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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 60-62

Accidental ingestion of a denture in a Nigerian man: A case report


1 Department of Medicine, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Paediatrics, College of Medicine/Lagos University Teaching Hospital, Lagos, Nigeria

Date of Submission17-Aug-2021
Date of Acceptance10-Jan-2022
Date of Web Publication24-Feb-2022

Correspondence Address:
Dr. Daniel Ekhaeyouno Ezuduemoih
Department of Medicine, College of Medicine/Lagos University Teaching Hospital, Lagos.
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njgh.njgh_7_21

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  Abstract 

The tooth contributes to the esthetic appearance of the face. As a result of tooth loss from caries and periodontal diseases, there is an increase in the number of people wearing dentures, and thus a proportionate increase in the incidence of foreign body in the esophagus. We report the case of a 49-year-old man who presented to the Endoscopy suite at our institution with a 6-week history of severe retrosternal pain, dysphagia, and odynophagia after inadvertently swallowing his old denture. At gastroscopy, the denture was seen to be impacted in the esophagus at about 25 cm from the incisor. When managing patients with chest pain, dysphagia, and odynophagia, a high index of suspicion for foreign body ingestion is needed, even with prolonged symptoms. Obtaining a history of use of dentures, and duration, is important, and a thorough examination of the oral cavity and dentition is essential.

Keywords: Denture, esophagus, gastroscopy, Nigeria


How to cite this article:
Ezuduemoih DE, Odeghe EA, Adeniyi OF, Oyeleke GK. Accidental ingestion of a denture in a Nigerian man: A case report. Niger J Gastroenterol Hepatol 2021;13:60-2

How to cite this URL:
Ezuduemoih DE, Odeghe EA, Adeniyi OF, Oyeleke GK. Accidental ingestion of a denture in a Nigerian man: A case report. Niger J Gastroenterol Hepatol [serial online] 2021 [cited 2022 Jun 30];13:60-2. Available from: https://www.njghonweb.org/text.asp?2021/13/2/60/338254




  Introduction Top


The tooth contributes to the esthetic appearance of the face. In addition, replacing missing teeth makes eating a more pleasant experience and enhances clarity of speech. As a result of tooth loss from caries and periodontal diseases, there is an increase in the number of people wearing dentures and thus, a proportionate increase in the incidence of dentures as foreign body in the esophagus.[1]

Impaction of dentures in the esophagus is notoriously challenging to diagnose due to their radiolucent nature. Although the use of radiopaque substances in denture manufacturing has been recommended, such materials have yet to be successfully used without compromising denture quality.[2] Hence, there is often a delay in the diagnosis and management of patients with impacted dentures, predisposing them to higher risks of complications such as esophageal perforation, diverticulum or fistula formation, or obstruction of the bowel.[2]

There are several published cases of denture impaction in the aerodigestive tract. The complications increase proportionally with increasing duration of impaction. Such complications include diverticular formation, para or retroesophageal abscess, mediastinitis, empyema, perforation, and esophago-aortic fistula.[3] Though only a few cases have been reported from this part of the world, impaction of esophageal dentures is relatively common in our locality as reported by Adedeji et al.[4] The report also showed a male preponderance in 14 cases aged 32–75 years seen over a 7-year period.[4]

A similar study over a 10-year period by Adeyemo and Ogunkeyede[5] also showed a male preponderance in denture impaction and correlation between advanced age, female gender, and site of denture impaction.

Here we present the case of a middle-aged man with a 6-week history of retrosternal chest pain, dysphagia, and odynophagia following accidental ingestion of his denture


  Case presentation Top


A 49-year-old man presented to the Endoscopy suite at our institution on referral with a 6-week history of severe retrosternal pain and choking while eating. This was associated with nonprogressive dysphagia to solids and liquids, and odynophagia. He did not have a fever, cough, difficulty in breathing, aspiration, or regurgitation. His past medical and surgical history was unremarkable.

Prior to his presentation at our institution, the patient had visited a private hospital, where he had done a chest X-ray, which was reported as normal. In addition, his basic laboratory investigations (complete blood count) were normal. Subsequently, he was referred to our center for gastroscopy. On examination, he was alert, afebrile, and in no distress. He had no difficulty with phonation or respiration. There was no neck tenderness or swelling. On oral examination, he was noted to have a missing lower right incisor.

At gastroscopy, a denture was seen to be impacted in the esophagus at about 25 cm from the incisor. There was no other abnormality noted in the rest of the esophagus, stomach, and duodenum. Due to lack of accessories for flexible gastroscopy retrieval, he was referred to the cardiothoracic surgical unit for further management and subsequently had rigid esophagoscopy with denture removal and symptoms resolved.


