Management of dental-origin gastrointestinal foreign bodies: a proposed site-based, risk-stratified framework for multidisciplinary care.

OBJECTIVES

To propose a risk-stratified, site-specific framework tailored to the biomechanical hazards of dental-origin gastrointestinal foreign bodies (DGIFBs).

MATERIALS AND

METHODS

We conducted a narrative review with expert consensus-based synthesis, evaluating leading gastroenterological and surgical consensus statements on aerodigestive and gastrointestinal emergencies. Dedicated guidelines for DGIFBs are currently scarce. Consequently, we systematically extrapolated management principles for sharp, complex objects and integrated them with clinical data on dental device complications.

RESULTS

DGIFBs (e.g., endodontic files, prostheses) possess sharp, rigid morphologies that inherently increase the mechanical risk of perforation and mediastinitis compared to blunt objects. The proposed algorithms are derived from extrapolated evidence rather than prospectively validated recommendations. By adapting generic guidelines to dental device morphologies, the extrapolated framework supports emergent endoscopic assessment and retrieval (within 2-6 h) for pharyngeal and esophageal DGIFBs. Gastric and proximal small bowel impactions warrant urgent extraction (< 24 h) if the object is sharp or exceeds 6 cm in length or 2.5 cm in diameter. Distal intestinal DGIFBs require serial radiologic monitoring, and surgical consultation/intervention should be considered when a sharp object fails to progress over approximately 3 days, particularly in the presence of symptoms or imaging evidence of complications. Plain radiography serves as the primary screening tool, with an immediate transition to CT for radiolucent materials or suspected extraluminal migration.

CONCLUSIONS

DGIFBs represent a high-morbidity subset of foreign bodies. Their management requires a departure from generic conservative observation in favor of rapid risk stratification, supporting timely endoscopic or surgical assessment of high-risk objects while avoiding prolonged conservative observation when established risk criteria are present.

CLINICAL RELEVANCE: This review highlights the need for primary prevention. Routine rubber dam isolation is an important practice in dental care. The proposed pathway promotes teamwork between dentistry, emergency medicine, gastroenterology, and surgery. This helps improve patient safety and reduce severe complications.