Down in the mouth – have those missing dentures been swallowed?
Ross Webster is a Senior Specialist Speech & Language Therapist at Western Sussex NHS Foundation Trust and graduate of the NIHR Clinical Research MRes programme. Here, he discusses best practice for managing ‘swallowed’ dentures as highlighted in his Age and Ageing Clinical Reminder 'Denture plate discovered lodged in pharynx'.
One of the risks of wearing dentures is the possibility that they may be swallowed. Though this may seem unusual, unintentional denture ingestion can be considered relatively common. The risk of swallowing dentures has been linked to neurological impairments, particularly dementia, but also cerebral haemorrhage and learning difficulties, as well as intoxication.
There is also a risk of accidental denture swallowing if individuals regularly sleep with false teeth in situ. Dentures may be worn overnight out of habit, ease, for cosmetic or communication reasons, or lack of awareness of the risk of swallowing/aspirating particularly ill-fitting prosthesis. Swallowed dentures may lodge in the pharynx or descend into the oesophagus or lungs. Due to their size it is less common to aspirate full dentures into the lungs, though partial dentures may be aspirated, impairing respiration. Despite this noted risk, the notion of dentures as foreign bodies often seems to be regarded as unusual.
Pharyngeal denture impaction is a choking risk and may be life-threatening, therefore prompt diagnosis and management is required. Symptoms of upper airway and upper oesophageal foreign bodies include throat pain, swallowing problems, impaired respiration, persistent harsh cough, unusual voice quality and foreign-body sensation. Reports of missing or absent dentures or the suspicion that dentures may have been swallowed is regularly reported alongside these symptoms and should be regarded as significant until the presence of a foreign body is ruled out.
Radiographic evaluation is often required where the presence of a foreign body is suspected. Acrylic dentures, commonly used in the UK, are radiolucent and may not be detected with a standard radiograph - they may even be overlooked if they include radiopaque elements such as a metal clasp. Similarly, a chest X-ray may not be sufficient to detect a radiopaque foreign body lodged in the throat. Where symptoms persist in the presence of a non-diagnostic X-ray or insignificant oral exam, instrumental visualisation by ENT (Ear, Nose and Throat) is required e.g. via flexible nasendoscopy. Oesophageal or bronchial visualisation may be required if the suspected foreign body is not visible during an examination of the pharynx as it may have descended below the level of the pharynx.
This post is based on a clinical reminder which outlines the hospital admission of a 91-year-old individual whose admission symptoms were discovered to be secondary to his own dentures lodged in his hypopharynx. The denture plate had become dislodged overnight during sleep. The dentures were identified via oral examination by a respiratory physiotherapist while providing secretion management and removed by hand, resulting in an immediate improvement in symptoms. This event highlights the risk of dislodging dentures during sleep, particularly if the dentures are loose or ill-fitting. It also demonstrates that chest X-rays may not indicate the presence of an impacted foreign body lodged in the upper airway. Subsequently, the need for a thorough visual examination of the hypopharynx and laryngeal structures, to ensure the upper airway is clear of foreign bodies or pathology, is highlighted - particularly where pharyngeal and laryngeal symptoms such as dysphagia and dysphonia are present.
Read the Age and Ageing Clinical Reminder 'Denture plate discovered lodged in pharynx'