Aspiration of a dental crown — ORE Part 1 MCQ

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HardOral SurgeryAspiration of a dental crownORE Part 1

A 67-year-old patient coughs suddenly during crown try-in and the crown disappears from the mouth. He has persistent coughing and mild wheeze but can speak in sentences. Oral examination cannot locate the crown and oxygen saturations are 96% on air. What is the most appropriate investigation?

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Correct answer: B — Urgent chest radiograph with medical referral

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · C = shown as D · A = shown as E

In suspected foreign body aspiration of a radiopaque object with respiratory symptoms and maintained airway, urgent chest radiography is the standard investigation. It confirms the location of the crown in the tracheobronchial tree and establishes the need for immediate bronchoscopic retrieval by a respiratory specialist. A dental crown is radiopaque and easily visible on CXR. The intra-oral radiograph (A) does not visualise the thorax. Abdominal imaging (B) is inappropriate because the patient has airway, not gastrointestinal, symptoms and the crown is not in the mouth. Waiting for stool passage (C) is dangerous—aspiration causes airway obstruction, not GI transit. Home discharge (E) risks life-threatening complications including post-obstructive pneumonia and bronchiectasis. Medical referral is essential because bronchoscopy is a specialist hospital procedure.

Reference: Aspiration of dental items: Case report with literature review and proposed management algorithm (PubMed 34687948, 2021); The Lost Crown: A Case of an Aspirated Tooth Crown Causing Post-Obstructive Pneumonia (PMC 10017206, 2023). Standard international trauma and respiratory medicine protocols, applicable to UK emergency and respiratory practice. https://pubmed.ncbi.nlm.nih.gov/34194591/