A swallowed endodontic file: case report.

Because the swallowing of endodontic instruments has been the subject of relatively few articles, dentists may not be aware of the medical and legal complications of such an occurfence. Search of the literature during the past 20 years showed that many of these swallowed instruments pass through the patient 's digestive tract, x̀ However, there are a number of reported cases in which this does not occur? '6 The legal complications should be obvious in both instances. Most swallowed foreign bodies will be passed within a few days to a month. 7 However, if such an incident occurs, the dentist is obligated to refer the patient immediately to a physician to determine the location of the foreign body? After it has been located by radiographs in the digestive tract, the patient should be instructed to report any occurrences that might indicate the need for surgical intervention, such as abnormal coloration of stools, cramps, nausea, or abdomina l tenderness.'-' Intestinal obstruction, chills, or fever are symptoms of peritonitis caused by an instrument that has perforated the digestive tract. Trea tment is immediate surgical care. Considering the ease of application of the rubber dam for endodontic procedures, *' it is surprising that such cases occur. There are several recently reported cases of malpractice because of swallowing or aspiration of endodontic instruments.""" '1 Legally, the occurrence is unjustifiable and may be indefensible. In a Kansas Supreme Court decision '~ involving a patient who swallowed an endodontic instrument, the court held the opinion that the s tandards applicable to the specialist are to be maintained by the general practitioner who is doing the work of a specialist. When performing endodontics, the specialist's s tandards include using a rubber dam to protect the patient.