced her intestines in multiple places and she required emergency surgery to remove the 7 cm piece of wire.1
I wondered about the chances of a patient swallowing brackets or small pieces of arch wire during the process of orthodontic treatment and our position as clinicians. A similar scenario would be a patient inhaling or swallowing an endodontic file but it is well known that defending the dentist in such a case is very difficult if no rubber dam is placed. Obviously rubber dam placement while undergoing bond-ups or wire changes for a patient is not possible, so if this were to occur, in what position would the provider find themselves if the patient decided to pursue litigation?
Jane Merivale from Dental Protection offered me the following advice which I would like to share: 'sit the patient in an appropriate position to protect the airway and allow you the best possible vision and dextrous control of the wires and brackets. It is always important to keep detailed contemporaneous notes and if adverse event materialises such as the swallowing of a small object, then this should be thoroughly documented and the patient advised as per the usual protocol to have a chest X-ray to identify the location of the object and for necessary steps to be taken for retrieval'.
I am grateful for this advice and would be interested to hear other readers' thoughts or experiences on the matter.