Monday, February 24, 2014

Hard to Swallow

“Doc, I think I just ruined your afternoon.” Although my patient is a joker, I knew he was not joking when he uttered those words.

This illustrates how a routine day can quickly become a memorable one. Let’s talk about those times when something completely unexpected happens during a dental visit.

I always try in my crowns before final cementation. For twenty-odd years, patients have asked if anyone has ever swallowed a crown. Fortunately, for all those years, I’ve been able to answer say no. Until now.

We were trying in the lower left second molar. The crown needed to be inserted several times as I needed to adjust the occlusion quite a bit. We were just about there with the occlusion when… Gulp! Just like that. I turned my back and it was gone!

It was not a great feeling when I realized what had just happened. How does one handle this situation? I first made sure he had indeed swallowed the crown. In other words, he was not choking or struggling to cough. Fortunately, there were no signs that. Quite simply, the crown was there one second and gone the next. Plus the patient was absolutely sure he had swallowed the crown. That made it unnecessary to subject the patient to a chest x-ray in order to confirm that he had not aspirated the crown.

The take-home lesson for my staff and I was to be prepared and remain calm. Although this was my first such encounter, my staff had been through it before with previous dentists they’d worked with. It felt good to have my staff compliment me on how I handled the situation. Remember, it is best to remain calm and reassure everyone in the room.

Understandably, the patient wanted to know what would happen next. In my usual honest way, I informed him that it would “come out the other side.” I gave him a minute to, uh, digest that thought. Then I told him he could either look for the crown or we could make him a new one. He scheduled for a new impression. Since this visit had already caused enough excitement for everyone involved, we opted to recement the temporary crown and call it a day.

I felt I needed a new impression since the original crown needed so much adjustment. At this point we might as well start over. When he came in for his next appointment, he was joking about what had happened and promised not to swallow anything. He also kept apologizing for stressing me out by swallowing that crown.

Now, when patients ask me if anyone has ever swallowed a crown, I have a different answer.

Andy Alas, DDS

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