Thanks to Dr. Sanford C. Barnum for the invention of the rubber dam...

!!! Never do ENDODONTICS if you cannot place DENTAL DAM !!!

Case Report-Article posted by Saudi Endo Journal april 2013

A 6 year old female child reported to the Department of Pediatric Dentistry, SDM College of Dental Sciences complaining of pain and swelling in the oral cavity in the right lower back jaw since 4 days. Intra oral examination revealed deep dental caries in relation to right mandibular second primary molar associated with gingival swelling with the same after radiographic examination; a diagnosis of acute periapical abscess was made. The patient was apparently cooperative, and hence a decision to carry out emergency access cavity preparation to facilitate abscess drainage under antibiotics coverage was made. Rubber dam application was not possible because of associated swelling. During the extirpation of the pulp with an endodontic file the child experienced pain and suddenly moved with jerky movements leading to slipping of the file from the operators fingers, which the patient swallowed. All the emergency protocol to retrieve the aspirated foreign objects was carried out including thumping on the back, trendelenburg position, and Heimlich maneuver. The child was immediately examined and as there were no signs of respiratory obstruction (dyspnea or cyanosis). There was mild gagging, coughing and slight increase in breathing, probably caused by anxiety. Otherwise the child was cooperative.The child was rushed to the emergency room of Department of Radiology where the anterior - posterior X-ray of chest and abdomen was taken half an hour after the incident. The file was located in the stomach from the X-ray [Figure - 1]a and was decided to retrieve the file by gastro scope to prevent further complications, considering that the file is a sharp endodontic instrument. During endoscope procedure that was done under general anesthesia after parents consent and medical fitness, the upper GIT was normal, with no evidence of lacerations or bleeding from the mucosal lining. The gastroscope located the file which had pierced mucosal lining in the region of pylorus sphincter[Figure - 1]b and retrieved the file with special nipper successfully [Figure - 1]c and d. The patient was discharged the next day without any post operative complications.