So You've Swallowed Your Dentures

Inadvertent ingestion of everyday objects happens much more often than you'd think. 3,500 Americans swallow batteries every year.

"On being questioned, the patient recalled having accidentally swallowed her dentures recently." [©RadioGraphics 2011]

Fish bones, followed by other types of bones, followed by dentures, are what most often end up in adults' digestive tracts, according to a new review, from Düsseldorf University Hospital, of adults accidentally swallowing things. (For more on this last problem, see the engaging case study entitled, "Where Are My Teeth?")

Small children, as everyone knows, are constantly putting things in their mouths that don't belong there, and it's not uncommon for them to end up swallowing them. That's why we keep small toys, coins, and other things that look like candy but aren't away from people under the age of six. But even grown-ups, upon confronting a non-childproofed world, are at risk of accidentally swallowing foreign objects. Their stories make for a fascinating and instructive tour of the medical literature.

Eighty percent of the time, mistakenly ingested objects make their way naturally out of the body -- usually within four to six days, although in rare cases can take up to a month (the myth that chewing gum hangs around for seven years is, it appears, just that). The other 20 percent gets "hung up" in the esophagus or intestines and may require surgical or endoscopic intervention to remove.

peninset.jpgThe pen remained friendly after 25 years in a woman's stomach. [©British Medical Journal 2011]

In general, can take two lessons away from stories like those of the woman who lived 25 years with a felt-tip pen lodged in her abdomen, which doctors initially refused to believe she'd swallowed. The first, as the author responsible for her case study concluded: "Occasionally it may be worth believing the patient's account however unlikely it may be." The second: Like the pen, which, after being removed, was still able to write, these things sometimes have a way of turning out okay.

After conducting a thorough review of the literature, researchers advise that how worried you should be depends on four main characteristics of the swallowed object in question:

How big it is. In "Journey of a Swallowed Toothbrush to the Colon," for example, we hear the story of a foreign object that tried its hardest to show itself out but ended up lodged in the patient's digestive system.

An ingested battery, easily identified. [©RadioGraphics 2011]

How sharp it is. A swallowed object that's otherwise small enough to be easily passable can be rendered far more dangerous if it has rough or pointy edges, as in the case of a 45-year old woman whose liver was basically torn apart by a toothpick.

If the object in question is both big and sharp, as with the young lady who accidentally swallowed a knife , it goes without saying that emergency care is going to be required. Immediate danger aside, as James Hamblin wrote of this case, a desensitized gag reflex can be indicative of an eating disorder (and while this was a particularly bizarre example, toothbrushes are known to be inadvertently swallowed by patients with bulimia). Similarly, having a "voracious appetite" can cause problems: Case studies demonstrate how fish and chicken bones tend to be swallowed by people who overeat at a rapid pace.

Plastic bread clips, it would appear, are also frequently swallowed -- their danger comes from the combination of their small size and unique shape. A review out of London from a while back noted that the design that makes them perfect for keeping bread fresh in its bag also leads them, upon accidental ingestion, to cling on the bowels, making removal difficult. The authors suggested that it's elderly dentures-wearers who are most susceptible to this issues. But in "Plastic bread-bag clips: The saga continues," we hear of a young, single father who didn't have time to chew his food properly, and in his haste failed to realize that one of these clips had made its way into his sandwich.

TSWJ2012-102642.001inset.jpgTSWJ2012-102642.003inset.jpgA ring and a spring. [©Scientific World Journal 2012]

How potentially poisonous it is. "Body packers," also known as drug mules, are particularly difficult to treat because if the packages of cocaine or heroine or whatever else they're trying to smuggle through security are ruptured in the process of removal, they'll suffer from a massive overdose. But the swallowing of toxic items can happen absent monetary incentive -- each year, according to the D.C. poison center, over 3,500 Americans "of all ages" swallow batteries. Button batteries may be small and smooth, but their electrochemical properties make them extremely dangerous once they start to be digested.

How easy it is to find. Not everything that makes its way into one's body will show up on an x-ray. A swallowed object's visibility therefore factors into how concerning the incident is. And while doctors, through some combination of CT scans and, in some cases, metal detectors, are usually able to figure out where a foreign body has landed, some people might not even realize that there's something that needs to be found (see, again, "Where Are My Teeth?"). Parcels hidden in the stomachs of body packers, of course, don't want to be found, and according to a review of CT techniques, "may go undetected unless a high degree of suspicion exists."

Sometimes, these things are just unavoidable, and once you've swallowed a drill bit, as occurred for an unfortunate dental patient this fall in Sweden, you're just going to have to deal with the consequences. While not as common as denture ingestion, this type of dental incident is apparently not without precedent. As the medical chief of the hospital in question said, with (one would imagine) a resigned shrug, "Unfortunately, drills are going to be dropped every now and then."