The Lost Crown: A Case of an Aspirated Tooth Crown Causing Post-Obstructive Pneumonia

Foreign body aspiration (FBA) can be a serious and sometimes fatal medical condition that needs prompt identification and early intervention to prevent serious complications, such as respiratory failure, airway edema, infection, and pneumothorax. We report a case of a 93-year-old male who was found to have post-obstructive pneumonia secondary to an inhaled tooth two years prior during a dental procedure. Aspiration of a tooth is frequently seen with maxillofacial injuries or dental procedures and is most common in children, elderly patients, and those at high risk of aspiration, including individuals with altered mentation and neurologic disorders. However, aspiration of a tooth remains an uncommon occurrence and accounts for approximately 0.4% of all cases of FBA

Non-asphyxiating foreign body aspiration (FBA) is an uncommon occurrence in adults, but it can lead to serious complications and sequelae. Diagnosis of FBA can be difficult as symptoms can mimic other respiratory diseases and the majority of foreign bodies are not visible on chest X-ray.

Researchers report a case of an older male who presented with respiratory failure secondary to pneumonia after aspiration of a dental crown. The patient improved after antibiotic therapy and removal of the foreign body by bronchoscopy. The case is unusual because the diagnosis was delayed after the aspiration event because the patient was asymptomatic before presenting with pneumonia two years later.

In this case study, right lower lobe pneumonia was diagnosed in an afebrile 93-year-old man who exhibited respiratory distress and dyspnea on talking and exertion. The patient recalled undergoing a dental extraction 2 years prior, during which two pieces of the tooth were delivered but a third portion went missing. As the patient was asymptomatic, the dentist assumed that the missing piece had been swallowed, and no chest imaging was performed at the time.

Upon hospital admission, CT revealed a metallic foreign body, which was subsequently removed during bronchoscopy.

This case emphasizes the importance of early recognition and management of possible aspiration events to prevent life-threatening sequelae.

Reference:

Gabriella Primera, Jessika Matta, Louis Eubank, Puncho Gurung, "The Lost Crown: A Case of an Aspirated Tooth Crown Causing Post-Obstructive Pneumonia", Case Reports in Dentistry, vol. 2023, Article ID 4863886, 4 pages, 2023. https://doi.org/10.1155/2023/4863886