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ORIGINAL ARTICLE
Year : 2022 | Volume
: 21
| Issue : 3 | Page : 274-277
Impacted dentures in the pharynx and esophagus – Implication for advocacy
Kenneth Baidoo1, Paa-Kwesi Blankson2, Sally Kwakye3, Estella Bilson Amoah1, Kafui Searyoh1, Grace E Parkins2, Amazing Grace Edem4, Evelyn Nyamekye1, Waltraud N O. D. Quartey5, Christiana Boateng6, Sandra Hewlett7
1 Department of Ear, Nose and Throat, Korle Bu Teaching Hospital, Accra, Ghana
2 Oral and Maxillofacial Surgery Unit, Korle Bu Teaching Hospital; Department of Oral and Maxillofacial Surgery, University of Ghana Dental School, Accra, Ghana
3 Department of Ear, Nose and Throat, 37 Military Hospital, Accra, Ghana
4 Oral and Maxillofacial Surgery Unit, Korle Bu Teaching Hospital, Accra, Ghana
5 Department of Oral Medicine, Oral Pathology, Oral Diagnosis, University of Ghana Dental School, Accra, Ghana
6 Department of Ear, Nose and Throat, Korle Bu Teaching Hospital; Department of Restorative Dentistry, University of Ghana Dental School, Accra, Ghana
7 Department of Restorative Dentistry, University of Ghana Dental School, Accra, Ghana
Correspondence Address:
Paa-Kwesi Blankson
Oral and Maxillofacial Surgery Unit, Korle-Bu Teaching Hospital, P. O. Box Kb-20, Korle-Bu, Accra
Ghana
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/aam.aam_54_21
Abstract
Background: Impaction of dentures has potentially significant morbidity and management challenges. This study sought to leverage on the occurrence of swallowed dentures to advance discussions on its management and prevention. Methods: A 5-year retrospective review of patients seen on account of impacted dentures at the Ear, Nose, and Throat Department of the Korle-Bu Teaching Hospital was done. Variables obtained included age, sex, location of impacted denture, treatment done, denture type, number of teeth, and complications. Variables were analyzed, and descriptive summaries were reported. Results: There was a record of 898 cases of impacted foreign bodies which presented to the department. Fifty-five (6.1%) records were on account of impacted dentures. These consisted of 25 (45%) males and 30 (55%) females. Ranging from 23 to 98 years, the mean and median ages were 55.7 (±18.1) years and 56.5 years respectively. There were no complications, and no identifiable predisposing patient conditions. All prostheses were removable acrylic dentures, and some observations included worn-out and loose dentures, while several had their prostheses dislodging in the process of swallowing tablet medications with water. Conclusion: Swallowed dentures are not rare occurrences in Ghana. Denture wearers should, therefore, be encouraged to get professional reviews, especially when prostheses get unretentive, while dental professionals are urged to incorporate measures in their fabrication to reduce the occurrence of swallowed dentures.
Abstract in French Résumé
Contexte: L'impaction des prothèses dentaires présente des problèmes de morbidité et de gestion potentiellement importants. Cette étude visait à tirer parti de la survenue de prothèses avalées pour faire avancer les discussions sur sa prise en charge et sa prévention. Méthodes: Une étude rétrospective sur 5 ans des patients vus en raison de prothèses impactées au service des oreilles, du nez et de la gorge de l'hôpital universitaire de Korle Bu a été réalisée. Les variables obtenues comprenaient l'âge, le sexe, l'emplacement de la prothèse incluse, le traitement effectué, le type de prothèse, le nombre de dents et les complications. Les variables ont été analysées et des résumés descriptifs ont été rapportés. Résultats: On dénombre 898 cas de corps étrangers impactés qui se sont présentés au service. Cinquante-cinq (6,1 %) dossiers concernaient des dentiers impactés. Il s'agissait de 25 (45 %) hommes et 30 (55 %) femmes. Allant de 23 à 98 ans, les âges moyen et médian étaient respectivement de 55,7 (±18,1) ans et 56,5 ans. Il n'y a eu aucune complication et aucun état prédisposant identifiable du patient. Toutes les prothèses étaient des prothèses amovibles en acrylique, et certaines observations incluaient des prothèses usées et desserrées, tandis que plusieurs avaient leurs prothèses se délogant en avalant des médicaments en comprimés avec de l'eau. Conclusion: Les dentiers avalés ne sont pas rares au Ghana. Les porteurs de prothèses dentaires devraient donc être encouragés à obtenir des examens professionnels, en particulier lorsque les prothèses deviennent non rétentives, tandis que les professionnels dentaires sont invités à intégrer des mesures dans leur fabrication pour réduire l'apparition de prothèses avalées.
