Author(s): Adewumi et al.
Journal: Pediatric Dentistry 30:1,2008
Type of Journal: Case Report
Purpose: Describe the aspiration of an SSC in a young child undergoing conscious sedation for restorative dental treatment.
Case Report: 5 year old boy was scheduled for four sedation appointments due to anxiety. Patient was healthy, ASA I, and airway normal. The failure of oral midazolam at the first restorative appointment prompted the use of midazolam and hydroxyzine at subsequent sedations. This combination was successful and the sedations were uneventful.
At the final appointment involving SSC’s on #I and #J, patient was given 10mg (0.6mg/kg) of midazolam with 50mg (3mg/kg) of hydroxyzine. Patient was placed in the supine position and stabilized using a Papoose Board. When removing the SSC prior to cementation, the SSC became dislodged distally behind the throat pack into the patient’s airway.
Following quick oral exam and vacuum suction, mouth prop and Papoose Board was removed. Patient was given several back slaps and Heimlich maneuver. Patient was choking, coughing, and exhibited mild expiratory wheezing with no obvious signs of respiratory distress.
The patient was escorted to the hospital’s radiology department for chest Xray. While waiting for the Xray, the patient was escorted back to the dental clinic and the SSC’s were cemented on #I and #J. The radiologist confirmed the presence of the SSC in the entrance to the right main stem bronchus. The pediatric surgeon on call was contacted and diagnostic laryngoscopy with rigid bronchoscopy was performed under GA to retrieve the SSC. The surgery was uneventful and the patient was discharged home the same day.
Assessment of the article: Good example of how a dental emergency was handled correctly. The SSC was retrieved within 2 hours of the incident. It shows that good communication with a nearby hospital is critical in ensuring an efficient response in an emergency situation. This article reinforces the use of rubber dam whenever possible and a throat pack when extracting teeth/fitting SSC’s.