Patients who swallow dental instruments are at risk and may need referral to hospital for further assessment, says UK-wide dental defence organisation MDDUS.

All practitioners should realise that emergency medical assessment is required when any object is inhaled, but swallowing an instrument can be just as harmful to the patient.

'Swallowing a crown or amalgam could pose a reduced risk to the patient but for endodontic instruments such as hand files or fractured tips of dental instruments such as scalers, patients should be referred to hospital immediately for assessment,' says MDDUS dental adviser Claire Renton (pictured).

'MDDUS has dealt with cases where patients have swallowed an endodontic instrument or the fractured sharp end of an ultrasonic scaler during a scale and polish and even parts of faulty handpieces. While all professionals should be aware of the seriousness of inhaling objects, some believe that there is no need to refer a patient who ingests a dental instrument.

'However, in these cases, the practitioner should explain to the patient that they need to be examined and assessed at the hospital as a precaution.

'While swallowing an object may pose a reduced risk, a medical practitioner should be the one making the judgement and so the patient should be referred to A&E, complete with letter containing their dental history.

'It may be beneficial to provide an identical object to help the doctor with their assessment. This gives the doctor sufficient information to judge whether a 'watch and wait' approach can be adopted or if surgery is required to retrieve the object before it does harm to the gut.

'Practitioners should make a clear note of the incident in the patient's records, outlining the treatment given and whether a referral was made.'