Mots-clés: Dentier, Œsophage, Ghana, impacté, avalé
Keywords: Denture, esophagus, Ghana, impacted, swallowed
Introduction 
Impaction of dentures could have significant morbidity and cost implications. In general, foreign body impactions are common emergencies, especially in high-risk groups. The impaction of dentures is, however, reported to be infrequent and also has some peculiarities in presentation and management.[1] Foreign body impactions happen mostly in children, though occurring in all ages,[2] with some of the foreign bodies being groundnuts, fish bone, meat bolus, and coins.[1],[3] Dentures are noted by several authors to be seldom ingested or impacted.[4],[5] When it occurs however, it passes posteriorly into the oropharynx, or down into the hypopharynx, and may continue into the aerodigestive system, be impacted in the hypopharynx, or be expelled back to the oral cavity by the gag reflex.[6] Any condition which inhibits the gag reflex (such as stroke, multiple sclerosis, or Parkinson's disease) could be considered to increase the risks of aspirating or swallowing a denture. Major reasons for ingesting dentures are reported to include maxillofacial trauma, dental treatment procedures, alcohol intoxication, lack of retention, and dementia.[6],[4],[7]
Replacement of missing teeth and their supported structures are essential in providing masticatory, speech, and deglutition functions, while restoring the esthetics of affected individuals.[8] Prosthodontics has, therefore, evolved as a discipline to incorporate modern methods into oral rehabilitation.[9] In general, however, tooth replacement may be removable or fixed, and may be made out of plastic, metal, ceramic, or a combination of these.[10] The choice for tooth replacement would consequently integrate several factors such as the amount of remaining alveolar bone, dental health of remaining teeth, and importantly for many people in emerging economies, the cost of the prosthesis.[6] In Ghana, acrylic-based-only dentures are the most common form of teeth replacement.
It has been suggested that the burden of partially edentulous adults is about 20%, with this number expected to rise in the next decade.[11],[12] A critical appraisal of current events with respect to prosthodontics is therefore relevant, among them being the undesirable complication of swallowed and impacted dentures. This study, therefore, set out to determine the incident proportion of swallowed dentures, and discuss applicable methods in dental practice, and general population health behaviors to reduce its occurrence.
Method This was a 5-year retrospective study of patients seen at the Department of Otorhinolaryngology (Ear, Nose, and Throat) of Korle-Bu Teaching Hospital, Accra, Ghana, from January 2015 to December 2019. The hospital is the largest health facility in the country, serving as a major referral center for the entire southern Ghana and beyond.
Records of all patients who were seen on account of a swallowed or impacted denture were included in the study. Patients with incomplete records were excluded from the study. A review of all records and annual hospital reports to ascertain the total number of aspirated and ingested foreign bodies was carried out. Variables obtained included age, sex, location of impacted denture, treatment done, denture type, number of teeth, and complications. Data were entered into a computerized sheet using Microsoft Excel 2010. All variables were analyzed using Stata 14 software (StataCorp. College Station, TX, USA). Background characteristics for all respondents were described, and descriptive summaries were reported. The study was approved by the Institutional Review Board of Korle-Bu Teaching Hospital.
Results Over the 5-year study period, there was a record of 898 cases of ingested or aspirated foreign bodies that presented to the study site. However, a total of 56 people presented to the department on account of swallowed or impacted dentures. For one of these cases though, no denture was found, as confirmed with endoscopy. Therefore, 55 records were included in this study. These consisted of 25 (45%) males and 30 (55%) females. Ranging from 23 to 98 years, the mean and median ages were 55.7 (±18.1) years and 56.5 years, respectively.
The proportion of impacted dentures among ingested or aspirated foreign bodies was found to be 6.1%. All prostheses recorded were removable partial dentures with acrylic baseplate [Table 1]. Many of the patients (41%) were above the age of 60, while the most common location of impaction was the esophagus. There were no recorded complications arising after endoscopic removal of the dentures under general anesthesia. There were no identifiable predisposing patient conditions among the records reviewed. Some observations, however, included worn-out and loose dentures, while many had the prostheses dislodging in the process of taking in tablet medications with water. Plain lateral cervical radiograph [Figure 1] and [Figure 2] was used in all cases as a preoperative investigative tool.
