Reviewer: S. Randhawa, M.D.
A 3-year-old boy had his teeth cleaned by his mother and wanted to play with the dental floss afterwards. Half an hour later, the mother could not find the dental floss and asked her son where it was. The boy pointed to his mouth and said that he "am-am" the floss.
What would you do?
Examine the mouth and airway to make sure that the dental floss is not still in the mouth. If the vital signs are stable and the child looks at baseline, the preferred approach is to wait for the dental floss to appear in stools in about 24 hours.
Would you search the medical literature?
Google and Pubmed searches for "dental floss ingestion" were not very helpful. The only article that mentioned "dental floss ingestion" was about a child who was intubated and had an endoscopic removal of the dental floss piece.
Our patient was in a good playful mood and definitely did not look as if he would need any surgical intervention.
A day later, the mother found the entangled 40-cm piece of dental floss within the bowel movement of her son.
What did we learn from this case?
Up to 90 percent of foreign bodies that have passed the esophagus will pass spontaneously.
Radiopaque foreign bodies require an X-ray to determine position. Batteries and sharp objects lodged in the esophagus require urgent endoscopic removal.
Objects that have been lodged in the esophagus for more than 24 hours should be removed endoscopically.
Serious complications, such as bowel perforation and obstruction occur in less than 1% of the cases. Approximately 1,500 deaths per year are due to ingestion of foreign bodies in the United States.
Dental floss ingestion with spontaneous passage of the ingested piece in 24 hours.
It looks like this is the second case in reported the literature (a subject of verification by a more thorough Pubmed search).
Dental flossingestion requiring endoscopic retrieval. Pediatr Emerg Care. 2000 Oct;16(5):339-40.
Foreign Body Ingestion in Children. AFP, Vol. 72/No. 2 (July 15, 2005).
Pediatrics, Foreign Body Ingestion. eMedicine, May 10, 2006.
A swallowed denture: All objects that have passed the duodenal sweep should be managed conservatively. Lancet, 2009.
Foreign Objects Found in Patients: Slideshow. Medscape.
Swallowed Objects That Went Straight Into History - NYTimes, 2011.