  Discussion Top


Accidental ingestion of foreign bodies is a problem often faced in the emergency department with acute symptoms or, less frequently, in clinics with insidious presentations.[2] Accidental ingestion with impaction of dental prostheses has been reported in the literature. The incidence of esophageal denture impaction among foreign body ingestions ranges between 0.4% and 17.6%, and the most common site of impaction is the esophagus as seen in our patient.[1],[6],[7]

Certain patient characteristics have been identified as risk factors for accidental denture ingestion and impaction, including patients with confusion, alcohol inebriation, general anesthesia, medication overdose, and neurological diseases.[8],[9] However, a systematic review by Kent et al.[10] evaluated published reports of denture swallowing or aspiration over 15 years and concluded that 56% of patients did not have any identifiable predisposing factors. They also noted that most retrieved dentures were damaged or loose which was the case in our patient as he admitted to the denture being old.[10]

Most patients with inadvertent swallowing of denture may present with a clear history of the ingestion incident with or without additional complaints, the most common symptoms being throat discomfort, dysphagia, odynophagia, persistent foreign body sensation, and sometimes chest pain as reported in our patient.[2],[4]

Dentures are frequently made of radiolucent acrylic resin, as seen in our patient, but the radiopaque wire clasps can sometimes be seen in radiographs.[11] If a radiolucent foreign body is suspected, swallowing studies with a contrast medium should be performed, although barium may also cover the foreign body and make endoscopy/endoscopic identification difficult.[12],[13]

The diameter of the esophagus is reduced at four points: the cricopharyngeus, the crossing of the aorta at 25–30 cm from the incisors, the crossing of the left bronchus, and the hiatus at the diaphragm; it is therefore not surprising that our patient’s denture was impacted at 25 cm from the incisors [Figure 1] and [Figure 2].[1]
Figure 1: Showing the denture impacted in the esophagus

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Figure 2: Showing a closer view of the denture impacted in the esophagus

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  Conclusion Top


When managing patients with chest pain, dysphagia, and odynophagia, a high index of suspicion for foreign body ingestion is needed, even with prolonged symptoms. Obtaining a history of use of dentures, and duration, is important, and a thorough examination of the oral cavity and dentition is essential.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his investigation and other clinical information to be reported in the journal. The patient understands that name and initials will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.



 
  References Top

1.
Fitri F, Fitria H Removal of foreign body (denture) in esophagus with rigid esophagoscope J Kesehat Andal 2012;1:92-7.  Back to cited text no. 1
    
2.
Samargandy S, Marzouki H, Al-Khatib T, Merdad M Denture impaction causing an upper esophageal diverticulum. Case Rep Gastrointest Med 2019;2019:9621383.  Back to cited text no. 2
    
3.
Athanassiadi K, Gerazounis M, Metaxas E, Kalantzi N Management of esophageal foreign bodies: A retrospective review of 400 cases. Eur J Cardiothorac Surg 2002;21:653-6.  Back to cited text no. 3
    
4.
Adedeji TO, Olaosun AO, Sogebi OA, Tobih JE Denture impaction in the oesophagus experience of a young ENT practice in Nigeria. Pan Afr Med J 2014;18:330.  Back to cited text no. 4
    
5.
Adeyemo AA, Ogunkeyede SA Denture impaction in the oesophagus: Correlation of site and duration of impaction with sequelae. Ann Ib Postgrad Med 2019;17:65-70.  Back to cited text no. 5
    
6.
Nandi P, Ong GB Foreign body in the oesophagus: Review of 2394 cases. Br J Surg 1978;65:5-9.  Back to cited text no. 6
    
7.
Gretarsdottir HM, Jonasson JG, Björnsson ES Etiology and management of esophageal food impaction: A population based study. Scand J Gastroenterol 2015;50:513-8.  Back to cited text no. 7
    
8.
Dar GA, Ganie FA, Ishaq M, Jan K, Ali ZS, Lone GN, et al. Prolonged impacted denture in the esophagus: A case report and review of the literature. Bull Emerg Trauma 2015;3: 32-5.  Back to cited text no. 8
    
9.
Hashmi S, Walter J, Smith W, Latis S Swallowed partial dentures. J R Soc Med 2004;97:72-5.  Back to cited text no. 9
    
10.
Kent SJW, Mackie J, Macfarlane TV Designing for safety: Implication of a fifteen year review of swallowed and aspirated dentures. J Oral Maxillofac Res 2016;7:e3.  Back to cited text no. 10
    
11.
Fang R, Sun J, Hu Y, Yao K, Hu W Endoscopic removal of esophageal impacted dentures. Ann Otol Rhinol Laryngol 2010;119: 249-51.  Back to cited text no. 11
    
12.
Ritcliff KM Esophageal foreign body. Am Fam Phy 1994;44: 824-31.  Back to cited text no. 12
    
13.
Joshi SW, Pawar A, Lakhkar D Denture in esophagus mimicking carcinoma. Ind J Radiol Imag 2005;15:229-30.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]



 

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