Figure 1: (a) Radiographic evidence of impacted denture (presence of radiolucent shadow along the anterior soft tissue contour at the level of C6), (b) Retrieved denture (showing loss of retentive features)
Figure 2: (a) Impacted denture in the esophagus at the level of C7, (b) Retrieved acrylic denture Discussion This study sought to leverage on the occurrence of swallowed dentures to further discussions on the practice of prosthodontics and dental patient behavior regarding dentures in Ghana. Dentures accounted for 6% of all foreign body impactions in this study, while its occurrence was observed in all age categories.
There are several publications in the literature on impacted dentures, with many of these being case reports and case series. A review by Kent et al. for instance yielded 86 case reports and case series.[6] However, the incidence of impacted dentures was reported to be 0.4% by Nandi and Ong,[13] 11.5% by Abdullah et al.,[14] and 17.6% by Bandyopadhyay et al.[15] While this study's proportion of 6.1% over a 5 year period seems comparable to other findings, the potential morbidity and cost associated with its occurrence are of considerable importance, especially for people in emerging economies. There have been reports of necrosis, perforation, penetration to adjacent organs, bleeding, obstruction, and even death associated with impaction of dentures, which would all typically depend on the specific anatomic site of impaction, duration of impaction, and denture design.[1],[6]
Removal of the denture as soon as the diagnosis is made is paramount due to the progressively increased risk of complications with each day of delay. Management options include endoscopic and surgical removal.[16],[17],[18] Commonly, endoscopic removal either by flexible or rigid esophagoscopy under general anesthesia is done.[1] A success rate of over 70% has been demonstrated in the use of rigid esophagoscopy in removing impacted dentures by Adedeji,[19] while a study conducted in Japan reported a comparatively higher success rate of 92%.[17] Complications due to the sharp edges and metal hinges attached to dentures during endoscopic removal are common. Therefore, a considerable level of skill and patience is needed in performing the endoscopic removal of impacted dentures.[1],[18] An open surgical approach is warranted when endoscopic removal is unsuccessful, or when there is a contraindication to endoscopic removal. The location of the impacted denture will determine whether the open approach would be cervical or transthoracic esophagotomy.[1],[16],[18],[19] Esophagotomy may potentially lead to serious complication of mediastinitis from esophageal leakage due to the breakdown of the repaired esophagotomy which could result in high mortality.[18] Esophagocutaneous fistula may occur even after healing following 3 weeks of conservative management according to a case report by Dorner,[20] and in such scenarios, re-exploration is advisable.[16] In rare cases, where esophageal tissues are nonviable, esophageal replacement with a colon bypass might be needed to restore continuity of the lumen.[17]
Prevention strategies could be viewed from several approaches: dental professional-related, patient-related, as well as regulation and advocacy. The principles of denture designing harness esthetics, cost-effectiveness, elastic modulus, ease of handling, and strength to produce retentive and functional prostheses. Polymethyl methacrylate has become the most common and cheapest substance used in the fabrication of denture bases. A well-known desirable property of these denture bases is for them to be radio-opaque.[11] However, most of the dentures made are radiolucent, thereby presenting a potential diagnostic challenge in the event of accidental ingestion or inhalation [Figure 1]a and [Figure 2]a. Dentists and dental laboratory technologists should, therefore, make the effort of incorporating radio-opaque components to the fabrication of dentures, especially for smaller removable prostheses.
Observations made from this study included poor routine dental-visit culture, no reviews following provision of denture, even when patients noticed that their prostheses were loose, and failure to remove dentures when taking in medication or going to bed. Although the diversity in prosthodontics keeps widening, cost implications limit the choices for many people in emerging economies, while many even utilize quacks in acquiring prostheses. Patients are required to have periodic reviews and repair when dentures fracture or get unretentive. Long-term recall appointments and reminders are thus recommended for all such patients. Regulation of the dental practice and quality control of products is equally pertinent at both professional and institutional levels. Furthermore, the importance of public oral health education with regard to dentures cannot be overemphasized. The Ghanaian population is projected to age in coming years.[21] Alongside the association of tooth loss with advancing age,[22] many more people are likely to use removable partial dentures. It is imperative, therefore, that appropriate measures are put in place to reduce the incidence of ingestion of dentures.
This study, being retrospective in design, was limited by the absence of many other variables, due to their unavailability from medical records. Its findings are, however, important in ascertaining the burden of ingested dentures in Ghana.
Conclusion Dentures accounted for 6% of all foreign body impactions in this study. Dental professionals are urged to incorporate measures in their fabrication to reduce the occurrence of swallowed dentures.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References 
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