Think about your practice and the procedures you perform every day. Your patient is lying in the chair with their mouth wide open, and what are we, as practitioners, doing? Placing a composite? Seating a crown? Bonding orthodontic brackets? Taking an impression? You get the idea. It all seems very routine, until the unexpected happens.

Consider this scenario: You have a patient in the chair in a supine position. You are planning to seat an onlay on tooth #2, the maxillary second molar. Your assistant has lined the internal surfaces of the onlay with cement and is ready for the hand-off for you to seat it on the patients tooth. You ask your patient to open really wide for access, which opens the throat wide open, too. Your gloved fingers have been in the patient’s mouth and are somewhat wet from touching the soft tissues and saliva. Just as you are ready to transfer the onlay to the tooth, it slips from your fingers and……….Uh-Oh!

This could play out a few different ways:

1. Your assistant with her speedy fast reflexes quickly roll the patient’s headto the side and saves the day! The crown is retrieved with cotton pliers in the back corner of the mouth.Whew! That was close.
2. The patient swallows just as the onlay hits the back of the throat. Oh no! The restoration has been swallowed. Now you can either have the patient monitor their stool for the next couple of days, or you go to the expense of having another onlay fabricated. Either way, your patient will not be happy and time and revenue has been lost.
3. The restoration went down the throat and into the airway. Your patient starts coughing and wheezing and cannot seem to get it to come up. At minimum, this is going to mean a trip to the hospital for the patient. Aspiration of foreign objects can be very serious, if not fatal. The practitioner, again, has lost time and revenue, and possibly ends up with a lawsuit.

According to the National Journal of Maxillofacial Surgery, the potential of a foreign body aspiration or ingestion is a worldwide health problem in dentistry.

Dental items are the second most commonly ingested or aspirated foreign objects in adults. These objects include teeth, root tips, burs, orthodontic brackets, crowns, pins, posts, impression material, and among others. Items as large as dental dam clamps, expansion keys, endo files, and even air/water syringe tips have been reported to go “down the hatch”and land in the GI tract or into a lung. Now you have a medical emergency on your hands. Given the fact that such cases are avoidable, you, the practitioner, are liable for malpractice litigation.

Some of the consequences of an aspirated object are complete or partial airway obstruction, respiratory distress or failure, pneumothorax, and hemorrhage. In addition, inadvertent aspiration of foreign objects in asymptomatic patients may not be evident for months, resulting in late complications such as post obstructive pneumonia, bronchiectasis, or lung abscess. The key sign that most dentists recognize when patients aspirate an object during a dental procedure is coughing. It has been reported that coughing resulting from aspiration of foreign objects may range from mild to severe. There are cases that dental items have been aspirated without the patient or practitioner even realizing it. It may not be as obvious as the onlay scenario. It could be as simple as a piece of amalgam scrap or a broken bur. The dental practitioner must have a degree of suspicion if a patient suddenly develops a cough during or after a procedure. Also, special attention needs to be given to our armamentarium to assess that everything used in the procedure is accounted for.

So, how do we prevent ingestion and aspiration in the dental office? Typically, gauze packs are used in the back of the throat for this purpose, but patients and dentists alike find this to be cumbersome and uncomfortable. Gauze moves around, does not provide complete isolation, can become caught by the bur, becomes saturated and has to be replaced frequently. In fact gauze has been reported to have been swallowed and aspirated, which is the exact thing it was there to prevent! Dental dams are a better solution than gauze for airway protection, but again, they are cumbersome and uncomfortable. Dams often require four hands just to put on, plus they limit the visibility of the oral cavity and can cover the patients nose – making it difficult to breath. Because gauze and dental dams were not considered ideal, protecting the airway is not done as often as it should be!

Dr. Gargi Mukherji and Dr. Ralph Cooley, both dentist’s and professors at TexasUniversity College of Dentistry, wanted to design a device that would provide patient safety and make it so easy to use that every dentist would be inclined to use it for more procedures. They nailed it with their original and innovative design. “I just feel like we [all] could be better dentists if we are protecting patients’ airways to the best of our ability,” said Dr. Mukherji. “This is something that can really improve our profession, and improve the care we render to our patients.”

Zirc’s Airway Armor^® is a one-of-a-kind product for the prevention of ingestion and/or aspiration of foreign objects in the dental office. There is really nothing like it on the market! Airway Armor^® is designed to be more comfortable and reliable for the patients than gauze packs and they are quicker and easier to use than dental dams. The small holes are beneficial to allow the patient to breathe comfortably while Airway Armor^® is in use. Tying floss to either side allows for easy removal of the device. Get Airway Armor^® in all three sizes today, so you can: Protect your patients and protect yourself.

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